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Imaging in Otorhinolaryngology

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Foto
Waters

Deskripsi
Sinus maksilaris, frontal, dan
ethmoidal

Schedel
PA
sinus frontal
PA
dan Lateral
sinus frontal,
lateral
sphenoidal,dan ethmoidal
Schuller

Mastoid lateral

Towne

Dinding
posterior
maksilaris

Caldwell

Sinus frontalis

Rhese/
oblique

Bagian posterior dinding
ethmoid, kanalis optikus, dan
dasar orbita

Stenver

Seluruh bagian mastoid

sinus

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OTITIS EKSTERNA

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O

s Eksterna Furunkulosa (Sirkumskripta)

Penyebab: Staph. Aureus, Staph. Albus.
Terletak di folikel rambut atau gld.sebasea yang tersumbat.
Hanya terjadi di 1/3 ext canal (part kar laginosa)
TRAUMA ABRASION / MACERATION
STAPHY. SP (DM)
INFECTION
SPONTANEUS / RECURRENCY

O

s eksterna difusa

Penyebab: Pseudomonas (usually), Staph albus, E. Coli.
Mengenai seluruh CAE, menyebabkan penyempitan kanal
Manipulasi liang telinga hilangnya lapisan lemak muara kelenjar
terbuka resorbsi cairan dari luar oedem sekresi kelenjar sebacea
& sudorifera
permukaan kulit kering rasa gatal pada liang telinga
ingin menggaruk & laserasi kulit mempermudah invasi kuman
(Mawson 1974 )

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Diberikan pada orang dewasa ampisillin 250 mg qid. actives againts S. visit: www. E. Klebsiella sp. hidrokor son dan anestesi topikal. Anak-anak diberikan dosis 40-50 mg per kg BB. eritromisin 250 qid. Pilihan antibiotika yang dipakai adalah campuran polimiksin B. active againts Pseudomonas sp. actives againts Pseudomonas sp.foxitsoftware... (PPM Puskesmas) Pada otitis eksterna difus dengan memasukkan tampon yang mengandung an bio k ke liang telinga supaya terdapat kontak yang baik antara obat dengan kulit yang meradang. and E. gentamicin. and Klebsiella sp.coli. neomisin. coli. (PPM Puskesmas) Kebanyakan furunkel direabsorpsi secara spontan. Topical antibiotics usually contains boric or acetic acid to decrease pH of the canal neomycin.Terapi OE Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Furunkulosa/Sirkumskripta Difusa Otitis eksterna sirkumskripta pada stadium infiltrat diberikan salep ikh ol atau an bio k dalam bentuk salep seperti polymixin B atau basitrasin. aureus. polymyxin B or E. newer quinolon preparations of cipro oxacin and o oxacin appear to equally efficacious in controlling acute otitis externa . Proteus sp. namun jika dalam 24-48 jam bisulnya belum pecah maka dilakukan insisi dan drainase Sistemik : Antibiotika diberikan dengan pertimbangan infeksi yang cukup berat..

campuran dari alkohol/ gliserin dalam H2O2. Diagnostic handbook of otorhinolaryngology. Buku Ajar THT-KL FKUI. Thieme. 2007. BACK . 3x seminggu Menner. visit: www. 2003.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor Keratosis Obturans To remove this notice.com/shopping Penumpukan epitel skuamous dalam jumlah besar yang susah di keluarkan Penyebab: inflamasi kronik Tx: aural drops. a pocket guide to the ear.

dan debridement agresive BACK . visit: www.foxitsoftware. osteomielitis the osseous auditory canal & skull base ( fissures). X atau XI jika terjadi di foramen jugularis Kematian jika terjadi trombosis sinus lateralis Tx: antibiotik sistemik dan topikal. osteitis. IX.com/shopping Sering terjadi pada penderita diabetes usia tua atau imunokompromised Berasal Otitis eksterna selulitis. kondritis.Malignant O s Eksterna (Necro zing OE) Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Bisa menyebabkan facial nerve paralysis n.

dan ukuran bula yang bervariasi pada membran timpani dan struktur tulang sekitar kanalis Penyebab: virus.com/shopping Infeksi pada membran mpani yang dikarakteristikkan dengan onset cepat. nyeri sekali.foxitsoftware. dan tetes kortikosteroid Hindari pemecahan bula dan irigasi telinga!! BACK . visit: www. Mycoplasma. antibiotik topikal.Edited with the trial version of Foxit Advanced PDF Editor Miringi s Bulosa To remove this notice. dan bakteria Bula cairan serosa dan hemoragic Tx: analgesia.

com/shopping BACK . Involvement of the facial & cochleoves bular nerves facial palsy.Edited with the trial version of Foxit Advanced PDF Editor Herpes Zooster O cus Herpes zooster otticus The virus stays dormant in the sensory ganglia & reactivates under conditions of decreased immune competence. with or without hearing loss & dizziness Ramsay Hunt syndrome. visit: www.foxitsoftware. even on the lateral surface of the tympanic membrane. Tx: acyclovir & corticosteroid ©Bimbel UKDI MANTAP To remove this notice. The mostly self-limiting. the EAC. The virus causes blisters on the auricle.

bengkak. nyeri.Edited with the trial version of Foxit Advanced PDF Editor Celluli s of the Auricle To remove this notice. ©Bimbel UKDI MANTAP BACK . & nyeri tekan. laserasi atau ear piercing.com/shopping Infeksi bakteri aurikula abrasi.swelling is contagious. perawatan luka Bentuk KHUSUS: Erysipelas disebabkan -hemolytic Streptococcus Tanda: Systemic toxicity: fever and chills Erythema Pain . Jika trauma (-) alergi / polychondritis Tx: antibiotik oral / iv. Etilogi: Staphylococcus or Streptococcus. Tanda: merah.foxitsoftware. Tx: oral / intravenous penicillin G & wound care. visit: www. Pseudomonas (jarang).

Etiologi: inadequately treated auricular cellulitis. red. visit: www. The most common pathogen: Pseudomonas sp.com/shopping Perichondritis / chondritis a bacterial infection of perichondrium or car lage of the auricle. accidental or surgical trauma. acute otitis externa. Sign: painful.purulent exudates.foxitsoftware. ©Bimbel UKDI MANTAP BACK . or multiple ear piercing in the scapha.Edited with the trial version of Foxit Advanced PDF Editor Perichondri s & Chondri s To remove this notice. swollen & drains serous . Extend to the surrounding soft tissues of the face & neck.

com/shopping Auricula Hematom / Othaematom BACK . visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. visit: www.com/shopping Pseudokista Terdapat benjolan didaun telinga yang disebabkan oleh adanya kumpulan cairan kekuningan diantara lapisan perikondrium dan tulang rawan telinga .

Adanya benda asing di liang telinga 5. visit: www. DRY .com/shopping Ear wax mixture of secretions of the ceruminose & pilosebaseus glands.HARD BACK .Edited with the trial version of Foxit Advanced PDF Editor Cerumen Prop To remove this notice. Liang telinga sempit 3. Dermatitis kronik liang telinga luar 2. Pada pemeriksaan penala dapat ditemukan tuli konduktif akibat sumbatan serumen.foxitsoftware.SOFT Symtomps : Hearing impairment (deafness) CHL Earache Reflex cough Fullness in the ear Tinitus vertigo Objec ve Otoskopi: dapat terlihat adanya obstruksi liang telinga oleh material berwarna kuning kecoklatan atau kehitaman. Protection acid condition : PH 6 Transport of debris Lubricant Bactericid efect Faktor Risiko 1. Produksi serumen banyak dan kering 4. dust & other foreign debris located in the cartilaginous portion of the ears canal. Konsistensi dari serumen dapat bervariasi. Kebiasaan mengorek telinga WET . squames of epithelium.

serumen yang sangat keras dan pasien yang tidak kooperatif merupakan kontraindikasi dari suc on. Menghindari memasukkan air atau apapun ke dalam telinga 3. Serumen yang keras dikeluarkan dengan pengait atau kuret. Kontraindikasi dilakukannya irigasi adalah adanya perforasi membran timpani. Menghindari membersihkan telinga secara berlebihan 2. Bila terdapat keluhan tinitus. otitis eksterna. dibersihkan dengan kapas yang dililitkan pada pelilit kapas.foxitsoftware. visit: www. Serumen dianjurkan dikeluarkan setiap 6-12 bulan sekali . Indikasi untuk mengeluarkan serumen adalah sulit untuk melakukan evaluasi membran timpani.com/shopping Serumen yang lembek. oklusi serumen dan bagian dari terapi tuli konduktif.Apabila dengan cara ini Serumen tidak dapat dikeluarkan. dikeluarkan dengan mengalirkan (irigasi) air hangat yang suhunya disesuaikan dengan suhu tubuh. Serumen yang sudah terlalu jauh terdorong kedalam liang telinga sehingga dikuatirkan menimbulkan trauma pada membran timpani sewaktu mengeluarkannya. maka serumen harus dilunakkan lebih dahulu dengan tetes karbogliserin 10% selama 3 hari.Edited with the trial version of Foxit Advanced PDF Editor Penatalaksanaan 1. Tatalaksana farmakoterapi: To remove this notice.

visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.com/shopping Irriga on Ceruminoly c Manual Removal BACK .

visit: www.com/shopping Gejala klinik : otalgia dan otorrhea sebagai gejala yang paling banyak dijumpai. Ketiadaan serumen. A. To remove this notice. rasa penuh pada telinga gatal Gambaran hifa dan spora dalam liang telinga Cotton wool appearance (Candida) BACK . Allescheria boydii. Absidia.foxitsoftware. dan nyeri Aspergillus niger A. Rhizopus. Penicillium. dan Candida Spp. pengelupasan epitel superfisial penumpukan debris yang berbentuk hifa. fumigatus. disertai suppurasi.Edited with the trial version of Foxit Advanced PDF Editor Otomycosis Otitis Eksterna yang disebabkan oleh jamur Mikosis pembengkakan. Peningkatan pemakaian preparat steroid dan antibiotik topikal. Olah raga air Status pasien yang immunocompromised . kurangnya pendengaran. avus. Scopulariopsis. Instrumentasi pada telinga. Faktor Resiko Cuaca yang lembab.

