ANATOMY OF EAR TYPE:

- Allergic rhinitis
o Cause by: allergens
- Seasonal allergic rhinitis
o Called: Hay Fever
o Tp ga perlu selalu demam/exposed
tp hay (jerami)
o Allergic reaction to pollen from
trees, grasses, weeds
o Mainly: spring/fall
- Perennial allergic rhinitis
o Caused by allergen yg present all
year long
o Allergens: dust mites, mold, animal
dender, cockroach debris
- Non-allergic rhinitis
o Smoke, chemicals, hormonal
changes, physical defects of the
nose, overuse of nose spray
o Common in patient with non llergic
asthma
- Infectious rhinitis
o Most common type
o Common cold/URI
o Cold occur when viruses ke mucus
membrane od the nose and sinus 
infection

RHINITIS

DEFINISI: inflammation of the nose SYMPTOMS:

Normalnya: nose produce fluid: mucus (thin & clear) trs - Gatal di hidung dan mata (kadang mata bs
drains out from the back of the throat. merah)
- Bersin2
Patologi: ketika ada iritasi pada hidung kt, maka mucus - Kongesti (hidung mampet)
nya itu jadi thick & pale yellow, drains out from the front - Runny nose
and back. Mucus may irritate the back and cause - Mucus in throat (post nasal drip)
coughing. – post nasal drip: more mucus drains at the
back ALLERGIES OR COLD?

- Tapi biasanya self-limiting - A: occur the same time every year and last (2-
- Kalo chronic: weeks to months (recurs jg bs) 3 weeks per allergen), gatal di hidung dan
mata along w/ other nasal symptoms
CAUSES: - C: last 1 week and less itching of nose & eye
- Irritants/allergens
ALLERGIC RHINITIS - Nasal corticosteroid – nasal dpray; reduce
inflammation & block allergic reaction
- Is a: Type 1 Hypersensitivity reaction - Leukotriene receptor antagonist – block the
KLASIFIKASI ARIA 2001 action of important chemical messenger oher
than histamine that are involve in allergic
reaction
- Cromolyn sodium – nasal spray that blocks the
release of chemicals that cause allergy
symptoms (e.g histamine and leukotrienes);
taken 4x/day.

PEMERIKSAAN PENUNJANG:

- ↑eosinofil, kadar IgE total serum

- Sitologi: mukosa shows ↑eosinofil
- Uji kulit alergen: determine status atopi dan
causative allergen – kurang bermakna pada
anak usia <3thn
- Kalo ada keluhan mata  pemeriksaan
eosinofil pada sekret mata
- Usia ≥4 tahun  CT-scan sinus paranasalis
(bila dicurigai komplikasi sinusitis/ada deviasi
septum nasi)

DIAGNOSIS

Anamnesis:

- Riwayat atopi dalam keluarga (faktor

predisposisi rinitis alergi pd anak) CHRONIC OTITIS MEDIA
- Allergen most common: debu rumah, bulu
binatang, tungau, dll OME (Otitis Media Efusi)/Glue Ear

PF: DEFINISI: peradangan dan akumulasi cairan di telinga

tengah (tdk ada perforasi MT)
- PF: rinoskopi  utk singkirin dd:
polip/tumor/infeksi - Insidens tertinggi (60%): anak – 1 episode by
- Tanda klasik**: mukosa edema & pucat the age of 6
kebiruan dgn ingus encer – tanda ini hanya - Most common cause tuli pada anak
found pada penderita yg sdg serangan - Biasanya muncul stlh upper respi tract
- Tanda lain: otitis media serosa/hipertrofi infection
adenoid - Self-limiting – 3 months
- Kl disertai: konjungtivitis = rinokonjungtivitis
CAUSES & RF:
alergi
- Malfunction of tuba eustachian

TREATMENT FOR ALLERGIC RHINITIS SYMPTOMS:

- Avoid contacts with allergens Older ones:

- Antihistamine – taken by mouth/nasal spray;
relieve bersin & gatal pada nose and eyes - Sakit telinga
- Decongestants – taken by mouth/nasal spray - Hearing loss
or drops; shrink lining of nasal passages which - Rasa penuh di telinga
relieves nasal stuffiness.
Younger ones:
 - Rewel - Jaga telinga tetap kering
- Susah tidur - 1st line: obat tetes telinga yg mengandung
- Suka narik2 telinga mrk antiseptik (asam asetat 2%/larutan povidon yg
diencerkan 1:2) atau antibiotik: fluor kuinolon
SIGN: (ofloksasin, siprofloksasin) krn tdk ototoksik –
Membran timpani (MT): obat topikal ini dikasi 1x sehari selama 2 weeks

- Tdk tdp tanda infeksi akut & tdk ada perforasi TINDAK LANJUT/FOLLOW UP
- Warna: keabuan/kemerahan Pasien diperiksa lagi dalam 5 hari:
- Kadang ada tampak gelembung udara/cairan
di kavum timpani - Jika masih bernanah: masih dibersihin ga? trs
- MT retraksi/terdorong keluar/pada posisi bs kasih antibiotik oral (choosing antibiotiknya
normal depend on causative agent)
- MT menipis/menebal, vaskularisasi bertambah o Sekret kuning keemasan:
Staphylococcus aureus 
TREAT: betalaktam
Medikamentosa: o Sekret hijau kebiruan  anti
Pseudomonas
- Antibiotik o Sekret berbau busuk  anti anaerob
- Dekongestan - Kalo 3 bln ga sembuh: terapi bedah
- Mukolitik - Bila fase aktif > 3 bln lngsung rujuk spesialis
- Perasat Valsava THT  mastoidektomi & timpanoplasti/op
- Antihistamin  given saat ada tanda rinitis eradikasi kolesteatom & timpanoplasti
alergi

