THT

TULI MENDADAK
Anamnesis+ pemeriksaan fisik Tiba-tiba tuli Unilateral/ bilateral Tinitus Vertigo Paresis N.VII +/ Penyakit virus (parotitis, influenza, herpes zoster otikus) ISKEMIA KOKLEA

-Infus komplamin/ vasodilansia - prednison

-Infus komplamin/ vasodilansia - prednison

INFEKSI VIRUS

TRAUMA KEPALA Pasca trauma

TRAUMA BISING KERAS Pasca bunyi ledakan vasodilansia

TULI MENDADAK

TINDAKAN SEGERA - rawat: tirah baring

PEMERIKSAAN PENUNJANG Audiologi lengkap Vestibuler (ENG) Konsul sub-Bagian Hematologi Penyakit Dalam Konsul Bagian Kardiiologi Konsul Bagian Saraf Rasiologi (atas indikasi)

PERUBAHAN TEKANAN ATMOSFIR Penerbangan akrobatik/ penyelaman dalam

OBAT OTOTOKSIK
PENYAKIT MENIERE NEUROMA AKUSTIK

Stop Obat Ototoksik - vasodilansia - antihistamin - antivertigo Pembedahan

KOMPLIKASI INTRAKRANIAL OTITIS MEDIA AKUT/ OTITIS MEDIA SUPURATIF KRONIS

Anamnesis+ pemeriksaan fisik Riwayat keluar cairan dari telinga Sakit kepala (kadang- kadang hebat) Demam Mual/muntah Kejang Lesu Kesadaran menurun

-MENINGITIS OTOGENIK - mastoidektomi radikal

-TROMBOSIS SINUS LATERALIS - mastoidektomi radikal dalam waktu 2x24 jam

-ABSES EKSTRADURAL -Mastoidektomi radikal -Abses dibuka -ABSES OTAK OTOGENIK - aspirasi/ eksisi abses otak - mastoidektomi radikal

KOMPLIKASI INTRAKRANIAL OMA/OMSK

TINDAKAN SEGERA
- Pasang infus - Antibiotika dosis tinggi - Anti konbulsi - Konsul bagian saraf/ - Saraf anak

PEMERIKSAAN PENUNJANG Laboratorium darah Pem.Rontgen mastoid CT scan kepala Pungsi lumbal (bila tidak ada kontraindikasi)

-HIDROSEFALUS - antibiotika intravena - kortikosteroid -Diuretik - pungsi lumbal berulang -Shunt cairan otak -Mastoidektomi simple/ radikal

SUDDEN SENSONEURAL HEARING LOSS

History Trauma Barotrauma Noise exposure Upper respiratory tract infection Diabetes Coronary/ carotid artery disease Vertigo Tinnitus Family history Visual complaints Headaches
Ear examination Cerumen impaction Perforation Hemotypanum Blood in canal Trauma CT scan Perilymphatic fistula Electronystagmography test Direct or indirect trauma Noise exposure Barotrauma Perilymphatic fistula Surgical excision Radiotheraphy Observation Neurology consult Consider CT scan Amplification Steroid Methotraxate Imuran Cyclophosphamide Treat underlying condition Steroids Bed rest Eliminate noise exposure

Surgical repair
See chapters 31,32

Likely etiology identified by history physical exam MRI and laboratory test

Intracranial mass acoustic neuroma meningomioma other tumors Multiple sclerosis Congenital

Start empirical treatment if <4 weeks = steroid/antivirals

Autoimmune/ metabolic

SUDDEN SENSONEURAL HEARING LOSS

Viral idiopathic at presentation Vascular compromise

Steroids Antiviral Steroids Antivirals Dextran Hypaque

Laboratory Audiogram MRI with gadolinium CT scan Elektronystagmography Metabolic panel

Bilateral both ears at once only hearing ear

Cochlear implant

INTRACRANIAL COMPLICATION OF OTITIS MEDIA

Steroids

History and examination otologic symptoms and signs systemic symptoms and signs neurologic signs presence of other complications Lumbal punture intraoperative findings persistent postoperative symptoms

Puncture, incision, thrombectomy, ligation of internal jugular

Optic nerve decompression Shunt

Meningitis Acetazolamide Repeated LP Examine/ expose dura

Lateral sinus thrombosis

Granulation
Mastoidectomy Ventilation tube Mastoid drain Consider radical or modified radical mastoidectomy

Papilledema Nuchal rigidity

Otitic hydrocephalus Ekstradural abscess

SUSPICION OF INTRACRANIAL COMPLICATION

stable

CT scan/MRI with contras

Subdural empyema Parenchymal findings Assess general status

Extensive cholesteatoma Concurrent otologic and neurosurgica l treatment Prioritize neurosurgical treatment Delay ear surgery Observe with repeat CT scans

Laboratory Audiology MRI CT scan Vestibular testing

Start IV antibiotics

unstable
Brain abscess

Craniotomy Aspirate Drain Excise

Acute otitits media or otorrhea

Miringotomy and/or suction with culture

Cerebritis

Resolution