S Jimenez Alvarez.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. E Gil-carcedo Sanudo. Manajemen Ear toilet Obat anti jamur topikal Nystatin efektif untuk Candida sp.foxitsoftware. 56. dan dieramkan pada suhu kamar. 181-186. (2005). visit: www. P Hueso Gutirrez. Acta Otorinolaringol Esp. Miconazole efektif utk Aspergillus sp. Asam asetat 2 % dalam alkohol sebagai keratolytic Jaga telinga tetap kering dan cegah manuver2 pada telinga BACK 1. dan kadang-kadang dapat ditemukan spora-spora kecil.com/shopping Pemeriksaan penunjang Preparat langsung : skuama dari kerokan kulit liang telinga diperiksa dengan KOH 10 % hifa-hifa lebar. Presumed diagnosis : Otomycosis. . Pembiakan : Skuama dibiakkan pada media Agar Saboraud. berseptum. Koloni akan tumbuh dalam satu minggu. et al. A study of 451 patients.

Edited with the trial version of Foxit Advanced PDF Editor OTITIS MEDIA AKUT The presence of in amma on in the middle ear accompanied by the rapid onset of signs and symptoms of an ear infection To remove this notice.foxitsoftware. visit: www.com/shopping BACK BACK .

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visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Acute : <3 minggu Subacute : 3 minggu 2 bulan Chronic > 2 bulan BACK .foxitsoftware.

com/shopping Faktor Resiko Pa ent Factors Environmental Factors Prematurity and low birth weight Day care Young age Crowded living conditions Early onset Family history Race Native American. visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. 2004) BACK . Inuit. prolonged bottle use (AAP. Australian aborigine Altered immunity Craniofacial abnormalities Low socioeconomic status Tobacco and pollutant exposure Use of pacifier Prone sleeping position Neuromuscular disease Fall or winter season Allergy Not breastfed.

Tuning fork: conduc ve dea ness BACK .com/shopping Stage 1 : Oklusi tuba Stage 2 : Pre supurasi Stage 3 : Supurasi Stage 4 : Perforasi Stage 5 : Resolusi Nasopharyngeal oedema blocks the tube negative intratympanic pressure TM retrac on + minimal e usion in the middle ear Symptoms: Deafness earache (no fever) Signs. Retracted TM with handle of malleus more horizontal position.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware. prominence of lateral process of malleus and loss of light reflex.

Children high fever Signs: Conges on of pars tensa.com/shopping Stage 1 : Oklusi tuba Stage 2 : Pre supurasi Stage 3 : Supurasi Vasodilatation of vessel in tympanic membrane(cartwheel appearance) edema and hyperemic TM Symptoms: earache disturb sleep. visit: www. Reddening of whole tympanic membrane Tuning fork: conductive deafness Stage 4 : Perforasi Stage 5 : Resolusi BACK . Deafness and tinnitus. Leash of blood vessels appear along the handle of malleus.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.

Signs:red and bulging. visit: www. convulsions.com/shopping Stage 1 : Oklusi tuba Stage 2 : Pre supurasi Stage 3 : Supurasi Formation of pus in the middle ear Tympanic membrane starts bulging to the point of rupture. Symptoms: Earache excruciating. X-rays of mastoid: clouding of air cells exudate Stage 4 : Perforasi Stage 5 : Resolusi Tx: Myringotomy BACK . TM: Yellow spot may be seen on the tympanic membrane (rupture is imminent).Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Deafness increases Child: 102-103°F may be accompanied by vomiting.foxitsoftware.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.com/shopping Stage 1 : Oklusi tuba Stage 2 : Pre supurasi Stage 3 : Supurasi Stage 4 : Perforasi Stage 5 : Resolusi The delayed take of antibiotic or high virulence of bacterial tympanic membrane ruptured and pus extend to external ear. Symptoms : Decrease of temperature Restless kid calm Sign : Perforated TM Discharge (+) BACK .foxitsoftware.

2007) BACK . Pada stadium ini proses penyakit menyembuh Oedem mukosa berkurang. if perforated tympanic membrane is permanent.com/shopping Stage 1 : Oklusi tuba Stage 2 : Pre supurasi Stage 3 : Supurasi Stage 4 : Perforasi Stage 5 : Resolusi If the immune stage is high and low virulence of bacterial self limiting. sekret berkurang/mengering Membrana tympani kembali normal.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. if sterile effusion persists for more than 3 months (without any perforation) (FKUI.foxitsoftware. AOM serous otitis media (sequele). fungsi tuba membaik. terjadi resolusi pada perforasi membran timpani AOM chronic suppurate otitis media. visit: www.

com/shopping Pemberian farmakoterapi Topikal Pada stadium oklusi.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. tujuan terapi dikhususkan untuk membuka kembali tuba eustachius. dilanjutkan an bio k adekuat yang dak ototoksik seperti o oxacin tetes telinga sampai 3 minggu. visit: www.05%) Pada stadium perforasi.foxitsoftware.025 0.5-1% (atau oksimetazolin 0. Obat tetes hidung HCl efedrin 0. . diberikan obat cuci telinga H2O2 3% selama 3-5 hari.

dewasa 3x625 mg/hari. Pada stadium supurasi dilakukan miringotomi (kasus rujukan) dan pemberian an bio k. Anak 10 mg/KgBB 4 x sehari Jika terdapat resistensi. An pire k seperti paracetamol sesuai dosis anak. Anak 25 mg/KgBB 4 x sehari atau Amoksisilin: Dewasa 500 mg 3 x sehari.com/shopping Oral sistemik Dapat diberikan an histamin bila ada tanda-tanda alergi. Anak 10 mg/KgBB 3 x sehari atau Eritromisin : Dewasa 500 mg 4 x sehari. anak (trimethroprim 40 mg dan sulfamethoxazole 200 mg) suspensi 2x5 ml. Antibiotik yang diberikan pada stadium hiperemis ialah penisilin atau eritromisin. selama 10-14 hari: Ampisilin : Dewasa 500 mg 4 x sehari. dapat diberikan kombinasi dengan asam klavulanat atau sefalosporin. Jika kuman sudah resisten (infeksi berulang): kombinasi amoxyciline dan asam klavulanat. . visit: www. atau Erythromycine: Dewasa/ anak sama dengan dosis amoxyciline. Pada bayi/anak 50mg/kgBB/hari. Antibiotik yang diberikan: Amoxyciline: Dewasa 3x500 mg/hari.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.atau Cotrimoxazole: (kombinasi trimethroprim 80 mg dan sulfamethoxazole 400 mg tablet) untuk dewasa 2x2 tablet.

visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.com/shopping Manajemen BACK .

2002) .foxitsoftware. Myringotomy Insisi kecil melubangi gendang telinga Fungsi: mengeluarkan cairan dari telinga dalam dan menghilangkan rasa sakit. bulging Impending intracranial complica ons Perforated AOM with insufficient drainage Secretory AOM Hemotimpanum Unresolutive AOM (Bhargava.com/shopping Pengobatan Operatif Indications : 1.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. untuk mengaspirasi sekret yang tebal seperti lem (glue ear) ©Bimbel UKDI MANTAP Suppurative stage: extreme pain. Terkadang dibuat dua insisi pada membran timpani (opencan): daerah anteroinferior dan insisi kedua di daerah anterosuperior. visit: www.

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berlangsung 6 hingga 12 bulan di dalam telinga hingga infeksi telinga bagian tengah membaik dan sampai tuba Eustachi kembali normal. tonsilektomi dan mencuci (membersihkna) sinus maksillaris ©Bimbel UKDI MANTAP . Terapi pembedahan (opera f) faktor predisposisi (+) mungkin dibutuhkan adenoidektomi.com/shopping 2. visit: www. 3. Pemasangan Tube Ven lasi Tube ventilasi ini dipasang sifatnya sementara.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.com/shopping Indikasi miringotomi dan pemasangan pipa Komplikasi Otitis media akut berulang yang tidak respon terhadap terapi medikamentosa Otitis media efusi persisten >3 bulan & disertai CHL Indikasi absolut jika terjadi OME 40dB Indikasi relatif jika penurunan pendengaran 21-40dB Tujuan : Mengurangi frekuensi dan keparahan OMA Secara umum memperbaiki CHL yang disebabkan oleh OME ©Bimbel UKDI MANTAP Persisten perforasi MT pada waktu TT diambil(pipa yg dipertahankan selama 36 bulan) Timpanosklerosis atau scarring Pipa tersumbat Pembentukan jaringan granulasi disekitar pipa Penipisan atau atrofi disekitar pipa .

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. harus kontrol ke THT Tube biasanya lepas pada 9-12 bulan Pengambilan tube setelah 1824 bulan Surgical Care Tympanocentesis . For: Immunosupressed child Neonates with AOM Patients in whom antimicrobial therapy has failed and who continue to experience local or systemic signs of sepsis Complication of AOM (CMDT.foxitsoftware.com/shopping Post Pemasangan Grommet tube Follow up 3 minggu setelah pemasangan tube Kemudian kontrol se ap 6 bulan sampai tube diambil Jika terjadi 2x episode otore sebelum jadwal folow up 6 bulan.the aspiration of middle ear fluid.2008) ©Bimbel UKDI MANTAP BACK . visit: www.

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foxitsoftware.com/shopping Komplikasi Intra-temporal complica ons: Intra-cranial complica ons: Mastoiditis Petrositis Labyrinthitis Facial nerve paralysis extradural abscess brain abscess subdural abscess sigmoid sinus thrombophlebitis otic hydrocephalus meningitis BACK . visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

swelling.Edited with the trial version of Foxit Advanced PDF Editor Mastoidi s Inflammation of the mastoid air cells of the temporal bone Acute mastoiditis To remove this notice. pain behind ear.com/shopping Fever. associated with AOM. otalgia. ear discharge.foxitsoftware. visit: www. Chronic mastoiditis most commonly associated with Chronic suppurative otitis media (OMSK) and particularly with cholesteatoma formation BACK . redness.

