LAPORAN

KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang Bulan : Januari

Kab/Kota : Surabaya Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH PENDERI
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn 10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

A Jenis Gangguan Pendengaran dan Ketulian

(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 2 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 2 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 3 0 1 0 1 0 0 0 1 0 0 0 0 0 2 0 0 0 2 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 0 0 0 0 0 0 0 0 0 0 3 0 1 0 1 0 0 0 1 0 0 0 0 0 2 0 0 0 2 0

a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 3 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 2 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH DIRUJUK
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P TOTAL KETERANGAN
L P L P TOTAL
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

A Jenis Gangguan Pendengaran dan Ketulian

(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 2 2 4 0 0 0
6 Lain-lain (Sebutkan) : 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 5 1 6 0 6 6 12 0 0 0
a. Otitis Media Akut 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 1 0 3 1 4 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 3 0 5 0 3 5 8 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 2 0 1 1 1 0 0 0 0 0 0 0 0 0 7 1 8 0 8 8 16 0 0 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 1 0 2 0 1 1 1 0 2 0 0 14 0 0 0 0 9 1 8 14 10 22 32 0 0 0

a. Balita 3 0 1 0 3 1 4 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 2 2 4 0 0 0
c. Dewasa 1 0 2 0 1 1 1 0 0 0 0 0 0 0 0 0 2 1 5 0 3 5 8 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0
f. Lansia 2 0 0 14 0 0 0 0 2 0 0 14 2 14 16 0 0 0

Mengetahui, Surabaya, 1 Februari 2019

Plt Kepala Puskesmas Ketabang Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Februari

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 2 0 2 0 2 0 4 0 1 0
a. Otitis Media Akut 0 0 1 0 1 0 1 0 1 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 1 0 1 0 1 0 3 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 2 0 2 0 2 0 4 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 2 0 2 0 2 0 4 0 1 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 0 0 2 0 2 0 2 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 4 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 3 0
6 Lain-lain (Sebutkan) : 0 0 1 0 1 0 1 0 0 0 3 0 0 0 0 0 7 0 10 0
a. Otitis Media Akut 0 0 1 0 0 0 1 0 0 0 2 0 0 0 0 0 2 0 7 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 5 0 3 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 2 0 1 0 2 0 0 0 3 0 0 0 0 0 7 0 13 0

B Skrining / Deteksi Dini Gangguan 0 0 2 0 1 0 2 0 0 0 3 0 0 0 0 0 7 0 13 0

Pendengaran
a. Balita 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 5 0
c. Dewasa 0 0 2 0 1 0 2 0 0 0 0 0 0 0 0 0 5 0 5 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0
f. Lansia 0 0 3 0 0 0 0 0 0 0 3 0

Mengetahui, Surabaya, 1 Maret 2019

Plt Kepala Puskesmas Ketabang Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 3 3 0 0 0
6 Lain-lain (Sebutkan) : 7 10 17 0 0 0
a. Otitis Media Akut 2 7 9 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0
d. Otitis Eksterna 5 3 8 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 7 13 20 0 0 0

B Skrining / Deteksi Dini Gangguan 7 13 20 0 0 0

Pendengaran
a. Balita 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 2 5 7 0 0 0
c. Dewasa 5 5 10 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 0 3 3 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1

a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Maret

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH PENDERITA
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 1 0 1 0 3 0 0 0 3 0
a. Otitis Media Akut 0 1 0 0 0 1 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 1 0 2 0 0 0 2 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 1 0 1 0 3 0 0 0 3 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 1 0 1 0 3 0 0 0 3 0

a. Balita
b. Anak Sekolah dan Remaja 0 1 0 1 0 3 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 3 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 4 0 9 0 4
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 4 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 5 0 4
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 4 0 9 0 4

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 0 0 0 0 0 0 0 3 1 22 0 0 0 0 4 3 9 22 7

a. Balita 1 0 0 0 1
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 5 0 3
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0
f. Lansia 0 3 1 22 0 0 0 0 0 3 1 22 3

