Presenter : chok chun hung

Name : Bapak Amat Soekoni Alamat: purworejo Umur : 73 thn Pekerjaan : tidak bekerja Agama : islam Nikah : sudah bernikah

• KU : Patient mengeluh sejak beberapa ini pendengaran telinga kirinya menurun dan tidak dapat mendengar dengan baik

telinga kirinya juga sering suka berdengung dan kepalanya juga sering suka pusing.bau tetapi tidak sakit. . Patient juga suka menusuk nusuk telinganya dengan kayu kelapa ketika telinganya gatal. patient mengeluh telinga kirinya suka keluar cairan berwarna kuning .• RPS: 1 minggu sebelum masuk poliklinik THT.

. Patient tidak mempunyai riwayat hypertensi atau allergy.• RPD : patient mengeluh telinga kanannya sudah tidak bisa mendengar sejak patient kecil lagi.

• RPK : keluarganya tidak pernah ada yang seperti ini .

Test garpu tala • Test rinne : • AD positive SNHL/ normal • Test weber : • Lateralisasi ke kiri • Test schwabach • AD pemendekan pendengaran AS negative CHL AS pemanjangan pendengaran .

x anatomy kelainan x pus P : tragus helix antehelix tidak nyeri AS sama sama .• • • • • Pemeriksaan fisik : AD I : x merah. inflamasi.

• • • • Pemeriksaan otoscope AD -Dinding telinga bersih. x cerumen.tampak lecet . -Tympani membran buram. luka pada dinding disertai pus -perforasi luas pada bagian tengah . telinga • -cone of light • Dan tulang incus x kelihatan AS .

5 mg ) • S3dd1 • ambroxol ( mucolytic ) 30mg • S3dd1 • tarivid ( ofloxacin drops ) • S2ddI .• Dx : Otitis media supurative chronic auris sinistra • Tx : Trifed ( pseudo ephedrin 60mg Tripolidine 2.

jika mandi dibalut Jgn ditusuk tusuk lagi. jika gatal kembali kontrol lagi Kontrol lagi setelah obat selesai .• • • • Education : Jgn sampai kena air dulu.

Introduction • CSOM is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. .

poor nutrition and lack of health education.Epidemiology • Higher in developing countries because of poor socioeconomic standards. . • Both sexes and all age groups.

TYPES Tubotympanic or safe • Profuse. odourless discharge • Central perforation • Granulations uncommon • Pale polyp • Cholesteatoma absent • Complications rare • Mild to moderate conductive deafness Atticoantral or unsafe • Scanty. foul-smelling discharge • Attic or marginal perforation • Granulations common • Red and fleshy polyp • Cholesteatoma present • Complications common • Conductive or mixed deafness . mucoid. purulent.

Tubotympanic type Aetiology • It is the sequelae of acute otitis media usually following exanthematous fever and leaving behind a large central perforation. fish. etc. eggs. • Persistent mucoid otorrhea is sometimes the result of allergy to ingestants such as milk. . • Ascending infections via the eustachian tube.

Central perforation .

Oedematous and velvety when disease is active.Pathology • Perforation of pars tensa • Middle ear mucosa.normal when disease is quiscent or inactive. • Polyp • Ossicular chain • Tympanosclerosis • Fibrosis and adhesions .

E. • Common aerobic organisms are Ps. while anaerobes include Bacteroides fragilis and anaerobic Streptococci. Aeruginosa. . coli and Staph. Aureus.Bacteriology • Pus culture in both types of aerobic and anaerobic CSOM may show multiple organisms. Proteus.

. • Inactive. inflammation of mucosa and mucopurulent discharge.retraction pockets in pars tensa or pars flaccida.presence of cholesteatoma of posterosuperior region of pars tensa or in pars flaccida. • Inactive.permanent perforation of pars tensa but middle ear mucosa is not inflamed and there is no discharge.perforation of pars tensa.Alternative classification Tubotympanic • Active. Atticoantral • Active.

oedematous and swollen.normally.Clinical features • Ear discharge. . mucoid or mucopurulent.non-offensive. when inflamed it looks red. constant or intermittent.conductive type Round window phenomenon • Perforation • Middle ear mucosa. it is pale pink and moist. • Hearing loss.

rays/ CT scan temporal bone .Investigations • • • • Examination under otoscope Audiogram Culture and sensitivity of ear discharge Mastoid X.

maxillary antra and nasal allergy • Surgical treatment • Reconstructive surgery . mucolytics and such) Systemic antibiotics Precautions Treatment of contributory causes. adenoids.tonsils.Treatment • • • • • Aural toilet Ear drops (decongestant.

often including cholesterol. usually in the middle ear and mastoid region. .a cystlike mass lined with stratified squamous epithelium filled with desquamating debris. 3.Atticoantral type • Aetiology. but some people acquire it at birth or because of perforations to the tympanic membrane (eardrum)) Patology Cholesteatoma Osteitis and granulation tissue Ossicular necrosis Cholesterol granuloma • 1.(usually associated with chronic inflammation and infection of the middle ear. 4. 2.cholesteatoma .

Cholesteatoma .

Symptoms and signs Symptoms • Ear discharge.usually scanty. but always foul smelling due to bone destruction • Hearing loss • Bleeding Signs • Perforation • Retraction pocket • Cholesteatoma .

Investigations • • • • Examination under otoscope Tuning fork tests and audiogram X.ray mastoids/ CT scan temporal bone Culture and sensitivity of ear discharge .

nausea and vomiting Irritability and neck rigidity Diplopia Ataxia Abscess around ear .Features indicating complications of CSOM • • • • • • • • • • Pain Vertigo Persistent headache Facial weakness A listless child refusing to take feeds and easily going to sleep Fever.

Treatment • 1. • • Surgical treatment Canal wall down procedure Canal wall up procedure Reconstructive surgery Conservative treatment . 2.

Comparison of procedures Canal wall up procedure Canal wall down procedure Meatus Normal appearance Widely open meatus communicating with mastoid Dependence on doctor for cleaning mastoid cavity once or twice a year Low rate of recurrence or residual disease and thus a safe procedure Not required Dependence Does not require routine cleaning Recurrence or residual disease High rate of recurrent or residual cholesteatoma Requires second look surgery after 6 months or so to rule out cholesteatoma No limitation. Easy to wear a hearing aid if needed Second look surgery Patients limitations Swimming can lead to infection of mastoid cavity and it is thus curtailed Problems in fitting a hearing aid due to large meatus and mastoid cavity which sometimes gets infected Auditory rehabilitation . Patient allowed swimming.

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