Edited with the trial version of Foxit Advanced PDF Editor Aero s (Barotrauma) To remove this notice. visit: www.foxitsoftware.com/shopping Disebabkan perubahan tekanan telinga tengah menjadi nega f dalam waktu cepat Mukosa tuba bersifat one way ball valve Saat take off tekanan telinga tengah > lingkungan luar masih dapat terkompensasi Saat landing tekanan telinga tengah < lingkungan luar Retraksi membran mpani & resiko hemotympanum dan efusi Pencegahan: Preflight dose of a 12 hour vasoconstricting nasal spray like oxymetazoline Oral decongestant Gum chewing while landing BACK .

BACK .Edited with the trial version of Foxit Advanced PDF Editor O s Media Supura f Kronik (OMSK) Radang kronis telinga tengah dengan perforasi membrane timpani dan riwayat keluarnya secret dari telinga (otore) lebih dari 2 bulan. klebsiella. and E. baik terus-menerus atau hilang timbul.com/shopping Biasanya OMSK akibat campuran bakteri aerob dan anaerob: Aerobic: Pseudomonas aeruginosa. Secret mungkin encer atau kental. proteus species. Bacteroides fragilis.foxitsoftware. coli Anaerobic: prevotella and porphyromonas. anaerobic Streptococci. tympani < 2 bulan To remove this notice. bening atau berupa nanah OMSK : OMA + Perforasi memb. visit: www. aureus and epidermidis. tympani > 2 bulan OMSA : OMA + Perforasi memb. Staph.

gizi kurang Higiene buruk Gangguan fungsi tubuh oleh ISPA. tonsillitis kronis. infeksi persisten Daya tahan tubuh pasien rendah. obstruksi parsial retraksi membrane timpani Perforasi membrane telinga persisten Aerasi telinga tengah/mastoid yang mengalami obstruksi Skuestri atau osteomyelitis Alergi ISPA dengan sepsis atau obstruksi (adenoid.com/shopping Faktor.faktor yang menyebabkan OMSA menjadi OMSK: Terapi terlambat diberikan Terapi tidak adekuat Virulensi kuman tinggi.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www. sinusitis) .

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware.com/shopping Safe Dangerous/Unsafe Central A c or marginal Intermiten Mukopurulen/purulen +/Putih/kekuningan Jarang Banyak Kontinu Selalu purulent + Kekningan/kecoklatan/kehijauan Bisa ada darah Sedikit Tidak berpengaruh Polyp Jarang Sering Kolesteatoma Sangat jarang Hampir selalu ada Tuli Konduksi ringan sampai sedang Konduksi atau mix Ringan sampai berat Complication Sangat jarang Sering Radiograph mastoid Seluler or sklerotik Sklerotik with erosi Perforasi Discharge Frekuensi Mukus Bau tidak enak Warna Berdarah Volume Hubungan dengan URTI BACK .

visit: www.foxitsoftware.Edited with the trial version of ©Bimbel UKDI MANTAP Foxit Advanced PDF Editor Tataksana OMSK To remove this notice.com/shopping OTOREA KRONIS OTOSKOPI MT PERFORASI MT UTUH OMSK OTITIS EKSTERNA DIFUSA OTOMIKOSIS DERMATITIS/EKSIM OTITIS EKSTERNA MALIGNA MIRINGITIS GRANULOMATOSA KOMPLIKASI (-) KOLESTEATOM (-) OMSK non kolesteatoma ALGORITMA 1 ONSET. RIWAYAT PENGOBATAN GEJALA/TANDA KOMPLIKASI KOMPLIKASI (+) KOLESTEATOM (+) OMSK kolesteatoma ALGORITMA 2 BACK . FOKUS INFEKSI. PROGRESIVITAS. PREDISPOSISI PENYAKIT SISTEMIK.

MIKRO-ORGANISME OTOREA MENETAP >3 BLN IDEAL: MASTOIDEKTOMI + TIMPANOPLASTI PILIHAN ATIKOTOMI ANTERIOR TIMPANOPLASTI DINDING UTUH TIMPANOPLASTI DINDING RUNTUH ATIKOANTEROPLASTI TIMPANOPLASTI BUKA TUTUP BACK .foxitsoftware.com/shopping ALGORITMA 1 OMSK TENANG OMSK AKTIF STIMULASI EPITELIALISASI TIPE PERFORASI PERFORASI MENUTUP Tuli Konduksi? TIDAK (sembuh) OMSK BAHAYA KOLESTEATOM OMSK NON KOLESTEATOM PERFORASI MENETAP RO MASTOID (SCHULLER) X-RAY AUDIOGRAM TULI KONDUKTIF (+) IDEAL: TIMPANOPLASTI TANPA/ DENGAN MASTOIDEKTOMI Cuci telinga Antibiotik sistemik Lini 1 : Amoksisilin/sesuai kuman penyebab Antibiotik topikal OTOREA MENETAP >1 MGG ANTIBIOTIK BERDASAR PX. visit: www.Edited with the trial version of Foxit Advanced PDF Editor ©Bimbel UKDI MANTAP To remove this notice.

VII PTROSEKTOMI ©Bimbel UKDI MANTAP KOMPLIKASI INTRA KRANIAL ABSES EKSTRA DURA ABSES PERISINUS TROMBOFLEBITIS SINUS LATERAL MENINGITIS ABSES OTAK MENINGITIS OTIKUS RAWAT INAP PERIKSA SEKRET TELINGA ANTIBIOTIK I.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. DOSIS TINGGI 7-15 HARI KONSUL SPESIALIS SARAF/SARAF ANAK MASTOIDEKTOMI ANASTESI LOKAL/UMUM OPERASI BEDAH SARAF . visit: www.V.com/shopping ALGORITMA 2 OMSK + KOMPLIKASI KOMPLIKASI INTRA TEMPORAL ABSES SUBPERIOSTEAL LABIRINTISTIS PARESIS FASIAL PETROSITIS ANTIBIOTIK DOSIS TINGGI MASTOIDEKTOMI DEKOMPRESI N.

visit: www. beberapa faktor yang mempengaruhi faktor keturunan dan gangguan sirkulasi pada stapes Gejala dan tanda klinis Penurunan pendengaran progresif Tinnitus dan Vertigo Membran timpani kemerahan akibat pelebaran pembuluh darah pada promontorium ( sign) Pasien merasa pendengaran lebih baik pada ruang bising (Paracusis Willisi) Terapi Stapedektomi. stapes diganti bahan prostesa Pemberian Alat Bantu Dengar (ABD) ©Bimbel UKDI MANTAP BACK .foxitsoftware.com/shopping Otosklerosis merupakan penyakit pada kapsul tulang labirin yang mengalami spongiosis di daerah kaki stapes sehingga stapes menjadi kaku dan tidak dapat menghantarkan getaran suara ke labirin dengan baik Penyebab belum dapat dipastikan.Otosclerosis Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

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dpt sampai kavitas tympani atau faring. visit: www. rekurensi tinggi. sehingga harus ekstirpasi ©Bimbel UKDI MANTAP BACK . incisi pada lubang. pembengkakan hiperemis. purulent.com/shopping Adanya lubang kecil di depan auricula (crux helix) akibat tidak tertutupnya sulcus brachialis II lubang yang berlanjut sebagai saluran pendek/panjang. jangan tegak lurus.Preaurikular fistule Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. dibatasi epitel sehingga dari lubang dapat keluar hasil deskuamasi epitel Bila lubang tetap terbuka tidak ada gangguan Bila lubang tertutup kista atau abses. tidak ada elemen mukoid krn bukan mukosa Pemeriksaan radiologik : Fistulografi Bila terjadi abses. karena bisa terbentuk sikatrik.

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com/shopping 1. Nerve impuls hearing cortex Perceptive process Organum spirale N. auditory VIII Central nerve system BACK . Physical energy conversion nerve impuls 3. ossiculae ovale fenestra Bone conduction cranial bone internal auditory canal To remove this notice. visit: www. Sound resources receiver organ 2.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor Pemeriksaan Pendengaran Conduction process Air conduction EAC Tympanic mb.

diusahakan memakai perkataan yang digunakan sehari-hari. 4. Ruangan cukup lebar. 3. pemeriksa mengucapkan materi tes.Edited with the trial version of Foxit Advanced PDF Editor Pemeriksaan Pendengaran Tes Bisik (Whispered Voice Test) Tes Garputala Audiometri Nada Murni (Pure tone audiometry) Audiometri Nada Tutur (Speech audiometry) Impedance Audiometri Suprathreshold Audiometri To remove this notice. setengah ekspirasi. visit: www. Ruangan cukup sepi. jarak 6 meter. kebisingan maksimal 40 dB.6m dibelakang pasien) Syarat : 1.com/shopping Suara berbisik. BACK . Telinga tidak diperiksa ditutup & pasien tidak melihat bibir pemeriksa (pemeriksa berdiri sekitar 0. 2. Pemeriksa harus terlatih mengucapkan materi tes.foxitsoftware. Materi tes disiapkan.

visit: www.Edited with the trial version of Foxit Advanced PDF Editor Pemeriksaan Pendengaran Tes Bisik (Whispered Voice Test) To remove this notice.foxitsoftware.com/shopping TES RINNE Tes Garputala Audiometri Nada Murni (Pure tone audiometry) Audiometri Nada Tutur (Speech audiometry) Impedance Audiometri Suprathreshold Audiometri TES WEBER TES SCHWABACH Garpu tala 512 HZ!!! BACK .

©Bimbel UKDI MANTAP .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. sehat SNHL. visit: www. BC ps > BC Normal # latss px CHL.foxitsoftware.com/shopping Tes Garputala TES TUJUAN INTERPRETASI RINNE WEBER SCHWABACH AC VS BC BC Ka VS Ki BC Px VS Pasn Rinne(+) = AC>BC N/SNHL Rinne(-) = BC>AC CHL Lateralisasi ke BC ps = BC arah sakit px normal. BC ps < BC Lateralisasi ke px SNHL. CHL.

visit: www.foxitsoftware.com/shopping Tes Bisik (Whispered Voice Test) Tes Garputala Audiometri Nada Murni (Pure tone audiometry) Audiometri Nada Tutur (Speech audiometry) Impedance Audiometri Suprathreshold Audiometri BACK .Edited with the trial version of Foxit Advanced PDF Editor Pemeriksaan Pendengaran To remove this notice.

