otitis media purulenta kronik
TRANSCRIPT
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OTITIS MEDIA PURULENTA KRONIK
Dr.Azwar SpMK, SpTHT-KLBagian Ilmu Kesehatan THT-KL
FK UNSYIAH/RSUZA Banda Aceh
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OTITIS MEDIA PURULENTA KRONIK(OMPK)
• DifinisiKeradangan / infeksi kronik yang mengenai mukosa dan struktur tulang di dalam kavum timpani
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Kuman Penyebab• Pseudomonas• Proteus• E. Coli
Etiologi
OMP Akut
FaktorOMP Kronik
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Faktor2 Penyebab Terjadinya OMPK• Faktor Rinogen
Infeksi saluran nafas atas : rinitis, adenoiditis, sinusitis
• Faktor EksogenKebersihan MAE yg jelek, korek-korek, mandi di kali
• Faktor EndogenKU yang jelek, malnutrisi, KP, DM, Alergi
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Gambaran Patologi
• Perubahan pada Membran Timpani
• Perubahan pada mukosa• Perubahan pada tulang
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Perubahan Pada Membran Timpani
• Perforasi sentralPerforasi pada pars tensa
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• Perforasi MarginalPerforasi yang terjadi pada pinggir margo timpani
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• Perforasi atikPerforasi yang terjadi pada pars flaksida
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Perubahan pada mukosa• Hipertrofi : mukosa mengalami pembelahan
sel• Degenerasi : mukosa mengalami degenerasi
granulasi / polip• Metaplasi : mukosa mengalami perubahan sel
kuboid sel epitel terbentuk kolesteatoma
Perubahan pada Tulang• Osteitis• Destruksi• Nekrosis
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Pembagian Klinik
• Tipe Benigna (Tubo-timpanal, Hipertropik)
Perforasi sentral Mukosa hipertrofi Granulasi (-) Kolesteatoma (-)
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• Tipe Maligna (Atiko antral)– Degeneratif
– Metaplastik
Perforasi besar Granulasi / polip (+)
Perforasi atik/marginal Kolesteatoma (+)
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Kolesteatoma• Difinisi
Tumpukan dari pengelupasan lapisan keratin epitel bertatah dalam kavum timpani atau kavum mastoid
• Teori Terjadinya– Teori Invaginasi– Teori Migrasi– Teori Metaplasi
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• Teori InvaginasiTekanan negatif di dlm kavum timpani menyebabkan tertariknya epitel dari lapisan luar membran timpani ke dlm kavum timpani
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• Teori MigrasiSel epitel masuk ke dlm kavum timpani melalui perforasi
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• Teori MetaplasiSel kuboid sel epitel bertatah
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Diagnosis
Keluhan & Gejala• Otore : pus pada MAE
– Kental / busuk Kolest./destruksi tulang– Encer Mukosa hipertrofi
• Pendengaran menurun – Sekret dalam MAE– Perforasi– Penebalan mukosa– Kerusakan osikula
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Pemeriksaan Telinga (Otoskopi)
• Sekret pada MAE• Perforasi membran timpani• Mukosa :
– Menebal– Granulasi / polip– kolesteatoma
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Pemeriksaan Pendengaran• Suara bisik• Tes garpu suara• AudiogramTuli Konduksi/campuran
X-Foto mastoid (Posisi Schuller)• Mastoid : Sklerotik
Rongga kolesteatoma
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TERAPI
Tipe Benigna• Stadium Aktif
– Antibiotik– Cari faktor-faktor penyebab :
Rinogen berantas sumber infeksiEksogen oortoilet, H2O2 3%
• Stadium Tenang– Dianjurkan operasi miringoplasti
Tipe Maligna• Operasi mastoidektomi
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Komplikasi•Mastoiditis Kronik•Labirintitis•Meningitis•Abses Otak
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ALGORITMA PENATALAKSANAAN PASIEN OMSK
OTOREA KRONIS
OTOSKOPI
MT UTUH MT PERFORASI
OTITIS EKSTERNA DIFUSAOTOMIKOSIS
DERMATITIS/EKSIMOTITIS EKSTERNA MALIGNA
MIRINGITIS GRANULOMATOSA
OMSK
Predisposisi, OnsetProgresivitas, Penyakit sistemik, Fokus infeksi, Riwayat pengobatanCari gejala komplikasi
KOMPLIKASI (-) KOMPLIKASI (+)
KOLEATEATOM (-)OMSK BENIGNA
KOLESTEATOMA (+)OMSK BAHAYA
LIHAT ALGORITMA 1 LIHAT ALGORITMA 2
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OTITIS MEDIA SEKRETORIA/SEROSA
Patofisiologi :Obstr tuba Ventilasi kav timpani
terganggu Absorbsi O2 vakum Efusi cairan
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Diagnosis• Keluhan & Gejala
– Telinga terasa penuh / tersumbat– Pendengaran menurun– Keluhan lain (Sinusitis, adenoiditis)
• Pemeriksaan– Otoskopi : Membran timpani
retraksi,Kavum timpani ada
cairan– Tes Pendengaran : Tuli konduksi
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Terapi• Bila ada cairan parasintesis (utk drainage
& ventilasi) pasang gromet.sekret mukous “Glue Ear”
• Mengobati Penyebabnya– Alergi Hindari alergen, desensitisasi– Adenoid > Adenoidektomi– Sinusitis Irigasi sinus
Gromet
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OTITIS MEDIA TUBERKULOSA
Definisi • Keradangan kronik kavum timpani oleh
karena Mikobakt.TBC yg berasal dari Paru
Diagnosis• Keluhan & Gejala
– Otore : sekret bau busuk– Nyeri (-)– Pendengaran menurun
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Pemeriksaan• Otoskopi :
– Sekret serous / purulen– Perforasi multipel
• Tes Pendengaran : Tuli Konduksi / campuran berat
• X-Photo Torak : KP
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Terapi• Lokal : oortoilet• Umum : Anti TBC
Perforasi multipel
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MASTOIDITIS KRONIK
• Tak dpt dipisahkan dgn OMPK Otomastoiditis Kronik
• Diagnosis : sama dgn OMPK• Terapi : Mastoidektomi
Tujuan Operasi Mastoidektomi• Menghilangkan sumber infeksi• Mencegah terjadinya komplikasi• Mempertahankan fungsi pendengaran
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Mastoidektomi• Rongga Terbuka
– Mastoidektomi Radikal– Mastoidektomi Radikal modifikasi
• Rongga Tertutup– Mastoidektomi simpel (schwatze)– Atiko-Antrotomi
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• Gambar Mastoidektomi
RADIKAL MURNI
RADIKAL MODIFIKASIATIKOANTROSTOMI
SIMPEL
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KOMPLIKASI• Ekstra kranial : - Abses
Retroaurikularis - Abses Bezold - Abses Mouret
• Intra temporal : - Labirintitis - Parese/Paralise N VII
• Intra kranial : - Abses Ekstra Dura - Meningitis
- Abses Otak
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Aspek Sosial OMK
Hubungan penderita OMK denganmasyarakat ada hambatan karena :• Bau (foetor)
– Dijauhi teman– Rasa rendah diri
• Komplikasi– Meningitis– Paralisa N VII
• Tuli– Komunikasi– Pekerjaan / Sekolah
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