pemicu 3kelompok b4 oma

7/29/2019 Pemicu 3kelompok b4 Oma

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Pemicu: Otitis Media Akut


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Seorang ibu datang melawat anak perempuanya,yang berusia 5 tahun, ke praktek dokter umum

dengan keluhan telinga kanan berair sejak 1 hari

yang lalu, carian berwarna putih kekuningan.

Sebelumnya pasien mengeluh sakit pada telingakanan sejak 4 hari lalu disertai demam dan

berkurang setelah pasien minum obatparasetamol.

Riwayat pilek sejak 1 minggu yang lalu. Ibu pasienmengeluh anak sering tidak mendengar kalau

dipanggil.


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Status LokalisataPada Pemeriksaan:

Otoskopi telinga kanan: Pada liang telinga dijumpai mukoid, mebran timpani tampakperforasi sentral yang kecilOtoskopi telinga kiri: Liang telinga normal, membran timpani utuh, refleks cahaya (+)

Pada pemeriksaan rinoskopi anterior: mukosa hidung hiperemis, konka inferior danmedia eutrofi, sekret dijumpai

Pemeriksaan rinoskopi posterior dan laringoskopi indirek normal

Pemeriksaan kultur sensitifitas: Streptokokkus sp.Tes pendengaran sederhana:Telinga kanan: Rinne Test (-), Weber lateralisasi kanan, Scwabach memanjangTelinga kiri: Rinne Test (+), Scwabach sama dengan pemeriksaPlay audiometri:Telinga kanan: Tuli konduktif rinagn 30 dBTelinga kiri: Normal

Apakah kesimpulan anda mengenai penyakit pasien ini sekarang?


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1. Anatomi telinga2. Histologi telinga3. Fisiologi pendengaran4. Otitis Media Akut

Definisi, Faktor Resiko, Klasifikasi Etiologi dan Patogenesis Gejala Klinis dan Patofisiologi Diagnosa

Diagnosa Banding Penatalaksanaan Farmakolgis dan Non-

farmakologis Komplikasi, Prognosis dan Inidikasi Rujuk.


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1. External Ear2. Middle Ear

3. Inner Ear


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Pinna (Auricle) Irregularly shaped plate o/t elastic cartilage covered by

thin skin Meatus acusticus externa

The canal that extends f/t pinna into the temporal boneto the external surface o/t tympanic membrane

Superficial portion is composed of elastic cartilage,which is continuous with the cartilage o/t pinna.Temporal bone replaces the cartilage as support in theinner 2/3 o/t canal

Is covered with skin containing hair follicles, sebaceousglands, ceruminous glands (modified sweat glands)


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Tympanic membrane Tympanic cavity

Auditory ossicles malleus (hammer) incus (anvil) stapes (stirrup)

Auditory (Eustachian) tube

Muscle Tensor tympani muscle

Stapedius muscle


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Tympanicmembrane

External surface

is covered byepidermis;

Collagen andelastic fibers,

fibroblastsinterposed btw 2epithelial layersInternal surface

is covered bysimple squamous

to cuboidalepithelium


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Is an air filled space located i/t petrous portion o/ttemporal bone

Posterior: mastoid air cell Anterior: auditory (eustachian) tube Medial wall: oval window and round window Lateral wall: tympanic membrane Bony ossicles spans the distance btw tympanic

membrane and the membrane o/t oval window. Is lined mostly by simple squamous epithelium, and

pseudostratified ciliated columnar ep (near auditory tube) Lamina propria

Bony wall: Adheres to bony wall and has no glands Overlaying cartilage portions: has many mucous glands whose

ducts open into tympanic cavity

Muscles M tensor tympani: movement o/t tympanic membrane

M stapedius: movement o/t bony ossicles


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Malleus Is attached to tympanic membrane

Incus Interposed btw malleus and stapes

Stapes Is attached to the oval window

Are articulated in series by synovial joints linedwith simple squamous ep.


