IntroductionAdenoids are part of the ring of waldeyer and have a role in the body's defense function. 1,2) Symptoms of adenoid hypertrophy include rinolalia occlusal, mouth open to breathe, adenoid face, nasal aprosexia, headache, runny nose, chronic cough, decreased appetite, and reduced hearing. The adenoids become hypertrophied in pathological conditions that often occur in children, which can cause complications in nasal obstruction, snoring, sleep apnea, otitis media, and affect the craniofacial shape. Adenoid hypertrophy management with medication or requires an adenoidectomy. Indications for adenoidectomy include chronic infection and obstructive airways caused. 3,4) The choice to undergo adenoidectomy should be carefully, even if the consequences of post-adenoidectomy on

The COVID 19 pandemic impacts the early detection of hearing impairment. Socialization is needed in the form of early detection education of hearing loss in the era of the COVID 19 pandemic to health workers in the front line. The purpose of educational activities is to improve the knowledge and skills of health workers to conduct early detection of hearing impairment in the era of the COVID 19 pandemic. The condition of the COVID 19 pandemic changed the interaction pattern between people, including in education and training activities in the field of health. Education with on line means is becoming a common thing to do today. This training activity is conducted on line and off line methods with limited participants. The training for health workers was carried out using an off line method and was attended by 39 participants. The average result of the pre test was 45.20 (+ 15.69), and the average post test was 80.67 (+ 22.73). Comparison of the pre test and post test results with the t-test, the results were significantly different (p < 0.0001). The training with the on line method was attended by 1,145 participants. The results of the average pre test score were 55.30 (+15.61), and the post test average score was 72.82 (+21.61). Comparison of the pre test and post test scores with the t-test results was significantly different (p < 0.0001). On line and off line methods in training activities provide significant results in increasing the knowledge of health workers so that the pandemic does not hinder the implementation of training activities to increase the knowledge of health workers in an effort to improve the quality of life of the community, in this case, hearing.

A child with a hearing and speech impairment has the same right to education as all children. An equal access to education as an investment to their future. The Acceleration of Digitization and restrictions on activities that occurred during the pandemic and the fourth industrial revolution have led to a challenge of education process, especially for hearing and speech impairments students. This cross-sectional study aims to discover the quality of education and evaluate the knowledge gained from participating in an educational course by giving pre-test and post-test questionnaire. A polling method was conducted to assess the participants' attitudes and psychomotor. This study was attended by 627 respondents including SLB B teachers 267 respondents (43%), parents of students 191 respondents (30%) and the public 169 respondents (27%).  The average pre-test score was 47,67 (+15,69) and the post-test average was 80,67 (+22,73). A mean difference between pretest and post-test score was significant at p < 0.0001. The principles of the education for a child with a hearing and speech impairment is to building children's independence by 293 respondents (23%), using innovative methods of teaching 143 respondents (20%) and increase the utilization of educational facilities and infrastructure 64 respondents (10%).  The strategies to teach a child with a hearing and speech impairment is using innovative methods, starting with understand the children’s character and needs. One of the keys to a successful academic experience for children with disabilities is a productive and supportive relationship between parents and teachers.Keywords : Hearing impairment, speech impairment, educational, independence AbstrakAnak dengan tuna rungu dan wicara memiliki hak dasar. Salah satu hak dasar adalah mendapatkan akses pendidikan yang berkualitas untuk  memberikan bekal untuk kehidupan masa depan.  Pandemi, revolusi industri 4.0 terjadi percepatan digitalisasi informasi yang terjadi dan pembatasan fisik menjadi tantangan terhadap proses pendidikan untuk anak tuna rungu dan wicara. Studi cross sectional untuk menilai kualitas dan upaya peningkatan kualitas pendidikan dilaksanakan dengan seminar pendidikan dan dilakukan pre test sebelum kegiatan dan post test setelah kegiatan untuk menilai peningkatan pengetahuan. Survei jajak pendapat dilakukan untuk menilai sikap dan psikomotor peserta. Studi ini diikuti oleh 627 responden meliputi guru SLB B 267 orang (43 %), orang tua anak didik191 orang (30 %) dan masyarakat umum 169 orang (27 %). Aspek pengetahuan didapatkan hasil pre test 47,67 (+15,69). Hasil rata rata post test 80,67 (+22,73). Perbandingan hasil pre test dan post test  didapatkan hasil yang berbeda signifikan (p<0,0001) sehingga didapatkan peningkatan pengetahuan sebelum dan setelah kegiatan. Sedangkan fokus pendidikan untuk anak tuna rungu dan wicara adalah menumbuhkan kemandirian anak di masa depan 293 orang (47 %), inovasi metode pembelajaran 143 orang (23 %), 127 orang (20 %) dan Penguatan sarana dan prasarana pembelajaran 64 orang (10 %). Perlu inovasi dalam metode pendidikan untuk anak tuna rungu dan tuna wicara. Inovasi dimulai dengan memahami karakter dan kebutuhan anak tuna rungu dan wicara. Kolaborasi antara segenap elemen orang tua dan guru menjadi kunci keberhasilan pendidikan untuk anak tuna rungu dan tuna wicara yang bertujuan untuk kemandirian dan bekal di masa depanKata kunci : Tuna rungu dan tuna wicara, pendidikan, kemandirian

