otomikosis dhana.pptx
TRANSCRIPT
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Pradhana F Wicaksana
12798
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IDENTITAS Nama : Ny Sum
Tanggal Lahir : 12 Juli 1979
Umur : 34 tahun
Jenis Kelamin : Perempuan
Alamat : Bubutan, Purwodadi
Purworejo
No. RM : 096914
Tanggal Masuk : 15 Juli 2013
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KELUHAN UTAMA
Gatal Pada
Telinga Kanan
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RIWAYAT PENYAKIT SEKARANG
H1SMRS OS mengeluh telinga kanan terasa gatal,Nyeri. Tanpa disertai gangguan pendengaran. Namuntelinga terasa seperti tersumbat.
OS mengatakan telinga kanan sering terasa gatal, seringdikorek menggunakan cotton bud. OS mememeriksakandiri ke dokter, waktu itu hanya dibersihkan kotorannya,dan dikasih obat. Keluhan membaik. Diagnosis waktu itu
OS tidak tahu. Keluhan keluar cairan dari telinga kanan disangkal,
keluhan telinga kiri disangkal, keluhan hidung dantenggorok disangkal.
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RIWAYAT PENYAKIT DAHULU
OS pernah menderita keluhan serupa pada kedua
telinga bulan april lalu.
Riwayat asma, rhinitis alergi, dermatitis atopi
disangkal.
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STATUS LOKALIS
TELINGA KANAN KIRI
Auricula Nyeri tekan (-) dbn
Plano mastoideum dbn dbn
Gld. Lymphatica dbn dbn
Canalis auditoris
externa
Hifa/ Debris (+)
discharge(-), edema (-),
serumen minimal
hiperemis(-),
discharge(-), edema (-),
serumen minimal
Membrana tympani intak, cone of light di arah
jam 7. tidak ada perforasi
intak, cone of light
diarah jam 5, tidak ada
perforasi
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STATUS LOKALIS
HIDUNG KANAN KIRI
Discharge tidak ada tidak ada
Concha dbn dbn
Septum dbn dbn
Tumor tidak ada tidak ada
Sinus paranasal dbn dbn
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STATUS LOKALIS
OROPHARYNX KANAN KIRI
Palatum dbn dbn
Uvula dbn dbn
Tonsila palatina dbn dbn
Tonsila lingualis dbn dbn
Dinding belakang dbn dbn
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STATUS LOKALIS
OROPHARYNX KANAN KIRI
Palatum dbn dbn
Uvula dbn dbn
Tonsila palatina dbn dbn
Tonsila lingualis dbn dbn
Dinding belakang dbn dbn
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RESUME ANAMNESIS DANPEMERIKSAAN FISIK
Anamnesis :
Nyeri telinga kanan (+)
Telinga terasa gatal (+)
Telinga terasa tersumbat (+)
Pemeriksaan fisik
Otoscopi : Debris/ hifa berwarna putih di Canalis auditory
Dextra
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DIAGNOSIS
AD Otomycosis
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PENANGANAN
Evakuasi kotoran cerumen
Medikamentosa
Ketoconazole 1 x 200 mg
Loratadine mg 10
1 x 1
Edukasi: hindari masuknya air ke dalamtelinga, hindari mengorek telinga, rutinkontrol.
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Anatomy Of The Ear
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DEFINITION
OTOMYCOSIS => FUNGAL OTITIS EKSTERNA
Inflammatory process of the external ear canal due to infection withfungi.
The Most commonly:
1. Aspergillus
2. Candida
3. Pityrosporum
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PATHOGENESIS
Spora orHyfa in the
air
EnteringEAC
Moisture,warmth,
darkness
FungalgrowthOtomycosis
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EPIDEMIOLOGY
The most commonly in tropical country.
In various studies, it has been predicted that
incidence of otomycosis happened in the late of
summer
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Predisposition Factor
- Low productivity of Cerumen
- High Humidity, Increased temperature, moisture-
water entering ear while
- Localized trauma caused by cotton buds
- Ear plug instruments
- Immunocompromised - history of steroid and antibiotics use
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ANAMNESIS
Pruritus, pain, feeling something in the ears, discharge,discomfort.
Activities related by water for example: swimming, diving .etc.
(S. pneumoniae, H.influenza),
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Physical Examination
Inflamation sign on ear canal (hyperemia,ulceration ,tighten)
Debris (white/gray/dirty yellow/black or wet
blotting paper filling)
(S. pneumoniae, H.influenza),
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Laboratory Diagnosis
The clinical diagnosis of otomycosis should be
supplemented by microscopy and culture of debris
material.
Fungal structures is seen in KOH. AspergillusNiger septha hyphae, sporulating vesicles and
abundant black spores are seen.
Fungal spesific monoclonal antibodies has been
performed as rapid and sensitif diagnostic
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MANAGEMENT
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MANAGEMENT Drying and cleaning of external auditory canal carefully.
Acidity agent
Topical Therapy
- Keratolytic Agent
- Antifungal drugs :
Amphotericin B (3%)
Nystatin
FluconazoleEconazole cream (1%) very effective in vivo treatment
within 1-3 weeks.
Clotrimazole cream,powder or solution (1%)
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Salicylic acid, griseofulvin and ketoconazole are less
effective ?
Tolnaftate 1% solution (tinactin) should be used to avoid
ototoxicity if tymphanic membrane is perforated.
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Immunocompromised Individual
Topical
Antifungal
No of
Cases
1st
followup
2nd
followup
3rd
followup
4th
followup
Clotrimazole 180 Good Good Good NAD
Fluconazole 20 No
response
Good Good NAD
A Clinical study of Otomycosiswww.iosjournal.org
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COMPLICATION
Perforation of Tymphanic Membrane OMS
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Prognosis and Preventive Care
Risk of recurrence is high if the factors which
caused the original infection are not corrected.
Avoiding sudden maneuvers in the external
auditory canal
Avoid excessive moisture
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MATURNUWUN