refkas csom

Download refkas CSOM

Post on 14-Apr-2018

219 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • 7/29/2019 refkas CSOM

    1/33

    Chronic Suppurative Otitis Media

    Ivan Wudexi

  • 7/29/2019 refkas CSOM

    2/33

    Identitas Pasien

    Nama: Ny. P

    Umur: 42 tahun

    Jenis Kelamin: Perempuan Alamat: Balingasal, Padureso, Kesumen

    Pekerjaan: Pegawai Negeri

    Tanggal Masuk: 19-07-2013 No. RM: 280109

  • 7/29/2019 refkas CSOM

    3/33

    Keluhan utama

    Pengeluaran cairan dari telinga kanan

  • 7/29/2019 refkas CSOM

    4/33

    Riwayat Penyakit Sekarang (RPS)

    Keluhan pengeluaran cairan tersebuttelah dirasakan olehpasien sejak kurang lebih 2 bulan yang lalu. Selama kurun2 bulan, pasien mengkonsumsi antibiotik oral namunkeluhan masih menetap.

    Pasien mendeskripsikan bahwa cairannya berwarnakekuningan dan sedikit berbau tanpa disertai darah.Selain itu, pasien juga mengeluhkan adanya penurunanpendengaran di telinga kanan yang bertambah parah bilatelinga kanan terpapar air. Rasa nyeri di telinga tidakdirasakan. Keluhan di kepala, leher, tenggorokan danhidung disangkal.

  • 7/29/2019 refkas CSOM

    5/33

    Riwayat Penyakit Dahulu (RPD)

    Pasien mempunyai riwayat infeksi telinga

    berulang yang disertai dengan pengeluaran

    cairan (otorrhea)

    Tidak ada riwayat allergi.

  • 7/29/2019 refkas CSOM

    6/33

    Pemeriksaan THT

    Telinga

    Dextra Sinistra

    Pinna Ukuran dan bentuk dbn,

    massa(-), hiperemis(-)

    Ukuran dan bentuk dbn ,

    massa(-), hiperemis(-)

    Tragus and/orpinna pain

    (-) (-)

    Canalis

    auditorius

    externus

    massa(-), hyperemis (-),

    bengkak(-)

    massa(-), hyperemis (-),

    bengkak(-)

    Membran

    timpani

    Terlihat perforasi central

    subtotal, discharge (+),

    granulasi (-)

    Dalam batas normal, cone of

    light positive(+), hyperemis (-)

    Mastoid Normal, nyeri (-) Normal, nyeri(-)

    Lymp. node Tidak ada perbersaran

  • 7/29/2019 refkas CSOM

    7/33

    Pemeriksaan THT

    HidungNose

    Paranasal

    Sinus

    Kanan Kiri

    Inspeksi hidung Normal Normal

    Palpasi hidung

    dan sinusNormal, nyeri(-) Normal, nyeri (-)

    Anterior

    Rhinoscopy

    Discharge(-), concha terlihat

    normal, septum tidak

    terdeviasi, massa(-)

    Discharge(-), concha terlihatnormal, septum tidak

    terdeviasi, massa(-)

    Posterior

    Rhinoscopy

    Tidak dilakukan

  • 7/29/2019 refkas CSOM

    8/33

    Pemeriksaan THT

    Mulut dan tenggorokanLips Normal

    Tooth Ginggiva Normal

    Tongue Normal

    Palate Normal

    Uvula Normal

    Tonsil Normal

    Posterior Oropharynx Normal

  • 7/29/2019 refkas CSOM

    9/33

    Diagnosis

    Otitis Media Kronis Type Benign Active pada

    Auris Dextra

  • 7/29/2019 refkas CSOM

    10/33

    Manajemen

    Aural Toilet

    Aldisa tab (pseudoephredine + loratadine)

    Alkilen tab (ofloxacin)

  • 7/29/2019 refkas CSOM

    11/33

    Pembahasan

  • 7/29/2019 refkas CSOM

    12/33

    Anatomy of middle ear

  • 7/29/2019 refkas CSOM

    13/33

    Chronic Otitis Media

    Definition

    A recurrent infection of the middle ear and/or

    mastoid air cell tract in the presence of a

    tympanic membrane perforation

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    14/33

    Chronic Otitis Media- Classification

    Benign (inactive) COM

    Characterized by a dry tympanic membraneperforation, not associated with active infection

    Chronic Serous Otitis MediaCharacterized by continuous serous drainage(typically straw-colored)