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The bony labyrinth consists of:

The vestibule: the central space of the bony labyrinth,containing the utricle and saccule of the membranouslabyrinth

The semicircular canals extending from the vestibuleposteriorly

The cochlea, extending from the vestibule anteriorlyThe semicircular canals lie at about right angles toeach other in superior, posterior and horizontalplanes, and each has an expanded ampulla at theirlateral end.The cochlea is a conically shaped helix that spiralsabout 2.5 turns around a bony core calledthe modiolus, which contains the spiral ganglion ofthe vestibulocochlear nerve (CN VIII).


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The membranous labyrinth, suspended withinthe perilymph of the bony labyrinth, consists of:

The membranous semicircular ducts, within thesemicircular canals The utricle and saccule, contained in the

vestibule, and connected by the utriculosaccularduct The membranous cochlear duct, within the bony

cochlea, continuous with the saccule.The semicircular ducts, utricle and saccule and

part of the vestibular system, concernedwith balance and posture, whilst the cochlear ductis part of the auditory system, concernedwith hearing.


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There are 6 special sensory regions in the inner

ear:3 cristae ampullaris, in the ampullae of thesemicircular ducts, which are sensitive to angularacceleration (turning) of the head

2 maculae of the vestibule: one in the utricle(macula utriculi) and the other in the saccule(macula sacculi), both of whichsense gravity,position and linear movement

The organ of Corti, within the cochlear duct,that transduces sound vibrations into nerveimpulses.


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Hair cells of the vestibulocochlear system These non-neuronal mechanoreceptors are the

common receptor cells in this system, that function

to initiate nerve impulses.All hair cellsare epithelial, possessnumerous stereocilia (sensory hairs), areassociated with both afferent and efferent nerveendings, and transduce mechanicalenergy into electrical energy.

In the vestibular system, there are 2 types of haircells:

Type I hair cells, piriform in shape with a roundedbase and thin neck, surrounded by an afferentnerve chalice and a few efferent fibres.

Type II hair cells, cylindrical in shape, with afferentand efferent bouton nerve endings the synapsebasally.


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Both types of vestibular hair cell has one cilium calleda kinocilium

The hair cells of the inner ear function by

the bending of their sensory hairs: Bending ofstereocilia ---> stretch plasma

membrane ---> changed transmembranepotential ---> conveyed to afferentnerves associated with cell. In the vestibular system, the location of the

kinocilium relative to the bending stereocilia isimportant:

Bending away from kinocilium ---> hyperpolarisation of receptor cell

Bending towards kinocilium ---> depolarisation ---> action potential


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CRISTAE AMPULLARIS

Each crista is lined with the epithelium containing sensory haircells and supporting epithelial cells.The stereocilia and kinociliumof each hair cell are embedded in a gelatinous cupula that projectsinto the lumen of the ampulla, and is surrounded byendolymph.During turning movements, the endolymph tends tolag behind because of its inertia, thus swaying the cupula andbending the sensory hairs that lie within, and generating nerveimpulses.

MACULA SACCULI AND MACULA UTRICULILike the cristae ampullaris, the maculae are innervated sensorythickenings of the epithelium.The maculae are oriented at rightangles to each other, so that when a person in standing,the macula utriculi is in a horizontal plane, and the maculasacculi is in avertical plane.The stereocilia and kinocilium of eachhair cell are embedded in the gelatinous otolithic membrane, uponwhich crystalline particles called otoconia (otoliths) lie.Again, thestereocilia are bent by gravity in the stationary individual or linearmovement in the moving individual as the otolithic membranedrags on the stereocilia due to inertia.


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ORGAN of CORTIThe cochlear duct divides the cochlea into 3 scalae (compartments): The scala vestibuli, above The scala tympani below, and The scala media, which, itself, is the cochlear duct, filled with

endolymph, with the organ of Corti on its lower wall. The scala vestibuli, starting at the oval window, and the scalatympani, ending at the round window, are filled with perilymph,

and communicate with each other at the apex of the cochlea

through the helicotrema. The scala media is a triangular space with its acute angle attached

to the osseous spiral lamina that extends from the modiolus. The upper wall, separating the scala vestibuli, is

the vestibular(Reissners)membrane. The lateral wall is the stria vascularis, lined by thick, vascular,

pseudostratified epithelium that produces endolymph

The lower wall, separating the scala tympani, is the basilarmembrane.


