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Chronic Suppurative Otitis Media
Ivan Wudexi
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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
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Keluhan utama
Pengeluaran cairan dari telinga kanan
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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.
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Riwayat Penyakit Dahulu (RPD)
Pasien mempunyai riwayat infeksi telinga
berulang yang disertai dengan pengeluaran
cairan (otorrhea)
Tidak ada riwayat allergi.
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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
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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
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Pemeriksaan THT
Mulut dan tenggorokanLips Normal
Tooth Ginggiva Normal
Tongue Normal
Palate Normal
Uvula Normal
Tonsil Normal
Posterior Oropharynx Normal
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Diagnosis
Otitis Media Kronis Type Benign Active pada
Auris Dextra
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Manajemen
Aural Toilet
Aldisa tab (pseudoephredine + loratadine)
Alkilen tab (ofloxacin)
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Pembahasan
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Anatomy of middle ear
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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)
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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)
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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
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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)
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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)
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Types of TM Perforation
(buku ajar THT UI)
1. Central perforation annulus
is preserved
2. Marginal perforation
portion or the entire annulus
is involved
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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
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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)
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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)
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Diagnosis
Clinical features and otoscopic findings
WHO,2004
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Clinical features
Otorrhea (either intermittent or continuous)
Absence of pain and fever
Hearing loss (made worse by water exposure)
WHO,2004
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Otoscopic findings
Discharging tympanic perforation
Mucoid otorrhea
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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)
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Management
Medical Management
Surgical Management
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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)
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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)
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Complication of CSOM
Mastoiditis
Facial nerve paralysis
Petrositis Labyrinthitis
Intracranial complications (ex. Lateral sinus
thrombosis, meningitis, brain abscess)
(Lustig LR et al., 2013)
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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)
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Maturnuwun
Mohon asupan
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