Management of stable COPD : smoking cessation ( PULMO HANDBOOK OF COPD )

Tuesday, March 17, 2009



1. Points

· Smoking is an addiction and a chronic relapsing disorder.

· Smoking should be routinely evaluated whenever a patient presents to a healthcare facility

· All smokers should be offered the best chance to treat this disorder.

· Permanent remissions can be achieved in a substantial percentage of smokers with currently available treatments.

· Successful treatment of this disorder can have a substantial benefit in reducing many secondary complications of which chronic obstructive pulmonary disease (COPD) is one.

· Smoking cessation activities and support for its implementation should be integrated into the healthcare system.

2. Background

A. Smoking as a primary disorder

Cigarette smoking is an addiction and a chronic relapsing disorder regarded as a primary disorder by the Department of Health and Human Services Guidelines in the USA and by the World Health Organization. Therefore, treating tobacco use and dependence should be regarded as a primary and specific intervention. Preventing the development and progression of COPD can be regarded as one of the secondary effects prevented by treating the primary disorder, because although cigarette smoking is the single most important cause of COPD, it is also a major risk factor for many other diseases including atherosclerotic vascular disease, cancer, peptic ulcer and osteoporosis.

B. Smoking prevention

Effective primary prevention of smoking would eliminate the need for smoking cessation. Unfortunately, measures to decrease smoking initiation have had limited success. Yet, the following measures have been shown to prevent smoking addiction:

- increasing the price of cigarettes

- enforced programmes which limit access to cigarettes

- society can have a major effect on smoking behaviour and it is hoped that

- comprehensive programmes designed to control smoking initiation can have similar benefits.

C. Smoking in COPD

Smokers experience an accelerated rate of decline in lung function. Individual susceptibility, however, varies greatly and depends on a complex interaction of many genetic and environmental factors. It is often stated that 15% of smokers will develop COPD. This dramatically underestimates the impact of smoking because the majority of smokers will develop loss of lung function,and reduced lung function, at any level, is predictive of increased mortality. Many smokers with undiagnosed COPD have symptoms. It is necessary to identify and properly diagnose individuals earlier in the course of the disease when physiological limitation and symptoms are milder. Quitting smoking can slow the progressive loss of lung function and can reduce symptoms at any point in time. Yet, the beneficial impact of smoking cessation on the natural history of COPD is greatest the earlier cessation is achieved. Adolescents who quit smoking will have increased lung growth

D. Passive smoking and COPD

Smoking during pregnancy is associated with low birth weight, and infants with low birth weight appear to have a greater risk of developing COPD. Smoking and probably passive smoke exposure in childhood compromises lung growth leading to diminished maximal lung function in young adulthood. Passive smoke exposure is a risk factor for symptoms of cough and sputum production, and may account for some of the COPD that develops in nonsmokers.

3. Brief intervention

A brief intervention can be effective for many smokers and should be practiced in all clinical settings. Often this can take the form of several minutes during a routine visit. The key steps in the algorithm for brief intervention are the “5 As”.

· Ask: systematically identify all tobacco users at every visit; implement an office-wide system that ensures that tobacco-use status is queried and documented for every patient at every clinic visit.

· Advise: strongly urge all tobacco users to quit, in a clear, strong and personalized manner.

· Assess: determine willingness to make a quit attempt.

· Assist: help the patient with a quit plan, provide practical counselling, provide intratreatment social support, help the patient obtain extra-treatment social support, recommend use of approved pharmacotherapy (except in special circumstances) and provide supplementary materials.

· Arrange: schedule follow-up contact, either in person or via the telephone.

4. Intensive intervention

Intensive intervention refers to behavioural programmes more extensive than the brief intervention described above. Review of multiple studies demonstrates a dose-response effect, indicating that quit rates increase with the intensity, duration and frequency of behavioural support sessions. All smokers willing to participate in intensive intervention should be offered the opportunity as quit rates will increase. Many smokers, however, will not wish to participate in such programmes and, for these individuals, properly executed brief intervention is the best alternative. Intensive intervention can be provided by any suitably trained clinician with adequate resources. Availability of such a programme should be an essential part of every healthcare system, particularly those caring for COPD patients.