Mengetahui, Surabaya, 1 April 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELI

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0
6 Lain-lain (Sebutkan) : 9 13 0 0 0
a. Otitis Media Akut 4 4 0 0 0
b. Kelainan telinga luar 0 0 0 0 0
c. Tinnitus 0 0 0 0 0
d. Otitis Eksterna 5 9 0 0 0
e. ….. 0 0 0 0 0
j. ..................... 0 0 0 0 0
k. ................. 0 0 0 0 0
l. ............... 0 0 0 0 0
m. .................. 0 0 0 0 0
n. ................. 0 0 0 0 0
o. .................... 0 0 0 0 0
p. .................... 0 0 0 0 0
q. .................... 0 0 0 0 0
r. .................... 0 0 0 0 0
s. .................... 0 0 0 0 0
t. .................... 0 0 0 0 0
JUMLAH TOTAL 9 13 0 0 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 31 38 0 0 0

a. Balita 0 1 0 0 0
b. Anak Sekolah dan Remaja 5 8 0 0 0
c. Dewasa 3 3 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0
f. Lansia 23 26 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : April

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUM
5-9 thn 10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 1 0 1 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 1 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 1 0 0 0 1 0 3 0 3 0 2 0
a. Otitis Media Akut 0 0 1 0 0 0 0 0 2 0 1 0 2 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 1 0 1 0 2 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 1 0 0 0 1 0 4 0 4 0 3 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 1 0 0 0 1 0 4 0 4 0 3 0

a. Balita
b. Anak Sekolah dan Remaja 0 0 1 0 0 0 1 0 4 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 4 0 3 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 8 0
a. Otitis Media Akut 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 5 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 9 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 9 0

a. Balita 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0
c. Dewasa 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 5 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0
f. Lansia 1 0 0 0 0 0 0 0 1 0

Mengetahui, Surabaya, 2 Mei 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT P TOTAL KETERANGAN
L P L P TOTAL
Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 1 0 1 1 2 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0

5 Serumen Prop 1 0 0 1 1 0 0 0
6 Lain-lain (Sebutkan) : 6 0 8 6 14 0 0 0
a. Otitis Media Akut 5 0 5 5 10 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 3 1 4 0 0 0
e. ….. 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0
JUMLAH TOTAL 8 0 9 8 17 0 0 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 8 0 9 8 17 0 0 0

a. Balita 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 4 0 3 4 7 0 0 0
c. Dewasa 4 0 5 4 9 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0
f. Lansia 0 0 1 0 1 0 0 0

Surabaya, 2 Mei 2019

Penanggung jawab

dr. Virta Sativane

 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0 0 0 2 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0 0 0 2 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0 0 0 2 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Mei

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 1 0 0 0 1 0 0 0 0 0
6 Lain-lain (Sebutkan) : 1 0 2 0 1 0 1 0 1 0 1 0
a. Otitis Media Akut 0 0 0 0 0 0 1 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 2 0 1 0 0 0 1 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 3 0 1 0 2 0 1 0 1 0

B Skrining / Deteksi Dini Gangguan 1 0 3 0 1 0 2 0 1 0 1 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 1 0 3 0 1 0 2 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 1 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
6 Lain-lain (Sebutkan) : 1 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 7 0 12 0
a. Otitis Media Akut 0 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 3 0 8 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 4 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 2 0 1 0 1 0 1 0 1 0 0 0 0 0 8 0 15 0

B Skrining / Deteksi Dini Gangguan 1 0 2 0 1 0 1 0 1 0 1 0 0 0 0 0 8 0 15 0

Pendengaran
a. Balita 2 0 3 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 7 0
c. Dewasa 1 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 3 0 4 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 1 0 1 0 0 0 0 0 1 0 1 0