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Tes Bisik (Whispered
Voice Test)
Tes Garputala
Audiometri Nada Murni
(Pure tone audiometry)
Audiometri Nada Tutur
(Speech audiometry)
Impedance Audiometri
Suprathreshold
Audiometri

Kata-kata
sumber bunyi
Kegunaan :
1.
2.
3.
4.

Mengetahui jenis & derajat ketulian
Mengetahui lokasi kerusakan rantai
pendengaran
Mengetahui kenaikan ambang
pendengaran post-timpanoplasti
Untuk pemilihan hearing aid

SRT Speech Reception Threshold menirukan secara
betul kata-kata yang disajikan sebanyak 50%.
SDS Speech Discrimination Score Diperoleh dg
intensitas antara 25 40 dB diatas titik SRT
menirukan jumlah kata disajikan antara 90 100%.

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Tes Bisik (Whispered
Voice Test)
Tes Garputala
Audiometri Nada Murni
(Pure tone audiometry)

3 komponen dasar
impedans:
1.Acoustic Impedance
2.Tympanometri
3.Acoustic Reflex Tresshold

Audiometri Nada Tutur
(Speech audiometry)
Impedance Audiometri
Suprathreshold
Audiometri

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Tes Bisik (Whispered
Voice Test)
Tes Garputala
Audiometri Nada Murni
(Pure tone audiometry)
Audiometri Nada Tutur
(Speech audiometry)
Impedance Audiometri
Suprathreshold
Audiometri

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visit: www. bilateral dan simetris Pemeriksaan audiometri nada tutur menunjukkan gangguan diskriminasi wicara (speech discrimination) PRESBIKUSIS Tuli sensorineural Usia > 65 tahun Bilateral Akibat proses degenerasi NOISE INDUCED HEARING LOSS Akibat pajanan bising yang cukup keras dalam waktu yang cukup lama Pemeriksaan audiometri nada murni didapat tuli sensori neural pada frekuensi 3000-6000 Hz.foxitsoftware.com/shopping Gejala klinis Penurunan pendengaran progresif.Tuli Sensorineural Koklea Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. terutama bila diucapkan dengan latar belakang bising (Cocktail party deafness) Bila intensitas ditinggikan akan timbul rasa nyeri di telinga akibat faktor kelelahan (recruitment) Diagnosis Tes penala didapat tuli sensorineural Pemeriksaan audiometri nada murni didapat hasil tuli saraf nada tinggi. terberat pada 4000 Hz Pencegahan dengan mengusahakan bising < 85dB ©Bimbel UKDI MANTAP BACK . simetris Tinnitus nada tinggi Pasien dapat mendengar suara percakapan tetapi sulit memahaminya.

foxitsoftware. visit: www.Presbycusis Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Gradually slopping downward pa ern ©Bimbel UKDI MANTAP BACK .

com/shopping ©Bimbel UKDI MANTAP BACK .foxitsoftware. visit: www.Edited with the trial version of Foxit Advanced PDF Editor Noise Induced Hearing Loss To remove this notice.

Degenerasi stria vaskularis Neomisin. visit: www.com/shopping Aminoglikosida (Streptomisin.Ototoxic Drug Kerusakan yang di mbulkan Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Kanamisin Terjadi pada hampir semua obat Gentamisin) ototoksik Degenerasi sel epitel sensori pada organon cor dan labirin Loop Diure c ves bular. aminoglikosida bumetanide. Pada penggunaan (Furosemide. Degenerasi sel ganglion ethycrinic acid) Sekunder akibat degenerasi sel epitel sensori An Malaria (Kina dan Klorokuin) ©Bimbel UKDI MANTAP Eritromisin An in amasi (Salisilat dan aspirin) An Tumor (Cisplatin Karboplatin) BACK .foxitsoftware.

visit: www.foxitsoftware.33% karena gangguan kardio vaskuler tekanan darah Aritmia kordis Penyakit koroner Infeksi < glikemia Intoksikasi Obat: Nifedipin. Benzodiazepin.com/shopping Vertigo adalah perasaan penderita merasa dirinya atau dunia berputar Otologi Neurologik Interna 24-61% kasus Benigna Paroxysmal Positional Vertigo (BPPV) Meniere Desease Parese N VIII Uni/bilateral Otitis Media 23-30% kasus Gangguan serebrovaskuler batang otak/ serebelum Ataksia karena neuropati Gangguan visus Gangguan serebelum Gangguan sirkulasi LCS Multiple sklerosis Malformasi Chiari Vertigo servikal +/.Edited with the trial version of Foxit Advanced PDF Editor Ver go To remove this notice. Xanax. Psikiatri > 50% kasus Klinik dan laboratorik : dbn Depresi Fobia Anxietas Psikosomatik Fisiologi Melihat dari ketinggian BACK .

horizontal. torsional Romberg.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Jenis Vertigo Gejala Ver go Perifer Ver go Sentral Onset Mendadak Tersembunyi Intensitas Berat Ringan -Sedang Munculnya Episodik Konstan Durasi Singkat Panjang Eksaserbasi posisi Berat Ringan Nistagmus Horizontal atau torsional Vertikal. visit: www.test mata Terbuka Tertutup Normal Abnormal Abnormal Abnormal Gejala Neurologis Jarang Sering .

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Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware. 1999) Second Minutes to hours Hours to days BPPV Cervical spondilosys Postural hypotension disease Labyrinthitis Labyrinthine failure Ototoxicity Central vestibular ©Bimbel UKDI MANTAP disease .com/shopping Dura on of symptom in rela on to ae ology (Dhillon.

1999) ©Bimbel UKDI MANTAP . Operative observation of freecupular basophilic densities floating endolymphatic 2. visit: www. Reports of positive responses by this pathophysical theory to physical treatment inspired by this pathophysical theory (Velde.et al. 1969 Hall.. Histological observation of 1.foxitsoftware.1979 Location of lesion Posterior semicircular canal (PSC) PSC Proposed pathophysiology Cupulolithiasis (basophilic densities adhered to the PSC cupula) alter the specific gravity of the cupula making it sensitive to gravitational changes Canalith (free-floating psc endolympathic densities) create a hydrodynamic drag which displaces & stimulates the cupula Supportive evidence 1. Reports of positive responses densities to physical treatment inspired 2.com/shopping BPPV Comparison of two pathophysiological theories for BPPV Theory Cupulolithiasis Canalithiasis Originator Schuknecht.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

visit: www.foxitsoftware.com/shopping KRITERIA DIAGNOSIS BPPV: a.turning over in the supine position .bending forward d.lying down or . Not attributable to another disorder (Brevern ©Bimbel UKDI MANTAP ..Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. 2007) .or at least 2 of the following manouvres: .rising up from supine position . Duration of attack always < 1 minute c. Symptoms invariably provoked by the following changes of head position: .reclining the head . Recurrent vestibuler vertigo b.

foxitsoftware.DIX-HALLPIKE MANEUVER D I A G N O S I S ©Bimbel UKDI MANTAP Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.com/shopping .

com/shopping Non surgical Spontaneous resolution within several months Vestibular habituation position of maximal stimulation with the affected ear in the dependent position Liberatory maneuvers displace the heavy debris on the cupula away from the ampula of PCS (Young & Quin. visit: www.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor TREATMENT BPPV To remove this notice. 1994) Expectant observation self limiting natural history of BPPV Medication Physical treatment inspired by canalithiasis theory Operative procedures for intractable case (Velde. 1999) ©Bimbel UKDI MANTAP .

Reclined head hanging 45 degree turn Edited with the trial version of b. Turn forward chin down 20 degrees c.foxitsoftware. Keep head turn and to sitting e.a. visit: www. Rotate 45 degrees contralateral Foxit Advanced PDF Editor To remove this notice.com/shopping EPLEY d. Head and body rotated to 135 degrees from supine ©Bimbel UKDI MANTAP .

com/shopping SEMONT BRANDT & DAROFF EXCERCISES ©Bimbel UKDI MANTAP . visit: www.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.com/shopping Vertigo sentral ©Bimbel UKDI MANTAP .foxitsoftware.

com/shopping . Menghambat ak vitas nukleus ves buler a.4 mg/im Scopolamin : 0. Golongan antihistamin Golongan ini.5 mg/im/oral bisa diulang tiap 2 jam ii. Diphenhidramin: 1. Simpatomime ka Epidame 1. visit: www.5 mg IV bisa diulang tiap 30 menit 3. Dimenhidrinat: 50-100 mg/ 6 jam iii. Fase Akut An kolinergik Sulfas Atropin : 0.foxitsoftware.6 mg IV bisa diulang tiap 3 jam 2. yang menghambat aktivitas nukleus vestibularis adalah : i. Flunarizin ©Bimbel UKDI MANTAP Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.Secara garis besar terapi dibagi dalam: 1.

c.b. ii.com/shopping . Epilepsi: Phenitoin Carbamazeoin c. iii. Sedatif i.foxitsoftware. b. visit: www. Migren: Ergotamin Flunarizin a. Terapi Opera f Tumor Spondilosis servicalis Impresi basiler ©Bimbel UKDI MANTAP Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Phenobarbital: 15-30 mg/ 6 jam Diazepam: 5-10 mg Chlorpromazin (CPZ): 25 mg Terapi Kausalis Oklusi: Anti platelet agregasi Vasodilator Flunarizin b. a.

foxitsoftware. visit: www.Edited with the trial version of Foxit Advanced PDF Editor NOSE To remove this notice.com/shopping .