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The organ of Corti rests of the basilar membrane, and is overlainby the tectorial membrane.

It is composed of: Inner hair cells in an single row, close to the spiral lamina; Outer hair cells in a row 3-5 cells wide, farther from the spirallamina; Phalangeal (supporting) cells for both rows of hair cells,

preventing them from touching the basilar membrane.

Inner phalangeal cells surround their hair cells completely. Outer phalangeal cells only surround the basal part of their

hair cells, but have apical processes that covers the apicalsurface of the hair cells, together forming a reticularlamina that separates the endolymph-filled endolymphaticspace from the cortilymph-filled cortilymphatic space.

Pillar cells are "flattened" cells that rest of the tympanic lip of thespiral lamina (inner pillar cells) and on the basilar membrane(outer pillar cells), thus forming the tunnel of Corti between thehair cell rows.

The tectorial membrane, attached medially to the modiolus,projects over the organ of Corti, attached to the stereocilia of thehair cells.


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The basic mechanism oftransduction of soundvibrations is as follows: Sound waves ---> tympanic membrane vibrates ---

> stapes moves at oval window ---> vibrations inperilymph of scala vestibuli, transmitted to scalamedia and scala tympani ---> vibration ofbasilarand tectorial membranes ---> shearing of hair cells---> generation ofmembrane potentials --->afferents ofspiral ganglion.


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External Ear :Pinna = - Collect sound waves and channelthem to the ear canal

- Help person to distinguish whethera sound is coming from in front or

behindEar canal (meatus acusticus externus) =

- transmit the sound wave tomembran tympani

- guarded by fine hairs, modifiedsweat glands that produce cerumen

(earwax). Both,prevent airboneparticles from reaching the innerportion of the ear channel


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Tympanic membrane- vibrate when it struck by sound waves.- In resting air pressure on both side

(outside and inside) tympanic membran must

be equal.

Transfers the vibratory movement of thetympanic membrane to the fluid of the innerear. Transfering facilited by :

Malleus bone (attached to tympanic membrane)IncusStapes (attached to oval window)


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Cochlea Hearing reseptor / mechanoreseptor (organ

of corti). Apparatus vestibularis

COCHLEA Divided into 3 compartement :1. Upper compartement (skala vestibuli)2. Middle compartement (skala media)3. Lower compartement (skala timpani)


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Pada skala vestibuli dan skala timpanimengandung cairan perilimfe

Skala media mengandung cairan endolimfe.

Ujung skala vestibuli dan skala timpanibertemu = Helicotrema

Skala vestibuli yang berada dekat telingabagian tengah dibatasi oleh oval window


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Skala media :Membran vestibularis

Duktus kokhlearis

Membran tektorial tempat terbenamnyasel- sel rambut

Membran basillaris tempat melekatnyaorgan corti (reseptor pendengaran)


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Gelombang suara ditangkap/ dikumpulkanoleh pinna merambat melalui meatusacusticus externus menggetarkanmembrana tympani tulang-tulang

pendengaran


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1. Stapes melekat pada oval window, menutupi skalavestibuliBila stapes bergerak oval window bergerak terdorongke arah depan mendorong perilimfe ke depanmengelilingi helikotrema skala timpani

(kompartemen bawah)Ketika stapes bergerak munduroval window tertarik kearah telinga bagian tengah perilimfe bergerak ke arahyang berlawanan.

