Otitis Media Supuratif

Kronik dengan Penyulit

Hipertrofi Adenoid
Pembimbing :
dr. Indah Saraswati, Sp THT-KL

Disusun oleh :
Reinaldo Cendana (01073170157)
Daniel Kusnadi (01073170157)
Identitas
• Nama : S.G.
• Jenis Kelamin : Laki – laki
• Tanggal Lahir : 17 Juni 2013 (4 tahun)
• No MR : 00-88-xx-xx
Anamnesis

Autoanamnesis pada 29 Maret 2018 pukul 11.00 di

bangsal lantai 2 Rumah Sakit Siloam Gedung B, Lippo
Karawaci
Keluhan Utama
Keluar cairan pada kedua telinga ± 2 minggu
Perjalanan Penyakit

Keluar cairan mukoid,

3-4 hari sebelumnya tidak berwarna dan
pasien demam dan berbau serta disertai
batuk pilek dengan nyeri pada
kedua telinga
Riwayat Penyakit Dahulu

• Sejak umur 1 tahun pasien sering mengalami kejadian

keluar cairan sebanyak 4-5 kali pertahunnya
• Riwayat menjalani pengobatan di puskesmas sejak
serangan pertama
• pasien bebas gejala selama 1 tahun (dari usia 3-4 tahun)
Pemeriksaan Fisik
• Kesadaran : Kompos Mentis
• TTV :
• BP : Tidak diukur
• Nadi : 106
• Laju nafas : 26
• Suhu : 36,9
• Hidung
• Rhinoskopi anterior : sedikit sekret
• Rhinoskopi posterior : adenoid membesar
• Tenggorok
• Tonsil : T1-T1
• Telinga
• Inspeksi
• Normotia
• Otoskopi :
• Liang telinga lapang
• Perforasi membran timpani sentral AD dan AS
• Palpasi
• Nyeri tekan tragus dan nyeri tarik pinna negatif
Diagnosis dan Diagnosis
Banding
• Diagnosis
• OMSK dengan hipertrofi adenoid
Tatalaksana
• Farmakologis
• Cefixime
• Tramenza
• Ambroxol
• Akilen Ear Drop
Tinjauan Pustaka
Anatomi & Fisiologi Telinga

Tortora G, Derrickson B. Principles of anatomy & physiology.

2012.
Adenoid
Tuba Eustacius
Fisiologi
Otorrhea
• Bacterial Otitis Eksterna
• Korpus alienatum
• Otitis media akut
• Otitis media supuratif akut
• Serumen
• Drainase tuba timpanostomi
Otalgia / Nyeri Telinga
1. Primer
Telinga Luar Telinga Tengah
• Furuncle • Otitis Media Akut
• Cerumen Impaction • Mastoiditis
• Otitis Eksterna • Otitis Media Efusi
• Herpez Zozter Oticus
• Tumor Kanalis Auditorius
Eksternal

2. Sekunder
Sakit pada telinga yang disebabkan akiibat refered pain karena telinga
mendapatkan persarafan dari saraf kranial V, IX, X, dan C2 C3
Otitis Media
• Otitis Media Akut Supuratif
• Otitis media akut rekuren
• Otitis media efusi
• Otitis media barotrauma
• Otitis media supuratif kronik
Otitis Media Akut

OMA (Otitis Media Akut) didefinisikan sebagai

penonjolan dari membrane timpani dengan
tingkat sedang sampai parah atau otore < 2
minggu seiring dengan gejala akut dari inflamasi
telinga tengah

