Anatomy

External ear canal

Middle ear and mastoid
Anatomy


External ear canal
Middle ear and mastoid
Classification of Ear Disease


Otitis media with
effusion (OME)
OME with purulent
effusion (acute OME)
Classification of Ear Disease


Otitis media with
effusion (OME)
OME with serous effusion

Classification of Ear Disease


Otitis media with
effusion (OME)
OME with mucoid
effusion or chronic otitis
media with effusion
(COME)
Classification of Ear Disease


Chronic suppurative
otitis media (CSOM)
The presence of a
perforation implies
CSOM
Classification of Ear Disease


Chronic suppurative
otitis media (CSOM)
Inactive
Active
Classification of Ear Disease


Chronic suppurative
otitis media (CSOM)
Central perforation
Marginal perforation
Classification of Ear Disease


Chronic suppurative
otitis media (CSOM)
Cholesteatoma
Chronic Suppurative Otitis Media
(CSOM)


Perforations
Etiology
Acute Otitis Media

Chronic Suppurative Otitis Media
(CSOM)


Perforations
Etiology
Poor Eustachian tube
function
Chronic Suppurative Otitis Media
(CSOM)


Perforations
Etiology
Marginal perforations
Chronic Suppurative Otitis Media
(CSOM)


Perforations
Etiology
Traumatic perforations


Chronic Suppurative Otitis Media
(CSOM)
Cholesteatoma -
keratinizing epithelium
medial to TM
Retraction versus
migration
Primary cholesteatoma

Chronic Suppurative Otitis Media
(CSOM)
Polyps
Chronically infected
perforation
Associated with
cholesteatoma
Tuberculosis
Multiple small
perforations
Scant grayish drainage

Chronic Suppurative Otitis Media
(CSOM)
Diagnosis of Perforation
Inactive
Active
Foul smelling discharge
Intermittent drainage
Long term discharge
Chronic Suppurative Otitis Media -
Therapy
Pseudomonas is the most common organism
Systemic therapy is not indicated if there are no
systemic symptoms
Aural Toilet
Wet or dry swab
Saline irrigation (one teaspoon NaCl to one pint of
boiled water)

Chronic Suppurative Otitis Media -
Therapy
Local therapy
Otic versus opthalmic drops
Ototoxic versus non ototoxic drops
Cipro ear drops 250-500 mg tablet dissolved in
25-50 cc of saline
Dose 3 to 4 drops BID or TID
Betadine ear drops
Tragal pressure
Water precautions
Chronic Suppurative Otitis Media -
Therapy
Cholesteatoma
Will require surgery
May control symptoms or
progression by using
antibiotic ear drops
Regular aural toilet to
remove collecting
epithelial debris and
discharge

Chronic Suppurative Otitis Media -
Complications


Hearing loss
Vertigo

Chronic Suppurative Otitis Media -
Complications



Mastoiditis

Chronic Suppurative Otitis Media -
Complications



Lateral sigmoid sinus
thrombosis
Chronic Suppurative Otitis Media -
Complications


CNS complications
Meningitis
Abscesses brain,
epidural or subdural
PENGERTIAN OTITIS MEDIA (OM)
DEFINISI : PERADANGAN TELINGA TENGAH >
3 BULAN

GEJ ALA & TANDA ( SIMPTON & SIGN ):
OTORHOE
PERFORASI MEMBRANA TYMPANI +/ -
TULI ( DEAFNESS / HEARING LOSS )
KADANG OTALGIA
VERTIGO ( GANGGUAN VESTIBULARIS )
OTITIS MEDIA
AKUT
( OMA )
( SUB AKUT )
( SUB KRONIS )

KRONIS / OMSK / OMK
NON PERFORATA

PERFORATA
Otitis Media Akut : < dari 1minggu
Otitis Media Kronis : > dari 3 minggu
Otitis Media Sub Akut : Antara 1- 2 minggu
Otitis Media Sub Kronis : antara 2 3 minggu
DIAGNOSA :

* OTORHOE





* PERFORASI MEMBRANA TIMPANI
SEROUS
MUCOID
PURULENT
CAMPURAN
HEMORARGIS ( JARANG )
SERO PURULENT
MUCO PURULENT
CENTRAL SUB TOTAL
SAFE EAR TOTAL

PERIFER ( PROS FLACIDA )


CHOLESTEATOMA (KONGENITAL)
CHOLESTEATOMA

DANGEROUS EAR

PEMERIKSAAN PENUNJANG


RO FOTO MASTOID
- ADANYA MASTOIDITIS
- PENGKABUTAN CELLULAE MASTOID
- CHOLESTEATOMA
- GRANULOMA
- BATAS FIGMEN TIMPANI & SINUS LATERALIS
PEMERIKSAAN LAB. DARAH RUTIN
KULTUR & SENSIVITAS DISCHARGE TELINGA
TES PENDENGARAN




TULI
DEAFNESS/
HEARING LOSS
KONDUKSI/ HANTARAN UDARA
( OK PERFORASI MEMBRAN TIMPANI )
CAMPURAN/ MIXED
( AIR BONE GAB > 25 DB
SYARAF / SENSORI
( OK KOMPLIKASI - LABIRINTITIS
+ GEJALA GEJALA LAIN
PEMERIKSAAN FUNGSI PENDENGARAN
A. TES GARPU TALA - RINNE
- WEBER
- SCHWA BACH
B. AUDIOMETER - NADA MURNI / PURE TONE
- TUTUR / SPEECH ( SDS )
PENGOBATAN

A. KERING : - MEDIKAMENTOSA
- HINDARI KEMASUKAN AIR
- PEMBEDAHAN : TIMPANOPLASTI

B. BASAH : - ANTI BIOTIKA ( SESUAI KULTUR
& SENSITIVITAS )
- CLEANSING / DRAINASE
- TAK ADA RESPONS
- OPERASI : MASTOIDEKTOMI SIMPLE
/ RADIKAL
C. CHOLESTEATOMA : OPERASI MASTOIDECTOMI
VERTIGO : - NISTAGMUS
- OM.LABIRINTITIS


PEMERIKSAAN :
- TES KESEIMBANGAN
- LENSA FRENZEL ( 10 DIOPTRI )
- KALORI TES
- NISTAGMOMETER