Edited with the trial version of Foxit Advanced PDF Editor Rhinitis Alergi To remove this notice. 1986) Kelainan pada hidung dengan gejala bersin-bersin.com/shopping Rhini s alergi adalah penyakit inflamasi yang disebabkan oleh reaksi alergi pada pasien atopi yang sebelumnya sudah tersensitisasi dengan alergen yang sama serta dilepaskannya suatu mediator kimia ketika terjadi paparan ulangan dengan alergen spesifik terkait. (WHO ARIA (Allergic Rhini s and Its Impact on Asthma) tahun 2007) BACK . visit: www. (Von Pirquet. rasa gatal dan tersumbat setelah mukosa hidung terpapar alergen yang diperantai oleh IgE.foxitsoftware. rinorea.

com/shopping perennial Alergi WHO ARIA Viral Rhinitis Rhinitis Edited with the trial version of Foxit Advanced PDF Editor Sifat berlangsungnya Berat/ringannya Moderatesevere Vasomotor rhinitis Rhinitis Medicamentosa Rhinitis during pregnancy NARES Rhinitis atrofi ©Bimbel UKDI MANTAP Persistent Mild Occupational Rhinitis Non Alergi Intermitten Bailey.Klasi kasi seasonal Waktu timbulnya To remove this notice. visit: www. . 2006 et CMDT.foxitsoftware.

Alergen yang sering inhalan (indoor atau outdoor) dan alergen ingestan To remove this notice. polinosis/rino konjung vi s: gejalanya muncul krn trigger yang musiman. spora jamur Perennial Allergic Rhini s (PAR): gejala muncul hampir sepanjang tahun.foxitsoftware. visit: www.com/shopping BACK .Edited with the trial version of Foxit Advanced PDF Editor Dikategorikan berdasar munculnya gejala: Seasonal Allergic Rhini s (SAR)/hay fever. Alergen: serbuk sari. biasanya pada negara 4 musim.

com/shopping Pemeriksaan Penunjang Serangan bersin berulang Keluar ingus (rhinorrhea) encer dan banyak Hidung tersumbat Hidung dan mata yg gatal Kadang2 disertai dengan lakrimasi Riwayat alergi BACK .foxitsoftware. visit: www.Edited with the trial version of Foxit Advanced PDF Editor How to diagnose? Anamnesis Pemeriksaan Fisik To remove this notice.

Berdasarkan cara masuknya alergen dibagi atas: Alergen inhalan masuk bersama dengan udara pernapasan misalnya debu rumah. misal bahan kosmetik atau perhiasan ©Bimbel UKDI MANTAP . ikan. dan bulu binatang serta jamur. serpihan epitel. Alergen injektan Alergen kontaktan masuk melalui suntikan atau tusukan masuk melalui kontak kulit atau jaringan mukosa.com/shopping Etiologi Rhinitis Alergi Rhinitis alergi merupakan reaksi alergi hipersensitivitas tipe 1 yang terjadi akibat paparan alergen.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware. Alergen ingestan masuk ke saluran cerna berupa makanan seperti susu. coklat. telur. tungau. udang.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. livid. sekret encer yang banyak Gejala spesifik pada anak: Allergic shinner: stasis vena o/k obstruksi hidung Allergic sallute: gerakan gosok hidung Allergic crease: garis melintang dorsum nasi 1/3 bawah Facies adenoid: karena mulut sering terbuka Cobblestone appearance: dinding post faring granuler dan edema Geographic tongue BACK .com/shopping Anamnesis Pemeriksaan Fisik Pemeriksaan Penunjang Rhinoskopi anterior: mukosa edem. visit: www. basah.

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Anamnesis

Pemeriksaan
Fisik

Pemeriksaan
Penunjang

Pemeriksaan
sitologi hidung,

berguna sebagai pelengkap. Jika ditemukan eosinofil meningkat,
menunjukan kemungkinan alergen berasal dari alergen inhalan.

Hitung eosinofil
darah tepi,

dapat normal atau meningkat

Pemeriksaan IgE
total

dengan metode prist-paper radio immunosorbent test, RAST, atau ELISA.

Uji kulit

uji intrakutan tunggal atau serial (Skin End-Point Titration/SET), uji cukit
(prick test)
uji tempel (patch test). SET dilakukan untuk alergen inhalan dengan
menyuntikan alergen dalam berbagai konsentrasi yang bertingkat
kepekatannya. Keuntungannya adalah selain menentukan alergen
penyebab juga dapat menentukan derajat alergi serta dosis inisial untuk
desensitisasi.

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visit: www. Steroid 4.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. generasi 2: 2.Loratadine 10mg.com/shopping Medikamentosa 1.5% 4x2 tetes/hari (max 3-4 hari) Sistemik: Pseudoepehdrine 60mg.Zafirlukast BACK . 1x1 Nasal: Phenylephrine 0. Decongestant 3.foxitsoftware. 1x1 .Mometasone spray . H1-antagonist. Leukotriene inhibitor . 2x1 .Cetirizine 10mg.Fluticasone spray .

Drug-induced rhini s: using over-the-counter topical vasoconstrictive nasal sprays prolonged periods leads to rebound UKDI MANTAP rhinitis severe obstruction©Bimbel as the effects of the topical agents subside. .Edited with the trial version of Foxit Advanced PDF Editor Rhinitis non alergi To remove this notice.com/shopping 1. Increase in mucous glands and a decrease in nasal cilia during pregnancy. Rhini s irita f-toksik (occupa onal): iritan secara airborne (pelarut. asap rokok) dan agen toksik 2.foxitsoftware. bahan kimia. Rhini s hormonal: byk pd saat hamil -> estrogen terbukti meningkatkan asam hyaluronat yg membuat edema dan nasal congestion. both of which heighten nasal congestion decreasing mucus clearance. Rhinitis is usually most severe during the second and third trimesters of pregnancy. Estradiol dan progesteron juga meningkatkan jumlah reseptor H1 shg membuat nasal congestion. 3. visit: www.

visit: www. sneezer.foxitsoftware. ©Bimbel UKDI MANTAP .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Rhinitis vasomotor merefleksikan ketidakseimbangan antara parasimpatis dan simpatis shg muncul capillary leakage dan hipersekresi glandula. Non-allergic rhini s with eosinophilia (NARES): etiologi masih blm diketahui. hidung tersumbat. Menunjukkan gejala bersin terus-menerus. Dibagi menjadi tipe runner. gatal di hidung. dan blocker 5. profuse watery rhinorrhea. dan hyposmia dengan tes alergi negatif dan jumlah eosinofil > 25% pada nasal smear. Biasa pada pasien usia >60 thn. Rhini s vasomotor (idiopathic): diagnosis ditegakkan jika sdh menyingkirkan sebab alergi dan non-alerginya.com/shopping Rhinitis non alergi 4. Bisa dengan atau tanpa rhinorrhea.

adanya atrofi progesif pada mukosa dan tulang konka mukosa hidung menghasilkan sekret yang kental dan cepat mengering terbentuk krusta yang berbau busuk Bailey. CMDT. malaise. body aches. Rhini s atrophy (ozaena): infeksi hidung kronis.foxitsoftware. and cough. 2006. Nasal drainage in viral rhinitis is most often clear or white and can be accompanied by nasal congestion and sneezing 7. visit: www. Viral rhini s: very common and often associated with other manifestations of viral illness.Edited with the trial version of Foxit Advanced PDF Editor Rhinitis non alergi 6.com/shopping . which can include headache. 2007 ©Bimbel UKDI MANTAP To remove this notice.

maka infeksi gigi mudah menyebar ke sinus sinus dentogen BACK .foxitsoftware. letaknya dekat akar gigi rahang atas.. 2003) Sinus yang paling sering terkena: sinus ethmoid dan maksilla Sinus maksilla disebut juga sebagai antrum Highmore.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.com/shopping Rhinosinusi s Rinosinusitis peradangan mukosa sinus paranasal & mukosa hidung (Benninger et al.

Edited with the trial version of Foxit Advanced PDF Editor Klasi kasi RSK To remove this notice.foxitsoftware.com/shopping . visit: www.

namun kembali ke eksaserbasi baseline setelah terapi akut ©Bimbel UKDI MANTAP . Catarrhalis Akut Subakut Rhinosinusi s Kronis Rekuren 4-12 minggu S. Mirabilis. Pneumonia (30-50%).com/shopping S. -10 hari. In uenzae (20-40%). H. Aureus (40%). K. P.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. M. visit: www.foxitsoftware. ada periode sembuh sempurna Kronik Perburukan RSK. Aeruginosa (10-25%). P. Pneumoniae.

faktor predisposisi BACK . polipoid.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. bakteri anaerob.foxitsoftware. hipoksia. atau pembentukan polip dan kista mukosa makin bengkak inflamasi. visit: www.com/shopping Patofisiologi Edema os um KOM tersumbat dan cilia dak dapat bergerak tekanan nega f RSA non bakterial bisa self-limi ng transudasi serosa Bila menetap pertumbuhan bakteri RSA bakterial terapi antibiotik tidak berhasil Gangguan patensi ostiumostium sinus dan mucociliary clearance hipertrofi.

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atau pertumbuhan polipoid pada pemeriksaan rhinoskopi (dengan dekongesti) atau endoskopi Edema or erythema meatus media pada endoskopi Erythema. baik terlokalisir atau difus. atau jaringan granulasi. bone changes. polip. pencitraan radiologis diperlukan untuk konfirmasi diagnosis Pemeriksaan pencitraan untuk konfirmasi diagnosis: .CT scan: mucosal thickening. air-fluid levels . Bila tidak melibatkan meatus media atau bulla ethmoid.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.Plain sinus Xray: air-fluid levels atau >5 mm 1 sinus ©Bimbel UKDI MANTAP Bailey 2006 .com/shopping Temuan Objek f Gejala atau tanda klinis terus menerus dengan kriteria Task Force 1996 Adanya sekret rongga hidung purulen. visit: www. edema.

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foxitsoftware.com/shopping Treatment ©Bimbel UKDI MANTAP .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.

com/shopping ©Bimbel UKDI MANTAP .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware.

2007 .com/shopping Antibiotik Source: American Academy of Otolaryngology Head ©Bimbel UKDI MANTAP and Neck Surgery Foundation.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. visit: www.

visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Komplikasi Kelainan orbita Selulitis orbita abses subperiosteal Abses orbital Optic neuritis Thrombosis sinus cavernosis Miscellaneous: mucocele dan osteomielitis (pott puffy tumor) Kelainan intracranial Meningitis Abses epidural/subduran/cerebral ©Bimbel UKDI MANTAP .foxitsoftware.