5. Systems approach

A major impediment in the delivery of established treatments to treat tobacco use and dependence has been lack of appropriate institutional support. Adequately trained staff with access to the necessary materials and with sufficient time to diagnose, stage and treat the smoking patient must be provided by all reputable healthcare systems. Systems approaches are particularly important as coordinated interventions, involving healthcare providers at a variety of levels, are both more effective and more cost efficient. The healthcare provider has the obligation to provide state-of-the art behavioural and pharmacological treatments. The healthcare administrator has a clear responsibility to insure that smoking cessation services are adequately provided. The healthcare purchaser should expect that tobacco intervention, at the most effective level, will be a contractually covered obligation of insurers and providers. Patients have a reasonable expectation that the most preventable threat to their health will be addressed.

6. Intervention in the smoker not ready to make a quit attempt

Empathetic, nonconfrontational interactions that maximise patient participation are believed to be most effective when dealing with smokers not ready to make a quit attempt. The “5 Rs” can serve as a guide permitting the clinician to focus on the important issues, recognising that multiple interactions are likely to be required in order to achieve a quit attempt.

· Relevance: personalise the reasons to quit. This may include issues in addition to COPD.

· Risks: both acute (i.e. dyspnoea, cough, exacerbations, increased carbon monoxide), chronic (i.e. COPD progression, cancer, cardiovascular disease, osteoporosis, peptic ulcer) and other environmental risks (i.e. disease risk to spouse, household members, increased risk of smoking in children).

· Rewards: such as improved health, improved self image, regaining sense of taste and smell, and saving money.

· Roadblocks: such as withdrawal symptoms, fear of failure, weight gain, lack of support, depression and the enjoyment of tobacco.

· Repetition: most smokers make several quit attempts before achieving long-term abstinence; smoking can be regarded as a chronic relapsing condition, but prolonged remissions are possible A variety of interventions including acupuncture, hypnosis and aversive training methods, among others, have been suggested to aid cessation. None have been shown to be more effective than behavioural interventions alone.

7. Intervention in the smoker ready to make a quit attempt

Every effort should be made to maximise the chances of success in the smoker ready to make a quit attempt, and the following should be offered: behavioural support, pharmacological treatment and follow-up.

· Pharmacological treatment

All smokers willing to make a serious quit attempt should be offered pharmacological support The approach to males and females and to racial and ethnic groups should not vary. Pregnant women should quit, although use of medications in pregnancy has undefined risks. Smoking cessation treatments can be initiated in hospitalised patients. Patients with concurrent psychiatric morbidities may require specific treatment of these conditions. Smoking cessation treatment in adolescence is difficult. The same approaches used in adults can be tried. Quit rates approximately double with first-line pharmacological treatments. First-line treatments include various forms of nicotine replacement treatment and bupropion. Second-line treatments can be considered for smokers unsuccessful with or unable to utilise first-line medication.

First-line treatments

· Nicotine replacement is available in five approved formulations and several others are in development. Their different routes of administration permit individual preference. All that have been assessed are similar in efficacy.

· Nicotine polacrilex (gum) contains nicotine bound to a polacrilex resin together with a buffering agent. Chewing releases the nicotine from the polacrilex. Varying the rate of chewing varies the rate of nicotine release. Once released, nicotine is present in the saliva and is absorbed across the buccal mucosa. Low oral pH causes the nicotine base to ionise and the charged form is absorbed much more slowly. Both 2- and 4-mg formulations are available. Eight to 10 gums per day should be recommended, but are often difficult to chew. Treatment for 3–6 months is recommended, but some smokers will substitute gum for smoking and sustain their addiction with gum.

· Transdermal nicotine system or “patch” is applied to the skin in a nonhairy area of the torso or proximal area of the extremities. Each device contains an adhesive, a reservoir that contains nicotine and an impermeable backing. Nicotine diffuses from the reservoir through the skin and is absorbed into the capillary blood of the skin. Absorption is continuous and relatively slow. Several formulations are available. Transdermal nicotine reduces the intensity, but does not eliminate, withdrawal symptoms. Treatment with nicotine patches is generally recommended at “full dose” for 4–6 weeks. This is often followed by a tapering regimen for several additional weeks.

· Nicotine inhaler consists of a mouthpiece and a nicotine-containing cartridge. Nicotine is released when air is inhaled through the device. Most of the nicotine is deposited in the mouth and absorbed through the buccal mucosa. The device should not, therefore, be inhaled like a cigarette as very little nicotine will reach the lower respiratory tract. Because the nicotine is absorbed through the buccal mucosa, absorption is into the venous circulation. The device contains ~10 mg of nicotine, of which ~1 mg is released with ~100 inhalations.