2. Gelombang tekanan di kompartemen atas dipindahkan

melalui membran vestibularis yang tipis ke dalam duktuskokhlearis melalui membran basillaris ke kompartemenbawah (menyebabkan oval window keluar-masuk)


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Transmisi gelombang tekanan melalui m.basilarismenyebabkan membran ini bergerak ke atas dan ke bawah

atau bergetar. Organ corti dan sel-sel rambut ikut bergerak

naik turun sewaktu membran basillaris bergetar o.k rambut-

rambut sel reseptor terbenam di dalam membran tektorialsel rambut bergerak ke depan dan ke belakang.

3. Perubahan maju mundur ini menyebabkan saluran ion

gerbang mekanis di sel-sel rambut terbuka dan tertutupsecara bergantian. perubahan potensial depolarisasi dan

hiperpolarisasi secara bergantian


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Depolarisasi sel-sel rambut (sewaktu membranbasillaris bergeser keatas) meningkatkankecepatan pengeluaran zat perantaraMenaikkan potensial aksi di serat-serat aferen.Pada saat hyperpolarisasi (sewaktu membranbasilaris begerak ke bawah) sel-sel rambut

mengeluarkan sedikit zat perantara kecepatanpembentukan potensial aksi

5. Sel-sel rambut bersinaps membentuk sarafauditorius (koklearis).Penutupan dan pembukaan saluran di selreseptor perubahan potensial berjenjangdireseptor perubahan kecepatan Pembentukan potensial aksi


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Otitis Media adalah peradangansebagian atau seluruh mukosatelinga tengah, tuba eustachius,

antrum mastoid, dan sel mastoid. Otitis media supurativa akut yaituinfeksi akut dalam < 3 minggu

yang disebabkan inflamasi padatelinga tengah.


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Jenis kelamin ( > ) Usia

Ras

Anomali kongenital Faktor lingkungan :

Alergi

Paparan asap rokok

Paparan dengan anak lain

Musim


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PenyebabOtitis media akut bakterial : Streptococcus sp.,

dllOtitis media akut viral : Rhinovirus, RespiratorySyncytial Virus (RSV)

Jangka waktu

otitis media akut : < 3 mingguotitis media subakut : 3 11 mingguotitis media kronik : > 11 minggu

Gejala

otitis media akut supuratifotitis media akut efusi / serosa


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1. Stadium oklusi tuba eustachius Ditandai adanya membrana timpani retraksi

dan berwarna suram

Gejala : tinnitus, gangguan pendengarandan rasa penuh di telinga

2. Stadium hiperemis

Membran timpani kemerahan karena terjadi

pelebaran pembuluh darah. Gejala : Selain gejala stadium oklusi, mulai

didapai rasa nyeri.


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3. Stadium supurasi

Membran timpani bulging. Pasien tampaksakit dan suhu meningkat

4. Stadium perforasi

Didapati nanah pada liang telinga yangmengalir dari kavum timpani akibatrupturnya membran timpani.

Anak yang sebelumnya gelisah menjadi

lebih tenang.5. Stadium resolusi

Membran timpani mulai kembali normal.


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Faktor anatomi dan immunologi dengan URI Bakteri : Streptococcus pneumonia,

Haemophilus influenzae, Moraxella species.

Virus: Rhinovirus dan respiratory syncytialvirus (RSV)

ISPA


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ISPA

Menjalar kecavum timpani

melaui tuba eustachi

Menyebar ketelingatengah

Menginfeksi mukosatelinga tengah

Terjadi proses inflamasi

Saat bakteri melalui saluran

eustachi dpt menyebabkan infeksidisaluran trsbt

Terjadi proses inflamasi

Pembengkakan(odem) disekitar saluraneustachi

Saluran tersumbatdan menyempit

Fungsi tuba eustachiterganggu untukventilasi dan drainase

Sel-sel imuninfiltrat,sprtneutrofil,monosit,danleukosit serta sel lokalseperti keratinosit dan

sel mastosit.


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Mediator inflamasi

Permeabilitasdinding sel

Permeabilitaspembuluhdarah,limfe.