Jika perdarahan terlihat dapat dikauter Jika masih berdarah dapat ditampon anterior 2x24 jam Perdarahan dimulai dari arteri ethmoidalis posterior atau arteri sphenopala na Mempengaruhi pasien dengan hipertensi atau arteriosklerosis Terapi: aplikasi tampon belloq/posterior selama 2-3 hari. visit: www. ©Bimbel UKDI MANTAP Buku ajar ilmu THTK&L FKUI edisi keenam .foxitsoftware.com/shopping Epistaksis Epistaksis anterior Epistaksis posterior Perdarahan dari arteri eithmoidalis anterior atau pleksus kisselbach Biasanta diawali oleh trauma atau infeksi Penanganan awal berupa penekanan digital selama 1015 menit.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

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Edited with the trial version of Foxit Advanced PDF Editor Polip Hidung To remove this notice. dan lobular Tunggal/ multiple dan tidak sensitif Berasal dari kompleks ostio-meatal di meatus media dan sinus ethmoid Polip koana tumbuh kearah belakang dan membesar di nasofaring Berasal dari sinus maxillaris ©Bimbel UKDI MANTAP Disebut juga polip antro-koana BACK .com/shopping Massa lunak dan berwarna pu h/ keabu-abuan yang terdapat pada rongga hidung Epidemiology Biasanya timbul di dewasa usia >20 thn dan lebih sering di usia > 40 thn menyerang pria 2-3 kali lebih besar dibandingkan dengan wanita Massa bertangkai dgn permukaan licin Berbentuk bulat/lonjong.foxitsoftware. bening. visit: www. berwarna putih keabu-abuan.

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Etiologi
Inflamasi kronik
Sinusitis Kronis
Rhinitis allergi
Asma
Fibrosis Kistik
Predisposisi genetik
Disfungsi saraf autonom
Chronic in amma on causes a
reac ve hyperplasia of the intranasal
Intoleransi alkohol
mucosal membrane, which results in
the forma on of polyps.
Intoleransi aspirin
The precise mechanism of polyp
forma on is incompletely
Edema Peningkatan
understood.
tekanan cairan interstitial
Medscapesehingga timbul edema
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mukosa hidung

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Diagnosis
Pemeriksaan Fisik

Anamnesis

Rhinoskopi anterior massa berwarna
pucat, berasal dari meatus medius dan
mudah digerakkan

Gejala Utama

Hidung tersumbat
Stadium polip(Mackay dan Lund
Rinore (dari jernih sampai purulen);1997)
Stadium 1 polip masih terbatas di
meatus medius
Hiposmia / Anosmia
Stadium 2 polip sudah keluar dari
Nyeri pada hidung
meatus medius, tampak di rongga
hidung tapi belum memenuhi rongga
Sakit kepala
hidung

Gejala Sekunder

Stadium 3

Bernafas melalui mulut
Suara sengau
Halitosis
Gangguan tidur
Penurunan kualitas hidup

polip yang masif

Pemeriksaan Penunjang
Naso-Endoskopi
Pemeriksaan Radiologi

©Bimbel UKDI MANTAP

Foto polos SPN (posisi Waters,
AP, Caldwell dan lateral)
CT Scan SPN

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Tatalaksana
Operasi

Medikamentosa

Indikasi: anak dengan multipel ,
benign polip nasi atau
rhinosinustitis kronis yang
tidak membaik dengan terapi
medis maximum

Kortikosteroid
oral most e ec ve
treatment
Dewasa: prednisone (3060 mg) selama 4-7 hari,
ditaper 1-3 minggu.
Anak - dosis max 1
mg/kg/d selama 5-7 hari,
ditaper selama 1-3
minggu.

Intranasal spray pertumbuhan polip kecil

Antibiotik
Antiallergi

©Bimbel UKDI MANTAP

Polipektomi
Etmoidektomi
intranasal/ekstranasal polip
etmoid
Operasi Caldwell-Luc sinus
maxilla

ESS (Endoscopic sinus surgery)
Melebarkan celah di meatus
media rekurensi berkurang

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com/shopping Komplikasi Prognosis Polip antro-koana Obstructive sleep apnea Chronic mouth breathing Cenderung berulang setelah operasi (jika polip multiple) pada informed consent perlu memberitahu pasien tentang kemungkinan polip berulang setelah operasi ©Bimbel UKDI MANTAP BACK .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. visit: www.

visit: www. ©Bimbel UKDI MANTAP .foxitsoftware.com/shopping Nasal Foreign Bodies Intranasal foreign bodies (FBs) occur most commonly in young children and consist of a variety of inorganic and organic objects.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Nasal Foreign Bodies CLINICAL MANIFESTATIONS History of nasal FB insertion without symptoms (71 to 88 percent) Unilateral mucopurulent nasal discharge (17 to 24 percent) Foul odor (9 percent) Epistaxis (3 to 6 percent) Nasal obstruction (1 to 3 percent) Mouth breathing (2 percent) ©Bimbel UKDI MANTAP . visit: www.

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Edited with the trial version of Foxit Advanced PDF Editor Tonsili s To remove this notice.foxitsoftware. terutama pada anak ©Bimbel UKDI MANTAP BACK . visit: www. kontak langsung Dapat terjadi pada semua umur.com/shopping Tonsilitis adalah peradangan tonsil palatina yang merupakan bagian dari cincin waldeyer Cincin waldeyer: tonsil pharyngeal (adenoid) tonsil palatina (faucial) tonsil lingual (tonsil pangkal lidah) dan tonsil tuba Eustachius (lateral band dinding faring/ tonsil) Rute penyebaran infeksi: airborne droplets.

foxitsoftware. Treponema vincentii and Spirochaeta denticulata (Vincent angina).com/shopping syncytial virus (RSV). reovirus. rhinovirus. Streptoccus pyogenes. Hemofillus infulenza. Candida albicans 7 or more episodes of tonsillitis in 1 year Rekuren akut Consider surgery 5 episodes/y for 2 consecutive years 3 episodes/y for 3 consecutive years Kronis ©Bimbel UKDI MANTAP BACK . Coxschakie Klasifikasi Viral GABHS Akut Bakterial Fungal Tonsilitis Other bacteria Streptococcus viridan.Edited with the trial version of Foxit Advanced PDF Editor remove this notice. visit: Adenovirus. Corynebacterium diphtheriae. and the influenza and parainfluenza virusesEpstein-Barr Virus.Torespiratory www.

com/shopping Tonsilitis akut penularan mikroorganisme melalui droplet menginfiltrasi lapisan epitel jaringan tonsil epitel terkikis reaksi dari jaringan limfoid superfisial reaksi radang berupa keluarnya leukosit polimorfonuklear terbentuk detritus (kumpulan leukosit. visit: www. ©Bimbel UKDI MANTAP BACK .foxitsoftware. dan epitel yang terlepas) mengisi kriptus tonsil dan tampak sebagai bercak kuning Tonsilitis kronis Jika proses radang ini berulang epitel mukosa dan jaringan limfoid akan terkikis jaringan parut pengerutan sehingga kripta tertarik dan melebar drainase kripta menjadi kurang baik retensi debris sel menembus kapsul tonsi perlekatan dengan jaringan di sekitar fossa tonsilaris. bakteri yang mati.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

and lowgrade fever. severe lethargy and malaise.com/shopping Gejala yang tampak seperti common cold + nyeri tenggorok Demam. oropharynx hiperemis. visit: www. biasanya tanpa eksudat Coxsackie virus result in herpangina. axillary. which presents as ulcerative vesicles over the tonsils. and palate Consider infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis. ©Bimbel UKDI MANTAP BACK .foxitsoftware. splenomegaly. and/or inguinal nodes. nyeri menelan. A gray membrane may cover tonsils that are inflamed from an EBV infection. sakit tenggorokan. particularly when it is accompanied by tender cervical. posterior pharynx. This membrane can be removed without bleeding.Edited with the trial version of Foxit Advanced PDF Editor Tonsilitis Viral To remove this notice.

On exam: White co age-cheese-like plaques over the pharyngeal mucosa Plaques bleed if removed with a tongue depressor ©Bimbel UKDI MANTAP BACK . visit: www.foxitsoftware.com/shopping Tonsilitis Fungal Oropharyngeal candidiasis (thrush) often presents in immunocompromised patients or in patients who have undergone prolonged treatment with antibiotics.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

the tongue may also become red ("strawberry tongue") Bentuk detritus: Jelas tonsilitis folikularis Bercak detritus menjadi satu. dysphagia. visit: www. membentuk alur tonsilitis lakunaris Melebar membentuk pseudomembrane ©Bimbel UKDI MANTAP BACK .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. dry sore throat.IX) and odynophagia. The tonsils and pharyngeal mucosa are erythematous and may be covered with purulent exudate.com/shopping Tonsilitis Bakterial GABHS most common and important pathogen causing acute bacterial pharyngotonsillitis most commonly presents in children aged 5 6 characterized by fever.foxitsoftware. cervical adenopathy. otalgia (referred pain from n.

©Bimbel UKDI MANTAP BACK . visit: www.com/shopping Patients with all four of the classic symptoms of Group A Streptococcal pharyngitis: 1.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. pharyngeal or tonsillar exudate 2.foxitsoftware. swollen anterior cervical nodes 3. a history of a fever greater than 38°C 4. absence of cough a 44% chance that they will not have Group A Streptococcal pharyngitis.

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gigi dan gusi mudah berdarah Tonsili s sep k. penyebabnya Steptococcus hemoli cus.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. akibat bakteri spirocheta atau treponema.foxitsoftware.com/shopping Tonsilitis bakterial Other bacterial Angina Plaut Vincent (stomatitis ulseromembranosa). gejala: demam. visit: www. rasa nyeri dimulut. hipersalivasi. terdapat dalam susu sapi ©Bimbel UKDI MANTAP BACK .

