Proceeding of Surabaya International Health Conference July 13-14, 2017

CORRELATION OF EQUALIZATION TECHNICAL TO BAROTRAUMA EVENTS IN TRADITIONAL DIVERS VILLAGE KEDUNG COWEK, DISTRICT BULAK, KENJERAN, SURABAYA Diyah Arini, Imroatul Farida, Rafika Rosita Sari College of Health Sciences Hang Tuah Surabaya Email : [email protected]

Abstract Barotrauma is the most common problem in traditional divers, due to pressure differences. Pressure can be equated doing of equalization technique. The purpose of this study was to analyze the relationship of the technique of equalization to the incidence of barotrauma on traditional divers.The research design was analytic with Cross Sectional approach. Sample size 35 respondents, sample technique use probability sampling (simple random sampling). Data were collected use questionnaires and observation sheets. Data were analyzed using Spearman Rho test. The result of this study use the technique of equalization performed by traditional divers using toynbee equalization technique, and the incidence of barotrauma on the traditional diver in the diver not equalize according to the procedure. In prove with the results of spearman rho test shows the value p = 0.029 (p <α = 0.05).The implications of this research require the support of the traditional divers as the coordinator for traditional divers to change the traditional divers behavior in performing diving procedures. Keywords: Equalization Technique, Barotrauma Occurrence, Traditional Diver

INTRODUCTION symptoms as like on barotrauma mark Diving is a beneath water activity using a head, ear , full some illnes on the ears, tool or without tools (Soepadmo, 1990 pain on cheast. The data collected was Abshor, 2008). Diving have a standard recorded Sepim Kesma Health in 2008, procedure that needs to be done, the from traditional divers find from 1026 procedure should be performed when the divers, 93.9% of divers have experienced dive one is the equalization health problems as many dives problems, technique.Equalization is an engineering 39.5% experiencing Barotrauma, 29.8% technique to equalize the outside and experienced a Decompression, and 10.3% inside pressure of the body cavities. There experiencing paralysis (Directorate are body cavitys , ear, nose, lungs General of disease control and (LAKESLA, 2013).The Divers who do not environmental health of the 2008 Joon, comply with the procedure's can get health 2009). Based on a preliminary study of problems, especially on barotrauma’s about in kedung cowek of 5 traditional disease (PKHI, 2006).Barotrauma is the divers , 100% did not do equalization detriment one of body that occurs due to technique so the result is 3 or 60% of the difference in air pressure inside the divers have experienced of pain symptoms hollow space with a pressure environment with the mark 1 ear, vertigo and 2 or 40% (Dwi Sumiarto Suhandi, Mes, 2015).Based of divers have experience of barotrauma, on preliminary survey in kedung cowek 0 signs symptoms of ear , and doing a live interview on traditional dizziness.Barotrauma can be reduced if the divers, mostly the divers did not do traditional diver want to do techniques of equalization techniques when diving and equalization time on diving. The many divers are experiencing sharp Government in this regard the Ministry of