Terjadiakumulasi sel-sel radangditelinga tengah

OMA

Milla


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Infeksi atau

peradangan

Neutrofil

mengeluarkan

pirogen

endogen

Prostaglandin

Set point

panas

meningkat di

hipotalamus

Peningkatanproduksi

panas,

pengurangan

pengeluaran

panas

Peningkatan

suhu tubuh ke

set point baru


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Inflamasi

Pelepasan

IL-10

memicu P6

Peningkata

n

permeabilit

as kapiler

Edema,

iritasi saraf

aurikula

temporal,

saraf

timpani

dan saraf

aurikula

Impuls ke

medula

Persepsi

rasa nyeri


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Infeksimemicu

neutrofil dan

fagositosis

Membentuk

pus

Penumpukan

mukopurulen

Telinga rasa

penuh


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Inflamasi

Penebelanmukosa tiub

eustachio

dan

penyumbata

n

Udaradiserap ke

pembuluh

darah

mukosa

Penurunan

tekanan

dalam

telinga

Restriksi

membran

timpani

Kurang

pendengara

n


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Bacterial culture

This test detects and identifies bacteria from

fluid or discharge found in the middle ear. Itis used to help treat acute otitis media(inflammation of the middle ear) and chronicpurulent otitis media. A sample of fluid or

discharge from the middle ear may becollected by sterile swab, tympanocentesis ormyringotomy.


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Methods used to obtain a sample for culturevary and will depend on the healthcare

worker. For perforated (burst) eardrums, fluidor pus may be collected from your ear canal.The sample may be obtained using a sterilecotton-tipped swab. The sample is placed in

a sterile container, and sent to the laboratoryfor testing.


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For intact eardrums, a tympanocentesis maybe done. An ear speculum and a special

magnifying tool called an operative otoscopeare used to locate and inspect your eardrum.The healthcare worker will puncture youreardrum with a needle, and remove the fluid

using a syringe. The fluid sample from themiddle ear is collected using a sterile swab,and placed in a container to be tested.


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If a myringotomy is done, an ear speculumand a special magnifying tool called anoperative otoscope are used to locate andinspect your eardrum. The healthcare workerwill make a small cut on your eardrum. Thefluid sample from the middle ear is collected

into a sterile suction trap or device. It isgathered using a sterile swab, and placed in acontainer for testing.


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Bacterial culture The Quellung Reaction

Stained Smears

Complete Blood Count


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Penyakit DiagnosaOtitis media dengan effuse

- Infeksi pada telinga tengah dengn efusi non

purulen.

- Etiologi: S pneumoniae 35% kasus, H

influenza 20% kasus, Disrupsi pada opening

of the eustachian tube orifice

Gejala klinis:

Effusi non-purulen (mucoid/serous), Tiada

inflamasi ekstensif

Otoscopic:

Tiada pengurangan mobilitas membran timpani,

kekuningan atau kemerahan (hipervaskuler),

Efusi tidak purulen.

Otitis EksternaInflamasi atau infeksi pada telingaluar (meatus akustikus eksterna)

Etiologi: Trauma telinga, infeksibakteri, jamur

Gejala Klinis:Nyeri apabila struktur telinga luardisentuh

Otoscopic:Meatus akustik eksterna terlihateritema, edema dan menyempit.

Faringitis akutInflamasi atau iritasi pada faring

atau/dan tonsil

Gejala Klinis:Demam, nyeri ke telinga (refered

pain), dysphagia


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RISHI

Centers for Disease Control and Prevention published 6


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principles of appropriate antibiotic use in an attempt tobring precepts of good public health and responsibletherapy and minimize resistant strains of bacteria

Classify episodes of OM as AOM or OME.

Antimicrobials are indicated for treatment of AOM; however,diagnosis requires documented middle ear effusion and signsor symptoms of acute local or systemic illness.

Uncomplicated AOM may be treated with a 5- to 7-day courseof antimicrobials in certain patients older than 2 years.

Antimicrobials are not indicated for the initial treatment ofOME; treatment may be indicated if effusions persist for longerthan 3 months.

