laporan kasus tht purry

7/24/2019 Laporan Kasus THT Purry

1/49

DAFTAR ISIKATA PENGANTAR.......................................................................................... 1

DAFTAR ISI........................................................................................................ 2DAFTAR GAMBAR........................................................................................... 3

BAB I. PENDAHULUAN

1.1 Latar Belakang..................................................................................... 4

1.2 Bataan Maala!.................................................................................. "

1.3 T#$#an Pen#l%a!................................................................................. "

1.4 Met&'e Pen#l%an................................................................................ "

BAB II. TIN(AUAN PUSTAKA

2.1 De)%n%%................................................................................................ *

2.2 Anat&+%............................................................................................... *

2.3 E,%'e+%&l&g%....................................................................................... 1-

2.4 Kla%)%ka%............................................................................................ 112." Pat&gene%........................................................................................... 14

2.* Fakt&r R%%k&........................................................................................ 1"

2. Ge$ala kl%n%.......................................................................................... 1

2./ D%agn&%.............................................................................................. 10

2.0 Penatalakanaan.................................................................................... 21

2.1-.K&+,l%ka%......................................................................................... 2

2.11 Pr&gn&%............................................................................................ 3"

BAB III.PENUTUP

3.1 Ke%+,#lan.......................................................................................... 3*

DAFTAR PUSTAKA........................................................................................... 3

DAFTAR GAMBAR

Ga+ar 1. Anat&+% Tel%nga.................................................................................

Ga+ar 2 Anat&+% tel%nga tenga!.......................................................................

Ga+ar 3. Tel%nga kanan. Me+ran T%+,an% N&r+al........................................ 0

Ga+ar 4. K&leteat&+ k&ngen%tal...................................................................... 12

Ga+ar " K&leteat&+ k&ngen%tal....................................................................... 13

-


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Ga+ar *. K&leteat&+ '%'a,at........................................................................... 13

Ga+ar . Pat&gene% t%t% Me'%a.................................................................... 1"

Ga+ar /. Pe'&+an tatalakana MSK............................................................. 2

BAB I

PENDAHULUAN

1.1 Latar Belakang

t%t% Me'%a S#,#rat%) Kr&n%k MSK ata# 5ang %aa '%e#t 67&ngek8

a'ala! ra'ang kr&n% tel%nga tenga! 'engan a'an5a l#ang ,er)&ra% ,a'a

1


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gen'ang tel%nga +e+ran t%+,an% 'an r%9a5at kel#arn5a 7a%ran ekret 'ar%

tel%nga &t&re le%! 'ar% 2 #lan: a%k ter# +ener# ata# !%lang t%+#l. Sekret

+#ngk%n er: +#k: ata# ,#r#len. Ter$a'% MSK !a+,%r elal# '%+#la%

'engan &t%t% +e'%a er#lang ,a'a anak: $arang '%+#la% etela! 'e9aa. 1:2

Pre;alen% MSK '% '#n%a a'ala! *".---.---tra'#ral: ene)al%t% 'an tr&+&% %n# lateral%.

K&+,l%ka% ektrakran%al 5ang 'a,at t%+#l a'ala! la%r%nt%: ,are% ner;#

)a%al%: +at&%'%t%: ,etr&%t%."

K&+,l%ka% ke %ntrakran%al +er#,akan ,en5ea #ta+a ke+at%an ,a'a

MSK '% negara e'ang erke+ang: 5ang eag%an ear ka# ter$a'% karena

,en'er%ta +engaa%kan kel#!an tel%nga era%r. Ke+at%an ter$a'% ,a'a 1/:*= ka#

MSK 'engan k&+,l%ka% %ntrakran%al e,ert% +en%ng%t%.3

2


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le! karena t%ngg%n5a %n%'en MSK 'an eratn5a k&+,l%ka% 5ang

'%t%+#lkan &le! MSK %n%: +aka ,en#l% tertar%k +engangkat t&,%k %n% eaga%

$#'#l ,en#l%an re)erat.

1.2 Batasan Masalah

Pe+a!aan t#l%an %n% '%ata% ,a'a 'e)%n%%: ,at&gene%: '%agn&% 'an

,enatalakaan MSK erta k&+,l%ka%n5a.

1.3 Tuuan Penul!san

T#l%an %n% ert#$#an #nt#k +ena+a! ,engeta!#an ,e+a7a #+#+n5a

'an ,en#l% k!##n5a +engena% &t%t% +e'%a #,#rat%) kr&n%k erta

k&+,l%ka%n5a.

