Differential Diagnosis

Muhammad Luthfi Ikbar

Fistula Preaurikula

• Definition
o Congenital abnormalities when there is a tunnel or canal that looks like a hole in the earlobe.
o Empties in front of helix (90%) (1 mm)
• Symptom
o No Symptoms
o If there is obstruction / blockage and infection:
1. White viscous liquid smells
2. Sometimes it hurts
3. Swelling in the fistula area
• Risk Factors
o Marfan syndrome
o Cerebro-okulo-facial-skeletal Syndrome (COFS)
o Fragile X Syndrome
o Anophthalmia plus Syndrome
• Management / treatment
o If the preauricular fistula is not infected, neither therapy nor surgery is required.
o If there is infection, systemic antibiotics should be given.
Penicillin is the recommended initial antibiotic therapy. If there is an abscess, incision and drainage
should be performed.
Mastoiditis

• Definition
o Inflammatio mastoidei mucoperiostei selulae (Haemophilus influenza, Moraxella catarrhalis,
Staphylococcus aureus, etc.)
• Symptom
o Fever, malaise
o Swelling and pain behind the ear
o Yellow, thick, smelly discharge from the ear (otorrhea).
o Decreased hearing
• Risk Factors
o Acute otitis media (acute mastoiditis): immunosuppression, virulence of bacteria
o Inadequate use of broad-spectrum antibiotics to treat middle ear disease (chronic mastoiditis).
• Management / treatment
o Medikamentosa :
High-dose antibiotics: amoxicillin or ampicillin. If the cause is anaerobic bacteria, chloramphenicol or
metronidazole can be given
o Operatif :Mastoidektomi
Otitis Media Kronik

• Definition
o Inflammation/inflammation of part or all of the middle ear mucosa, which occurs for more than 2
months (chronic).
• Symptom
o Thick ear discharge that smells constantly or comes and goes
o Hearing disorders
• Risk Factors
o Acute otitis media that received late, inadequate therapy, high germ virulence. Immunosuppression, poor
hygiene
• Management / treatment
o Active stage benign type given antibiotics. Oral antibiotics are ampicillin, amoxicillin or erythromycin.
o In the calm stage (kept dry for 2 months), it is recommended to operate myringoplasty (closing the
tympanic membrane perforation) or tympanoplasty to prevent recurrent infections.
o The principle of treatment for the malignant type of OMK is mastoidectomy. Aims to remove
granulation tissue, pus, polyps or necrotic bones.
Referensi
1. Sosialisman, Hafil AF, Helmi. Kelainan telinga luar dalam buku ajar ilmu kesehatan telinga hidung tenggorokan kepala
leheredisi ke 11. FK UI, Jakarta. 2018, 60.
2. Ikatan dokter Indonesia (IDI). Panduan praktik klinis bagi dokter di fasilitas pelayanan kesehatan primer edisi 3. 2018.
3. Ikatan dokter Indonesia (IDI). Panduan praktik klinis bagi dokter di fasilitas pelayanan kesehatan primer edisi 1. 2018.
4. Blomgren K and Pitkaranta A. Is it Possible to diagnose acute otitis media accuretely in primary health care?. Fam practice.
2018;20:524-527.
5. J, W. (2019). Otitis externa. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://
www.ncbi.nlm.nih.gov/pubmed/24439876 [Accessed 23 Jun. 2019].
6. Overview, O. (2019). Outer ear infection: Overview. [online] Ncbi.nlm.nih.gov. Available at:
https://www.ncbi.nlm.nih.gov/books/NBK279353/ [Accessed 24 Jun. 2019]