Persistent OME after therapy for AOM is expected and doesnot require re-treatment with antimicrobials.

Reserve antimicrobial prophylaxis for controlling recurrentAOM, defined as 3 or more distinct, well-documentedepisodes in 6 months or 4 or more episodes in 12 months.

ANTIBIOTICSEmpiric antimicrobial therapy must be comprehensive and should cover all


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Empiric antimicrobial therapy must be comprehensive and should cover alllikely pathogens in the context of the clinical setting.

Amoxicillin (Amoxil, Trimox, Wymox)DOC for management of AOM. Interferes with synthesis of cell wallmucopeptides during active multiplication, resulting in bactericidal activity

against susceptible bacteria. DosingAdult

250-500 mg PO q8hPediatric90 mg/kg/d PO q8-12h for all initial therapy for AOM

Amoxicillin/clavulanate (Augmentin)Combination drug that includes a blocking agent (clavulanic acid).

DosingAdult250-500 mg amoxicillin with 62.5-125 mg clavulanate PO q8hPediatric90 mg/kg/d PO of Amoxicillin component for recurrent AOM

Erythromycin ethylsuccinate/sulfisoxazole (E.E.S. 400)D li d i 200 /5 L ( th i ) d


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Doses supplied in 200 mg/5 mL (erythromycin) and600 mg/5 mL (sulfisoxazole). Widely used forindividuals who are penicillin-sensitive. Well absorbedfrom GI tract but best administered on full stomach to

avoid GI upset. DosingAdult

Not usedPediatric50 mg/kg/d of erythromycin component divided PO q8-12h

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS,Septra, Septra DS)Inhibits bacterial growth by inhibiting synthesis ofdihydrofolic acid.

DosingAdult160 mg TMP with 800 mg SMZ PO bidPediatric8 mg/kg TMP with 40 mg/kg SMZ PO divided q12h

Cefixime (Suprax)By binding to one or more of the penicillin-binding proteins, arrests


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y g p g p ,bacterial cell wall synthesis and inhibits bacterial growth.

DosingAdult400 mg PO qd or divided bidPediatric8 mg/kg PO qd or divided bid

Cefuroxime Axetil (Ceftin)Second-generation cephalosporin that maintains gram-positive

activity of first-generation cephalosporins; adds activity againstProteus mirabilis, H influenzae, E coli, Klebsiella pneumoniae,and M catarrhalis.Condition of patient, severity of infection, and susceptibility ofmicroorganism determine proper dose and route ofadministration.

DosingAdult250-500 mg PO q12hPediatric15-30mg/kg/po

Cefprozil (Cefzil)Bi d f h i illi bi di i


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Binds to one or more of the penicillin-binding proteins,which, in turn, inhibits cell wall synthesis and results inbactericidal activity.

DosingAdult250-500 mg PO q12hPediatric15-30 mg/kg/d PO divided q12h

Cefpodoxime (Vantin)Indicated for management of infections caused by

susceptible mixed aerobic-anaerobic microorganisms. DosingAdult

100-200 mg PO q12hPediatric10 mg/kg/d PO divided q12h

Cefdinir (Omnicef)Third generation cephalosporin indicated for treatment of


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Third-generation cephalosporin indicated for treatment ofuncomplicated skin infections.

DosingAdult600 mg PO qd or divided bidPediatric14 mg/kg PO qd or divided bid

Clindamycin (Cleocin HCl)Lincosamide for treatment of serious skin and soft tissue

staphylococcal infections. Also effective against aerobic and anaerobicstreptococci (except enterococci). Inhibits bacterial growth, possiblyby blocking dissociation of peptidyl t-RNA from ribosomes, causingRNA-dependent protein synthesis to arrest.

DosingAdult600-1800 mg/d PO divided q6-8hPediatric10-25 mg/kg/d PO divided q6-8h

Clarithromycin (Biaxin)I hibi b i l h ibl b bl ki di i i f


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Inhibits bacterial growth, possibly by blocking dissociation ofpeptidyl t-RNA from ribosomes, causing RNA-dependent proteinsynthesis to arrest.