· Nicotine nasal spray consists of an aqueous solution of nicotine. It is delivered by direct spray to the nasal mucosa [23]. One spray in each nostril delivers 1 mg of nicotine. The nicotine is absorbed into the venous blood in the nasal mucosa. Absorption, however, is relatively rapid with peak levels being achieved in ~10 min. This comes closest to that observed with smoking. As a result, the nicotine nasal spray has increased potential for prolonging nicotine dependence as compared to other nicotine replacement therapies. Local irritation is exceedingly common and can be severe, although most individuals are able to adjust to the local effects with continued use.

· Nicotine lozenges are the most recently approved formulation of nicotine as an aid for smoking cessation [24]. It is approved for over-the-counter use in the USA and is available in 2- and 4-mg nicotine doses. The smoker is allowed to select the dose based on the time from awakening to the first cigarette, a measure of intensity of addiction. Those who use a cigarette within 30 min of awakening are advised to use the 4-mg nicotine dose. Dosing is recommended at nine lozenges per day, one every 1–2 h for up to 6 weeks, followed by tapering of daily use with discontinuation after 6 months.

· Combined modality treatment with several formulations, while not approved by regulatory agencies, has been reported to improve efficacy. Retreatment after a failed attempt can be successful. Treatment is generally started on the quit day. Variable durations of treatment have been suggested. Nicotine replacement can be discontinued abruptly, but gradual tapering is generally preferred. Concurrent cardiac disease should always engender caution, but evidence does not demonstrate an increase in acute cardiac events with the use of nicotine replacement.

· Bupropion is a non-nicotine drug previously approved for use as an anti-depressant .

o It approximately doubles quit rates compared to placebo.

o Treatment is usually initiated at 150 mg daily and increased to 150 mg twice daily after 3 days, if tolerated.

o The quit day should be after 1 week of treatment.

o Treatment is generally continued for 7–12 weeks.

o Bupropion may be more effective than nicotine replacement therapy for individuals with a past history of depression.

o It may also be useful for those concerned about weight gain since it has been shown to delay but not prevent weight gain during cessation.

o Bupropion may cause insomnia and dry mouth. It has been reported to cause seizure in patients with known history of seizure disorder.

o Bupropion can be combined with nicotine replacement treatment, although this may lead to worsening of hypertension.

o Contraindications include increased seizure risk, bulimia, concurrent use of monoamine oxidase inhibitors or a bupropion preparation for depression.

Second-line treatments

· Clonidine has been evaluated in several trials, and while results are equivocal, efficacy is supported by a meta-analysis.

· Nortriptyline is also supported by two studies. Neither second-line treatment currently has an indication for smoking cessation approved by regulatory agencies, but both are approved for other indications and may be used by the experienced clinician “off label” for smoking cessation. Use of other medications for smoking cessation is not supported by currently available data.

8. Harm Reduction

For the smoker who is unable or unwilling to quit, there are few options. The concept that the toxic effects of smoking can be partially mitigated while smoking continues is termed harm reduction . Several strategies are possible, including partial nicotine replacement, substituting cigarettes for less harmful tobacco products and engineering the cigarette to produce less toxins. None of these approaches have been demonstrated to have clinical benefit.

READ MORE - Management of stable COPD : smoking cessation ( PULMO HANDBOOK OF COPD )

VALENTINE’S DAY ( SHORT HISTORY )


My dearest,
When two souls, which have sought each other for,
however long in the throng, have finally found each other
...a union, fiery and pure as they themselves are...
begins on earth and continues forever in heaven.
This union is love, true love,...
a religion, which deifies the loved one,
whose life comes from devotion and passion,
and for which the greatest sacrifices are the sweetest delights.
This is the love which you inspire in me...
Your soul is made to love with the purity and passion of angels;
but perhaps it can only love another angel, in which case I must tremble with apprehension.



Valentine's Day or Saint Valentine's Day is a holiday celebrated on February 14 by many people throughout the world. In the English-speaking countries, it is the traditional day on which lovers express their love for each other by sending Valentine's cards, presenting flowers, or offering confectionery. The holiday is named after two among the numerous Early Christian martyrs named Valentine. The day became associated with romantic love in the circle of Geoffrey Chaucer in the High Middle Ages, when the tradition of courtly love flourished.

