Slide Otitis Media Supuratif Kronik
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OTITIS MEDIA SUPURATIF OTITIS MEDIA SUPURATIF OTITIS MEDIA SUPURATIF OTITIS MEDIA SUPURATIF KRONIKKRONIKKRONIKKRONIK
dr. Harry A. Asroel, Sp.THT-KL
Divisi Otologi
FK USU / RSUP. H. Adam Malik Medan
OTITIS MEDIA OTITIS MEDIA OTITIS MEDIA OTITIS MEDIA
SUPURATIF SUPURATIF SUPURATIF SUPURATIF
KRONIKKRONIKKRONIKKRONIK
Penyakit ini merupakan penyebab utama dari penyakittelinga tengah
Sudah dikenal sejak lama (dahulu kala, zaman pra sejarah)
Insiden bergantung pada ras & keadaan sosio ekonomi
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INSIDEN
Eskimo, Indian Amerika
Aborigin
Kulit hitam Afrika Selatan
Di negara sedang berkembang di mana higiene, makanan, perumahan jelek
PREVALENSI
� Kebanyakan laporan insidens OMSK dari data klinik.
� Ini cendrung data dari rujukan ke klinik dibandingkandengan prevalensi dalam populasi umumnya.
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ETIOPATOLOGI
1. Lingkungan (Environmental)
2. Otitis media sebelumnya (Previous otitis media)
4. Infeksi saluran nafas atas (Upper respiratory tract infections)
5. Alergic (Allergy)
3. Malfungsi tuba Eustachius (Eustachian tube malfunction)
JENIS OMSK
1. OMSK mukosa inaktif
2. OMSK mukosa aktif
3. OMSK epitel skuamos aktif, kolesteatom
4. OMSK epitel skuamos inaktif, kantong retraksi (retraction pocket)
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Jenis – jenis perforasi membran timpani
1. OMSK mukosa inaktif
� Defek permanen dari pars tensa, tapi tidak adatanda–tanda peradangan dari mukosa kavum timpaniatau membrana timpani
� Rantai osikular mungkin erosi atau terinfeksi
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2. OMSK mukosa aktif
� Defek membrana timpani–mukosa kavum timpani.Inflamasi dan edema dengan produksi mukus ataumukopus yang berlebihan, keadaan ini dapat intermiten(hilang timbul) atau terus menerus
� Pada beberapa telinga dapat timbul jaringan granulasiatau polip
3. OMSK epitel skuamous aktif : Kolesteatom
� Di sini OMSK mukosa aktif, di mana kantong epitelskuamous penuh dengan epitel skuamous dan debrisinflammatory
� Keadaan ini sering terjadi di pars flaksida, tapi dapat jugapars tensa
� Kata “ didapat “ –> “ acquired cholesteatoma “ kadangkala digunakan untuk membedakannya dengankolesteatoma kongenital
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4. OMSK epitel skuamous inaktif : retraction pocket
� Berbagai derajat dari retraksi pars flaksida harusdipertimbangkan, normal–tapi apabila sebagian dariretraksi tidak tampak oleh otologist, ini diperkirakanabnormal karena potensial untuk tertahannya debris epitelskuamous, yang mungkin menyebabkan penyakit epitelskuamous aktif yaitu kolesteatoma.
� Derajat retraksi pars flaksida digambarkan oleh Tos,Stangerup dan Larsen (1987).
� Retraksi pars tensa dapat juga terjadi dan jika ada bagianyang tidak tampak, ini dapat menyebabkan penyakit aktifyaitu kolesteatoma.
Classification of attic retraction pocket (Tos, 1988) Grade 1 : Pars flaccida not in contact with malleus neck. Grade 2 : Pars flaccida in contact with malleus neck.
Grade 3 : Limited outer attic wall erosion. Grade 4 : Severe outer attic wall erosion.