Mengetahui, Surabaya, 3 Juni 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 1 1 2 1 1 2

Usia Lanjut)
5 Serumen Prop 0 2 2 0 0 0
6 Lain-lain (Sebutkan) : 7 12 19 0 0 0
a. Otitis Media Akut 3 8 11 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 1 0 1 0 0 0
d. Otitis Eksterna 3 4 7 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 8 15 23 1 1 2

B Skrining / Deteksi Dini Gangguan 8 15 23 1 1 2

Pendengaran
a. Balita 2 3 5 0 0 0
b. Anak Sekolah dan Remaja 2 7 9 0 0 0
c. Dewasa 3 4 7 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 1 1 2 1 1 2
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Juni

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 1 0 2 0 0 0 0 0
6 Lain-lain (Sebutkan) : 1 0 1 0 1 0 2 0 1 0 1 0
a. Otitis Media Akut 0 0 1 0 1 0 1 0 1 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 0 0 0 0 1 0 0 0 1 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 1 0 2 0 4 0 1 0 1 0

B Skrining / Deteksi Dini Gangguan 1 0 1 0 2 0 4 0 1 0 1 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 1 0 1 0 2 0 4 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 1 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3 0
6 Lain-lain (Sebutkan) : 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 5 0
a. Otitis Media Akut 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 2 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 8 0

B Skrining / Deteksi Dini Gangguan 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 8 0

Pendengaran
a. Balita 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 6 0
c. Dewasa 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui, Surabaya, 1 Juli 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 1 3 4 0 0 0
6 Lain-lain (Sebutkan) : 6 5 11 0 0 0
a. Otitis Media Akut 4 2 6 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0
d. Otitis Eksterna 2 3 5 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 7 8 15 0 0 0

B Skrining / Deteksi Dini Gangguan 7 8 15 0 0 0

Pendengaran
a. Balita 1 1 2 0 0 0
b. Anak Sekolah dan Remaja 3 6 9 0 0 0
c. Dewasa 3 1 4 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn 10-14 t
NO NAMA PENYAKIT L P L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Juli

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH PENDERITA MENUR
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 0 0 1 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 1 0 0 0 0 0 1 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 0 0 0 0 1 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 1 0 0 0 1 0 0 0

B Skrining / Deteksi Dini Gangguan 1 0 1 0 0 0 1 0 0 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 1 0 1 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 1 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2 0
6 Lain-lain (Sebutkan) : 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 4 0 1 4
a. Otitis Media Akut 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3 0 1 3
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 3 0 5 0 3 5

B Skrining / Deteksi Dini Gangguan 1 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 3 0 5 0 3 5

Pendengaran
a. Balita 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1
c. Dewasa 1 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2 0 4 0 2 4
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui, Surabaya, 1 Agustus 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TE

Puskesmas
Kab/Kota
DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 1 0 1 1
2 Tuli Kongenital 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0
Usia Lanjut)
5 Serumen Prop 2 0 0 0
6 Lain-lain (Sebutkan) : 5 0 0 0
a. Otitis Media Akut 1 0 0 0
b. Kelainan telinga luar 0 0 0 0
c. Tinnitus 0 0 0 0
d. Otitis Eksterna 4 0 0 0
e. ….. 0 0 0 0
j. ..................... 0 0 0 0
k. ................. 0 0 0 0
l. ............... 0 0 0 0
m. .................. 0 0 0 0
n. ................. 0 0 0 0
o. .................... 0 0 0 0
p. .................... 0 0 0 0
q. .................... 0 0 0 0
r. .................... 0 0 0 0
s. .................... 0 0 0 0
t. .................... 0 0 0 0
JUMLAH TOTAL 8 0 1 1

B Skrining / Deteksi Dini Gangguan 8 0 1 1

Pendengaran
a. Balita 0 0 0 0
b. Anak Sekolah dan Remaja 2 0 0 0
c. Dewasa 6 0 1 1
d. Calon Pengantin (Catin) 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 0 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 0 51 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 0 51 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Agustus

