Refkas 1 Cerumen Prop
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Transcript of Refkas 1 Cerumen Prop
Refleksi Kasus
Ria Mediana09/289473/KU/13473
Group 13308
The external ear canal is a tube like structure,
at the bottom of which is the tympanic membrane.
The ear canal is blind-ended so nothing can pass through to keep it clean. It must stay open to allow sound to pass freely through tympanic membrane.
Introduction
Review anatomy
The earwax is deposited along the canal by
tiny structures called ceruminous glands. Cerumen forms when glandular secretions from the outer one-third of the ear canal mix with exfoliated squamous epithelium.
Each ear canal contains between 1000 to 2000 ceruminous glands. These glands are similar to the apocrine sweat glands (underarm)
Cerumen is composed of secretions and
sloughed epithelial cells and hair from the external auditory canal.
It protects the skin in the canal and is naturally extruded.
However, cerumen may accumulate and occlude the canal of one or both ears, causing discomfort, hearing loss, tinnitus, dizziness, and chronic cough.
Introduction
Normally, cerumen is eliminated or expelled
by a self-cleaning mechanism, which causes it to migrate out of the ear canal, assisted by jaw movement
The old cerumen is moved through the ear canal by motions from chewing and other jaw movements and as the skin of the ear canal grows from the inside out
Ceruminous glands work in concert with
sabaceous glands to produce small peptides, and waxy/oily substances such as fatty acids, sebum, squalene, and cholesterol.
The ear canal is not easily cleaned from the
outside, so it depends on the system of epithelial migration to clear the sloughed skin layers. The skin cells that are sloughed off (a process called skin desquamation) can accumulate in the cerumen that is deposited on the surface.
If it didn’t clean itself out, the outer layers of skin constantly peeling off accumulate block! symptoms appear
So the components of earwax are shed layers
of skin, with 60% of the earwax consisting of keratin, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene and 6–9% cholesterol
Components of earwax
Accumulation of cerumen that causes
symptoms, prevent a needed assessment of the ear canal/tympanic membrane or audiovestibular system, or both
Cerumen Impaction
Older age Abnormally narrow or misshaped ear canal
earwax has more difficulty being expelled Hairy ear canal Hearing air wearers Use of cotton-tip applicators (Q-tips) earwax
actually pushed deeper blockage! Psoriasis or seborrhea in the ear canal History of previous earwax impactions
Risks
Impaired hearing Feeling fullness in the ears Itching and/or ringing in the ears (tinitus) Ear pain (otalgia) Cough
Sign and symptoms
Direct visualization with an otoscope
Diagnosis
Nama : RK Umur : 5 tahun Alamat : Jalan Teratai 4/89
Condongcatur Pekerjaan : - No RM : 017196xx Tanggal masuk : 25 Februari 2015
Case Report
ANAMNESIS
KU : telinga sakit curiga kotoran RPS : Ortu os mengatakan os sering mengatakan
telinganya sakit dan gatal sudah lama. Ortu os curiga ada sesuatu yang masuk di kuping karena os sering memukul-mukul telinganya seakan-akan ingin mengeluarkan sesuatu. Penggunaan cotton bud untuk membersihkan telinga (+) namun tidak sering. Kemasukan air (-), keluar cairan dari telinga (-). Pendengaran berkurang (-). Keluhan lain pada hidung seperti pilek (-), pada tenggorokan seperti batuk (-)
RPD
Keluhan serupa (-) Alergi (-) Trauma (-)
RPK Tidak ada keluhan
PEMERIKSAAN FISIK
KU : baik, CM Vital sign
TD : 86/55 mmHg N : 109 x/min RR : 20 x/min Suhu : afebris
Ear examination
Right Left
AuriculaBentuk dan ukutran dalam batas normal, massa (-), hyperemic (-),
Lubang di dekat tragusLymph node no enlargement
Canalis auditorius externa discharge (-) discharge (-)
hyperemis (-) hypermis (-)
edema (-) edema (-)
Cerumen block (+) Cerumen block (+)
Tympanic membrane Tidak terlihat Tidal terlihat
Tragus and pinna pain (-) (-)
Tunning fork test Tidak dilakukan
Nose examination
Nose and Paranasal sinuses
Right Left
InspectionSimetris (+), deformitas (-), discharge (-), edem (-), hyperemic (-)
Palpation Tenderness (-), crepitation (-) Tenderness (-), crepitation (-)
Percussion Paranasal sinuses pain (-) Paranasal sinuses pain (-)
Anterior Rhinoscopy = tidak dilakukan Posterior Rhinoscopy = tidak dilakukan
Mouth and throat examination
Findings
Lips Warna dalam batas normal; tidak ada luka
Buccal mucous hiperemic(-); stomatitis (-); massa(-)
Tongue hiperemic(-); massa (-); deformity (-)
Palatum hiperemic(-); mass (-); deformity (-)
Gum edema (-); hiperemic (-); deformity (-)
Tooth carries (-); deformity(-)
Uvula deviation (-); edema (-); hiperemis (-)
Tonsilla T1 – T1 ; hiperemic (-); detritus (-); crypt enlargement (-)
Pharynx Hiperemic (-)
Indirect laryngiscopy = Tidak dilakukan
DIAGNOSIS
Berdasarkan anamnesis dan pemeriksaan fisik, diagnosis pasien Cerumen Prop Auris Dextra Sinistra
TERAPI
Irrigasi
EDUKASI Telinga tidak boleh terkena air Jaga kebersihan telinga, kurangi penggunaan
cotton bud
Discussion
Manual removal using currete, forceps, or
suction Irrigation of the external auditory canal with or
without using ceruminolytics Ceruminolytics
Treatment
Manual removal involves the use of a metal or
plastic loop or spoon. It generally is considered effective, but there are no trials comparing it with other methods for effectiveness or safety
Advantages of manual removal: It does not exposed the ear canal to moisture
and therefore may lessen the risk of infection. Quicker and allow direct visualization of the
procedure via a hand-held monocular otoscope
Manual removal
It involves washing out the ear canal with
water from irrigator or syringe with catheter attached.
The water must be close to body temperature (too cold or too warm can induce dizziness or nauseated)
After the irrigation, the ear canal should be dried out to prevent from infection
Irrigation
Irrigation should not be used if the patient’s
eardrum is ruptured; history of chronic otitis media; myringotomy
3 types of cerumen-softening prearations
Water-based Oil-based Non-water-based/non-oil-based
Ceruminolytics before irrigation may improve irrigation success by as much as 97 percent
Ceruminolytics
In most cases, impacted cerumen is
succesfully removed.
Prognosis
Cotton ear buds are not definitively associated
with cerumen impaction, but they have been implicated in impaction and otitis externa and should be avoided
Ear candling also should be avoided. It actually lead to occlusion with candle wax in persons who previously had clean ear canals.
Complications from ear candling including candle wax occlusion, local burns, and tympanic membrane perforation.
Warning!
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