Gangguan Telinga

Telinga luar:

Sumbatan serumen
Benda asing
Otitis eksterna
Ruptur membran timpani

Telinga tengah
Otitis media

Telinga dalam
Labirintitis
Vertigo

Sumbatan Serumen
Serumen: diproduksi oleh kele
njar minyak di liang telinga
Liang telinga separuh bagian
luar
Mencegah tumbuhnya
bakteri dan jamur
Mencegah kerusakan kulit di
liang telinga
Penumpukan terjadi karena
kebiasaan buruk sering
mengorek kotoran telinga
Diperburuk bila kemasukan
air pada saat mandi/
berenang
Air membuat serumen
bertambah besar

Gejala dan Tanda

Otalgia= nyeri pada telinga

Tumpukan serumen tidak

mengakibatkan nyeri, kecuali:
Menyentuh Tympanic Membrane
Mengiritasi liang telinga
Tuli

Bila menyumbat total

Vertigo atau gangguan keseimbangan

Bila menyentuh membran timpani

Kapan perlu
dikeluarkan?

Tuli
Otalgia
Serumen mengganggu pemeriksaan
Anak < 1 tahun

Tata Laksana
Obat pelunak serumen

Acetic acid 1.5% with water

Hydrogen peroxide or Benzalkonium
chloride
Pengeluaran serumen oleh dr THT:

Bilas dengan air hangat

Suction

Pencegahan
Jangan bersihkan liang telinga
dengan cotton buds membuat
serumen semakin menumpuk di
bagian dalam.

Benda Asing di Telinga

Benda Asing di Telinga

 Anak-anak: paling sering

Suka memasukkan mainan ke hidung,
mulut, telinga

Dewasa: proses pembersihan telinga yang

salah, kemasukan serangga, air dll.

Jenis Benda Asing:

Serangga
Inorganic inert
Organic (kacang)
Metallic material

Gejala dan Tanda:

1- nyeri (otalgia)
2- gangguan mendengar
3- telinga terasa penuh
4- keluar cairan dari telinga bila ada
otitis eksterna

Anamnesis dan
Pemeriksaan Fisik:

Kapan benda asing masuk ke telinga

Usaha apa yang sudah dilakukan untuk
mengeluarkannya
Perhatikan daun telinga, liang telinga
dan gendang telinga
Bila ada gangguan pendengaran: rujuk
ke dr THT untuk dilakukan audiogram

Serangga

Pengangkatan Benda Asing

Tekniknya bergantung pada:
- Tipe
- Lokasi
- Pasien kooperatif atau tidak
- Anak-anak biasanya harus di berikan
sedasi ringan untuk mencegah luka lebih
parah.

How to remove the foreign body

from the ear?
1234-

Hook
Suction
Syringing
Surgery

Hook

Ear syringe

Contraindications of
syringing
1- Organic foreign body: it will enlarge with
water and cause more pain and become
more difficult to remove.
2-Tympanic membrane perforation
3- Alive insect, water will irritate it and it will
move more and more and so will be more
painful, so here we should kill it first either
by putting oil in the ear, paraffin or
anesthetic agent then remove it by any
available method.

Teteskan antibiotik untuk mencegah

infeksi akibat luka terkena
instrumen
Kadang terjadi otitis eksterna
setelah pengangkatan benda
asing.

Otitis Eksterna
Peradangan pada
telinga luar:
Cuping telinga
Liang telinga

Klasifikasi Otitis Eksterna

Otitis eksterna sirkumskripta

Mengenai kulit liang

telinga bagian luar
Gejala dan tanda:
Otalgia
Furunkulosis (bisul)

Otitis eksterna difusa

Mengenai kulit liat
telinga bagian dalam
Bisa mrpkn penjalaran
dari otitis media yang
tidak diobati
Gejala dan tanda:
Otalgia
Furunkulosis
Sekret (+)

Ruptur Gendang Telinga

Ruptur Gendang Telinga

Etiology
Trauma
Physical abuse red flag
Benda asing
Irigasi telinga yang
terlalu kuat
Infeksi
Otitis Media
Acute Chronic Otitis
Media
Barotrauma (e.g. Scuba
Injury)

Tanda:
Otorrhea: keluar cairan dari
telinga
Robek gendang telinga

Ruptur Gendang Telinga

Management
Jaga telinga tetap
kering
Rujuk ke dr THT
Obat tetes telinga
masih kontroversial:
Cortisporin Otic
Suspension 1 drop
qid
Ciprofloxacin
Ophthalmic (Ciloxan)
1 drop qid
Robekan besar: operasi

Ruptur Gendang Telinga

Prognosis
Biasanya sembuh spontan
dalam 4-6 minggu

Otitis Media Akut

Epidemiologi
Insidens

Anak usia < 1 th: 62%

Anak usia s/ 3 th: 83%
1.5 kejadian per tahun

Faktor Risiko: Otitis Media berulang atau efusi yang

terus menerus.