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 1 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 1 0 2 0 1 0 2 0
a. Otitis Media Akut 0 0 0 0 0 0 1 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 1 0 1 0 1 0 2 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 1 0 2 0 2 0 2 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 1 0 2 0 2 0 2 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 0 0 0 0 1 0 2 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 2 0 2 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 4 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 6 0

B Skrining / Deteksi Dini Gangguan 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 52 0 56 0

Pendengaran
a. Balita 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 53 0
c. Dewasa 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui, Surabaya, 2 September 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 1 1 2 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 1 1 0 0 0
6 Lain-lain (Sebutkan) : 2 4 6 0 0 0
a. Otitis Media Akut 0 1 1 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0
d. Otitis Eksterna 2 3 5 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 3 6 9 0 0 0

B Skrining / Deteksi Dini Gangguan 52 56 108 0 0 0

Pendengaran
a. Balita 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 50 53 103 0 0 0
c. Dewasa 2 3 5 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang Bulan : September

Kab/Kota : Surabaya Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn 10-14 thn 15-19 thn
NO NAMA PENYAKIT L P L P L P L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru

A Jenis Gangguan Pendengaran dan Ketulian

(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 1 0 1 0 0 0 0 0 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 2 0 2 0 1 0 0 0 1 0 1 0 0

Skrining / Deteksi Dini Gangguan

B 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 2 0 2 0 1 0 0 0 1 0 1 0 0
Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 1 0 0 0 1 0 1 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
20 - 44
NO NAMA PENYAKIT L P
Lama Baru Lama

A Jenis Gangguan Pendengaran dan Ketulian

(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0
2 Tuli Kongenital 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0
6 Lain-lain (Sebutkan) : 0 1 0
a. Otitis Media Akut 0 1 0
b. Kelainan telinga luar 0 0 0
c. Tinnitus 0 0 0
d. Otitis Eksterna 0 0 0
e. ….. 0 0 0
j. ..................... 0 0 0
k. ................. 0 0 0
l. ............... 0 0 0
m. .................. 0 0 0
n. ................. 0 0 0
o. .................... 0 0 0
p. .................... 0 0 0
q. .................... 0 0 0
r. .................... 0 0 0
s. .................... 0 0 0
t. .................... 0 0 0
JUMLAH TOTAL 0 1 0

Skrining / Deteksi Dini Gangguan

B 0 1 0
Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 0 0 0
c. Dewasa 0 1 0
d. Calon Pengantin (Catin) 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH DIRUJUK
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P TOTAL KETERANGAN
L P L P TOTAL
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

A Jenis Gangguan Pendengaran dan Ketulian

(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 3 0 2 3 5 0 0 0
6 Lain-lain (Sebutkan) : 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 4 0 4 0 4 4 8 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 1 0 3 1 4 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3 0 1 3 4 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 6 0 7 0 6 7 13 0 0 0

Skrining / Deteksi Dini Gangguan

B 0 0 2 0 0 0 0 0 1 2 0 43 0 0 0 0 6 2 7 43 8 50 58 0 0 0
Pendengaran
a. Balita 1 0 1 0 1 1 2 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 3 0 4 3 7 0 0 0
c. Dewasa 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 3 3 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0
f. Lansia 1 2 0 43 0 0 0 0 1 2 0 43 3 43 46 0 0 0

Mengetahui, Surabaya, 1 Oktober 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn 10-14 t
NO NAMA PENYAKIT L P L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Oktober

