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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