The day is most closely associated with the mutual exchange of love notes in the form of "valentines". Modern Valentine symbols include the heart-shaped outline, doves, and the figure of the winged Cupid. Since the 19th century, handwritten notes have largely given way to mass-produced greeting cards.The sending of Valentines was a fashion in nineteenth-century Great Britain, and, in 1847, Esther Howland developed a successful business in her Worcester, Massachusetts home with hand-made Valentine cards based on British models. The popularity of Valentine cards in 19th century America was a harbinger of the future commercialization of holidays in the United States.

The U.S. Greeting Card Association estimates that approximately one billion valentines are sent each year worldwide, making the day the second largest card-sending holiday of the year, behind Christmas. The association estimates that, in the US, men spend on average twice as much money as women.

Valentine's Day started in the time of the Roman Empire. In ancient Rome, February 14th was a holiday to honour Juno. Juno was the Queen of the Roman Gods and Goddesses. The Romans also knew her as the Goddess of women and marriage.

Under the rule of Emperor Claudius II Rome was involved in many bloody and unpopular campaigns. Claudius the Cruel was having a difficult time getting soldiers to join his military leagues. He believed that the reason was that roman men did not want to leave their loves or families. As a result, Claudius cancelled all marriages and engagements in Rome. The good Saint Valentine was a priest at Rome in the days of Claudius II. He and Saint Marius aided the Christian martyrs and secretly married couples, and for this kind deed Saint Valentine was apprehended and dragged before the Prefect of Rome, who condemned him to be beaten to death with clubs and to have his head cut off. He suffered martyrdom on the 14th day of February, about the year 270. At that time it was the custom in Rome, a very ancient custom, indeed, to celebrate in the month of February the Lupercalia, feasts in honour of a heathen god. On these occasions, amidst a variety of pagan ceremonies, the names of young women were placed in a box, from which they were drawn by the men as chance directed.

The pastors of the early Christian Church in Rome endeavoured to do away with the pagan element in these feasts by substituting the names of saints for those of maidens. And as the Lupercalia began about the middle of February, the pastors appear to have chosen Saint Valentine's Day for the celebration of this new feaSt. So it seems that the custom of young men choosing maidens for valentines, or saints as patrons for the coming year, arose in this way.

READ MORE - VALENTINE’S DAY ( SHORT HISTORY )