--- 535 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 marine and fisheries has made the law No. are observed directly by a 7 year 2016 regarding about protection, physician.Implementation of the research empowerment of fishermen, fish farms and begins from, first assamble the divers enterprises saltness. On section 30 says come in research place, second give that the Central Government and local explanation about the objectives, benefits governments provide protection to the risk and implementation research, as well faced by fishermen when fishing On asking to the divers to fill the inform section 40 says that the Central consent after receiving the explanation. Government and the obligation to organize Traditional divers are requested fill the health education and training to fishermen questionnaire has given by the researcher and families in accordance with the then the divers would examined using provisions of the Act (Act of the Republic traditional otoskop to observe genesis of of Indonesia No. 7, 2016). Marine and barotrauma on the traditional diversby Fisheries Agency of the city of surabaya examining the tympanic membrane, accompany with healthy department and respondent. For All data collected are Chairman of the fishermen of the coastal presented in the form of a table. The Data area to do health education on traditional analysis using the method of test spearman divers. Health education especially the rho. safety on while diving seeking fish, one of them concerning the technique of RESULTS equalization in traditional scuba divers to This study was conducted on April 6, 2017, avoid barotrauma and reduce the incidence in the Village Kedung Cowek, Kenjeran, of barotrauma in kedung cowek. Surabaya. Respondents in this study is a traditional diver who totaled 35 people. METODE Characteristics of respondents in this study The design of this research is to analyze includeage, gender, education, religion, the relationship of events equalization long dive, dive depth, dive frequency technique of barotrauma on the traditional 1. General data divers in cowek kedung surabaya by using Table 1. Distribution Characteristics of observational analytic design and Cross Respondents by Gender Percentage Sectional approach. Sampling of this Gender Frequency (f) research uses a probability technique (%) sample random sampling.This research Man 35 100 was in the village Cowek, Kedung Bulak, woman 0 0 Kenjeran. Data has taken on 06 April 2017, the population of this research is the Total 35 100 traditional divers in kedung Based on the traditional diver table 1 is cowek,kenjeran surabaya with quantity obtained based on sex altogether 35 people population of 39 samples were obtained, (100%) male sex and there are no female and respondent amounted to 35 gender as a traditional diver. respondents. Table 2. Characteristics of Respondents The definition of operational from the by Age researchhas at below: Age Frequency (f) Percentage (%) The Research on the technique of 35-45 20 57.1 equalization instrument using a detailed 46-59 13 37.1 questionnaire. Research on the instrument of barotrauma 60-69 2 5.7 using observations containing about Total 35 100.0 berotrauma examination of ear, sinus According to the table 2 in a traditional barotrauma, and pulmonary barotrauma divers get by age mostly aged 35-45 years

--- 536 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 with a number of 20 persons (57.1%), (f) (%) almost half of 46-59-year-old with the number of 13 people (37.1%), and a small <10 meters 25 71.4 proportion aged 60 -69 years with the 10-30 meters 10 28.6 number 2 (5.7%). > 30 meters 0 0 Table 3. Characteristics of Respondents Total 100 100 by Education Based on table 6 obtained by traditional Percentage divers diving depth <10 meters largely Education Frequency (f) (%) amounted to 25 (71.4%), almost half of the traditional diver diving to a depth of 10-30 SD 1 2.9 meters a number of 10 people (28.6%) and SMP 28 80.0 none diver dives with a depth> 30 meters. High School 6 17.1 table 7 Characteristics of Respondents Total 35 100.0 Based on Frequency Diving frequency Percentage Based on Table 3 obtained by traditional Frequency (f) Diving (%) divers divers terkhir traditional education is almost entirely a junior secondary Rarely 1 2.9 education amounted to 28 (80%), high Sometimes 4 11.4 school educated fraction amounts to 6 Often 4 11.4 people (17.1%) and a small elementary Very often 26 74.3 school education numbered 1 (2.9%) , Total 35 100 table 4 Characteristics of Respondents Table 7 shows that the most traditional Based on Religion divers with diving fekuensi 24-30 times a Percentage week some 26 people (74.3%), the fraction Religion Frequency (f) (%) with a traditional diver diving frequency of 23-26 times a week 4 (11.4%), traditional Islam 35 100 diver small part of the frequency dive 8-15 Total 35 100 times a week 4 (11.4%), and a small part Based on Table 5.3, obtained by traditional of the frequency of 1-7 times a week a divers Moslem religion altogether totaling number of 1 (2.9%). 35 people (100%) 2. Custom table table 5 Characteristics of Respondents table 1 Diving equalization technique Based on the Old Diving Frequency Percentage doing equalization Years of Frequency Percentage (f) (%) service (f) (%) No 18 51.4 3-5 years 1 2.9 Toynbee maneuver 17 48.6 Frenzel maneuver 0 0 6-10 years 6 17.1 Lowry Technique 0 0 > 10 years 28 80.0 Edmonds Technique 0 0 Total 35 100.0 Valsavah maneuver 0 0 Based on Table 5 obtained by the old Total 35 100.0 traditional diver diving> 10 years of Table 1 shows the most traditional diver almost totaled 28 people (80%), 6-10 years who does not perform equalization were old dive fraction amounts to 6 people 18 people (51.4%), nearly half did (17.1%), 3-5 years old dive fraction totaled equalization while diving using 1 people (2.9%). equalization techniques Toynbee table 6 Characteristics of Respondents maneuver amounted to 17 (42.9%), none Based on Depth Diving of the divers who use the technique maneuver franzel , Lowry technique, Diving depth Frequency Percentage

