Case Ear
Case Ear
Case Ear
Supervisor:
dr. H. Oscar Djauhari, Sp.THT-KL
Presented by:
Maria Emmanuelle (201706010125)
Sean Peter (201706010175)
IDENTITY
•He started to feel pain in his right ear, felt insidiously and continuously all day
•The pain was mild, but slowly the boy become more irritable
•There was a high-grade fever following this earache. History of ear
2 days ago discharge, foul-smell discharge, facial pain was denied.
HISTORY OF PRESENT ILLNESS
• Previous illness with the same complaint • History of family/his siblings with the
was denied same complaint was denied
• Allergy was denied • History of tobacco exposure +
father
• History of prematurity was denied
PHYSICAL EXAMINATION
(GENERALIZED STATUS)
Auris dextra :
• Auricle : normal
• External auditory canal:
• hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) , cerumen
(+)
• Tymphanic membrane:
• Intact, hyperemic (-), bulging (-), light reflex (+)
PHYSICAL EXAMINATION
(EARS)
Auris sinistra :
• Auricle: normal
• External auditory canal:
• hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) , cerumen (+)
• Tymphanic membrane:
• Intact, hyperemic (+), bulging (-), light reflex ↓
Rinne test (+), Webber lateralitation to the left (Conductive Hearing Loss on
left ear)
PHYSIC AL EXAMINATION
(NOSE)
Right Nose :
• Mucous membrane : hyperemic (+), edema (+), mass (-), laceration (-), crust (-)
• Inferior concha: eutrophy
• Discharge : (+), mukoid, yellowis
• Septum : normal, no deviation
• Air passage : normal
Left Nose :
• Mucous membrane : hyperemis (+), edema (+)
• Inferior concha : eutrophy
• Discharge : (+), mukoid
• Septum : normal
• Air passage : normal
PHYSICAL EXAMINATION
(THROAT AND NECK)
• Oropharynx
• Posterior pharynx : hyperemic (-)
• Palatine tonsils : T1 / T1, hyperemic (-), detritus (-)
• Uvula : symmetrical
• Dental : no abnormatlities
• Maxillofacial : symmetrical
• Neck : mass (-), lymphadenopathy(-)
• Working Diagnosis
Acute otitis media dextra, hyperemic stage
• Workup
• tymphanometry
• Therapy
• Outpatient care
• Antibiotic : Amoxicilin 3 x 500 mg PO for 7 days
• Antipyretic and analgetic : Paracetamol 3 x 125 mg PO for 3 – 5 days
• Topical anticholinergic : Oxymetazoline HCL nasal spray 2 x 3 sprays per nostril for 3 days
OTOLOGIC SYMPTOMS &
ACUTE OTITIS MEDIA
LITERATURE REVIEW
Inflammatory
Primary Traumatic
Neoplastic
Earache
Head region
These regions are
Secondary innervated by the nerves
that also supply the ear
Neck region
CAUSES OF
OTALGIA
OTITIS MEDIA
= MIDDLE EAR + MASTOID SPACE
INFLAMMATION
• 0 to 3 weeks in
ACUTE
duration
• 3 to 12 weeks in
SUBACUTE
duration
• longer than 12
CHRONIC
weeks in duration
WHAT’S THE DIFFERENCE?
• Non purulent nearly sterile effusion in the middle ear cleft (without inflammation)
• Most often the unresolved stage of AOM
• May also resulted from eustachian tube dysfunction/upper respiratory tract infection
• Persistence of purulent otorrhea through a tympanic membrane (TM) perforation or tympanostomy tube
(TT) that is unresponsive to medical therapy
Most common:
Streptococcus pneumoniae, H. influenza,
Moraxella catarhhalis
Following the upper respiratory tract
• Eustachian tube in infant shorter, wider, more horizontal accounts for the
high rate of otitis media in infants and children
• The majority of children with multiple recurrences of AOM have their first
episode before the age of 12 month
• By the age of 7 the tube has a more adult configuration
PATOPHYSIOLOGY
influx of
bacteria and ↑↑ negative
Inflammation viruses middle-ear
nasopharynx pressure
when ET opens
Mucosal edema,
capillary
engorgement,
infiltration PMN
STAGING
• Edema and hyperemia of nasopharynx & ET occludes ET negative middle ear pressure
• Symptoms: mild deafness, ear fullness, ear pain, no fever
• Sign: retracted tympanic membrane, conductive hearing loss
Occlusion
• Late in giving antibiotics therapy, tympanic membrane will be rupture and pus drains out from the middle
ear.
• Symptoms: Child will be calm now, reduce in body temperature, and sleep well.
Perforated • PE: Tympatic membrane is rupture and pus drains out
• If the tympanic membrane still intact, the condition of tympanic membrane slowly back to
normal. If there is a perforation, secretes will reduced and dried. Resolution will takes place
Resolution without medication if the immune system still in good performance
Others:
Decongestants
Anaglesic, antipyretic
Ear drop and aural toilet
Dry local heat
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.
• Myringotmy
• Analgetics
• Antipiretics
• Perforated
• H2O2 3% 5 drops 3 dd 1 3-5 days
• Antibiotic local (ear drops)
MANAGEMENT
• Resolution
• If the resolution didn’t 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
SURGICAL TREATMENT
TYMPANOCENTESIS MYRINGOTOMY