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH PENDERITA MENUR
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 1 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 2 0 1 0 1 0
a. Otitis Media Akut 0 0 0 0 0 0 1 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 2 0 0 0 1 0
e. ….. 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 2 0 2 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 2 0 2 0 1 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 0 0 0 0 2 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 2 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
Jenis Gangguan Pendengaran dan Ketulian
A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia Lanjut)
5 Serumen Prop 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1
6 Lain-lain (Sebutkan) : 2 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 7 0 7 0 7 7
a. Otitis Media Akut 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 2 0 4 0 2 4
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 2 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 5 0 3 0 5 3
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 2 0 2 0 0 0 1 0 1 0 1 0 0 0 0 0 8 0 8 0 8 8

B Skrining / Deteksi Dini Gangguan 2 0 2 0 0 0 1 0 1 0 1 0 0 0 0 0 8 0 8 0 8 8

Pendengaran
a. Balita 1 0 1 0 1 1
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 2 2
c. Dewasa 2 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 4 0 4 0 4 4
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 1 0 1 0 0 0 0 0 1 0 1 0 1 1

Mengetahui, Surabaya, 1 November 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TE

Puskesmas
Kab/Kota
DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A
(H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 1 1 0 1
2 Tuli Kongenital 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 0 0 0 0
Usia Lanjut)
5 Serumen Prop 1 0 0 0
6 Lain-lain (Sebutkan) : 14 0 0 0
a. Otitis Media Akut 6 0 0 0
b. Kelainan telinga luar 0 0 0 0
c. Tinnitus 0 0 0 0
d. Otitis Eksterna 8 0 0 0
e. ….. 0 0 0 0
j. ..................... 0 0 0 0
k. ................. 0 0 0 0
l. ............... 0 0 0 0
m. .................. 0 0 0 0
n. ................. 0 0 0 0
o. .................... 0 0 0 0
p. .................... 0 0 0 0
q. .................... 0 0 0 0
r. .................... 0 0 0 0
s. .................... 0 0 0 0
t. .................... 0 0 0 0
JUMLAH TOTAL 16 1 0 1

B Skrining / Deteksi Dini Gangguan 16 1 0 1

Pendengaran
a. Balita 2 0 0 0
b. Anak Sekolah dan Remaja 4 0 0 0
c. Dewasa 8 1 0 1
d. Calon Pengantin (Catin) 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 2 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : November

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 1 0 0 0 0 0 1 1 0 0 1 0
6 Lain-lain (Sebutkan) : 1 0 1 0 1 0 0 0 0 0 0 0
a. Otitis Media Akut 0 0 1 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 0 0 1 0 0 0 0 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 2 0 1 0 1 0 1 1 0 0 1 0

B Skrining / Deteksi Dini Gangguan 2 0 1 0 1 0 1 1 0 0 1 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 2 0 1 0 1 0 1 1 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 1 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 3 1
6 Lain-lain (Sebutkan) : 1 0 2 0 0 0 0 0 0 0 1 0 0 0 0 0 4 0 6 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 2 0 0 0 0 0 0 0 1 0 0 0 0 0 4 0 3 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 2 0 0 0 1 0 0 0 1 0 0 0 0 0 5 0 9 1

B Skrining / Deteksi Dini Gangguan 1 0 2 0 0 0 1 0 0 3 1 45 0 0 0 0 5 3 9 46

Pendengaran
a. Balita 1 0 1 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3 1
c. Dewasa 1 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 4 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0 0 0
f. Lansia 0 3 1 45 0 0 0 0 0 3 1 45

Mengetahui, Surabaya, 4 Desember 2019

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 1 4 5 0 0 0
6 Lain-lain (Sebutkan) : 4 6 10 0 0 0
a. Otitis Media Akut 0 3 3 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0
d. Otitis Eksterna 4 3 7 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 5 10 15 0 0 0

B Skrining / Deteksi Dini Gangguan 8 55 63 0 0 0

Pendengaran
a. Balita 1 1 2 0 0 0
b. Anak Sekolah dan Remaja 3 4 7 0 0 0
c. Dewasa 1 4 5 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 3 46 49 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 2 0 0 0

B Skrining / Deteksi Dini Gangguan 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 2 0 0 0