    Chronic Suppurative otitis media (CSOM)Diagnosed when there is persistent purulentdrainage through a perforated tympanic membrane

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    15/33

    CSOM

    Definition

    WHO defines CSOM as a chronic inflammation

    of the middle ear and mastoid cavity, which

    presents with recurrent ear discharges or

    otorrhea through a tympanic perforation

    WHO,2004

  • 7/29/2019 refkas CSOM

    16/33

    CSOM

    The point in time when AOM becomes CSOM

    is still controversial

    The WHO definition requires only 2 weeks of

    otorrhea, but otolaryngologists tend to adopt

    a longer duration varying from 6 weeks up to

    3 months

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    17/33

    Types of CSOM

    There are two major types of CSOM:

    1. Mucosal type (tubo-tympanic disease,relatively safe)

    2. Bony type (attico-antral disease)

    According to the discharge activity, it can be

    divided into active CSOM dan inactive CSOM.

    (buku ajar THT UI)

  • 7/29/2019 refkas CSOM

    18/33

    Types of TM Perforation

    (buku ajar THT UI)

    1. Central perforation annulus

    is preserved

    2. Marginal perforation

    portion or the entire annulus

    is involved

  • 7/29/2019 refkas CSOM

    19/33

    Risk factor

    Lower socioeconomic areas

    Delay in tx for AOM

    Poorer hygienic condition

    Increased smoking

    Poorer nutrition History of recurrent ear infections in childhood, with

    longstanding (months or years) of otorrhea

    Race predisposition (Australian Aborigines, Alaskaneskimos, american indians)

    WHO,2004

  • 7/29/2019 refkas CSOM

    20/33

    Pathogenesis

    Occurs as a consequence of an episode ofAOM with perforation, with subsequentfailure of the perforation to heal.

    Multiple episodes of acute infection outerepithelial layer of TM grows over the

    perforation edges, covering middle fibrousand inner mucosal layer non-closing(chronic perforation) TM.

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    21/33

    Microbiology

    Most common recovered organism are P.aeruginosaand S.aureus

    In CSOM, typical pathogens reach the middle earthrough:

    Insufflation of respiratory pathogens through theeustachian tube from the nasopharnyx intomiddle ear

    Spread from the external canal inward through anon-intact tympanic membrane

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    22/33

    Diagnosis

    Clinical features and otoscopic findings

    WHO,2004

  • 7/29/2019 refkas CSOM

    23/33

    Clinical features

    Otorrhea (either intermittent or continuous)

    Absence of pain and fever

    Hearing loss (made worse by water exposure)

    WHO,2004

  • 7/29/2019 refkas CSOM

    24/33

    Otoscopic findings

    Discharging tympanic perforation

    Mucoid otorrhea

  • 7/29/2019 refkas CSOM

    25/33

    Management

    The goals of the tx of CSOM:

    Stop otorrhea

    Heal the tympanic membrane Eradicate current infection

    Prevent complications

    Prevent recurrence

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    26/33

    Management

    Medical Management

    Surgical Management

  • 7/29/2019 refkas CSOM

    27/33

    Medical Management

    Aural Toilet

    Topical antibiotics (ex. Ciprofloxacin or

    ofloxacin)

    Systemic antibiotics only considered in

    patients at risk for complicated or invasive ear

    infections or in those who have received

    several courses of empiric topical therapy and

    are at higher risk for resistant organisms.

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    28/33

    Surgical Management

    Indication: patients who develop complication

    of chronic otitis, to remove infected tissue in

    the middle ear or mastoid and to repair ear

    damage that results in hearing loss andpresence of cholesteatoma.

    Example: mastoidectomy, tympanoplasty,

    ossicular bone reconstruction(Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    29/33

    Complication of CSOM

    Mastoiditis

    Facial nerve paralysis

    Petrositis Labyrinthitis

    Intracranial complications (ex. Lateral sinus

    thrombosis, meningitis, brain abscess)

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    30/33

    Follow Up and Education

    Patient must be educated on how to apply

    topical antibiotic

    Patients should be advised to keep their ears

    dry to prevent future complications, even

    after medical tx results in a safe and dry ear.

    During bath, the affected ears may be

    occluded with petrolatum cotton

    (Lustig LR et al., 2013)

  • 7/29/2019 refkas CSOM

    31/33

    Maturnuwun

    Mohon asupan

  • 7/29/2019 refkas CSOM

    32/33

  • 7/29/2019 refkas CSOM

    33/33