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Refleksi KasusRia Mediana09/289473/KU/13473Group 13308

The external ear canal is a tube like structure, at the bottom of which is the tympanic membrane.The ear canal is blind-ended so nothing can pass through to keep it clean. It must stay open to allow sound to pass freely through tympanic membrane.

Introduction

Review anatomy

The earwax is deposited along the canal by tiny structures called ceruminous glands. Cerumen forms when glandular secretions from the outer one-third of the ear canal mix with exfoliated squamous epithelium.Each ear canal contains between 1000 to 2000 ceruminous glands. These glands are similar to the apocrine sweat glands (underarm)

Cerumen is composed of secretions and sloughed epithelial cells and hair from the external auditory canal. It protects the skin in the canal and is naturally extruded. However, cerumen may accumulate and occlude the canal of one or both ears, causing discomfort, hearing loss, tinnitus, dizziness, and chronic cough.Introduction

Normally, cerumen is eliminated or expelled by a self-cleaning mechanism, which causes it to migrate out of the ear canal, assisted by jaw movementThe old cerumen is moved through the ear canal by motions from chewing and other jaw movements and as the skin of the ear canal grows from the inside out

Ceruminous glands work in concert with sabaceous glands to produce small peptides, and waxy/oily substances such as fatty acids, sebum, squalene, and cholesterol.

The ear canal is not easily cleaned from the outside, so it depends on the system of epithelial migration to clear the sloughed skin layers. The skin cells that are sloughed off (a process called skin desquamation) can accumulate in the cerumen that is deposited on the surface. If it didnt clean itself out, the outer layers of skin constantly peeling off accumulate block! symptoms appear

So the components of earwax are shed layers of skin, with 60% of the earwax consisting of keratin, 1220% saturated and unsaturated long-chain fatty acids, alcohols, squalene and 69% cholesterolComponents of earwax

Accumulation of cerumen that causes symptoms, prevent a needed assessment of the ear canal/tympanic membrane or audiovestibular system, or bothCerumen Impaction

Older ageAbnormally narrow or misshaped ear canal earwax has more difficulty being expelledHairy ear canalHearing air wearersUse of cotton-tip applicators (Q-tips) earwax actually pushed deeper blockage!Psoriasis or seborrhea in the ear canalHistory of previous earwax impactionsRisks

Impaired hearingFeeling fullness in the earsItching and/or ringing in the ears (tinitus)Ear pain (otalgia)Cough

Sign and symptoms

Direct visualization with an otoscope

Diagnosis

Nama: RKUmur: 5 tahunAlamat: Jalan Teratai 4/89 CondongcaturPekerjaan: -No RM: 017196xxTanggal masuk: 25 Februari 2015Case Report

ANAMNESISKU : telinga sakit curiga kotoranRPS : Ortu os mengatakan os sering mengatakan telinganya sakit dan gatal sudah lama. Ortu os curiga ada sesuatu yang masuk di kuping karena os sering memukul-mukul telinganya seakan-akan ingin mengeluarkan sesuatu. Penggunaan cotton bud untuk membersihkan telinga (+) namun tidak sering. Kemasukan air (-), keluar cairan dari telinga (-). Pendengaran berkurang (-). Keluhan lain pada hidung seperti pilek (-), pada tenggorokan seperti batuk (-)

RPD Keluhan serupa (-)Alergi (-)Trauma (-)

RPKTidak ada keluhan

PEMERIKSAAN FISIKKU: baik, CMVital signTD: 86/55 mmHgN: 109 x/minRR: 20 x/minSuhu: afebris

Ear examinationRight Left AuriculaBentuk dan ukutran dalam batas normal, massa (-), hyperemic (-), Lubang di dekat tragusLymph nodeno enlargementCanalis auditorius externadischarge (-)discharge (-)hyperemis (-)hypermis (-)edema (-)edema (-)Cerumen block (+)Cerumen block (+)Tympanic membraneTidak terlihatTidal terlihatTragus and pinna pain(-)(-)Tunning fork testTidak dilakukan

Nose examinationNose and Paranasal sinusesRightLeftInspectionSimetris (+), deformitas (-), discharge (-), edem (-), hyperemic (-)PalpationTenderness (-), crepitation (-)Tenderness (-), crepitation (-)PercussionParanasal sinuses pain (-)Paranasal sinuses pain (-)

Anterior Rhinoscopy = tidak dilakukanPosterior Rhinoscopy = tidak dilakukan

Mouth and throat examinationFindingsLipsWarna dalam batas normal; tidak ada lukaBuccal mucoushiperemic(-); stomatitis (-); massa(-)Tonguehiperemic(-); massa (-); deformity (-)Palatumhiperemic(-); mass (-); deformity (-)Gumedema (-); hiperemic (-); deformity (-)Toothcarries (-); deformity(-)Uvuladeviation (-); edema (-); hiperemis (-)TonsillaT1 T1 ; hiperemic (-); detritus (-); crypt enlargement (-)PharynxHiperemic (-)

Indirect laryngiscopy = Tidak dilakukan

DIAGNOSISBerdasarkan anamnesis dan pemeriksaan fisik, diagnosis pasien Cerumen Prop Auris Dextra Sinistra

TERAPIIrrigasi

EDUKASI Telinga tidak boleh terkena air Jaga kebersihan telinga, kurangi penggunaan cotton bud

Discussion

Manual removal using currete, forceps, or suctionIrrigation of the external auditory canal with or without using ceruminolyticsCeruminolytics

Treatment

Manual removal involves the use of a metal or plastic loop or spoon. It generally is considered effective, but there are no trials comparing it with other methods for effectiveness or safetyAdvantages of manual removal: It does not exposed the ear canal to moisture and therefore may lessen the risk of infection. Quicker and allow direct visualization of the procedure via a hand-held monocular otoscope

Manual removal

It involves washing out the ear canal with water from irrigator or syringe with catheter attached.The water must be close to body temperature (too cold or too warm can induce dizziness or nauseated)After the irrigation, the ear canal should be dried out to prevent from infection

Irrigation

Irrigation should not be used if the patients eardrum is ruptured; history of chronic otitis media; myringotomy

3 types of cerumen-softening prearationsWater-basedOil-basedNon-water-based/non-oil-basedCeruminolytics before irrigation may improve irrigation success by as much as 97 percent

Ceruminolytics

In most cases, impacted cerumen is succesfully removed. Prognosis

Cotton ear buds are not definitively associated with cerumen impaction, but they have been implicated in impaction and otitis externa and should be avoidedEar candling also should be avoided. It actually lead to occlusion with candle wax in persons who previously had clean ear canals. Complications from ear candling including candle wax occlusion, local burns, and tympanic membrane perforation.

Warning!

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