FUNGSI PENDENGARAN PARA PENYELAM TRADISIONAL DI DESA BOLUNG KECAMATAN WORI KABUPATEN MINAHASA UTARA


Darryl Virgiawan Tanod, Sked
ABSTRAK
Penelitian ini adalah mengenai fungsi pendengaran pada penyelam tradisional yang dilakukan di desa Bolung kecamatan Wori kabupaten Minahasa Utara, tujuan dari penelitian ini adalah untuk mengetahui hubungan antara penyelaman dengan fungsi pendengaran pada nelayan tradisional ini.
Jenis penelitian yang digunakan adalah survei deskriptif dengan rancangan cross sectional – study (studi potong lintang ). Dimana pengukuran dilakukan hanya satu kali pada satu saat pada suatu populasi di suatu tempat/daerah.
Penelitian mendapat sampel berjumlah 11 orang dan melakukan tes fungsi pendengaran menggunakan Tes Bisik dan Tes Garpu Tala. Dari hasil pemeriksaan diatas maka didapati bahwa yang mengalami gangguan pendengaran sebesar 72,72 %, sedangkan yang tidak mengalami gangguan sebesar 27,27 %. Hal ini menurut peneliti dapat disebabkan oleh rupturnya membran timpani atau dapat disebabkan oleh hal – hal yang lain seperti trauma, infeksi atau keganasan.
Berdasarkan hasil penelitian diatas maka didapat kesimpulan berupa : gangguan pendengaran yang paling banyak diderita oleh para penyelam tradisional ini adalah tuli konduksi, terdapat gangguan pendengaran pada penyelam tradisional di desa Bolung kecamatan Wori kabupaten Minahasa Utara, serta umur, lamanya berprofesi sebagai penyelam, frekuensi, serta kedalaman menjadi faktor penentu terhadap gangguan pendengaran yang dialami oleh para penyelam tradisional ini.
PENDAHULUAN
Kapan manusia pertama kali menyelam ? tak seorangpun dapat memastikannya. Tapi menyelam dapat dipastikan sebagai profesi yang sudah tua usianya dalam sejarah peradaban umat manusia.
Kegiatan menyelam dapat dibedakan menjadi beberapa jenis tergantung antara lain kepada : kedalaman, tujuan dan jenis peralatan yang digunakan.
Jika kedalaman yang menjadi tolak ukur, penyelaman dapat dibedakan menjadi :
  1. Penyelaman dangkal
Yaitu penyelaman dengan kedalaman maksimum 10 meter
  1. Penyelaman sedang
Yaitu penyelaman dengan kedalaman <>
  1. Penyelaman dalam
Penyelaman dengan kedalaman > 30 m.
Menyelam pada umumnya dilakukan manusia dengan menggunakan peralatan selam yaitu : Skin diving : penyelaman yang dilakukan dengan menggunakan peralatan dasar selam ( masker, snorkel dan fins ), atau Scuba diving : penyelaman menggunakan peralatan scuba. Selain penyelaman memakai alat, ada juga penyelaman yang dilakukan tanpa memakai alat bantu apapun.
Di daerah kita Sulawesi Utara salah satu tempat dimana masih terdapat para nelayan tradisional adalah desa Bolung kecamatan Wori kabupaten Minahasa Utara.
Masyarakat Wori pada umumya berprofesi sebagai petani dan nelayan mengingat daerah Wori adalah suatu daerah yang terletak di daerah pesisir pantai para nelayan yang ada disini pada umumnya adalah laki – laki.
Para nelayan ini menangkap ikan atau buruan mereka dengan cara menyelam atau dalam bahasa masyarakat setempat disebut ’jubi’ cara menangkap ikan seperti ini sudah dipraktekkan masyarakan nelayan Wori secara turun – temurun sehingga tidak mengherankan jikalau di dalam komunitas masyarakat Wori terdapat banyak keluarga yang seluruh anggota keluarganya laki-laki baik ayah maupun anak berprofesi sebagai penjubi.
Satu hal yang perlu kita sadari didalam hal penyelaman adalah terdapatnya perbedaan tekanan antara permukaaan air dan di dalam air dimana hal ini akan mempengaruhi fungsi tubuh kita yang akan berdampak bagi kesehatan pada umumnya, banyak fungsi tubuh yang dipengaruhi salah satunya adalah fungsi pendengaran.
Beberapa penelitian menyangkut penyelaman memberikan hasil yang menunjukkan bahwa terdapat pengaruh yang disebabkan oleh perbedaan tekanan antara permukaan air dan didalam air sehingga menyebabkan penyakit pada penyelam yang disebut decompression sickness / barotrauma.
Barotrauma yang mempengaruhi fungsi pendengaran paling sering terjadi pada telinga tengah, gejala – gejala barotrauma telinga tengah : nyeri, rasa penuh dan berkurangnya pendengaran.
