lapkas oma dr.oscar amin

8/10/2019 Lapkas OMA Dr.oscar amin

1/22

Acute OtitisMedia

A CASE PRE

SU

DR. H. OSCAR DJAUHA

PRE

EBBEL TANTIAN IGAMU

FUAD FILARDHI NUGR OHO

SUS RETHA MONA ARDIANI


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The CasePART I


3/22

The Case

A 6-years old boys came to hospital with an earache of his right ears. He had a histortract infection.


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Identity and ComplaintName : An. A

Age : 6 years old

Occupation : Student

Address : Jl. Koperasi

Chief complaint : earache on the right ear

Additional complaint : runny nose, cough, fever since 7 days ago, and hearing lodays ago (gradually)


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History of Present Illness

Patient, 6 year old, male, comes to the ENT clinic with complain ofpain on his right ear.

Seven days ago he got fever (38,5 degree Celcius), cough, andrunny nose. The colour of the secrete was clear and serous. He hadtaken medication for cold and flu but his symptoms did not improve.

After four days, it became green yellowish, mucoid. He becomesmore irritable than usual, pulling his right ear. He had hearing lossgradually since 4 days ago. This complain occursfor the first time.Pain in the ear suddenly appeared, continuous all day and madehim uncomfortable and irritable.


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7/22

Physical Examination(Generalized Status)General appearance : moderately ill

Awakeness : compos mentis (E4M6V5)

Pulse rate : 115 bpm

Respiration rate : 25 bpm

Temperature : 38,7 oC


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Physical Examination(Ears)

Auris dextra :

- Auricle : hyperemia (-), oedema (-)

- Retroauricular : normal, no deformities

- Canalis acusticus externus :

skin : hyperemia (-), oedema (-)

discharge : (-)

serumen : (+) minimal

- Tymphanic membrane : intact, bulging (+), light reflex reduced (+), hyperemis

- Rinne test (-), Webber lateralitation to the right, prolonged Schwabach. (ConductiHearing Loss on Right ear)


9/22


10/22

Physical Examination(Nose)

Right Nose : Mucous membrane : hyperemis (+), edema (+)

Inferior concha : eutrophy

Discharge : (+), mukoid, green yellowish

Septum : normal, no deviation

Left Nose : Mucous membrane : hyperemis (+), edema (+)

Inferior concha : eutrophy

Discharge : (+), mukoid

Septum : normal


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Physical Examination(Throat and Neck)Throat :

Uvula : in the middle

Pharynx : anterior and posterior pharyngeal arcus normal, hyperemia (+)

Tonsil : T2/T2, hyperemis (-), cripta dilatation (-), detritus (-)

Maxillofacial : symmetric

Neck : unpalpable lymph node / unpalpable lymph node


12/22

Working Diagnosis

Acute Otitis Media supurative stage auris dextra

Workup Blood count including differential count of white blood cells

Culture of pus of the middle ear

Therapy Outpatient

Paracetamol tab 6 x 250 mg per oral, if temperature > 37,8 C

Amoxicillin tab 3 x 250 mg per-oral, for 7 days

Myringotomy


13/22

Acute Otitis MediaEtiology

Streptococcus pneumoniae (tersering)

Haemophillus influenzae

Streptococcus -hemoliticus group A

Staphyllococcus aureus

Staphylllococcus epidermidis

E. Coli


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PathophysiologyMiddle ear : steril mode

There is a connection between cavum tympani by eustachius tube.

There are barrier systems : cillia, muramidase (enzym that products mucous), antibhumoral factors, PMN, and phagocytic cells.

The barrier impairedinvasion of microbes to the middle ear


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STAGEOcclusion

Hyperemic

Suppurative

Perforated

Resolution


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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


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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 physiologicsolution, 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


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ManagementSuppurative

Antibiotics: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin 50-100 mg/kgBB/day in 4 deritromicin 40 mg/kgBB/day.

Decongestan

Analgetics

Antipiretics

Perforated

H2O2 3% 5 drops 3 dd 1 3-5 days

Antibiotic local (ear drops)


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ManagementResolution

If the resolution didnt take place, secretes will drained out by the perforation in tympaniThe antibiotics continued for 3 weeks. If 3 weeks pasts and secretes stills, mastoiditis shodifferential diagnosis


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ComplicationMastoiditis, subperiosteal abscesses, meningitis, brain abscesses.


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PROGNOSISQuo ad vitam : dubia

Quo ad functionam : dubia

Quo ad sanationam : dubia


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Thank you

lapkas oma dr.oscar amin

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