Age < 5 yrs (5 fold relative risk)

Otitis prone (4x) (see below)
Day care (4x)
Respiratory Illness (4x)
Smokers in home (3x)
Bottle Propped babies (2x)
Males (2x)
Pacifiers

Patofisiologi
Sumbatan tuba eustakius + invasi
kuman peradangan telinga tengah
( OMA)
Anak sering mengalamiinfeksi sal
nafas sering OMA
Bayi plg sering OMA krn : tuba
eustakius pendek, lebar, lebih
horizontal

kuman : streptokokus hemolitikus,

stapilokokus auereus, pneumokokus, h.
influenza, E coli, streptokokus
anhemolitikus, proteus vulgaris,
pseudomonas aeroginosa

Stadium :
stadium oklusi tuba : Mt retraksi
Stadium hiperemis : Mt hiperemis, oedem
Stadium supurasi : Mt bulging, anak
tampak sangat sakit
4. Stadium perforasi : Mt ruptur, anak tenang
5. Stadium resolusi : Mt normal kembali

1.
2.
3.

 gejala :
nyeri telinga
suhu tubuh tinggi
Ada riwayat batuk pilek sebelumnya
Ggn pendengaran / rasa penuh
Pada bayi / anak : gelisah, diare,
kejang
Bila Mt ruptur sekret (+) anak
tenang

 terapi :
tergantung stadium
AB
nasal decongestan
analgetik
miringotomi ( stad supurasi )
aural toilet ( stad perforasi )

Bila tidak terjadi resolusi > 3 bulan

OMSK
Pengobatan terlambat diberikan
Terapi tidak adekuat
Virulensi kuman tinggi
Daya tahan tubuh rendah / gizi
kurang
Hygiene buruk

OTITIS MEDIA SUPURATIV

KRONIS ( OMSK )
OMP = Congek
Yi : infeksi kronis ( > 3 bln ) telinga
tengah dgn perforasi Membrana
timpani, sekret terus menerus /
hilang timbul, sekret mungkin
encer, kental, bening atau nanah

 Letak perforasi penting untuk

menentukan tipe / jenis OMSK
Perforasi sentral : di pars stensa
Perforasi marginal : sbgn tepi
perforasi mengenai anulus
timpanikus atau sulkus timpanikus
Perforasi atik : di pars flasida
Gejala : perforasi Mt, sekret (+) / (-),
adanya polip / granulasi /
kolesteatoma di meatus akustikus
eksternus

 jenis OMSK
OMSK

tipe beniga / mukosa / aman

tipe maligna / tulang / berbahaya
Perforasi sentral
- perforasi marginal /atik / sub total
Jarang timbul komplikasi berbahaya - sering timbul komplikasi
berbahaya
Kolesteatoma (-)
- kolesteatoma (+)
Terapi : medikamen
- terapi : operasi : mastoidektomi dgn
/ tanpa timpanoplasti

 komplikasi OMSK terjadi akibat :

penyebaran hematogen, erosi tulang,
jalan yg sudah ada.
komplikasi OMSK
ekstrakranial

intrakranial

Mastoiditis
- abses ekstradural
Petrositis
- trombosis sinus lateralis
Paresis fasialis
- abses subdural
Labirinitis
- meningitis
Abses subperiosteal / abses
retroaurikular
- abses otak
Abses bezold
- hydrosefalus otitis

OTITIS MEDIA SEROSA =

OTITIS MEDIA EFUSI

1.
2.
3.
4.

keadaan terbentuknya sekret di

telinga tengah secara tiba-tiba
akibat ggn fungsi tuba :
Barotrauma
Virus / infeksi sal nafas atas
Alergi
idiopatik

gejala / tanda :
Kurang pendengaran
Telinga rasa tersumbat
Diplakusis binauralis
(suara sendiri terdengar
lebih nyaring pada telinga
yg sakit)
Spt ada cairan pd telinga
Nyeri
tinitus
Vertigo
Otoskopi : Mt retraksi,
tampak permukaan
cairan dlm kavum timpani
Test penala : tuli
konduktiv

Terapi :
Medikamentosa:
Nasal dekongestan
Antihistamin ( jika disebabkan oleh
alergi )
Perasat valsalva
Jika 1- 2 minggu gejala menetap
myringotomy k/p pasang gromet
( pipa ventilasi

Vertigo
Mahmoud Aldari

Vertigo Overview
Vertigo is the feeling that you or your
environment is moving or spinning.
It differs from dizziness in that vertigo
describes an illusion of movement.
When you feel as if you yourself are
moving, it's called subjective
vertigo, and the perception that your
surroundings are moving is called
objective vertigo.