Berdasarkan uraian diatas, membuat peneliti tertarik untuk mengadakan penelitian lebih lanjut mengenai pengaruh dari penyelaman yang dilakukan oleh para nelayan tradisional ini terhadap fungsi pendengaran mereka.
Gangguan – gangguan yang terjadi pada telinga dapat terjadi pada telinga luar, telinga tengah dan telinga dalam.
Dalam hal ini barotrauma pada telinga sering terjadi pada telinga bagian tengah dan penyakit pada telinga tengah ini lazim ditemukan di Amerika Serikat dan di seluruh dunia.
Gejala – gejala barotrauma telinga tegah termasuk nyeri, rasa penuh dan berkurangnya pendengaran. Diagnosis dipastikan dengan otoskop. Gendang telinga tampak mengalami injeksi dengan pembentukan bleb hemoragik atau adanya darah dibelakang gendang telinga. Kadang – kadang membrana timpani akan mengalami perforasi. Dapat disertai gangguan pendengaran konduktif ringan.
METODOLOGI PENELITIAN
Penelitian ini merupakan bagian dari penelitian payung yang dilakukan oleh beberapa orang peneliti ( 3 orang peneliti ). Jenis penelitian yang digunakan adalah survei deskriptif dengan rancangan cross sectional – study (studi potong lintang ). Dimana pengukuran dilakukan hanya satu kali pada satu saat pada suatu populasi di suatu tempat/daerah.
Penelitian dilakukan di desa Bolung kecamatan Wori kabupaten Minahasa Utara propinsi Sulawesi Utara dan dilaksanakan selama satu hari di desa Bolung kecamatan Wori kabupaten Minahasa Utara propinsi Sulawesi Utara.
Populasi dalam penelitian ini adalah seluruh penyelam tradisional di desa Bolung kecamatanWori kabupaten Minahasa Utara yang berjumlah 20 orang.
Sampel adalah sebagian dari populasi penyelam tradisional yang berjumlah 11 orang, yang ditentukan berdasarkan kriteria inklusi yaitu : mereka yang berbadan sehat, bersedia untuk menjadi subjek penelitian setelah menyetujui informed consent.
Data yang telah terkumpul di tabulasi ke dalam bentuk distribusi frekuensi dan ditampilkan dalan bentuk tabel.
HASIL PENELITIAN
Desa Bolung merupakan salah satu desa yang berada di kecamatan Wori kabupaten Minahasa Utara. Desa Bolung yang terletak di daerah pinggir pantai menjadikan daerah ini merupakan salah satu tempat pengembangan potensi kelautan dari kecamatan Wori sendiri sehingga di desa ini masih dapat ditemukan para penyelam tradisional.
Profesi yang dijalankan para penyelam tradisional ini merupakan profesi yang sudah dijalankan secara turun – temurun dalam kurun waktu yang sangat lama antara 5 – 20 tahun. Dengan frekuensi melaut yang sering yaitu 4 – 5 kali dalam seminggu.
Hal inilah yang membuat para penyelam tradisional di desa Bolung sangat rentan dengan berbagai penyakit dekompresi yang dapat mengganggu kesehatan mereka terlebih khusus dapat mengancam jiwa mereka.
1. Usia Responden.
Tabel 2 : Gambaran Umun Responden berdasarkan Usia.
Usia
n
Hasil
Normal
%
Gangguan Pendengaran
Konduksi
%
Persepsi
%
20 – 30 Tahun
31 – 40 Tahun
41 – 50 Tahun
4
2
5
1 Orang
1 Orang
1 Orang
33,33
33,33
33,33
2 Orang
1 Orang
2 Orang
40
20
40
1 Orang
-
2 Orang
33,33
0
66,66
Jumlah
11
3 Orang
100
5 Orang
100
3 Orang
100
2. Lama Bekerja Sebagai Penyelam Tradisional
Tabel 3 : Lama bekerja responden sebagai penyelam tradisional.
Lama Kerja
n
Normal
%
Gangguan Pendengaran
Konduksi
%
Persepsi
%
<>
1 – 3 Tahun
4 – 6 Tahun
> 6 Tahun
1 Orang
-
5 Orang
5 Orang
-
-
2 Orang
1 Orang
0
0
66,66
33,33
1 Orang
-
2 Orang
2 Orang
20
0
40
40
-
-
1 Orang
2 Orang
0
0
33,33
66,66
Jumlah
11 Orang
3 Orang
100
5 Orang
100
3 Orang
100
3. Frekuensi Penyelaman
Tabel 4 : Frekuensi penyelaman tiap minggu.
Frekuensi
n
Normal
%
Gangguan Pendengaran
Konduksi
%
Persepsi
%
1x / minggu
2 – 4x / minggu
5 – 7x / minggu
> 7x / minggu
1 Orang
2 Orang
6 Orang
2 Orang
1 Orang
-
1 Orang
-
50
0
50
0
-
1 Orang
4 Orang
1 Orang
0
16,66
66,66
16,66
-
1 Orang
1 Orang
1 Orang
0
33,33
33,33
33,33
Jumlah
11 Orang
2 Orang
100
6 Orang
100
3 Orang
100
4. Kedalaman Penyelaman.
Tabel 5 : Kedalaman penyelaman para penyelam tradisional
Kedalaman
n
Normal
%
GangguanPendengaran
Konduksi
%
Persepsi
%
<>
1 – 4 meter
5 – 8 meter
> 9 meter
-
-
6 Orang
5 Orang
-
-
1 Orang
2 Orang
0
0
33,33
66,66
-
-
3 Orang
2 Orang
0
0
60
40
-
-
2 Orang
1 Orang
0
0
66,66
33,33
Jumlah
11 Orang
3 Orang
100
5 Orang
100
3 Orang
100









