Anatomi telinga tengah

OMA(Defenisi)

• Acute Otitis Media (AOM)• “acute onset of symptoms, evidence of a middle ear effusion, and signs or

symptoms of middle ear inflammation.”

• Otitis Media with effusion (OME)• “Presence of MEE without signs or symptoms of infection, previously named:

secretory, serous, or glue ear. ”

Pathophysiology• Eustachian tube obstruction

• Length: shorter in children• Angle: 10o children vs. 45o adult

• Decreased immunocompetence• Follows upper respiratory infection (URI)

• Peak incidence 2 - 4 days

PathogensBacterial• Streptococcus pneumoniae• Haemophilus influenzae• Moraxella catarrhalis

Viral• RSV • Influenzae A & B• Parainfluenzae 1,2, & 3• Rhinovirus• Adenovirus• Enterovirus• Coronavirus

Sign and SymptomAlthough the history of AOM varies with age, a number of constant features manifest during the otitis-prone years, including the following:• Neonates: Irritability or feeding difficulties may be the only indication

of a septic focus• Older children: This age group begins to demonstrate a consistent

presence of fever and otalgia, or ear tugging• Older children and adults: Hearing loss becomes a constant feature of

AOM and otitis media with effusion (OME); ear stuffiness is noted before the detection of middle ear fluid

DiagnosisPneumatic otoscopy is the standard of care in the diagnosis of acute and chronic otitis media. The following findings may be found on examination in patients with AOM:• Signs of inflammation in the tympanic membrane• Bulging in the posterior quadrants of the tympanic membrane may bulge; scalded

appearance of the superficial epithelial layer• Perforated tympanic membrane (most frequently in posterior or inferior

quadrants)• Presence of an opaque serumlike exudate oozing through the entire tympanic

membrane• Pain with/without pulsation of the otorrhea• Fever

Imaging studies• Radiologic studies are generally

unnecessary in uncomplicated AOM. However, CT scanning may be necessary to determine if a complication has occurred. MRI might be more appropriate for diagnosing suspected intracranial complications.

Complications• Intratemporal - Perforation of the tympanic membrane,

acute coalescent mastoiditis, facial nerve palsy, acute labyrinthitis, petrositis, acute necrotic otitis, or development of chronic otitis media• Intracranial - Meningitis, encephalitis, brain abscess, otitis

hydrocephalus, subarachnoid abscess, subdural abscess, or sigmoid sinus thrombosis• Systemic - Bacteremia, septic arthritis, or bacterial

endocarditis

Management• Antibiotics are the only medications with demonstrated efficacy in the

management of AOM

• Surgery• Surgical management of AOM can be divided into the following 3 related

procedures:• Tympanocentesis• Myringotomy• Myringotomy with insertion of a ventilating tube

Tympanocentesis• Neonates who are younger than 6 weeks (and therefore are more

likely to have an unusual or more invasive pathogen)• Immunosuppressed or immunocompromised patients• Patients in whom adequate antimicrobial treatment has failed and

who continue to show signs of local or systemic sepsis• Patients with a complication that requires a culture for adequate

therapy

Klinis dan Penatalaksanaan• Stadium Okulsi Tuba Eustachius• Otoskopi : Retraksi Membran Timpani• Klinis : Hidung tersumbat, Telisa terasa penuh• Tatalaksana : Antibiotik untuk rhinitis (jika diperlukan), dekongestan.

• Stadium Hiperemis/Presupurasi• Otoskopi : Membran Timpani Hiperemis• Klinis : Hidung Tersumbat, Telinga terasa nyeri• Tatalaksana : Antibiotik, Obat tetes hidung dekongestan, Analgetik.

Klinis dan Penatalaksanaan(Lanjutan)

• Stadium Supurasi• Otoskopi : Membran timpani bulging, eksudat purulent kavumtimpani.• Klinis: Demam tinggi, nyeri telinga hebat, gelisah, sulit tidur, setelah rupture

membrane timpani suhu tubuh turun dan anak tertidur.• Tatalaksana : Antibiotik< bila jeas ada nanah di liang telinga di rujuk untuk

miringotomi.

• Stadium Perforasi• Otoskopi : membrane timpani perforasi.• Klinis : Terlihat banyak secret keluar, kadang secara berdenyut.• Tatalaksana : Diberikan obat cuci telinga H2O2 3% selama 3-5 hari serta

antibiotik sampai 3 minggu

Klinis dan Penatalaksanaan(Lanjutan)

• Stadium Resolusi• Otoskopi : membrane timpani berlangsung normal kembali• Klinis : secret tidak ada lagi• Tatalaksana : Bila membrane timpani belum menutup< anti biotik dapat

dilanjutkan sampai 3 minggu.