Case reflection Otitis Externa Diffuse
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7/30/2019 Case reflection Otitis Externa Diffuse
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Otitis Media Diffuse (OED)
Ivan Wudexi
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Identitas Pasien
• Nama: AM
• Umur: 35 tahum
•
Jenis Kelamin: Laki-laki• Alamat: Secang, Ngombol, Purworejo
• Pekerjaan: Pegawai Swasta
• Tanggal Masuk: 17 Juli 2013• No. RM: 242376
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Keluhan Utama
Sakit di telinga kiri
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Riwayat Penyakit Sekarang (RPS)
• Keluhan sakit di telinga kiri telah dirasakan oleh pasiensejak 4 hari yang lalu. Sebelum telinga kiri terasa sakitpasien pertama merasakan gatal di telinga kiri dan olehbeliau sempat dikorek-korek dengan menggunakan
cotton bud.
• selain ada sakit di telinga kiri, beliau juga merasakanadanya penurunan pendengaran dan pengeluarancairan kental dalam jumlah sedikit dari telinga kiri.Bapak AM menyangkal adanya keluhan dari pasienmeliputi asam mefenamat dan antibiotik yang didapatdari Puskesmas.
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Riwayat Penyakit Dahulu (RPD)
• Tidak pernah menderita penyakit seperti ini
sebelumnya
• Tidak ada riwayat allergy
• Tidak menderita diabetes
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Pemeriksaan THT
•Telinga
Dextra Sinistra
Pinna Ukuran dan bentuk dbn,
massa(-), hiperemis(-)
Ukuran dan bentuk dbn ,
massa(-), hiperemis(-)
Tragus and/orpinna pain
(-) (+)
Canalis
auditorius
externus
massa(-), hyperemis (-),
bengkak(-)
Bengkak(+), hyperemis (+),
discharge(+)
Membran
timpani
Dalam batas normal,
cone of light positive(+),
hyperemis (-)
Tidak dapat dinilai
Mastoid Normal, nyeri (-) Normal, nyeri(-)
Lymp. node Tidak ada perbersaran
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Pemeriksaan THT•
HidungNose –
Paranasal
Sinus
Kanan Kiri
Inspeksi hidung Normal Normal
Palpasi hidung
dan sinusNormal, nyeri(-) Normal, nyeri (-)
Anterior
Rhinoscopy
Discharge(-), concha terlihat
normal, septum tidak
terdeviasi, massa(-)
Discharge(-), concha terlihatnormal, septum tidak
terdeviasi, massa(-)
Posterior
Rhinoscopy
Tidak dilakukan
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Pemeriksaan THT
Mulut dan tenggorokanLips Normal
Tooth – Ginggiva Normal
Tongue Normal
Palate Normal
Uvula Normal
Tonsil Normal
Posterior Oropharynx Normal
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Diagnosis
Otitis Externa diffuse Auris sinistra
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Treatment
• Tampon sofra-tulle
• Asam mefenamat 250 mg 4 kali sehari (dipakai
bila nyeri)
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education & follow up
Edukasi:
• Telinga dihindari dari paparan air
•
Bila mandi telinga ditutup dengan kapas babyoil
• Jangan mengorek-gorek telinga dengan cotton
bud
Follow up: kontrol 2 hari lagi/ hari ke-3
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Pembahasan
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Acute otitis externa
Definition
• Acute otitis externa (AOE) is a form of cellulitisthat involves the skin and subdermis of the
external auditory canal, with acuteinflammation and variable edema.
• Otitis Externa diffuse involves the skin of the
external auditory canal , concha and possiblythe tympanic membrane
• Commonly caused by bacteria
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Pathogenesis
Defense mechanism of ear canal
• Tragus and conchal cartilage partially cover the
opening of the ear canal and help to prevent
foreign body entrance
• Hair follicles and the isthmus narrowing inhibit
entry of contaminants into the ear canal
• Cerumen helps create aciding ear canalenviroment, which inhibits bacterial and fungal
growth
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Pathogenesis (cont’)
• First step in the pathogenesis of external otitis isbreakdown of the skin-cerumen barrier.
• Subsequent insult Inflammation and edema of the skin
pruritus and obstruction scratching further injury
• This sequence of events alters the quality and amount of cerumen produced, impairs epithelial migration andincreases the pH of the ear canal
• The resulting dark, warm, alkaline, moist ear canal becomesan ideal breeding ground for numerous organism
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Otitis externa – classification
Classification based on severity
• Mild characterized by minor discomfortand pruritus, minimal canal edema
• Moderate intermediated degree of painand pruritus, the canal is partially occluded
• Severe intense pain, canal is completely
occluded from edema. There is usuallyperiauricular erythema, lymphadenopathyand fever
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Mild Otitis Externa
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Risk factors
• Local Trauma (excessive cleaning)
• External auditory canal obstruction(eg. Cerumen)
• Allergy (eg. Neomycin otic drops)
• High humidity, warmer enviromental temperatures
• Swimming
• Skin disease (allergic dermatitis, atopic dermatitis, psoriasis)
• Diabetes
• Immunocompromised
• Prolonged use of topical antibacterial agents
•
Device that occlude the ear (hearing aids, earphones)• Prior radiation therapy
• Chemical irritants
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Clinical Features
• Ear pain
• Tragal tenderness
• Ear canal swelling and erythema
•
Otorrhea• Aural fullness
• Itching
• Decreased hearing
• Erythematous tympanic membrane
• Granulation tissue in the ear canal (malignantotitis externa)
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Test
• Pneumatic otoscopy
• Tympanometry
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Diagnosis
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Treatment
Five fundamental steps
1. Thoroughly clean the ear canal
2. Treat inflammation and infection3. Control pain
4. Avoiding promoting factors
5. Follow-up and culture of recalcitrant cases
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Treatment
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Education and follow up
• Education on how to use ear drops to ensureadequate tx.
• Avoid exposing the affected ear to water duringthe acute phase of tx
• Avoid the use of cotton-tipped applicators orother foreign objects.
• Blood sugar control for diabetic patients shouldbe stressed
• Underlying dermatitis or other skin disordersshould be attented and treated whenever needed
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Prognosis
• Patient with uncomplicated diffuse otitis
externa usually respond to tx.
• Between 65%-90% of patients have clinical
resolution within 7 to 10 days
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Complication
periauricular cellulitis and malignant external
otitis
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Maturnuwun
Mohon asupan
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