ACUTE OTITIS MEDIA

Case Presentation
Supervisor : dr. H. Oscar Djauhari, Sp. THT-KL
Didi Suryana

2012730029

CASE
A 7-years-old boy came to ENT clinic with a
complain of right earache since 3 past days. He
was also having cough, runny nose and fever since
10 past days.

PATIENTs IDENTITY

Name
: Naufal
Gender
: Male
Age
: 7 years old
Occupation: Primary school student
Address
: Sukabumi

COMPLAINT
Chief complaint : Right earache since 3 past days
Additional complaint : cough, runny nose, and fever

HISTORY OF PRESENT ILLNESS

Right continously earache since 3 past days.
The pain was increasing in severity, from mild pain
at the beginning until severe pain at the time of
presentation.
Sensation of fullness at the right ear.
High-grade fever following this earache.
History of ear discharge, tinnitus and hearing loss
was denied.
Runny nose, cough, and fever. Since 10 days before
admission.
The nasal discharge was clear, watery, and massive
in amount.

PHYSICAL EXAMINTATION
General condition : Appear ill
Body weight
: 21 kg
Height
: 45 cm
Blood pressure
: 110/60 mmHg
Pulse
: 110 beat per minute
Respiratory rate
: 24 times per minute
Temperature
: 38, 8oC

ENT EXAMINATION -ear

Right ear
Auris : Normal
External auditory canal: hyperemic (-), edema (-), mass
(-), laceration (-) secretion (-) , cerumen (-)
Tymphanic membrane : intact, hyperemic (+),
bulging (+), light reflex
Left ear
Auris : Normal
External auditory canal: hyperemic (-), edema (-), mass
(-), laceration (-) secretion (-) , cerumen (-)
Tymphanic membrane: intact, bulging (-), light reflex (+)

ENT EXAMINATION -nose

Right nose
Mucous membrane : Hyperemic (+), edema (+), watery
and clear secretion (+), mass (-), laceration (-), crust (-)
Inferior conchae : Eutrophy
Septum : No deviation
Air passage : Normal
Left nose
Mucous membrane: Hyperemic (+), edema (+), watery
and clear secretion (+), mass (-), laceration (-), crust (-)
Inferior conchae : euTrophy
Septum
: No deviation
Air passage
: Normal

ENT EXAMINATION
Oropharynx, Maxillofacial and Neck
Oropharynx
Posterior pharynx : Hyperemic (-)
Palatine tonsils : T1 / T1, hyperemic (-), detritus
(-)
Uvula
: Symmetrical
Dental
: Normal
Maxillofacial : Symmetrical
Neck

: Mass (-), lymphadenopathy (-)

WORKING DIAGNOSIS
Acute otitis media dextra, suppurative stage

TREATMENT
Outpatient care
Antibiotic
: Amoxicilin 3 x 250 mg oral
Antipyretic- analgetic : Paracetamol forte 3 x 1 cth
Cough and runny nose : Pseudoefedrin spray 3 x 1

Acute Otitis Media

Etiology

Streptococcus pneumoniae (tersering)

Haemophillus influenzae
Streptococcus -hemoliticus group A
Staphyllococcus aureus
Staphylllococcus epidermidis
E. Coli

Pathophysiology
Middle ear : steril mode
There is a connection between cavum tympani
by eustachius tube.
There are barrier systems : cillia, muramidase
(enzym that products mucous), antibody and
humoral factors, PMN, and phagocytic cells.
The barrier impaired invasion of microbes to
the middle ear

STAGE

Occlusion
Hyperemic
Suppurative
Perforated
Resolution

Clinical Findings
Child

Upper tract infection

Pain inner ear
Fever
Restless
Seizures
Nausea and vomiting
Diarrhea
Holding the affected ear

Adults
pain
fullness in the ear
hearing loss occured

Management
Occlusion
To open the closed eustachius tube, so the pressure in middle ear
can be reduced.
Decongestan (Child < 12y.o: HCl ephedrine 0.5% in physiologic
solution, Child>12 th: HCl efedrine1% in physiologic solution)
Antibiotics

Hyperemic
Antibiotic: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin
50-100 mg/kgBB/day in 4 doses, eritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics

Management
Suppurative
Antibiotics: amoxicillin 40 mg/kgBB/day in 3 doses,
ampicillin 50-100 mg/kgBB/day in 4 doses, eritromicin
40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics

Perforated
H2O2 3% 5 drops 3 dd 1 3-5 days
Antibiotic local (ear drops)

Management
Resolution
If the resolution didnt take place, secretes will
drained out by the perforation in tympanic
membrane. The antibiotics continued for 3 weeks.
If 3 weeks pasts and secretes stills, mastoiditis
should be in differential diagnosis

Complication
Mastoiditis, subperiosteal abscesses, meningitis,
brain abscesses.