000 unit Antibiotik Penicillin atau Eritromisin 25-50 mg/kg dibagi 3 dosis selama 14 hari Kortikosteroid 1. badan lemah. infeksi yang menjalar ke kelenjar limfe bull neck (+) Terapi Anti difteri serum 20. visit: www. nyeri kepala. Gejala: kenaikan suhu subfebris. tidak nafsu makan.foxitsoftware.com/shopping Tonsilitis difteri Disebabkan oleh bakteri gram positif Corynebacterium diphteriae.2 mg/kgbb/ hari Pengobatan simptomatis (antipiretik) Isolasi dan tirah baring selama 2-3 minggu ©Bimbel UKDI MANTAP BACK . nadi lambat serta keluhan nyeri menelan.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. mudah berdarah.000100. Pemeriksaan sik: Tonsil membengkak ditutupi bercak pu h kotor yang melekat erat dengan dasarnya.

©Bimbel UKDI MANTAP BACK . dan beberapa kripta dapat terisi oleh detritus. The organisms involved are usually both aerobic and anaerobic mixed flora. It is also characterized by the presence of malodorous tonsillar concretions and the enlargement of jugulodigastric lymph nodes. and pharyngotonsillar erythema. Pada tonsilitis kronis. visit: www.com/shopping Tonsilitis kronis Defined by persistent sore throat.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. with a predominance of streptococci.foxitsoftware. dysphagia. anorexia. tampak pelebaran kripta. permukaan tonsil tampak dak rata.

com/shopping Grading Grading disusun berdasarkan rasio tonsil terhadap jarak antar arcus palatoglosus. Grading pembesaran tonsil adalah: T0 : tonsil masih berada dalam fossa tonsilaris T1 : <25% tonsil menempati orofaring T2 : 25-<50% tonsil menempati orofaring T3 T4 : 50-<75% : >75% ©Bimbel UKDI MANTAP .foxitsoftware. visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. dan diapus di permukaan medium agar darah. visit: www. Pemeriksaan penunjang Pemeriksaan ini dilakukan terutama jika Streptococcus beta hemolitikus grup A dicurigai sebagai penyebab.com/shopping How to diagnose Anamnesis Pemeriksaan sik Pemeriksaan penunjang pada tonsilitis ditujukan untuk mengetahui organisme penyebab dengan kultur dan mengetahui sensitivitas terhadap antibiotik. ASTO dapat dilakukan Bailey 2006 BACK . KED. Kultur organisme diperoleh dengan cara mengambil apusan dari permukaan tonsil dan orofaring posterior. ©Bimbel UKDI MANTAP Lab darah rutin.

dan terapi simtomatis seperti antipiretik dan analgetik. Periode tonsilitis akut dapat diberikan antibiotik spektrum luas (penicillin dan derivatnya). visit: www. sulfonamide.com/shopping Prinsip tatalaksana Prevensi: menjaga kondisi imun tubuh dan kebersihan serta kesehatan rongga mulut dengan cara berkumur atau cuci mulut. ©Bimbel UKDI MANTAP BACK .foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Opera f: Pada tonsilitis kronik dapat dilakukan tonsilektomi sesuai indikasi. Medikamentosa: Terapi medikamentosa diberikan jika terdapat serangan akut.

foxitsoftware.com/shopping BACK .Edited with the trial version of Foxit Advanced PDF Editor Indikasi TE ©Bimbel UKDI MANTAP To remove this notice. visit: www.

Tonsilitis yang membutuhkan biopsi untuk patologi anatomi Source: American Academy ofMANTAP Otolaryngology-Head and ©Bimbel UKDI Neck Surgery (AAO-HNS) BACK . dan komplikasi kardiopulmonar. Abses peritonsil yang tidak membaik dengan pengobatan medis dan drainase Indikasi absolute Tonsilitis yang menimbulkan kejang demam.foxitsoftware. gangguan tidur.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www. disfagia berat.com/shopping Indikasi Obstruksi saluran napas.

foxitsoftware.com/shopping Indikasi Infeksi rekuren akut dengan terapi antibiotik yang adekuat Indikasi relatif Halitosis akibat tonsilitis kronik yang tidak membaik dengan pemberian terapi medis Tonsilitis kronik atau berulang pada karier streptokokus yang tidak membaik dengan pemberian antibiotik beta-laktamase resisten Hipertrofi tonsil unilateral yang dicurigai merupakan suatu keganasan. Source: American Academy ofMANTAP Otolaryngology-Head and ©Bimbel UKDI Neck Surgery (AAO-HNS) BACK . visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Kontraindikasi TE Gangguan perdarahan Anemia Infeksi akut yang berat Penyakit sistemik tak terkontrol : diabetes mellitus ©Bimbel UKDI MANTAP BACK .foxitsoftware. visit: www.

foxitsoftware. visit: www.com/shopping BACK .Edited with the trial version of Foxit Advanced PDF Editor Komplikasi ©Bimbel UKDI MANTAP To remove this notice.

visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.com/shopping ©Bimbel UKDI MANTAP BACK .

com/shopping Abses dan Infiltrat peritonsiler Dilapisi kapsul secara medial (dari aponeurosis interpharyngeal) pathway untuk pembuluh darah dan saraf Abses peritonsillar di antara kapsul dan tonsil Kumpulan pus di belakang tonsil palatina Local accumumulation of pus ©Bimbel UKDI MANTAP quinsy Nama lain dari abses ini adalah abses BACK .foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.

2008) ©Bimbel UKDI MANTAP BACK . hiperemis. pembesaran tonsil Malaise Trismus Nyeri tengorrokan (lebih pada satu sisi) Drooling Dysphagia Hot potato voice Otalgia (ipsilateral Halitosis Cervical lymphadenitis (Gallioto. visit: www. deviasi uvula ke sisi kontralateral.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping GEJALA KLINIS SIMPTOM SIGN Demam Palatum molle edematous.

foxitsoftware. 2008) ©Bimbel UKDI MANTAP BACK .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Edema palatum molle Ton sil Pasien dengan PTA dextra Tonsil displaced ke inferior dan medial + deviasi kontralateral uvula (Gallioto. visit: www.

foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www. 2002) ©Bimbel UKDI MANTAP BACK .com/shopping DIAGNOSIS Dibuat melalu anamnesis dan pemeriksaan fisik DDx: Infectious mononucleosis Cellulitis peritonsiler area antara tonsil dan kapsul hiperemis + edema tanpa formasi pus Abses retromolar Aspirasi dengan jarum pus mengkonfirmasi diagnosis Intraoral USG cellulitis VS abses (Steyer.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware.com/shopping PEMERIKSAAN PENUNJANG Suspek penyebaran infeksi selain peritonsiler / komplikasi leher lateral = CT/MRI diindikasi CT scan : cellulitis vs. abses. spread of infection ke regio deep neck MRI : Superior dalam deteksi komplikasi dari deep neck infections (Gidley. visit: www. 1997) ©Bimbel UKDI MANTAP BACK .

visit: www.foxitsoftware. 2008) ©Bimbel UKDI MANTAP BACK .com/shopping PENATALAKSANAAN CLINICAL RECOMMENDATION (Gallioto.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

2008) .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware.com/shopping PENATALAKSANAAN Drainage Antibiotics ©Bimbel UKDI MANTAP Supportive (hydration dan kontrol nyeri) BACK Gallioto.

DRAINAGE Needle aspiration Incision and drainage Immediate tonsillectomy + antibiotics = resolusi dari 90% kasus PTA (Herzon et Martin .foxitsoftware. visit: www.2006) Immediate TE tidak lebih superior berbanding aspirasi jarum/insisi drainase dan lebih kurang kost-efektif (Johnson et al. 2003. 1995) ©Bimbel UKDI MANTAP BACK .com/shopping PENATALAKSANAAN . Herzon et Harris.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

Kieff et al. 1999) 50% kultur = beta-lactamase producers (Ozbek et al. 2005) ©Bimbel UKDI MANTAP BACK .com/shopping PENATALAKSANAAN .ANTIBIOTIK ORGANISME SERING PADA PTA (Brook. visit: www. 2004) AEROBIC ANAEROBIC Group A streptococcus Fusobacterium Staphylococcus aureus Peptostreptococcus Haemophilus influenzae Pigmented Prevotella Rx empiris inisial group A streptococcus & anaerobes IV Penicillin sama efektivitas berbanding broad spectrum lainnya (abscess adequately drained) (Herzon et Harris.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. 1995.

ANTIBIOTIK Regimen selama 10 hari (Fairbanks.com/shopping PENATALAKSANAAN . 2005) ©Bimbel UKDI MANTAP BACK . visit: www.foxitsoftware.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

Pada daerah superior dan lateral fosa tonsilaris merupakan jaringan ikat longgar sehingga bisa terjadi penjalaran pus. hipersalivasi. Keluhan: nyeri menelan. Pada pemeriksaan fisik terlihat: palatum mole membengkak dan uvula bergeser Terapi: antibiotik.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Komplikasi dari tonsilitis yang tidak diobati dengan sempurna. ©Bimbel UKDI MANTAP BACK . Namun pada infiltrate jumlah pus belum banyak dan terlokalisir sehingga tidak ditemukan fluktuasi. trismus.foxitsoftware. obat kumur dan obat simptomatik. visit: www.com/shopping Infiltrat Peritonsil Infiltrat peritonsil merupakan satu tahap sebelum terjadinya abses.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www. dasar mulut mendorong lidah ke atas dan belakang obstruksi jalan napas Penyebab: Infeksi gigi molar. premolar Tindik lidah peradangan kelenjar limfe servikal Gejala: Demam Nyeri tenggorokan Pembengkakan Drooling Trismus Terjadi secara bilateral BACK .com/shopping Angina Ludwig Infeksi ruang submandibula Ditandai dengan pembengkakan (edema) pada bagian bawah ruang submandibular yang mencakup jaringan yang menutupi otot2 antara laring dan dasar mulut. Peradangan kekerasan berlebihan jar.foxitsoftware.