DosingAdult250-500 mg PO q12h

Pediatric15 mg/kg/d PO divided q12h

Azithromycin (Zithromax)Broad-spectrum macrolide antibiotic. Absorption markedlyreduced when taken with food.

DosingAdult500 mg on day 1; then 250 mg/d on days 2-5

Pediatric10 mg/kg on day 1; then 5 mg/kg on days 2-5


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Ceftriaxone (Rocephin)Third-generation cephalosporin. Manufacturer hasheavily promoted IM use of this drug to physicians

and directly to the public for routine treatment ofAOM. Subsequently, MDRSP resistance hasemerged, making this less effective in manycommunities. Author believes this drug is bestreserved for IV use for management of severeinfections. Avoid widespread use for AOM.

DosingAdult1-2 g/d IM for 3 d

Pediatric50 mg/kg/d IM for 3 d


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Diagnostic procedure gives access to acuteor chronic middle ear effusions for cultureand other evaluations Performed without anesthesia, after sterilization of

ear canal with isopropyl alcohol or povidone-iodinesolution. Insert needle through anterior portion ofthe tympanic membrane, and aspirate the contentsof the middle ear into a sterile trap for identificationof microbes and their properties.


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Considered in:1. Immunosuppressed or immunocompromisedchildren

2. Neonates

3. Patients in whom antimicrobial therapy has failed

and who continue to experience local or systemicsigns of sepsis

4. Patients who have had a complication of AOM

Valuable research tool in the evaluation of newantimicrobial agents for efficacy in AOM and for

identification of host defense mechanisms orflaws in the middle ear immunochemistry


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A tympanocentesis may be converted to amyringotomy and become therapeutic byenlarging the hole in the tympanicmembrane, often by spreading the edges withmicroalligator forceps or suction tip.

Instilling antibiotic drops and suctioning themiddle ear are possible

Patient experiences prompt relief of localsymptoms


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Culture results must be obtained beforeextension of the incision

The use of a carbon dioxide laser inmyringotomy has been promoted widely and

directly, but emerging studies demonstratelittle or no change in efficacy over standardmyringotomy.


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If the patient has a suppurative complicationof the temporal bone and requisite prolongeddrainage seems likely

General anesthesia or sedation is necessary in

older children because topical anesthesia isrelatively ineffective in acutely inflamedtympanic membranes

Can be expected to increase in the comingyears with increasing antimicrobial resistance


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Sebelum ada antibiotika, OMA dapatmenimbulkan komplikasi, yaitu abses sub-periosteal sampai komplikasi yang berat(meningitis dan abses otak).

Sekarang setelah ada antibiotika, semua jeniskomplikasi itu biasanya didapatkan sebagaikomplikasi dari OMSK.


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Prognosis pada pasien OMA adalah baik

Sembuh bila terapi adekuat (antibiotika tepat dandosis cukup).

Indikasi Rujuk Anak dgn OMA yg sering. Definisi sering adalahlebih dari 4 kali dlm sebulan. 4 sumber lainmengatakan sering adalah lebih dari 3 kali dlm 6

bulan atau lebih dari 4 kali dalam 1 tahun.

Anak dgn efusi selama 3 bulan atau lebih


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Anak dgn efusi selama 3 bulan atau lebih,keluarnya cairan dari telinga, atau berlubangnyagendang telinga.

Anak dgn kemungkinan komplikasi serius sepertikelumpuhan saraf wajah/mastoiditis (mastoiditis:peradangan bagian tulang tengkorak , kurang lebih

terletak pd tonjolan tulang di belakang telinga). Anak dgn kelainan kraniofasial (kraniofasial: kepala

dan wajah), sindrom down, sumbing, atau dgnketerlambatan bicara.

OMA dgn gejala sedang-berat yg tdk memberirespon terhadap 2 antibiotika.

pemicu 3kelompok b4 oma

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