MATERI THT-KL

TIM UKMPPD UNIV MALHAYATIBANDAR LAMPUNG

Otitis

Acute otitis media• Th: – Occlusion tubal: topical decongestan (ephedrin HCl)– Presuppuration: AB for at least 7 days

(ampicylin/amoxcylin/ erythromicin) & analgetic.– Suppuration: AB, myringotomy.– Perforation: ear wash H2O2 3% & AB.– Resolution: if secrete isn’t stopped → AB is

continued until 3 weeks.

Sign of OE: Hurt if auricle is pulled backward or tragus is pressed

• Acute localized otitis externa (furuncle)– Etiology: Staph. Aureus, Staph. Albus.– Localized in an obstructed sebaceous gland or hair follicle.– Only occur in outer cartilaginous portion of ear.– No connective tissue below skin → very painful– Th/: topical AB. If bulging & soft → incision & drainage

• Acute diffuse otitis externa (swimmer’s ear)– Etiology: Pseudomonas (usually), Staph albus, E. Coli.– Dark, warm, humid conditions → promote bacterial growth– Swollen (narrow), draining (exudate), tender canal.– Very painful– Th/: Topical AB, sometimes need systemic AB.

Penurunan Pendengaran

Rinitis

• Atopic sign:– Allergic shiner

• Dark shadow below the eyes due to nasal obstruction causing secondary vein stasis

– Allergic crease• Horizontal line at the lower third dorsum nasi caused by

repeted rub

– Facies adenoid• Mouth open with high arch palate → disrupted teeth growth

– Cobblestone appearance at posterior pharyngeal wall– Geographic tongue

• Malignant otitis externa (necrotizing OE)– Elderly diabetics or immunocompromised.

– OE → cellulitis, chondritis, osteitis, osteomyelitis → cranial neuropathies.

– The canal may be swollen & tender, red granulation tissue is seen posteroinferiorly at the junction of cartilage with bone, one-third inward.

– Itch rapidly followed by pain, secrete, & swelling of canal ear.

– Th/: topical & systemic antibiotics & aggressive debridement

Rinore

Keganasan

Sore Throat

• Acute tonsillitis:– Viral: similar with acute rhinits + sore throat– Bacterial: GABHS, pneumococcus, S. viridan, S. pyogenes.

• Detritus → follicular tonsillitits• Detritus coalesce → lacunar tonsillitis.• Sore throat, odinophagia, fever, malaise, otalgia.• Th: penicillin or erythromicin

• Chronic tonsillitis– Persistent sore throat, anorexia, dysphagia, & pharyngotonsillar erythema – Lymphoid tissue is replaced by scar → widened crypt, filled by detritus.– Foul breath, throat felt dry.

Audiologic Testing in Pediatric• Behavioral observation audiometry

– Behavioral reflex audiometry: to observe reflexevoked by sound → eye widening, grimacing,auropalpebral reflex, moro reflex, cessation reflex.– Behavioral response audiometry (5-6 month) → toevoke spesific response: moving head toward sound.

• Play audiometry (2-5 year)– a kid is trained to do spesific task (games) whenhearing sound stimulus.

• Brainstem evoked response audiometry:– BERA is a series of scalp-recorded electrical potentialsgenerated in the auditory nerve and brainstem during thefirst 10 to 20 ms after the onset of a transient stimulus.– Can be used in infant, children, adults, & comatose patient.

• Tympanometry:– To assess middle air condition by placing probetone in ear canal to sense the pressure based onthe sound energy reflected from middle ear.

• Otoacoustic emission:– objective, noninvasive, and rapid measures usedto determine cochlear outer hair cell function.– Evoked OAE are acoustic signals generated by thecochlea in response to auditory stimulation.

• Pure tone audiometry:– The audiogram is a graph that depicts threshold as afunction of frequency. Threshold is defined as the softestintensity level that a pure tone (single frequency) can bedetected 50% of the time.

Epistaksis

• Anterior epistaxis:– Bleeding arises from kisselbach plexus or a.ethmoidalis anterior– it may be precipitated by infection or minor trauma &easy to stop.– Direct digital pressure for 10-15’ on the lower nosecompresses the vessel on the septum & will arrest thebleeding.– If bleeding source is seen cauterise with AgNO3.– If it’s still bleeding apply anterior tampon for 2 x 24hours.

• Posterior epistaxis– Bleeding arises from a. ethmoidalis posterior or a.Sphenopalatina and often difficult to stop– affect patient with hypertension orarteriosclerosis.– Therapy: apply bellocq/posterior tampon for 2-3days.

Mastoiditis• Acute mastoiditis

– the result of extension of acute otitis media into the mastoid air cells withsuppuration & bone necrosis.

• Symptoms:– Pain, otorrhoea (usually creamy & profuse), increasing deafness.

• Signs:– fever, tenderness over mastoid antrum , swelling in the postauricular region,pinna is pushed down & forward, the tympanic membrane is either perforatedand the ear discharging, or it is red and bulging.

• Investigation: CT scanning shows opacity & air cell coalescence.• Treatment:

– Antibiotics IV. If the organism is not known and there is no pus to culture, startamoxycillin & metronidazole immediately.– Cortical mastoidectomy. If there is a subperiosteal abscess or if the responseto antibiotics is not rapid and complete, cortical mastoidectomy must beperformed.