Presentator : dr.

Jenny
Moderator : dr. Budi Santoso

The peripheral auditory system is

divided into 3 parts :

The external ear

The middle ear
The inner ear

The external auditory canal consists of a 1/3

lateral cartilaginous portion and a 2/3
medial bony portion.

The tympanic membrane consists of three

layers: the outer, middle, and inner layers.

The middle ear cavity originates

embryologically from the first branchial
pouch

There are three ossicles the malleus, the

incus, and the stapes.

= inflammatory process within the middle ear

cleft.

Otitis media can be either acute or chronic.

There is no absolute time period that
distinguishes between acute and chronic OM,
but, in general, disease that persists for
more than 3 months should be considered
chronic.

Classification of Otitis Media.

Acute Otitis Media

Suppurative
Nonsuppurative
Recurrent
Chronic Otitis Media
Suppurative
Tubotympanic
Cholesteatoma
Nonsuppurative
Otitis media with effusion

Acute otitis media (AOM) is one of the most

common infectious diseases seen in children,
having its peak incidence in the first 2 years
of life.

Recurrent AOM is defined as 3 episodes of

acute suppurative OM in a 6-month period, or
4 episodes in a 12-month period, with
complete resolution of symptoms and signs
between episodes of infection.

Factors Relevant to the

Epidemiology of Otitis Media

Environmental Factors
Day-care attendance
Not being breast-fed
Exposure to tobacco smoke
Seasonal variation in respiratory infections
Host Factors
Genetics
Immunodeficiency
Birth defects
Cleft palate
Down syndrome

Acute Respiratory Tract Infection Eustachian

tube dysfunction Inflammation process
tube occlusion decrease oxygen
concentration mucocilliary defect
changes in pressure (-ve) sterile
transudation infection accumulation of
transudate bulging perforation
resolution (if adequate treatment and good
immune system)

1.

Occlusion stadium of Eustachian tube

Retraction feature of tympanic membrane may
appears as a normal or clouded

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2. Hyperemia stadium

Dilatation of blood vessels and edema in

TM exudate serous discharge are formed

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3. Suppurated stadium
Severe mucosal edema in the middle ear
TM is bulging toward external ear
Pulse, body heat, and earache are increase
severely

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4.

Perforation stadium
TM is rupture
Discharge flow out from the middle ear
Body heat is decrease or normal

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5.

Resolution stadium
Discharge is decrease and dried up
TM returns to normal
(

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To reduce the severity and duration of

pain and other symptoms,
To stop infection proses
To prevent complications,
To minimise adverse effects of treatment.

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1. Occlusion stadium :

Decongestant
Antibiotic

2. Hyperemia stadium :

Antibiotic
Decongestant
Analgetic\

3. Suppurated Stadium

Antibiotic
Analgesic, antipyretic If necessary
Myringotomi

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4. Perforation stadium

H2O2 3 % for 3-5 days

Antibiotic

5. Resolution Stadium

Antibiotic is continued until 3 weeks if discharge seen in

canal ear via perforation TM

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First choice : Amoxicillin

Dose : 40 50 mg/kg BW/day

Effectiveness 85 -94 %

Cheap

Save
If resistance :
Amoxyclav, cefuroxim, ceftriaxone
Third choice : clindamycin

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 The

prognosis of patients with acute otitis

media is excellent. However, patients
and/or their parents still should be
encouraged to finish the prescribed
medication and to keep their follow-up
appointments.
Symptoms usually improve within 24 hours
and almost always within 48-72 hours.

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Patients identity
Name
Age
Sex
Address
No. RM

:
:
:
:
:

N
53 y.o
Female
Ngentak Baru
1.36.68.41

Main complaint: earache in the both ear

History of present illness:
Since two days ago, she felt that her both
earache. Earache continoues, likely pulsating.
The pain more painfull before yesterday. She
also cmplaint in her both ear there is hearing
impairment. Since one weeks ago she also felt
cough and runny nose. Until now, sometime she
still felt runny nose. no sound nging or ngung in
her both ear. Sore throat (-), fever (-). History of
the same illness (-). Previous history of diabetes
mellitus, hypertension, allergic disease are
denied. There was no one who suffered from
that kind of disease in his family.

Resume Anamnesis
Otalgia (+)
Hearing loss (+)
Fever (+)
Rhinorrhea (+)

General condition: good, CM, well nourished,

body weight 17 Kg.
Vital sign:
R: 20x/mnt
BP: 120/80 mmHg
P: 80x/mnt
T: Afebris

Refer to the whiteboard

AD + AS Acute otitis media Hyperemic stage

ec. Rhinitis akut

This patient was treated with Antibiotic (Amoxicilin 500mg +

clavulanat 125mg threetimes a day), decongestan (pseudoefedrin
120mg + loratadine 10mg SR three times a day), mukolitic
(ambroxol 30mg three times a day), Antiinflammation
(metilprednisolon 4 mg 2 1 0), analgetic (paracetamol 500mg
three times a day).

Five days first control after treatment, complaint earache (-),

there is improvment AD + AS hearing impairment . The treatment
was Antibiotic (Amoxicilin 500mg + clavulanat 125mg three times
a day), decongestan (pseudoefedrin 120mg + loratadine 10mg SR
three times a tday), mukolitic (ambroxol 30mg three times a
day), Antiinflammation (metilprednisolon 4 mg 1 1 0 for three
days and 1 1 0 for three days)

Five days second control after treatment, the complaint of AS

hearing impairment is minimal. The treatment was decongestan
(pseudoefedrin 120mg + loratadine 10mg SR three times a day),
mukolitic (ambroxol 30mg three times a day), Antiinflammation
(metilprednisolon 4 mg 1 1 0)

Avoid

water exposure
Avoid ear manipulation
Maintain well nourished nutrition

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From some literate there is still controversion of using

antiboik to treat AOM. some of the study think aom is self
limin But in this patient we using anti because according to
anam, phiskal examin there is sekuninfe.
The sign and simpy sekunder infection like fever,
mukopurulendiscgae. In this case shown improment of the
treatment and we can see from the anam fisikal anan we
get hiper estage direct resolution stage.

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