Surgical: miringotomi
PEMERIKSAAN GARPU TALA
Alat bantu: pemasangan grommet
TEST:

- Rinne
OMSK (Otitis Media Supuratif Kronik) - Weber
- Schwabach
DEFINISI: radang kronik telinga tengah dengan perforasi
membran timpani & riwayat keluarnya sekret dari RINNE
telinga (otorea) > 2 bulan, terus menerus/hilang timbul.
TUJUAN: membandingkan hantaran udara dan hantaran
- Sekret: encer/kental, bening/nanah tulang pada telinga yg diperiksa

DIAGNOSIS CARA PEMERIKSAAN:

Types: - Bunyikan garpu tala frekuensi 512 Hz di tulang

mastoid (dibelakang ear), trs pas dia udh ga
1. Tipe aman
denger (bone)  pindahin ke ear nya (air
- Peradangannya terbatas pada mukosa telinga
conduction)
tengah
- Kalo di air dia masih denger: Rinne (+)
2. Tipe bahaya
- Kalo dia udh gak denger: Rinne (-)
- Terbentuk kolesteatoma (tumor jinak di
telinga tengah biasanya krn infeksi telinga INTERPRETASI
berulang) yg akan tumbuh terus dan destruksi
jaringan sekitarnya  cause komplikasi (e.g - Normal: Rinne (+)
fasial, labirinitis, meningitis, abses otak) - Tuli konduksi: Rinne (-)
- Ditandai dengan: ditemukan kolesteatoma yg - Tuli sensori neural: Rinne (+)
keluar dari kavum timpani/adanya perforasi yg
WEBER
letaknya postero-superior
TUJUAN: membandingkan hantaran tulang antara kedua
FASE:
telinga penderita
1. Fase tenang (bila kering)
CARA PEMERIKSAAN:
2. Fase aktif (bila ada otorea)
- Bunyikan garpu tala frekuensi 512 Hz  taro
TREAT:
tegak lurus di tulang median (biasanya: dahi)
 - Tanya pasien: ada kedengeran bunyi ga? kalo
ada, lebih keras di telinga kiri/kanan?
- Kalo denger lebih keras pada 1 telinga tsb,
maka ada laterisasi ke sisi tsb.
- Kalo 22nya ga denger maka gaada lateralisasi
INTERPRETASI
- Normal: Tdk ada lateralisasi
- Tuli konduksi: denger lbh keras ke ear yg sakit
- Tulis sensori neural: denger lbh keras ear yg
sehat
SCHWABACH
TUJUAN: bandingin hantaran lewat tulang antara
penderita dengan pemeriksa yg pendengarannya normal
CARA PEMERIKSAAN:
- Bunyikan garpu tala frekuensi 512 Hz 
tempel ke tulang mastoid pemeriksa, kalo udh
ga denger  pindahin ke tulang mastoid
penderita
o Kalo penderita masih denger:
schwabah memanjang
o Kalo penderita udh ga denger:
schwabah memendek/normal  utk
membedakan ini test tinggal dibalik,
dari penderita baru ke pemeriksa
INTERPRETASI
- Normal: schwabach sama dgn pemeriksa
- Tuli konduksi: schwabach memanjang
- Tuli sensorineural: schwabach memendek
AUDIOMETRY
AUDIOMETRY TEST  exam test utk liat ability to hear
sounds
SOUND WAVE
- Travel to inner ear through ear cannal,
eardrum, bones of the middle ear (air
conduction)
- Pass through the bones around behing of the
ear (bone conduction)
INTENSITY OF SOUND
- Measured in decibels (dB)
- Whisper – 20 dB
- Loud music – 80-120 dB
- Jet engine – 140-180 dB
- Sounds > 85 dB  hearing loss after few hours
& immidiate pain
TONE OF SOUND
- Measured in cycles per seconds/Hertz
- Low bass tone – 50-60 Hz
- High pitch tone ≥10.000 Hz
- Normal human range 20-20.000 Hz
- Human speech tone 500-3000 Hz
TEST:
1. AUDIOGRAM (pure tone testing): pake
earphone yg attached to audiometer. Pure
tones delivered to 1 ear at a time, kt disuru
signal everytime kt denger ada bunyi.
Minimum volume required to hear each tone
is graphed. Bone oscillator is placed di mastoid
bone utk test bone conduction nya.
2. SPEECH AUDIOMETRY: test ability to detect
and repreat spoken words at different
volumes heard lewat headset
3. IMMITTANCE AUDIOMETRY: measure the
function of eardrum and flow of sounds
through middle ear. Nanti bakal dimasukin
suatu alat yg bs change pressure within ear as
tones are produced. Microphone moitors how
well sound is conducted within ear under diff
pressure.
INTERPRETATION
NORMAL RESULT
- Kalo bs denger whisper, normal speech, ticking
watch
- Ability to hear tunning fork through air and
bone
- Hearing normal if: bs hear tones from 250-
8000 Hz at 25 dB/lower
ABNORMAL RESULT
- Hearing loss: inability to hear pure tones <25
dB
- Conditions that may affect result:
o Acoustic neuroma
o Trauma from loud noises
o Age-related hearing loss
o Alport syndrome
o Chronic ear infection
o Labyrinthitis
o Meniare’s dz
o Ongoing exposure of loud noises
(occupational)
o Ruptured/perforated eardrum
o Otosclerosis