Pemeriksaan fungsi pendengaran yang dilakukan terhadap para nelayan tradisional ini, menggunakan 2 cara yaitu :
  1. Tes Bisik
  2. Tes Garpu Tala : Scwabach, Rinne, Weber.
Berikut ini adalah hasil pemeriksaan fungsi pendengaran pada masyarakat nelayan tradisional desa Bolung kecamatan Wori kabupaten Minahasa Utara :
Hasil Tes Bisik :
Tabel 6 : Hasil dari Tes Bisik.
no
Responden
Kanan
Kiri
Lunak
Desis
Lunak
Desis
1
2
3
4
5
6
7
8
9
10
11
30 Thn
47 Thn
45 Thn
44 Thn
43 Thn
40 Thn
27 Thn
40 Thn
52 Thn
29 Thn
20 Thn
2/5
4/5
5/5
5/5
5/5
4/5
3/5
3/5
2/5
4/5
5/5
4/5
2/5
5/5
5/5
4/5
4/5
4/5
4/5
4/5
3/5
5/5
1/5
5/5
4/5
3/5
4/5
5/5
5/5
5/5
3/5
4/5
5/5
4/5
5/5
4/5
4/5
3/5
4/5
5/5
4/5
4/5
3/5
5/5
Hasil Tes Garpu Tala :
Tabel 7 : Hasil Pemeriksaan Tes Garpu Tala.
no
Responden
Scwabach
Rinne
Weber
Pemeriksa
Penderita
Ka
Ki
Lateralisasi
Ka
Ki
Ka
Ki
1
2
3
4
5
6
7
8
9
10
11
30 Thn
47 Thn
45 Thn
44 Thn
43 Thn
40 Thn
27 Thn
40 Thn
52 Thn
29 Thn
20 Thn
-
+
-
-
-
-
-
-
-
-
-
-
-
-
-
+
-
-
-
-
-
-
+
-
-
-
-
-
+
+
+
+
-
+
-
-
+
-
-
-
-
+
+
-
-
-
+
+
+
+
-
-
-
+
+
-
+
+
-
+
+
+
+
-
+
+
Ki
Ki
Ka
Ka
Ka
Ka
Ka
Ka
Ka
Ki
Ka
PEMBAHASAN
Dari hasil penelitian diatas tanpa memperhatikan penyakit – penyakit terdahulu yang pernah dialami para penyelam ini menyangkut fungsi pendengaran mereka, didapatkan hasil berdasarkan gambaran umum responden berupa : umur, lama berprofesi sebagai penyelam, frekuensi, serta kedalaman penyelaman, yaitu sebagai berikut :
Kelompok usia yang paling banyak menderita gangguan pendengaran akibat barotrauma adalah pada kelompok usia 41 – 50 tahun, diikuti kelompok usia 20 – 30 tahun dan yang paling sedikit mengalami gangguan adalah kelompok usia 31 – 40 tahun ( dapat dilihat pada tabel 2 ).
Dari hasil penelitian dari Kaplan, mengatakan bahwa walaupun tidak ada korelasi langsung antara umur dengan gangguan dekompresi, didapati bahwa umur yang paling sering terkena adalah 21 – 40 tahun, tetapi efek langsung dari barotrauma meningkat pada usia diatas 50 tahun. Berdasarkan penelitian diatas dapat dikatakan bahwa umur memiliki hubungan terhadap gangguan pendengaran pada penyelam dimana berdasarkan hasil penelitian terhadap para penyelam tradisional desa Bolung ini didapati gangguan barotrauma paling banyak pada kelompok usia 41 – 50 tahun.
Kemudian lama bekerja sebagai penyelam tradisional, dimana gangguan pendengaran banyak terdapat pada kelompok yang telah berprofesi sebagai penyelam tradisional selama > 6 tahun, sedangkan gangguan pendengaran yang paling sedikit terdapat pada kelompok yang berprofesi <>
Gangguan yang diakibatkan dari penyelaman yang dilakukan oleh para penyelam tradisional ini bukan hanya gangguan jangka panjang, tetapi gangguan yang langsung terjadi segera setelah penyelaman pun sering terjadi diakibatkan oleh gangguan dekompresi ini. Menurut penelitian dari Easmon, menyebutkan bahwa gejala dari gangguan dekompresi dapat segera terjadi segera setelah penyelam berada dipermukaan air, bahkan pada kasus yang lebih serius penyelam dapat langsung tidak sadar atau bahkan langsung mengalami kematian.