--- 537 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 edmonds technique, and valsavah correlation between the two variables maneuver. bersekala ordinal. Spearman rho test table 2 the incidence of barotrauma results obtained p value <α or 0,029 <0,05 barotrauma so that Ho refused and H1 accepted, then Frequency Percentage there is a correlation between the incidence (f) (%) of barotrauma equalization techniques in Yes traditional divers dikelurahan Kedung Ear 24 68.5 Cowek Surabaya. barotrauma Nose 1 2.9 DISCUSSION barotrauma 1. Equalization Technique On pulmonary 0 0 Traditional Divers Village Kedung barotrauma Cowek In Surabaya Dental 0 0 Tabel 1 the results showed the use of barotrauma equalization techniques in traditional No 10 28.6 divers dikelurahan kedung Cowek Total 35 100 Surabaya most of which did equalization Based on Table 2 shows mostly traditional were 18 people (51.4%), Surabaya and divers experience barotrauma total 25 medicine Faculty of Medicine, University persons (71.4%), with ear barotrauma of Hang Tuah Surabaya. This is because number of 24 people (68.5%), barotrauma the majority of low-educated traditional nose number 1 (2.9%), traditional divers divers proved by the data of divers who do almost half are not experience barotrauma not perform equalization technique with a of 10 people (28.6%). secondary school education 16 (88.9%). table 3 Correlation Between equalization According Rahayu (2015) education is a technique Genesis Against Ear barotrauma determining factor for every person in the On Traditional Diver act. The higher one's education, the better equalizati Barotrauma is also the person to keep his life in this Total on Yes No case health. According to investigators technique traditional divers with low education affect f % f % F % s a person's behavior in a positive action. Yes 8 32 9 90 17 100 Behavior like this makes traditional diver (Toynbee) equalization technique does not assume a No 17 68 1 10 18 100 negative impact on health. Total 25 100 10 100 35 100 Old diving also influence individuals Spearman rho = 0.029 α = 0.05 to perform the appropriate procedures such Based on Table 3 shows the majority of as equalization techniques that should be traditional diver who does not perform done when diving. The majority of equalization technique and experience traditional diver who does not perform barotrauma amounted to 17 (68%), a equalization technique is an old diver fraction of traditional diver who did not diving has more than 10 years. This is experience barotrauma equalization and evidenced by the data obtained by number 1 (10%). Traditional divers who researchers of 18 people (68%) of do not experience barotrauma equalization traditional diver who does not perform and almost seluruhanya totaled 9 (90%) equalization technique, almost entirely and traditional divers who perform traditional diver who does not perform equalization Toynbee but suffered equalization with the long dive> 10 years barotrauma almost halved number of 8 amounted to 14 (77.8%). This is because (32%). Based on statistical Spearman rho the traditional with old diver diving> 10 test that measures the level or the close years more experience and consider the