Reccurent OMA
3 atau lebih episode dari OMA dalam 6 bulan
terakhir / 4 episode atau lebih dalam 1 tahun
Epidemiologi
• Paling sering terjadi pada bayi dibawah 1
bulan dengan sosioekonomik rendah
• Pakistan, anak usia 0-2 tahun dari 1724
terdapat 75 anak dengan OMA (4,3%)
Patogen
• Steptococcus pneumoniae (36%)
• Haemophilus influenza (20%)
• Moraxella catharrhalis (12%)
• Pseudomonas aeruginosa
• 18-20% negative culture
Faktor Risiko
• Umur
• Puncak terjadi oma 6-18 bulan
• Riwayat keluarga yang pernah OMA
sebelumnya
Faktor Predisposisi
• Gangguan fungsi tuba
• Infeksi tonsil
• Infeksi adenoid
• Rhinosinusitis kronik
• Tumor nasofaring
• Nasal packing epistaksis
Stadium OMA
• Fase I : Oklusi Tuba
• Fase II : presupurasi
• Fase III : supurasi
• Fase IV : Resolusi
• Fase V : komplikasi
Gejala Klinis
• Fase I : penurunan pendengaran, nyeri telinga,
tidak ada demam, retraksi MT
• Fase II : eksudat MT, sakit telinga, gangguan
pendengaran, demam, mulai bengkak
• Fase III : sakit parah, bengkak, demam, MT
hampir pecah
• Fase IV : perforasi MT, gejala membaik, demam
menurun
Otitis Media Supuratif Kronik
Infeksi dari bagian atau seluruh rongga
telinga tengah yang dicirikan dengan
keluarnya cairan dari telinga dan perforasi
MT permanen.
Disertai dengan proses infeksi >2 bulan
atau sekret yang keluar lebih dari >2
minggu
EPIDEMIOLOGI
• 31 juta kasus baru setiap tahun ( ¼ nya anak <5
tahun) di dunia.
• Anak laki – laki > anak perempuan
• India anak usia 2 – 5 tahun, dari 296 anak 17
anak terkena OMSK (5,7%)
Patogen yang mengakibatkan
OMSK
• Aerobic
• Pseudomonas aeruginosa
• Proteus sp.
• Escherichia coli
• Staphylococcus aureus
• Aerob
• Bacteroides fragilis
Faktor Risiko
• Rekuren OMA
• OMA dini
• OME kronik
Klasifikasi OMSK
Patofisiologi
• Progresi OMA menjadi OMSK :
• Disfungsi tuba dan rongga nasofaring menjadi
reservoir pathogen
• Bakteri dari nasofaring mengakibatkan OMA ,
setelah perforasi MT maka bakteri dari kanal
akustik eksterna masuk
• TUBOTIMPANIK
• Terlokalisir pada mukosa
• Terbatas pada daerah anteroinferior rongga
telinga
• Perforasi pars tensa
• Atikoantral
• Kelainan pada sel skuamosa
• Kantung retraksi (inaktif)
• Kolesteatoma (aktif)
Gejala Klinis
• Otore
• Penurunan pendengaran
Hipertrofi Adenoid
Merupakan hipertrofi ataupun inflamasi yang terjadi akibat
infeksi virus ataupun bakteri, alergi, dan iritan.
1. Gejala Nasal
• Obstruksi Nasal
• Sekret Nasal
• Sinusitis Maksila
• Epistaksis
• Perubahan Suara
2. Gejala Aural
• Obstruksi Tuba 3. Gejala Lain
• Recurent OMA • Facies Adenoid
• OMSK • Hipertensi Pulmonal
• OME • Aprosexia (kurang
konsentrasi)
Treatment
• Medikamentosa :
• Latihan napas
• Nasal Decongestan
• Anti-Histamin

Evaluasi dalam 6 minggu – 3 bulan, dengan

pemberian antibiotik dan glukokortikoid nasal
selama 6 minggu
Membaik diteruskan sampai dengan 6 bulan
Tidak membaik  Adenoidektomi
• Indikasi :
• Obstruksi nasal
• Facies Adenoid
• Sinusitis Kronik
• Recurrent OMA / OME kronik / OMSK yang
tidak membaik dengan pemberian obat
• Kontraindikasi :
• Velopharyngeal  Akibat kelainan anatomis
pada palatum ataupun faring
• Hematologic  Anemia (Hb < 10 g/dL atau HT
< 30%) dan gangguan pembekuan darah
• Infectious
Pembahasan Kasus

Laki-laki S.G, 4 tahun

KU : keluarnya cairan mukoid, tidak

berwarna dan berbau berulang sejak
umur 1 tahun

PF : otoskopi  liang telinga lapang dan

terlihat perforasi membran timpani pada
bagian central pada kedua telinga
 OMA
OME OE

Otalgia
 OMSK

OE OMA

Otore
Korpus Drainase
alienatum tuba

Serume
n
 Cefixime
Tramenza Dinilai dalam 6
minggu – 3 bulan
Ambroxol Adenoidektomi
(Membaik lanjutkan
Akilen ear drop selama 6 bulan)

Glukokortikoid
Perforasi MT dinilai dalam 6 minggu
Nasal
– 3 bulan  tidak membaik 
miringoplasi / timpanoplasti
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Terima Kasih