Lamanya seseorang berprofesi sebagai penyelam tradisional menjadi salah satu penyebab terjadinya gangguan barotrauma dalam hal ini pada pendengaran, karena semakin lama seseorang terpapar dengan adanya suatu perbedaan tekanan yaitu perbedaan tekanan antara permukaan air laut dan dalam laut maka resiko untuk mendapat barotrauma semakin besar. Barotrauma dapat terjadi pada telinga luar, tengah dan dalam, tetapi yang paling umum terjadi adalah masalah pada telinga tengah dimana hal ini terjadi karena kegagalan dari telinga tengah untuk menyamakan tekanan dengan lingkungan dimana menurut hukum Boyle bahwa suatu penurunan atau peningkatan pada tekanan lingkungan akan memperbesar atau menekan (secara berurutan) suatu volume gas dalam ruang tertutup. Bila gas terdapat dalam struktur yang lentur, maka struktur tersebut dapat rusak karena ekspansi maupun kompresi.
Hal inilah maka seseorang yang telah lama berprofesi sebagai penyelam tradisional rentan terhadap barotrauma karena seringnya terpapar dengan lingkungan yang memiliki perbedaan tekanan.
Dapat dilihat frekuensi penyelaman yang dilakukan terhadap barotrauma yang dialami oleh penyelam tradisional ini, para penyelam yang frekuensi penyelamannya 5 – 7 x / minggu memiliki gangguan terbanyak, sedangkan penyelam yang memiliki frekuensi penyelaman > 7 x / minggu dari 2 orang yang diperiksa ternyata kedua – duanya terdapat gangguan ( dapat dilihat pada tabel 4 ).
Menurut penelitian dari kalangan medis kelautan selang penyelaman yang dianjurkan adalah 18 jam setelah sebelumnya dilakukan penyelaman, hal ini untuk mencegah terjadinya gangguan dekompresi bagi para penyelam.
Sehingga jika akan dirata – ratakan frekuensi penyelaman dengan selang 18 jam untuk penyelaman berikutnya adalah 4x dalam seminggu untuk memperkecil kemungkinan mendapat gangguan dekompresi.
Hal ini sesuai dengan hasil yang didapat dimana penyelam yang memiliki frekuensi penyelaman <>
Pada kedalaman penyelaman para penyelam tradisional ini, didapati bahwa kedalaman 5 – 8 meter terdapat gangguan sebesar 8,33 % sedangkan pada kedalaman > 9 meter sebesar 60 % ( dapat dilihat pada tabel 5 ).
Menurut literatur yang ada semakin dalam kita menyelam maka tekanan akan bertambah besar dimana pada kedalaman 33 kaki di bawah permukaan laut maka kita akan tepapar oleh tekanan sebesar 2 atm ( 1 atm berasal dari tekanan udara diatas laut dan 1 atm lagi berasal dari berat air sendiri ), pada kedalaman 66 kaki tekanannya adalah 3 atm dan seterusnya.
Sesuai dengan teori diatas, maka para penyelam yang menyelam lebih dalam, dalam hal ini > 9 meter memiliki resiko yang lebih besar untuk mendapat gangguan dekompresi dibandingkan dengan penyelaman yang dilakukan <>
Hasil pemeriksaan fungsi pendengaran pada para nelayan tradisional di desa Bolung, menggunakan tes bisik, dan tes garpu tala ( dapat dilihat pada tabel 6 dan 7 ).
Dari hasil pemeriksaan diatas maka didapati bahwa yang mengalami gangguan pendengaran sebesar 72,72 %, sedangkan yang tidak mengalami gangguan sebesar 27,27 %. Hal ini menurut peneliti dapat disebabkan oleh rupturnya membran timpani atau dapat disebabkan oleh hal – hal yang lain seperti trauma, infeksi atau keganasan.
KESIMPULAN
  1. Gangguan pendengaran yang paling banyak diderita oleh para penyelam tradisional ini adalah tuli konduksi.
  2. Terdapat gangguan pendengaran pada penyelam tradisional di desa Bolung kecamatan Wori kabupaten Minahasa Utara.


Umur, lamanya berprofesi sebagai penyelam, frekuensi, serta kedalaman menjadi faktor penentu terhadap gangguan pendengaran yang dialami oleh para penyelam tradisional ini.
READ MORE - FUNGSI PENDENGARAN PARA PENYELAM TRADISIONAL DI DESA BOLUNG KECAMATAN WORI KABUPATEN MINAHASA UTARA

Related Posts Plugin for WordPress, Blogger...
There was an error in this gadget
 
 
 

Popular Blogs

 
Twitter Bird Gadget