Otitis Media Diffuse (OED)

Ivan Wudexi

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

Keluhan Utama
Sakit di telinga kiri

Riwayat Penyakit Sekarang (RPS)

Keluhan sakit di telinga kiri telah dirasakan oleh pasien sejak 4 hari yang lalu. Sebelum telinga kiri terasa sakit pasien pertama merasakan gatal di telinga kiri dan oleh beliau sempat dikorek-korek dengan menggunakan cotton bud. selain ada sakit di telinga kiri, beliau juga merasakan adanya penurunan pendengaran dan pengeluaran cairan kental dalam jumlah sedikit dari telinga kiri. Bapak AM menyangkal adanya keluhan dari pasien meliputi asam mefenamat dan antibiotik yang didapat dari Puskesmas.

Riwayat Penyakit Dahulu (RPD)

Tidak pernah menderita penyakit seperti ini sebelumnya Tidak ada riwayat allergy Tidak menderita diabetes

Pemeriksaan THT
Telinga
Dextra
Pinna Ukuran dan bentuk dbn, massa(-), hiperemis(-)

Sinistra
Ukuran dan bentuk dbn , massa(-), hiperemis(-)

Tragus and/or pinna pain Canalis auditorius externus

(-)
massa(-), hyperemis (-), bengkak(-)

(+)
Bengkak(+), hyperemis (+), discharge(+)

Membran timpani
Mastoid

Dalam batas normal, cone of light positive(+), hyperemis (-)

Normal, nyeri (-)

Tidak dapat dinilai

Normal, nyeri(-)

Lymp. node

Tidak ada perbersaran

Pemeriksaan THT
Hidung
Nose Paranasal Sinus
Inspeksi hidung Normal Normal, nyeri(-)
Discharge(-), concha terlihat normal, septum tidak terdeviasi, massa(-)

Kanan

Kiri
Normal Normal, nyeri (-)
Discharge(-), concha terlihat normal, septum tidak terdeviasi, massa(-)

Palpasi hidung
dan sinus Anterior Rhinoscopy Posterior Rhinoscopy

Tidak dilakukan

Pemeriksaan THT
Mulut dan tenggorokan
Lips Tooth Ginggiva Tongue Palate Uvula Tonsil Posterior Oropharynx Normal Normal Normal Normal Normal Normal Normal

Diagnosis
Otitis Externa diffuse Auris sinistra

Treatment
Tampon sofra-tulle Asam mefenamat 250 mg 4 kali sehari (dipakai bila nyeri)

education & follow up

Edukasi: Telinga dihindari dari paparan air Bila mandi telinga ditutup dengan kapas baby oil Jangan mengorek-gorek telinga dengan cotton bud Follow up: kontrol 2 hari lagi/ hari ke-3

Pembahasan

Acute otitis externa

Definition Acute otitis externa (AOE) is a form of cellulitis that involves the skin and subdermis of the external auditory canal, with acute inflammation and variable edema. Otitis Externa diffuse involves the skin of the external auditory canal , concha and possibly the tympanic membrane Commonly caused by bacteria

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 canal enviroment, which inhibits bacterial and fungal growth

Pathogenesis (cont )
First step in the pathogenesis of external otitis is breakdown 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 and increases the pH of the ear canal The resulting dark, warm, alkaline, moist ear canal becomes an ideal breeding ground for numerous organism

Otitis externa classification

Classification based on severity Mild characterized by minor discomfort and pruritus, minimal canal edema Moderate intermediated degree of pain and pruritus, the canal is partially occluded Severe intense pain, canal is completely occluded from edema. There is usually periauricular erythema, lymphadenopathy and fever

Mild Otitis Externa

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

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 (malignant otitis externa)

Test
Pneumatic otoscopy Tympanometry

Diagnosis

Treatment
Five fundamental steps 1. Thoroughly clean the ear canal 2. Treat inflammation and infection 3. Control pain 4. Avoiding promoting factors 5. Follow-up and culture of recalcitrant cases

Treatment

Education and follow up

Education on how to use ear drops to ensure adequate tx. Avoid exposing the affected ear to water during the acute phase of tx Avoid the use of cotton-tipped applicators or other foreign objects. Blood sugar control for diabetic patients should be stressed Underlying dermatitis or other skin disorders should be attented and treated whenever needed

Prognosis
Patient with uncomplicated diffuse otitis externa usually respond to tx. Between 65%-90% of patients have clinical resolution within 7 to 10 days

Complication
periauricular cellulitis and malignant external otitis

Maturnuwun
Mohon asupan