--- 538 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 procedure dives is not too important. This individual to a stimulus, the other person is is evidenced by the theory of adaptation of the reference to commit an act of a Lawrence Green is a change in behavior, person's mindset and attitude towards a according to Lowrence Green behavior is particular stimulus. According to influenced three factors, predisposing investigators, Toynbee equalization factors which include knowledge and technique is mostly done by traditional attitudes, traditions and beliefs, levels of divers for divers according to this education and the economy to health, the technique is easily performed in water. factors enabling covers the availability of Mechanical Toynbee maneuver can be facilities and infrastructure or medical performed by pinching the nose, facilities needed in the implementation of swallowing hard. health behaviors, reinforcing factors include attitudes and behavior of families, 2. The incidence of barotrauma On health workers, community and religious Traditional Divers Village Kedung (Nursalam, 2013). According to Cowek In Surabaya investigators with the old traditional diver Tabel 2 research results obtained diving> 10 years are familiar with the mostly traditional divers experience circumstances and already does not care barotrauma total 25 persons (71.4%) most about the procedures to be followed when experienced ear barotrauma number of 24 diving. Traditional diver already people (68.5%). This is because when accustomed to not doing equalization diving ears get bigger pressure than the while diving and was not bothered by his other body cavity. Divers will more often health while new divers should be able to experience recurrent ear pressure on the adapt to the environment by way of eardrum. Traditional diver who suffered equalization techniques to equalize the barotrauma nose number 1 (2.9%), this is pressure from the outside and adjust the due to the relatively negative pressure due pressure of the body so it does not happen to contraction of the air in the nose that a disease dives. Diving frequency can also can occur bleeding at the nose. This is affect a person does not perform because most traditional divers ages 35-45 equalization techniques proven by the data years old with the number of 14 people of traditional divers who dive 24-30 times (56%) experienced barotrauma. Age is one / week the majority of some 15 people of the individual characteristics that will (83.3%) did not perform equalization influence the frequency of occurrence of techniques. Traditional divers dive with a disease because of the influence of the frequency very often already familiar with body's resistance to exposure, so the age do not perform equalization technique, can affect the durability of a traditional because at the time of the dive do not feel diver on the incidence of some diseases a disturbance in the body when you do not such as barotrauma. Increasing the perform equalization techniques. person's age will decrease the body's Traditional diver nearly half did resistance to disease. According to equalization techniques Toynbee research Ekawati (2010), age> 40 years maneuver a number of 17 (42.9%). more experience barotrauma barotrauma According notoatmojo (2012) health especially ear and tympanic membrane behavior is a person's response to the perforation compared with age <40 years. stimulus or object-related illness and Ekawati research consistent with research disease as well as the environment. from sowendro (2006) who said the cause Behavioral health for disease prevention, of a person experiencing barotrauma due cure when sick, Working and health to the tympanic membrane thickening and recovery. Changes in behavior can be seen stiffness that can lead to progressive from the thoughts and feelings of every hearing loss that is usually influenced by

--- 539 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 the age of over 45 years. According to the data of traditional divers with diving investigators the age factor can affect a dikedalaman <10 meters mostly person affected by barotrauma. experienced barotrauma evidenced by the Childbearing age can experience data of 18 people (72%). According Darjo barotrauma more than older adults age in Indriati (2010) deeper dive respondents, because they aged <40 years has not yet will get greater pressure, it means the adapted to the environment and other greater the effect on the health of divers. factors such as long dive also affect divers The human body gets the water pressure at experience barotrauma. The majority of depth will adjust to this pressure. When the traditional with old diver diving> 10 the body can not adjust to these pressures, meters almost most experienced it can happen squeese / trauma. Squeese / barotrauma proved by the data of 35 trauma generally can occur in 10-meter people, the traditional with old diver dives and decompression dives can occur diving> 10 years were mostly experienced at 12.5 meters. According to investigators barotrauma of 20 people (71.4%). traditional divers who dived <10 meters is Traditional experienced divers due to long not at risk of barotrauma, because diving barotrauma due to diving too long traditional divers dive is not too deep. done for many years and each day will Frequency can also affect one's diving give negative impact to our health, experience barotrauma evidenced by the especially the ability of auditory function. data of traditional diver who dives According to the study of revelation frequency of 24-30 times / week largely (2012) proved that length of term of office mengalamii barotrauma 18 men (72%). associated with risk of middle ear According to Fatmawati (2015) a diver barotrauma. The longer the term of office, who often divers will more often then the risk of barotrauma is increasing, traumatized repeated pressure on the due to repeated exposure to changes in the eardrum. This will result in the balance pressure of increasingly frequent and organ in the inner ear tissue swelling and Eustachian tube will often have exposure blockage of the Eustachian tube to to changes in atmospheric pressure which perforate the tympanic membrane can even can affect its function. The length of a cause bleeding and torn eardrum. person's work as a diver to be one cause of According to researchers respondents with barotrauma in this case at the hearing, frequency dive very often have a long because the longer a person is exposed to a working period and not carry out the pressure difference, the risk for the procedure dive right that many traditional occurrence of barotrauma greater. diver who suffered barotrauma especially According to investigators the longer a ear barotrauma. Another thing that can person diving, the greater a person's risk of affect is the physical condition at the time barotrauma occurs. The incidence of of the dive. From the interview at the time barotrauma is associated with a person's of the study obtained information that ability to adapt to exposure causes changes sometimes divers are forced to do the in pressure. Traditional divers were unable dives even though they feel unwell usually to equalize the pressure in the water will fixed divers to dive at the time of the flu. potentially experience barotrauma, repeated exposure to the pressures of 3. Correlation Between equalization increasingly frequent causes the body will technique Against Genesis often have exposure to changes in pressure barotrauma On Traditional Divers that may affect its function, especially in Village Kedung Cowek In Surabaya eustahius tube function. Not only long The results of the study Table 3 is dive, dive depth is also one factor affected obtained between engineering equalization by barotrauma divers. This is evidenced by on the incidence of barotrauma is of 18

