Presentator : dr. JennyModerator : dr. Budi Santoso

The peripheral auditory system is divided into 3 parts :

The external earThe middle earThe inner ear

The external auditory canal consists of a 1/3 lateral cartilaginous portion and a 2/3 medial bony portion.

The tympanic membrane consists of three layers: the outer, middle, and inner layers.

The middle ear cavity originates embryologically from the first branchial pouch

There are three ossicles the malleus, the incus, and the stapes.

= inflammatory process within the middle ear cleft.

Otitis media can be either acute or chronic. There is no absolute time period that distinguishes between acute and chronic OM, but, in general, disease that persists for more than 3 months should be considered chronic.

Classification of Otitis Media.Acute Otitis Media SuppurativeNonsuppurativeRecurrentChronic Otitis Media SuppurativeTubotympanicCholesteatomaNonsuppurativeOtitis media with effusion

Acute otitis media (AOM) is one of the most common infectious diseases seen in children, having its peak incidence in the first 2 years of life.

Recurrent AOM is defined as 3 episodes of acute suppurative OM in a 6-month period, or 4 episodes in a 12-month period, with complete resolution of symptoms and signs between episodes of infection.

Factors Relevant to the Epidemiology of Otitis Media Environmental FactorsDay-care attendanceNot being breast-fedExposure to tobacco smokeSeasonal variation in respiratory infectionsHost FactorsGeneticsImmunodeficiencyBirth defectsCleft palateDown syndrome

Acute Respiratory Tract Infection Eustachian tube dysfunction Inflammation process tube occlusion decrease oxygen concentration mucocilliary defect changes in pressure (-ve) sterile transudation infection accumulation of transudate bulging perforation resolution (if adequate treatment and good immune system)

*Occlusion stadium of Eustachian tubeRetraction feature of tympanic membrane may appears as a normal or clouded

*2. Hyperemia stadium Dilatation of blood vessels and edema in TM exudate serous discharge are formed

*3. Suppurated stadiumSevere mucosal edema in the middle earTM is bulging toward external earPulse, body heat, and earache are increaseseverely

*Perforation stadiumTM is rupture Discharge flow out from the middle earBody heat is decrease or normal

*

Resolution stadium Discharge is decrease and dried up TM returns to normal (

*To reduce the severity and duration of pain and other symptoms,To stop infection prosesTo prevent complications,To minimise adverse effects of treatment.

*1. Occlusion stadium :Decongestant Antibiotic

2. Hyperemia stadium :AntibioticDecongestantAnalgetic\

3. Suppurated StadiumAntibioticAnalgesic, antipyretic If necessaryMyringotomi

*

4. Perforation stadiumH2O2 3 % for 3-5 daysAntibiotic

5. Resolution StadiumAntibiotic is continued until 3 weeks if discharge seen in canal ear via perforation TM

*First choice : Amoxicillin Dose : 40 50 mg/kg BW/day Effectiveness 85 -94 % Cheap Save

If resistance :Amoxyclav, cefuroxim, ceftriaxoneThird choice : clindamycin

*The prognosis of patients with acute otitis media is excellent. However, patients and/or their parents still should be encouraged to finish the prescribed medication and to keep their follow-up appointments.Symptoms usually improve within 24 hours and almost always within 48-72 hours.

Patients identityName: NAge: 53 y.oSex: FemaleAddress: Ngentak BaruNo. RM: 1.36.68.41

Main complaint: earache in the both earHistory of present illness: Since two days ago, she felt that her both earache. Earache continoues, likely pulsating. The pain more painfull before yesterday. She also cmplaint in her both ear there is hearing impairment. Since one weeks ago she also felt cough and runny nose. Until now, sometime she still felt runny nose. no sound nging or ngung in her both ear. Sore throat (-), fever (-). History of the same illness (-). Previous history of diabetes mellitus, hypertension, allergic disease are denied. There was no one who suffered from that kind of disease in his family.

Resume AnamnesisOtalgia (+) Hearing loss (+) Fever (+) Rhinorrhea (+)

General condition: good, CM, well nourished, body weight 17 Kg.Vital sign:R: 20x/mntBP: 120/80 mmHgP: 80x/mntT: Afebris

Refer to the whiteboard

AD + AS Acute otitis media Hyperemic stage ec. Rhinitis akut

This patient was treated with Antibiotic (Amoxicilin 500mg + clavulanat 125mg threetimes a day), decongestan (pseudoefedrin 120mg + loratadine 10mg SR three times a day), mukolitic (ambroxol 30mg three times a day), Antiinflammation (metilprednisolon 4 mg 2 1 0), analgetic (paracetamol 500mg three times a day). Five days first control after treatment, complaint earache (-), there is improvment AD + AS hearing impairment . The treatment was Antibiotic (Amoxicilin 500mg + clavulanat 125mg three times a day), decongestan (pseudoefedrin 120mg + loratadine 10mg SR three times a tday), mukolitic (ambroxol 30mg three times a day), Antiinflammation (metilprednisolon 4 mg 1 1 0 for three days and 1 1 0 for three days)Five days second control after treatment, the complaint of AS hearing impairment is minimal. The treatment was decongestan (pseudoefedrin 120mg + loratadine 10mg SR three times a day), mukolitic (ambroxol 30mg three times a day), Antiinflammation (metilprednisolon 4 mg 1 1 0)

*Avoid water exposureAvoid ear manipulationMaintain well nourished nutrition

*

From some literate there is still controversion of using antiboik to treat AOM. some of the study think aom is self limin But in this patient we using anti because according to anam, phiskal examin there is sekuninfe.The sign and simpy sekunder infection like fever, mukopurulendiscgae. In this case shown improment of the treatment and we can see from the anam fisikal anan we get hiper estage direct resolution stage.