Lapkas OMA Dr.oscar amin
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Transcript of Lapkas OMA Dr.oscar amin
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8/10/2019 Lapkas OMA Dr.oscar amin
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Acute OtitisMedia
A CASE PRE
SU
DR. H. OSCAR DJAUHA
PRE
EBBEL TANTIAN IGAMU
FUAD FILARDHI NUGR OHO
SUS RETHA MONA ARDIANI
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The CasePART I
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The Case
A 6-years old boys came to hospital with an earache of his right ears. He had a histortract infection.
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Identity and ComplaintName : An. A
Age : 6 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 lodays ago (gradually)
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History of Present Illness
Patient, 6 year old, male, comes to the ENT clinic with complain ofpain on his right ear.
Seven days ago he got fever (38,5 degree Celcius), cough, andrunny nose. The colour of the secrete was clear and serous. He hadtaken medication for cold and flu but his symptoms did not improve.
After four days, it became green yellowish, mucoid. He becomesmore irritable than usual, pulling his right ear. He had hearing lossgradually since 4 days ago. This complain occursfor the first time.Pain in the ear suddenly appeared, continuous all day and madehim uncomfortable and irritable.
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Physical Examination(Generalized Status)General appearance : moderately ill
Awakeness : compos mentis (E4M6V5)
Pulse rate : 115 bpm
Respiration rate : 25 bpm
Temperature : 38,7 oC
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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. (ConductiHearing Loss on Right ear)
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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
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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
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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
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Acute Otitis MediaEtiology
Streptococcus pneumoniae (tersering)
Haemophillus influenzae
Streptococcus -hemoliticus group A
Staphyllococcus aureus
Staphylllococcus epidermidis
E. Coli
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PathophysiologyMiddle ear : steril mode
There is a connection between cavum tympani by eustachius tube.
There are barrier systems : cillia, muramidase (enzym that products mucous), antibhumoral factors, PMN, and phagocytic cells.
The barrier impairedinvasion of microbes to the middle ear
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STAGEOcclusion
Hyperemic
Suppurative
Perforated
Resolution
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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
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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 physiologicsolution, 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
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ManagementSuppurative
Antibiotics: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin 50-100 mg/kgBB/day in 4 deritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics
Perforated
H2O2 3% 5 drops 3 dd 1 3-5 days
Antibiotic local (ear drops)
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ManagementResolution
If the resolution didnt take place, secretes will drained out by the perforation in tympaniThe antibiotics continued for 3 weeks. If 3 weeks pasts and secretes stills, mastoiditis shodifferential diagnosis
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ComplicationMastoiditis, subperiosteal abscesses, meningitis, brain abscesses.
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PROGNOSISQuo ad vitam : dubia
Quo ad functionam : dubia
Quo ad sanationam : dubia
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Thank you