--- 540 --- Proceeding of Surabaya International Health Conference July 13-14, 2017 people (78%) divers traditional, which Diver traditional techniques does not perform equalization and equalization and did not experience experience barotrauma number of 17 barotrauma number 9 (90%), this is people (68%), while divers who do not because at the time diving outside pressure perform equalization and did not will press so that the body's response will experience barotrauma number 1 (10%). equalize the pressure by means of Traditional diver who does not perform equalization, so that the pressure between equalization, because there are still many the outside and inside of the body will traditional diver who do not know a good equal and there is no barotrauma. dive procedures, there is also a traditional According Ekawati (2010) traditional diver who already know the procedures to divers who perform procedures in be followed when diving but do not accordance with the given has a small risk comply with the recommended procedure of barotrauma or illnesses likely to occur dives. According to the law boyle (1662) more dives. The dives procedure should be in yupitri (2012) which states that the done by performing equalization volume of gas is inversely proportional to techniques such as Toynbee or valsavah pressure. A decrease or increase in because this technique is often used when environmental pressures will increase or performing equalization divers. Divers on depress a volume of air in a confined the way up to the surface should be slowly space. At the time down from an altitude, and not rush on the way up because it can atmospheric pressure will rise and the gas cause barotrauma. According to pressure in the middle ear will fall. The air researchers obedience person in will not enter the middle ear performing a procedure dives will also spontaneously, auditory tube must be affect the health. Traditional divers who opened with a yawn movement or other perform the appropriate procedures, will maneuver that often goes unnoticed, which minimize the occurrence of diseases such occur every minute, or more frequently. as barotrauma diving. Prevention of According to investigators traditional diver traditional diver dives to avoid diseases who dives will put air cavity filled with a such as barotrauma, the diver must be able gas such as the ears and lungs can occur to perform equalization techniques before barotrauma. Barotrauma most often the dive. Many traditional diver who can affected by novice divers because of not perform equalization techniques Toynbee knowing how to perform equalization surface before diving by pinching the nose during the dive and dive lack of control and then swallowed performed theory and new environmental factors also simultaneously. Equalization procedure is affect novice divers experience very important for all divers, especially barotrauma. Brotrauma the process begins traditional and divers should be trained when divers started diving makes the outer regularly in order to carry out the ear canal causing water to get into the procedure properly. open air replaces. The ear canal may be hampered by earwax or earmuffs will CONCLUSION cause disturbed balance ear pressure and The use of equalization techniques have a bleeding in the ear. Complaints are usually significant correlation to the incidence of emerge that sense of fullness in the ear, ear barotrauma on traditional divers in the pain to occur vertigo if the diver is Village Kedung Cowek Surabaya exposed ear barotrauma. The situation can be resolved by Toynbee equalization technique which is easily done by divers tradisisonal on during a dive. REFERENCES

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