1." Met#$e Penul!san

T#l%an %n% +er#,akan t%n$a#an ke,#takaan 5ang +er#$#k ke,a'a

eraga% l%terat#r.

BAB II

TIN%AUAN PUSTA&A

2.1 De'!n!s!

3


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t%t% +e'%a a'ala! ,era'angan eag%an ata# el#r#! +#k&a tel%nga

tenga!: t#a e#tak!%#: antr#+ +at&%': 'an el


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Ga+ar 1. Anat&+% Tel%nga.

Ga+ar 2. Anat&+% Tel%nga Tenga!

Tel%nga tenga! ter'%r% ata? +e+ran t%+,an%: ka;#+ t%+,an%: ,r&e#

+at&%'e#: 'an t#a e#tak!%#.1:":*

1. Me+ranT%+,an%

Me+ran t%+,an% '%ent#k 'ar% '%n'%ng lateral ka;#+ t%+,an% 'an

+e+%a!kan l%ang tel%nga l#ar 'ar% ka;#+ t%+,an%. Me+ran %n% +e+%l%k%

,an$ang ;ert%kal rata


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7. Strat#+ )%r+ la+%na ,r&,r%a 5ang letakn5a antara trat#+ k#tane#+ 'an

+#k+.

Se7ara Anat&+% +e+ran t%+,an% '%ag% 'ala+ 2 ag%an ?1

a. Par tena

Bag%an terear 'ar% +e+ran t%+,an% 5ang +er#,akan ,er+#kaan 5ang

tegang 'an ergetar: ekel%l%ngn5a +eneal 'an +elekat ,a'a an#l# )%r ,a'a

#lk# t%+,an%k# ag%an t#lang 'ar% t#lang te+,&ral.

. Par )lak%'a ata# +e+ran Shrapnell.

Letakn5a '% ag%an ata +#ka 'an le%! t%,% 'ar% ,ar tena. Par )lak%'a

'%ata% &le! 2 l%,atan 5a%t# ?

Pl%ka +ale&lar% anter%&r l%,atan +#ka. Pl%ka +ale&lar% ,&ter%&r l%,atan elakang.

Me+ran t%+,an% terletak 'ala+ al#ran 5ang '%ent#k &le! t#lang

'%na+akan #lk# t%+,an%k#. Akan teta,% ag%an ata +#ka t%'ak ter'a,at #lk#

%n% 'an ag%an %n% '%e#t %n%#ra t%+,an%ka rivini. Per+#kaan l#ar 'ar%

+e+ran t%+,an% '%ara)% &le! 7aang ner;# a#r%k#l& te+,&ral% 'ar% ner;#

+an'%#la 'an ner;# ;ag#. Per+#kaan 'ala+ '%ara)% &le! ner;# t%+,an%

7aang 'ar% ner;# gl&&)ar%ngeal.Al%ran 'ara! +e+ran t%+,an% eraal 'ar% ,er+#kaan l#ar 'an 'ala+.

Pe+#l#!


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Ka;#+ t%+,an% terletak '% 'ala+ ,ar ,etr&a 'ar% t#lang te+,&ral:

ent#kn5a %k&nka): ata# e,ert% k&tak k&rek a,%. D%a+eter anter&


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A'an5a )#ng% ;ent%la% t#a 'a,at '%#kt%kan 'engan +elak#kan ,eraat

ala;a 'an ,eraat T&5nee."

Peraat ala;a +en%#,kan 'engan kera 'ar% !%'#ng a+%l +#l#t

'%,en7et erta +#l#t '%t#t#,. B%la T#a ter#ka +aka akan teraa a'a #'ara 5ang

+a#k ke tel%nga tenga! 5ang +enekan +e+ran t%+,an% ke ara! lateral. Peraat

%n% t%'ak &le! '%lak#kan kala# a'a %n)ek% ,a'a $al#r na)a ata. "

Peraat T&5nee '%lak#kan 'engan 7ara +enelan l#'a! a+,a% !%'#ng

'%,en7et erta +#l#t '%t#t#,. B%la t#a ter#ka +aka akan teraa +e+ran t%+,an%

tertar%k ke +e'%al. Peraat %n% le%! )%%&l&g%."