Effective communication is a pillar of excellent service in the healthcare unit. Communication among health workers, hearing impaired and speech impaired will cause obstacles to services. Sign language skills need to be possessed by health workers in communicating with people who are deaf and speech impaired. Socializing sign language and developing sign language skills for health workers in health services. After participating in the training, health workers are expected to know and have sign language skills. Community service activities in the form of sign language training for health workers in health services are carried out with lectures, quiz, discussions and practice of sign language skills. Activities are carried out through online method. The activity was attended by 1,593 participants. The most participants were midwives (570 participants-35.8%), nurses (518 participants -32.5%) and doctors (191 participants -12%). A total of 1,333 participants (83.7%) experienced communication problems with the hearing impaired and speech impaired. The training was felt to be useful by 1,215 participants (76.3%). The average result of the pre-test quiz was 33.54 (+13.11) and the average post-test quiz was 61.23 (+10.41). Comparison of pre-test and post-test results of hearing health education obtained statistically significant differences (p < 0.0001). The benefits of training activities are felt to be useful and needs to be intensified to improve the quality of services and the quality of life for people who are hearing impaired and speech impaired.

Background: Tinnitus is believed to cause significant psychological distress leading to impairment in quality of life (QOL). Purpose: To assess the negative impact of tinnitus on patient’s QOL and discuss the management approach of tinnitus patient. Method: A cross-sectional study was conducted within one year duration on 88 patients who experienced tinnitus. Patients from Otorhinolaryngology clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were evaluated based on socio-demographic data, clinical data and QOL. QOL was assessed using Tinnitus Handicap Inventory (THI), a self-report questionnaire measuring 3 domains of QOL: functional, emotional and catastrophic scales. Result: Respondents consisted of 35 males (39.8%) and 53 females (60.2%), with mean age of 57.9±13.9 years old. Pure tone audiometry should be done at least once during the follow up period. Patients with persistent tinnitus had significantly higher mean THI total scores (p=0.042) and emotional subscale score (p=0.037) compared to patients with intermittent tinnitus. However, there were no significant associations between gender, duration of tinnitus and laterality of tinnitus with patient’s THI score. Discussion: All patients should have good history taking, proper physical examination and investigation. Those without the primary cause of tinnitus would be given tinnitus activity treatment by good counselling on tinnitus. Patient with vascular disorder would be given conservative treatment. Conclusion: Magnetic resonance imaging was indicated in asymmetrical hearing loss with tinnitus. Computed tomography scan with contrast was indicated when there is pulsatile tinnitus with/without abnormal ear finding. Patients with high grades THI questionnaire would be referred to psychiatrist for further assessment. ABSTRAKLatar belakang: Tinitus diyakini dapat menyebabkan stress psikologi yang signifikan sehingga mengakibatkan penurunan kualitas hidup seseorang (Quality of Life / QOL). Tujuan: Menilai dampak negatif tinitus pada kualitas hidup penderita dan merencanakan penatalaksanaannya. Metode: Penelitian ini merupakan studi potong lintang pada 88 penderita tinitus selama satu tahun. Penderita yang datang ke unit rawat jalan Telinga Hidung Tenggorok Bedah Kepala dan Leher (THT-KL), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) dilakukan evaluasi berdasarkan data demografi, data klinis dan QOL. Quality of life dinilai menggunakan Tinnitus Handicap Inventory (THI), kuesioner tentang penderita yang mengukur 3 domain QOL: skala fungsional, emosional dan katastropik. Hasil: Responden terdiri dari 35 laki-laki (39,8%) dan 53 perempuan (60,2%), dengan rerata usia 57.9±13.9 tahun. Audiometri nada murni perlu dilakukan minimal satu kali selama periode penelitian. Penderita dengan tinitus persisten secara signifikan memiliki nilai rata-rata THI yang lebih tinggi (p=0.042) dan nilai emotional subscale (p=0.037) dibandingkan dengan penderita tinitus intermiten. Tidak ada hubungan yang signifikan antara jenis kelamin, durasi tinitus dan lateralisasi tinitus dengan nilai THI penderita. Diskusi: Semua penderita diperlukan anamnesis yang baik dan pemeriksaan fisik yang menyeluruh. Penderita tanpa penyebab primer dari tinitusnya akan diberikan terapi konseling tinitus yang baik. Penderita dengan gangguan pembuluh darah akan diberikan pengobatan konservatif. Kesimpulan: Magnetic resonance imaging perlu dilakukan pada gangguan pendengaran satu sisi dengan tinitus. Computed tomography scan dengan kontras dilakukan pada tinitus pulsatil dengan atau tanpa kelainan pada telinga. Pada pendertita dengan nilai kuesioner THI yang tinggi akan dirujuk ke psikiater untuk penilaian lebih lanjut.