Pendengaran
a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas Bulan : Desember

Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH
10-14 thn 15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 1 0 0 0 0 0
6 Lain-lain (Sebutkan) : 1 0 1 0 1 0 2 0 1 0 2 0
a. Otitis Media Akut 1 0 1 0 1 0 1 0 0 0 1 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 1 0 1 0 1 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 1 0 1 0 1 0 3 0 1 0 2 0

B Skrining / Deteksi Dini Gangguan 1 0 1 0 1 0 3 0 1 0 2 0

Pendengaran
a. Balita
b. Anak Sekolah dan Remaja 1 0 1 0 1 0 3 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 1 0 2 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil)
f. Lansia
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 2 0
6 Lain-lain (Sebutkan) : 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 5 0
a. Otitis Media Akut 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 2 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 8 0 7 0

B Skrining / Deteksi Dini Gangguan 2 0 0 0 0 0 1 0 0 0 0 0 0 6 0 49 8 6 7 49

Pendengaran
a. Balita 1 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 4 0
c. Dewasa 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 0 3 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0
f. Lansia 0 0 0 0 0 6 0 49 0 6 0 49

Mengetahui, Surabaya, 2 Januari 2020

Kepala Puskesmas, Penanggung jawab

dr. Joyce Hestia Nugrahanti dr. Virta Sativane

NIP 19750923 200701 2 020
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TEL

Puskesmas
Kab/Kota
JUMLAH DIRUJUK
NO NAMA PENYAKIT TOTAL KETERANGAN
L P L P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0
Induced Hearing Loss (NIHL)

4 Presbikusis (Gangguan Pendengaran Karena 0 0 0 0 0 0

Usia Lanjut)
5 Serumen Prop 1 2 3 0 0 0
6 Lain-lain (Sebutkan) : 7 5 12 0 0 0
a. Otitis Media Akut 3 3 6 0 0 0
b. Kelainan telinga luar 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0
d. Otitis Eksterna 4 2 6 0 0 0
e. ….. 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0
JUMLAH TOTAL 8 7 15 0 0 0

B Skrining / Deteksi Dini Gangguan 14 56 70 0 0 0

Pendengaran
a. Balita 1 0 1 0 0 0
b. Anak Sekolah dan Remaja 4 4 8 0 0 0
c. Dewasa 3 3 6 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0
f. Lansia 6 49 55 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas : Ketabang
Kab/Kota : Surabaya
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
0-7 hari 8-28 hari >29-11 bln 1-4 thn 5-9 thn 10-14 thn
NO NAMA PENYAKIT L P L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Serumen Prop 0 0 0 0 0 0 0 0 0 0 0 0 2 0 1 0 2 0 4 0 1 0 1 0
6 Lain-lain (Sebutkan) : 0 0 0 0 0 0 0 0 0 0 0 0 9 0 7 0 6 0 5 0 9 0 9 0
a. Otitis Media Akut 0 0 0 0 0 0 0 0 0 0 0 0 4 0 4 0 3 0 2 0 4 0 5 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Otitis Eksterna 0 0 0 0 0 0 0 0 0 0 0 0 5 0 3 0 3 0 3 0 5 0 4 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 11 0 8 0 8 0 9 0 10 0 10 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 0 0 0 0 0 0 0 0 0 0 0 0 11 0 8 0 57 0 59 0 10 0 10 0

a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 11 0 8 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57 0 59 0 10 0 10 0
c. Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 LAPORAN LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota Tahun : 2019
JUMLAH PENDERITA MENURUT GOLONGAN UMUR JUMLAH PENDERITA MENURUT GOLONGAN UM
15-19 thn 20 - 44
NO NAMA PENYAKIT L P L P
Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 0 0 3 0 1 0
2 Tuli Kongenital 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0