Vertigo Causes
Vertigo can be caused by problems in
the brain or the inner ear.
Vertigo can be Central or
Peripheral.

Vertigo Causes

cont

I. Benign paroxysmal positional vertigo

(BPPV)

Is the most common form of vertigo.

Characterized by the sensation of motion
initiated by sudden head movements or
moving the head in a certain direction,
This type of vertigo is rarely serious and can
be treated.

Vertigo Causes

cont

II. inflammation within the inner ear

(labyrinthitis or vestibular neuritis)

characterized by the sudden onset of vertigo

and may be associated with hearing loss.
The most common cause of labyrinthitis is a
viral or bacterial inner ear infection.

Vertigo Causes
III. Meniere's disease
triad of symptoms:

a.
b.
c.

Episodes of vertigo.
Ringing in the ears (tinnitis).
Hearing loss.

IV. Acoustic neuroma.

A type of tumor of the nerve tissue.
Symptoms include:

a.
b.
c.

Vertigo.
One-sided ringing.
Hearing loss.

cont

Vertigo Causes

cont

V. Blood flow to the base of the brain.

Bleeding into the back of the brain (cerebellar

hemorrhage) is characterized by vertigo.

VI. As a symptom in multiple sclerosis.

VII.Head trauma and neck injury.
VIII.Migraine.
IX. Complications from diabetes.

diabetes can cause arteriosclerosis which can

lead to lowered blood flow to the brain,
causing vertigo symptoms.

Clinical Presentation
Vertigo implies that there is a sensation of motion
either of the person or the environment.
This should not be confused with symptoms of
lightheadedness or fainting.
symptoms include a sensation of disorientation or
motion.
In Addition:
nausea or vomiting.
Sweating.
abnormal eye movements.

Clinical Presentation
cont.
The duration of symptoms can be from minutes to
hours.
Symptoms can be constant or episodic.
Onset may be due to a movement or change in position.
History of recent head trauma.
any new medications the patient is taking.
The person may have hearing loss and a ringing
sensation in the ears.
The person might have visual disturbances, weakness,
difficulty speaking, a decreased level of consciousness,
and difficulty walking,

Vertigo Diagnosis
Important Points in History:
if the patient feels any sensation of motion, which may indicate
that true vertigo exists. Report any nausea, vomiting,
sweating, and abnormal eye movements.
how long the patient has symptoms and whether they are
constant or come and go. Do the symptoms occur when
moving or changing positions? Is the patient currently taking
any new medications? Has there been any recent head trauma.
Are there any other hearing symptoms? Specifically, report any
ringing in the ears or hearing loss.
Does the patient have other neurological symptoms such as
weakness, visual disturbances, altered level of consciousness,
difficulty walking, abnormal eye movements, or difficulty
speaking?

Vertigo Diagnosis

Cont.

Investigation:
CT scan if a brain injury is suspected to be the cause of
vertigo.
Blood tests to check blood sugar levels.
use of an electrocardiogram (ECG) to look at heart
rhythm may also be helpful.

Central vs. Peripheral

Vertigo
Central Vertigo

Peripheral
Vertigo

Onset

Gradual

Usually Sudden

Tinnitus, hearing
loss

Absent

Present

Neighborhood signs
(Diplopia, cortical
blindness,
dysarthria,)

Present

Absent

Nystagmus

Pure, vertical,
suppress with
fixation, &
multidirectional

Mixed, horizontal,
suppress with
fixation, &
unidirectional

Vertigo Treatment
The choice of treatment will depend on the
diagnosis.
Identifying and eliminating the underlying cause.
Bacterial infection of the middle ear requires antibiotics.
For Meniere's disease, in addition to symptomatic
treatment, people might be placed on a low salt diet and
may require medication used to increase urine output.

In addition to the drugs used for benign

paroxysmal positional vertigo, several physical
maneuvers can be used to treat the condition.
Vestibular rehabilitation exercises.
Particle repositioning maneuver.

Vertigo Medications
Commonly prescribed medications
for vertigo include the following:
Meclizine hydrochloride (Anticholinergic )
Diphenhydramine (Antihistamine)
Scopolamine transdermal
(Anticholinergics/Antispasmodics)
Promethazine hydrochloride (Antihistamine)
Diazepam

Thank You !
No question
plz