2.3 E)!$e(!#l#g!

t%t% +e'%a #,#rat%) kr&n%k +er#,akan ,en5ak%t THT 5ang ,al%ng an5ak

'%te+#kan '% negara e'ang erke+ang. Se7ara #+#+ %n%'en MSK

'%,engar#!% &le! ra 'an )akt&r &%&ek&n&+%. M%aln5a: MSK le%! er%ng

'%$#+,a% ,a'a &rang Ek%+& 'an In'%an A+er%ka: anak


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antara 2:1


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ek%tarn5a erta +en%+#lkan nekr&% ter!a'a, t#lang. Ter$a'%n5a ,r&e

nekr&% ter!a'a, t#lang '%,er!eat &le! reak% aa+ &le! ,e+##kan

akter%.1:3:"

K&leteat&+ 'a,at '%ag% ata 2 t%,e 5a%t#?

1. K&ngen%tal/

K&letat&+ k&ngen%tal terent#k ,a'a +aa e+r%&n%k. Pat&gene%

k&leteat&+ k&ngen%tal t%'ak e,en#!n5a '%+engert%. Na+#n a'a eera,a

te&r% '%antaran5a Tee' +en5atakan a!9a ,enealan e,%tel ekt&'er+al

erke+ang era+a


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K&leteat&+ 5ang terent#k etela! anak la!%r: 'a,at '%ag% ata?

Primary acquired cholesteatoma.

K&leteat&+ 5ang ter$a'% tan,a '%'a!#l#% &le! ,er)&ra% +e+ran

t%+,an% ,a'a 'aera! at%k ata# ,ar )la%'a: t%+#l ak%at a'an5a ,r&e

%n;ag%na% 'ar% +e+rane t%+,an% ,ar )lak%'a karena a'an5a tekanan

negat%) '% tel%nga tenga! ak%at gangg#an t#a.

Ga+ar *. K&leteat&+ '%'a,at

Secondary acquired cholesteatoma.

K&leteat&+ 5ang terent#k etela! ter$a'% ,er)&ra% +e+ran

t%+,an%. K&leteat&+ terent#k eaga% ak%at 'ar% +a#kn5a e,%tel k#l%t

'ar% l%ang tel%nga ata# 'ar% ,%ngg%r ,er)&ra% +e+ran t%+,an% ke tel%nga

tenga! te&r% +%gra% ata# ter$a'% ak%at +eta,la%a +#k&a ka;#+

t%+,an% karena %r%ta% %n)ek% 5ang erlan#ng la+a te&r% +eta,la%a.

Te&r% %+,lanta% '%katakan a!9a k&leteat&+ ter$a'% ak%at %+,lanta%

e,%tel k#l%t e7ara %atr&gen%k ke 'ala+ tel%nga tenga! e9akt# &,era%: etela!

blust inury: ,e+aangan ,%,a ;ent%la%: ata# etela! +%r%ng&t&+%.

K&leteat&+ +er#,akan +e'%a 5ang a%k #nt#k te+,at ,ert#+#!an

k#+an %n)ek%: 5ang ,al%ng er%ng a'ala!Proteus'anPseudomonas aeruginosa.Seal%kn5a %n)ek% 'a,at +e+%7# re,&n %+#n l&7al 5ang +engak%atkan ,r&'#k%

eraga% +e'%at&r %n)la+a% 'an eraga% %t&k%n. S%t&k%n 5ang '%%'ent%)%ka%

ter'a,at ,a'a +atr%> k&leteat&+ a'ala! %nterle#k%n


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2.* Pat#genes!s

MSK '%+#la% 'ar% e,%&'e %n)ek% ak#t terle%! 'a!#l#. Pat&)%%&l&g% 'ar%

MSK '%+#la% 'ar% a'an5a %r%ta% 'an %n)la+a% 'ar% +#k&a tel%nga tenga! 5ang

'%eakan &le! +#lt%)akt&r%al: '%antaran5a %n)ek% 5ang 'a,at '%eakan &le!

;%r# ata# akter%: gangg#an )#ng% t#a: alerg%: kekealan t##! t#r#n:

l%ngk#ngan 'an &%al ek&n&+%. Ke+#ngk%nan ,en5ea ter,ent%ng +#'a!n5a

anak +en'a,at %n)ek% tel%nga tenga! a'ala! tr#kt#r t#a ,a'a anak 5ang ere'a

'engan 'e9aa 'an kekealan t##! 5ang el#+ erke+ang e+,#rna e!%ngga

%la ter$a'% %n)ek% $alan na,a ata: +aka le%! +#'a! ter$a'% %n)ek% tel%nga

tenga! er#,a t%t% Me'%a Ak#t MA.1:3

Re,&n %n)la+a% 5ang t%+#l a'ala! er#,a #'e+ +#k&a. (%ka ,r&e

%n)la+a% %n% teta, er$alan: ,a'a ak!%rn5a 'a,at +en5eakan ter$a'%n5a #lk#

'an +er#ak e,%tel. Mekan%+e ,erta!anan t##! ,en'er%ta 'ala+ +eng!ent%kan

%n)ek% %aan5a +en5eakan ter'a,atn5a $ar%ngan gran#la% 5ang ,a'a ak!%rn5a

'a,at erke+ang +en$a'% ,&l%, '% r#ang tel%nga tenga!. (%ka l%ngkaran antara

,r&e %n)la+a%: #lera%: %n)ek% 'an terent#kn5a $ar%ngan gran#la% %n%

erlan$#t ter# akan +er#ak $ar%ngan ek%tarn5a.1:3

12

Se+#! n&r+al

Gangg#an

t#a

Fg.t#a teta, tergangg#

In)ek%


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Ga+ar Pat&gene% t%t% Me'%a"

2.+ Fakt#r R!s!k#

Ter$a'% MSK !a+,%r elal# '%+#la% 'engan &t%t% +e'%a er#lang ,a'a

anak: $arang '%+#la% etela! 'e9aa. Fakt&r %n)ek% %aan5a eraal 'ar%

na&)ar%ng a'en&%'%t%: t&n%l%t%: r%n%t%: %n#%t% 'an +en7a,a% tel%nga tenga!

+elal#% t#a e#tak!%#. F#ng% t#a e#tak!%# 5ang an&r+al +er#,akan )akt&r

,re'%,&%% 5ang '%$#+,a% ,a'a anak 'engan ,alat&k%% 'an %n'r&+ '&9n.

A'an5a t#a ,at#l: +en5eakan re)l#k %% na&)ar%ng 5ang +er#,akan )akt&r

%n%'en MSK 5ang t%ngg% '% A+er%ka Ser%kat. Fakt&r !&t 5ang erka%tan 'engan

%n%'en MSK 5ang relat%) t%ngg% a'ala! 'e)%%en% %+#n %te+%k. Kela%nan

!#+&ral: e,ert% !%,&ga++agll%ne+%a 'an cell-mediated%n)ek% HI 'a,at

t%+#l eaga% %n)ek% tel%nga kr&n%.

Fakt&r


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)akt&r a,a 5ang +en5eakan at# tel%nga 'an erke+angn5a ,en5ak%t ke

ara! kea'aan kr&n%.

4. In)ek%1:3

Pr&e %n)ek% ,a'a &t%t% +e'%a #,#rat%) kr&n% er%ng '%eakan &le!

7a+,#ran +%kr&&rgan%+e aer&%k 'an anaer&%k 5ang +#lt%re%ten ter!a'a,

tan'ar 5ang a'a aat %n%. K#+an ,en5ea 5ang er%ng '%$#+,a% ,a'a

MSK %ala! Pseudomonas aeruginosa ek%tar "-=: Proteus sp. 2-= 'an

Staphylococcus aureus2"=.

(en% akter% 5ang '%te+#kan ,a'a MSK agak e'%k%t ere'a 'engan

kean5akan %n)ek% tel%nga la%n: karena akter% 5ang '%te+#kan ,a'a MSK

,a'a #+#+n5a eraal 'ar% l#ar 5ang +a#k ke l#ang ,er)&ra% ta'%.

". In)ek% al#ran na)a ata1:3

Ban5ak ,en'er%ta +engel#! ekret tel%nga e#'a! ter$a'% %n)ek% al#ran

na)a ata. In)ek% ;%r# 'a,at +e+,engar#!% +#k&a tel%nga tenga!

+en5eakan +en#r#nn5a 'a5a ta!an t##! ter!a'a, &rgan%+e 5ang e7ara

n&r+al era'a 'ala+ tel%nga tenga!: e!%ngga +e+#'a!kan ,ert#+#!an

akter%.

*. A#t&%+#n1:3

Pen'er%ta 'engan ,en5ak%t a#t&%+#n akan +e+%l%k% %n%'en le%! ear

ter!a'a, &t%t% +e'%a kr&n%.

. Alerg%1:3

Pen'er%ta alerg% +e+,#n5a% %n%'en &t%t% +e'%a kr&n% 5ang le%! t%ngg%

'%an'%ng 5ang #kan alerg%. ang +enar%k a'ala! '%$#+,a%n5a eag%an

,en'er%ta 5ang alerg% ter!a'a, ant%%&t%k tete tel%nga ata# akter% ata# t&k%n

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