5 Serumen Prop 3 0 8 1 0 0 1 0
6 Lain-lain (Sebutkan) : 9 0 18 0 13 0 16 0
a. Otitis Media Akut 3 0 8 0 4 0 8 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0
c. Tinnitus 0 0 0 0 0 0 0 0
d. Otitis Eksterna 6 0 10 0 9 0 8 0
e. ….. 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0
JUMLAH TOTAL 12 0 26 1 16 0 18 0

Skrining / Deteksi Dini Gangguan

B Pendengaran 12 0 26 1 16 0 18 0

a. Balita 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 12 0 26 1 0 0 0 0
c. Dewasa 0 0 0 0 16 0 18 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TELINGA

Puskesmas
Kab/Kota
JUMLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH D
45 - 54 55 - 59 60 - 69 70+
NO NAMA PENYAKIT L P L P L P L P L P TOTAL
L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 3 0 3 0 3 3 6 1
2 Tuli Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 2 1

5 Serumen Prop 1 0 3 0 0 0 3 0 0 0 0 0 0 0 0 0 9 0 21 1 9 22 31 0
6 Lain-lain (Sebutkan) : 10 0 11 0 3 1 6 0 3 0 6 0 0 0 0 0 62 1 78 0 63 78 141 0
a. Otitis Media Akut 3 0 4 0 1 1 5 0 2 0 4 0 0 0 0 0 24 1 40 0 25 40 65 0
b. Kelainan telinga luar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Tinnitus 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0
d. Otitis Eksterna 6 0 7 0 2 0 1 0 1 0 2 0 0 0 0 0 37 0 38 0 37 38 75 0
e. ….. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. ..................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. .................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
n. ................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
p. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
q. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
r. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
s. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
t. .................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 11 0 15 0 3 1 10 0 4 0 7 0 0 0 0 0 75 1 103 1 76 104 180 2

Skrining / Deteksi Dini Gangguan

B Pendengaran 11 0 15 0 3 1 10 0 6 8 7 124 0 6 0 49 126 15 153 174 141 327 468 2

a. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 8 0 11 8 19 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 79 0 95 1 79 96 175 0
c. Dewasa 11 0 15 0 3 1 10 0 0 0 0 0 0 0 0 0 30 1 43 0 31 43 74 1
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 6 8 7 124 0 6 0 49 6 14 7 173 20 180 200 1

Mengetahui, Surabaya, ...........................

Kepala Puskesmas, Penanggung jawab
 LAPORAN
KEGIATAN PROGRAM GANGGUAN TE

Puskesmas
Kab/Kota
DIRUJUK
NO NAMA PENYAKIT KETERANGAN
P TOTAL

Jenis Gangguan Pendengaran dan Ketulian

A (H60- H95)
1 Otitis Media Supuratif Kronik (OMSK) 1 2
2 Tuli Kongenital 0 0
Gangguan Pendengaran Akibat Bising (GPAB) /
3 Noice 0 0
Induced Hearing Loss (NIHL)
Presbikusis (Gangguan Pendengaran Karena
4 Usia Lanjut) 1 2

5 Serumen Prop 0 0
6 Lain-lain (Sebutkan) : 0 0
a. Otitis Media Akut 0 0
b. Kelainan telinga luar 0 0
c. Tinnitus 0 0
d. Otitis Eksterna 0 0
e. ….. 0 0
j. ..................... 0 0
k. ................. 0 0
l. ............... 0 0
m. .................. 0 0
n. ................. 0 0
o. .................... 0 0
p. .................... 0 0
q. .................... 0 0
r. .................... 0 0
s. .................... 0 0
t. .................... 0 0
JUMLAH TOTAL 2 4

Skrining / Deteksi Dini Gangguan

B Pendengaran 2 4

a. Balita 0 0
b. Anak Sekolah dan Remaja 0 0
c. Dewasa 1 2
d. Calon Pengantin (Catin) 0 0
e. Ibu Hamil (Bumil) 0 0
f. Lansia 1 2