Acute Otitis

Media
a Case Presentation
Supervisor:
dr. H. Oscar Djauhari, Sp. THT
Presented by:
Yulius Andi Ruslim (2010-061-049)
Efrem Fridolin Suryadi (2010-061-144)
Farrell Tanoto (2010-061-149)

The Case
Part I

The Case

A 7-years old boys came to hospital with

an earache of his right ears. He had a
history of upper tract infection.

Identity and Complaint

Name
:A
Age
: 7 years old
Occupation : Student
Address
: Jl. Koperasi
Chief complaint
: earache on the right ear
Additional complaint : runny nose, cough, fever
since 7 days ago, and hearing loss since 4 days
ago (gradually)

History of Present Illness

Patient, 7 year old, male, comes to the ENT clinic

with complain of pain on his right ear.

Seven days ago he got fever (38,5 degree Celcius),

cough, and runny nose. The colour of the secrete
was clear and serous. He had taken medication for
cold and flu but his symptoms did not improve.

After four days, it became green yellowish,

mucoid. He becomes more irritable than usual,
pulling his right ear. He had hearing loss
gradually since 4 days ago. This complain occurs
for the first time. Pain in the ear suddenly appeared,
continuous all day and made him uncomfortable and
irritable.

History of Past Illness

Upper

respiratory tract infection

infrequently since he was infant.

Physical Examination
(Generalized Status)
General

appearance : moderately ill

Awakeness
: compos mentis
(E4M6V5)
Pulse rate
: 115 bpm
Respiration rate
: 25 bpm
Temperature
: 38,7 oC

Physical Examination
(Ears)

Auris dextra :
- Auricle
: hyperemia (-), oedema (-)
- Retroauricular
: normal, no deformities
- Canalis acusticus externus :
skin
: hyperemia (-), oedema (-)
discharge
: (-)
serumen
: (+) minimal
- Tymphanic membrane : intact, bulging (+), light reflex reduced
(+), hyperemis
- Rinne test (-), Webber lateralitation to the right, prolonged
Schwabach. (Conductive Hearing Loss on Right ear)

Physical Examination
(Ears)

Auris sinistra :

Auricle

Canalis acusticus externus:

: normal, no deformities

skin

: hyperemia (-), edema (-)

discharge

: (-)

serumen

: (+) minimal

Tymphanic membrane : intact, bulging (-), light reflex

(+), colour grey

Retroauricular

Rinne test (+), Webber lateralitation to the right,

Schwabach same with the examiner.

: normal, no deformities

Physical Examination
(Nose)

Right Nose :

Mucous membrane : hyperemis (+), edema (+)

Inferior concha : eutrophy
Discharge
: (+), mukoid, green yellowish
Septum
: normal, no deviation

Left Nose :

Mucous membrane : hyperemis (+), edema (+)

Inferior concha : eutrophy
Discharge
: (+), mukoid
Septum
: normal

Physical Examination
(Throat and Neck)

Throat :

Uvula
: in the middle
Pharynx
: anterior and posterior
pharyngeal arcus normal, hyperemia (+)
Tonsil
: T2/T2, hyperemis (-), cripta
dilatation (-), detritus (-)

Maxillofacial

: symmetric

Neck
: unpalpable lymph node /
unpalpable lymph node

Working Diagnosis

Acute Otitis Media supurative stage auris dextra

Workup

Blood count including differential count of white blood

cells
Culture of pus of the middle ear

Therapy

Outpatient
Paracetamol tab 6 x 250 mg per oral, if temperature >
37,8 C
Amoxicillin tab 3 x 250 mg per-oral, for 7 days
Myringotomy

Acute Otitis Media

Etiology

Streptococcus pneumoniae (tersering)

Haemophillus influenzae
Streptococcus -hemoliticus group A
Staphyllococcus aureus
Staphylllococcus epidermidis
E. Coli

Pathophysiology
Middle

ear : steril mode

There is a connection between cavum
tympani by eustachius tube.
There are barrier systems : cillia,
muramidase (enzym that products
mucous), antibody and humoral factors,
PMN, and phagocytic cells.
The barrier impaired invasion of
microbes to the middle ear

STAGE
Occlusion
Hyperemic
Suppurative
Perforated
Resolution

Clinical Findings

Child

Upper tract infection

Pain inner ear
Fever
Restless
Seizures
Nausea and vomiting
Diarrhea
Holding the affected ear

Adults

pain
fullness in the ear
hearing loss occured

Management

Occlusion

To open the closed eustachius tube, so the

pressure in middle ear can be reduced.
Decongestan (Child < 12y.o: HCl ephedrine 0.5%
in physiologic solution, Child>12 th: HCl
efedrine1% in physiologic solution)
Antibiotics

Hyperemic

Antibiotic: amoxicillin 40 mg/kgBB/day in 3

doses, ampicillin 50-100 mg/kgBB/day in 4
doses, eritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics

Management

Suppurative

Antibiotics: amoxicillin 40 mg/kgBB/day in 3

doses, ampicillin 50-100 mg/kgBB/day in 4
doses, eritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics

Perforated

H2O2 3% 5 drops 3 dd 1 3-5 days

Antibiotic local (ear drops)

Management
Resolution

If the resolution didnt take place,

secretes will drained out by the
perforation in tympanic membrane. The
antibiotics continued for 3 weeks. If 3
weeks pasts and secretes stills,
mastoiditis should be in differential
diagnosis

Complication
Mastoiditis,

subperiosteal abscesses,
meningitis, brain abscesses.