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Laryngitis

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Causes:
Most commonly due to to a viral infection (viral laryngitis).
Coughing-induced laryngitis may also occur in bronchitis,
pneumonia, influenza, pertussis, measles, and diphtheria.
Excessive use of the voice (especially with loud speaking or
singing)
Allergic reactions
Gastroesophageal reflux
Bulimia or
Inhalation of irritating substances (eg, cigarette smoke or certain
aerosolized drugs) can cause acute or chronic laryngitis.
Drugs can induce laryngeal edema, for example, as a side effect
of ACE inhibitors.
Bacterial laryngitis is extremely rare.
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Signs and symptoms
An unnatural change of voice is usually the most
prominent symptom.
Volume is typically greatly decreased (sometimes aphonia)
Hoarseness
A sensation of tickling, rawness, and a constant urge to
clear the throat may occur.
Symptoms vary with the severity of the inflammation.
Fever, malaise, dysphagia, and throat pain may occur in
more severe infections.
Laryngeal edema, although rare, may cause stridor and
dyspnea.

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Diagnosis

Treatment

Clinical evaluation
Sometimes direct or indirect
laryngoscopy
Diagnosis is based on symptoms.
Indirect or direct exible
laryngoscopy is recommended
for symptoms persis ng > 3 wk

Symptoma c treatment (eg,
cough suppressants, voice rest,
steam inhalations)
No specific treatment is
available for viral laryngitis.
Cough suppressants, voice rest,
and steam inhalations relieve
symptoms and promote
resolution of acute laryngitis.
Smoking cessation and
treatment of acute or chronic
bronchitis may relieve
laryngitis.
Depending on the presumed
cause, specific treatments to
control gastroesophageal reflux,
bulimia, or drug-induced
laryngitis may be beneficial.

Findings include mild to marked
erythema of the mucous
membrane, which may also be
edematous.
With reflux, there is swelling of the
inner lining of the larynx and
redness of the vocal cords that
extends above and below the
edges of the back part of the cords.
If a pseudomembrane is present,
diphtheria is suspected.

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BACK

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.com/shopping Laringomalasia Laringomalasia adalah kelainan kongenital dimana epiglotis lemah Kelemahan epiglotis akan menyebabkan penyumbatan saluran pernafasan nafas berbunyi/stridor terutama saat berbaring.foxitsoftware. no feeding intolerance. visit: www. biasanya remisi usia 2 tahun Pada pemeriksaan dapat terlihat laring berbentuk omega Bila sumbatan semakin hebat maka dapat dilakukan intubasi ©Bimbel UKDI MANTAP BACK .

sorethroat.com/shopping Epiglotitis akut Akibat Hib Onset rapid.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. stridor (late finding). cervical adenopathy ©Bimbel UKDI MANTAP BACK . adanya preceeding ISPA Tripod position. drolling. visit: www. odynophagia/dysphagi a. muffled voice/hot potato voice.

mis. sebesar kacang hijau berwarna keputihan. Predileksi di sepertiga anterior pita suara dan sepertiga medial.foxitsoftware. visit: www. Keluhan: suara parau.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Pengobatan: Istirahat bicara dan voice therapy. Bedah mikro . . penyanyi dan sebagainaya.com/shopping Nodul Pita Suara/Vocal nodule Kelainan ini biasanya disebabkan oleh penggunaan suara dalam waktu lama. batuk.dilakukan bila dicurigai ©Bimbel UKDI MANTAP adanya keganasan atau lesi fibrotik. Pemeriksaan sik: nodul pita suara. Nodul biasanya bilateral. pada seorang guru.

3) Keganasan laring: Keganasan pada daerah laring. peminum alkohol dan terpajan sinar radioaktif.com/shopping Massa lain pada pita suara Polip pita suara: lesi bertangkai pada seprtiga anterior. 2) Kista pita suara: kista retensi kelenjar minor laring. sepertiga tengah atau seluruh pita suara. faktor risiko berupa perokok. Pasien biasa mengeluhkan suara parau. visit: www. GERD dan infeksi. terbentuk akibat tersumbatnya kelenjar tersebut Faktor risiko: iritasi kronis.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. 1 1) ©Bimbel UKDI MANTAP 3 2 BACK .foxitsoftware.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. The prognosis is good with rapid diagnosis and proper treatment. Esophagitis is commonly seen in adults and is uncommon in childhood Patients may be asymptomatic. visit: www. but typical symptoms include the following: ©Bimbel UKDI MANTAP Onset of difficult or painful swallowing (ie.foxitsoftware.com/shopping Candida esophagitis Candida esophagitis is the most common type of infectious esophagitis. dysphagia or odynophagia) Heartburn Retrosternal discomfort or pain Nausea and vomiting Fever and sepsis Abdominal pain Epigastric pain Hematemesis (occasionally) Anorexia and weight loss Cough BACK .

visit: www. ©Bimbel UKDI MANTAP BACK .000 people.foxitsoftware.com/shopping Achalasia is an uncommon swallowing disorder Affects about 1 in every 100. the symptoms can usually be controlled with treatment.Edited with the trial version of Foxit Advanced PDF Editor Achalasia To remove this notice. The major symptom of achalasia is usually difficulty with swallowing. Most people are diagnosed between the ages of 25 and 60 years. Although the condition cannot be cured.

gets stuck in the chest. and weight loss ©Bimbel UKDI MANTAP BACK .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. hiccups. nerve cells in the esophagus degenerate for reasons that are not known. and large volumes of food and saliva can accumulate in the dilated esophagus. Other symptoms can include chest pain. the esophagus above the persistently contracted LES dilates. The loss of nerve cells in the esophagus causes two major problems that interfere with swallowing The muscles that line the esophagus do not contract normally The lower esophageal sphincter (LES) fails to relax normally with swallowing. both solids and liquids. visit: www. heartburn. a sensation of fullness or a lump in the throat. This problem often begins slowly and progresses gradually. Patients experience the sensa on that swallowed material.com/shopping Symptoms ACHALASIA CAUSE In achalasia. difficulty burping. ACHALASIA SYMPTOMS The most common symptom of achalasia is difficulty swallowing. the LES muscle con nues to squeeze the end of the esophagus Over time.foxitsoftware. regurgitation of swallowed food and liquid. Instead.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. This test is used to confirm the diagnosis of achalasia. failure of the LES to relax after swallowing. visit: www.com/shopping Diagnosis Esophageal manometry (aka esophageal motility study) measures changes in pressures within the esophagus that are caused by the contraction of the esophageal muscles. and an absence of useful (peristaltic) contractions in the lower esophagus ©Bimbel UKDI MANTAP X-ray: Bird beak sign or Rat tail Sign BACK . The test typically reveals three abnormalities in people with achalasia: high pressure in the LES at rest.

which can be used to relax the lower esophagus sphincter Surgery (called an esophagomyotomy). but any benefit wears off within a matter of weeks or months. This may help relax the sphincter muscles. Therapy may involve: Injec on with botulinum toxin (Botox). visit: www.com/shopping Treatment The approach to treatment is to reduce the pressure at the lower esophageal sphincter.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Medica ons. such as long-ac ng nitrates or calcium channel blockers. which may be needed to decrease the pressure in the lower sphincter Widening (dila on) of the esophagus at the location of the narrowing (pneumatic balloon dilatation) ©Bimbel UKDI MANTAP BACK .foxitsoftware.

exposed with nickel. Bulging of palatum. visit: www. with Anterior rhinoscopy: red recurrent epistaxis. otalgia nerves abnormality. diplopia. cranial food.foxitsoftware. unilateral obstruction & rhinorrea. enlargement of jugular lymph neuralgia trigeminal. BACK . shiny/bluish mass. preserva ve fossa Rosenmuller.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. cheek protrusion. No lymph nodes enlargement. induration of the tonsil. proptosis . Male. nodes. Diagnosis Treatment Ca sinonasal Surgery KNF Radiotherapy. young adult. anesthesia if involving n. Painful ulceration with otalgia & slight bleeding. surgery. 2007. epistaxis. chrom. Lymph node enlargement. Painful ulcera on.V Elderly with history of Posterior rhinoscopy: mass at smoking. ©Bimbel UKDI MANTAP Buku Ajar THT-KL FKUI. Tinnitus. chemoradiatio n. Diplopia. Ca tonsil Surgery Juvenile angio broma Surgery Physical Exam. terpentin.com/shopping Malignancy in ENT History Male in 5th decade. formalin.

foxitsoftware.com/shopping .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.

Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. visit: www.foxitsoftware.com/shopping Nasopharynx Carcinoma .

visit: www.foxitsoftware.com/shopping CORPUS ALIENUM IN ENT BACK .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.

com/shopping ©Bimbel UKDI MANTAP .Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. visit: www.

tanpa sianosis.com/shopping Jackson classification Jackson 1 : pernafasan cuping hidung. visit: www. stridor. pasien tenang Jackson 2: retraksi suprasternal dan epigastrium. intercostal. sianosis. sianosis ringan Jackson 3: retraksi suprasternal. penderita bisa tampak tenang seperti tidur. tampak gelisah dan sianosis Jackson 4: retraksi sangat jelas. infraklavikula. paralisa pusat pernafasan o/k hiperkapnea.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice.foxitsoftware. as ksia ©Bimbel UKDI MANTAP BACK .gelisah. retraksi suprasternal.

At first. there is a check-valve. thus producing those high-pitched sounds which are known as expiratory wheezes. This causes turbulent air flow and a rippling effect on the soft tissues. B.foxitsoftware. with each breath out.com/shopping A. As seen on Xrays. often within an entire lung. This causes lung collapse (atelectasis) . After more swelling. during the initial coughing fit. Also. there is usually a by-pass valve (air moves freely around the foreign body). but can no longer freely exit around the foreign body during expiration (when our bronchi collapse a little). there is a stop-valve. After a small amount of swelling occurs. only a tiny amount of air can escape past the foreign object. C. D. with each expiration. Each time the patient breaths out. this causes shifting of the heart to the opposite side. visit: www.Edited with the trial version of Foxit Advanced PDF Editor To remove this notice. Air can enter during inspiration. This causes trapping of air. the affected lung remains hyperinflated (obstructive emphysema).