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Staging of attic retraction (Tos, Stangerup and Larsen, 1987)
KLASIFIKASI
OMSK dibagi atas 2 :
I. Tipe Tubotimpani
II. Tipe Atiko antral
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I. Tubo timpanal
� Karakteristik perforasi pada parstensa.
� Penyakit tipe ini biasanya tidak berisiko komplikasiseperti sepsis intrakranial.
II. Atiko antral
� Tipe ini mengenai pars plasida dan karakteristikdengan pembentukan “ retraction pocket “, di manaterkumpul keratin untuk membentuk kolesteatoma.
� Kolesteatoma dibagi atas :
1. Kongenital (Congenital)
2. Didapat (Acquired)
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� Derlaki dan Clemis (1965) mengajukan 3 kriteria untukkolesteatoma kongenital:
1. Berkembang di belakang membrana timpani intak.
2. Tidak ada sejarah Otitis media.
3. Berasal dari epitel skuamous embrional.
� Kolesteatoma kongenital didapati dalam tulang temporalterutama di apeks petrous dan di telinga tengah.
DIAGNOSA
1. Anamnesa
2. Otoskopi
3. Ro foto
Foto Mastoid : Schuller
CT Scan temporal bone
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Foto mastoid posisi Schuller
PENATALAKSANAAN
A. Prinsip dasar management medik dari OMSK (medikamen)
1. Tetap menjaga telinga bersih (aural toilet)
2. Tetes telinga antibiotika golongan fluoroquinolon
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Terapi operatif berdasarkan keuntungan:
1. Mencegah telinga berair yang berulang
2. Memperbaiki pendengaran
3. Dapat berenang tanpa takut akan telinga berairlagi
B. Terapi operatif (surgical management)
KOMPLIKASI
I. Intrakranial
1. Abses ekstradural
2. Abses subdural (empiema)
3. Tromboflebitis sinus sigmoid/sinus lateral
4. Meningitis
5. Abses otak
6. Hidrosefalus otitis
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II. Intra temporal
1. Paralisis fasial.
2. Labirintitis.
Foto mastoid posisi Schuller menggambarkan erosi tulang di prosessus mastoideus
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Diagram of middle fossa extradural abscesses showing enlargement of the abscess and erosion through the vault of the skull to produce
a subperiosteal abscess
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Diagram of the relations of the petrous apex to show proximity of an apical extradural abscess to the Vth and Vith cranial nerves
Subdural abscess ( From Ludman, 1988, Mawson’s Diseases of the Ear, 5th ed, London : Edward Arnold)
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CT scan showing subdural abscess in middle fossa
Progression of venous sinus thrombophlebitis. (From Ludman, 1988, Mawson’s Disease of the Ear, 5th ed, London : Edward
Arnold)
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Pathogenesis of complication;methods of spread across the meninges:1, an
extradural abscess has broken through the dura, resulting in a subdural abscess or
spread into the subarachnoid space and diffuse meningitis;2, the subarachnoid
space has been obliterated through inflammatory reaction, resulting in direct
invasion of the brain as the dura breaks down; this results in the “ brain abscess
with a stalk.” 3, the infected thrombus in the lateral sinus has extended along a
communicating vessel, resulting I a cerebellar abscess.
Pathogenesis of complicatons : methods of spreads to the meningen : 1, a cholesteatoma has caused erosion of the mastoid with the matrix lying against
the dura; infection has resulted in an extradural abscess;2, osteitis of the mastoid has caused thrombophlebitis of the haversian system with resultant
perisinus abscess; a mural thrombus is forming in the lateral sinus adjacent to the abscess;3, osteitis has involved a mastoid emissary vein; the infected
thrombus is propagating into the lumen of the lateral sinus.
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PENYEMBUHAN OTITIS MEDIA
� Pars tensa & pars flaksida intak, tapi bentuk abnormal.
� Dapat dilihat adanya sikatriks, penebalan, bercakpengapuran atau penyembuhan perforasi.
TERIMA KASIH