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Tonsilitis,

Faringitis dan
Laringitis

Dr. Novialdi, SpTHT-KL


THT-KL FK Unand/RS Dr. M. Djamil

Tonsilitis

Tonsilitis

Cincin
Waldeyer

Tonsil Normal

Ukuran
Tonsil

Tonsilitis Akut

Tonsilitis Virus Epstein-Barr

Tonsilitis Virus Coxshackie

Tonsilitis Bakteri

Tonsilitis Folikularis

Tonsilitis
Lakunaris

Tonsilitis Difteri

Tonsilitis Jamur (Candidiasis)

Tonsilitis Sifilis

Tonsilitis Mononukleosis

Tonsilitis Mononukleosis

Tonsilitis Kronis

Kissing Tonsil with OSAS

Gejala Klinik

Penatalaksanaan
Terapi Medikamentosa

Penatalaksanaan
Tonsilektomi

Penatalaksanaan
Teknik Tonsilektomi

Abses
Peritonsil

Komplikasi dari tonsilitis akut,


infeksi dari gigi, infeksi yang
bersumber
dari
kelenjar
mukus Weber di kutub atas
tonsil.

Demam
Odinofagia
Otalgia
Sakit Kepala
Nyeri Leher
Trismus
Hot Potato Voice
Hipersalivasi
Foetor ex ore

25

Infeksi
tonsilitis akut

Patogenesis

Infiltrasi supurasi
kedaerah superior dan
lateral fosa tonsilaris
Peritonsil mendorong
tonsil & uvula
ke arah kontralateral

Pembengkakan
&
Hiperemis

Supurasi lunak

Abses pecah spontan

Iritasi pada
m.pterigoid interna Trismus

Aspirasi ke paru

Pemeriksaan
Palatum mole tampak membengkak dan
menonjol ke depan
Uvula bengkak, terdorong kesisi kontralateral
Tonsil bengkak, hiperemis, mungkin banyak
detritus dan terdorong ke arah tengah, depan,
dan bawah.

PENATALAKSANAAN
Stadium infiltrasi:
Antibiotika gol.
Penisilin/klindamisin
Obat simtomatik
Kumur- kumur dengan cairan
hangat dan kompres dingin
pada leher.
Bila telah terbentuk abses:
Pungsiinsisi
Kemudian pasien dianjurkan
operasi tonsilektomi

Komplikasi
Abses pecah spontan perdarahan,
aspirasi paru / piemia.
Penjalaran infeksi dan abses ke daerah
parafaring abses parafaring
mediastinitis.
Penjalaran intrakranial trombus sinus
kavernosus, meningitis & abses otak.

Faringitis

Faringitis

Faringitis Normal

Faringitis Akut

Faringitis Kronis

Faringitis Jamur
(Candidiasis)

Faringitis Sifilis

Faringitis Gonorea

Penatalaksanaan
Terapi Medikamentosa

Laringitis

Laringitis

Klasifikasi

Struktur Normal Laring

Laringitis Akut

Laringitis
Akut

Laringitis
Kronis

Laringitis
Jamur
Kronis

Laringitis Kronis Atrofi (Laringitis Sika)

Laringitis Kronis Hipertrofi

Laringitis Kronis Hipertrofi Difus

Laringitis Tuberkulosa

Laringitis Tuberkulosis

Gejala Klinik

Penatalaksanaan
Terapi Medikamentosa

Laringotrakeobronkitis Akut (Croup)

Definitions
Croup- term used to describe the clinical
picture of laryngotracheitis.
Hoarse voice
Barking cough
Inspiratory stridor
Possible respiratory distress

Epidemiology
Peak fall & winter.
Range primarily 1-6 years
Incidence 5/100 of children between age
1-2 years
Males > females

Etiologies
Parainfluenza, types 1,2,3
Contribute 65% of cases.

Influenza A & B
Adenovirus
RSV
Rarely mycoplasma.

Pathogenesis
Subglottic narrowing due to
inflammation.
Cricoid ring allows fixed area for
obstruction.
1mm swelling causes 65% obstruction in
infant.

Pathogenesis
Atelectasis/mucus plugging
Ventilation/perfusion mismatch
Negative intrapleural pressure may lead to
varying degrees of pulmonary edema.
Hypoxia/hypercarbia
Air hunger
Anxiety/Lethargy/Obtundation.

Clinical history
Parents usually report viral URI
symptoms 12-48hrs prior to cough.
Fever, Barking cough,Stridor
Typical course 3-5 days.

Worry if

Drooling
Dyphagia
Toxic appearance
Stridor without cough or without fever
Incomplete immunizations

Terapi Non Farmakologi


Kenyamanan posisi.
Humidifikasi udara
Oksigen
Campuran helium-oksigen

Terapi Farmakologi
Analgetik dan Antipiretik
Antibiotik
Nebulisasi 2 Agonis kerja cepat
Nebulisasi Epinefrin
Kortikosteroid

DD/

Epiglottis
Dysphagia
Odynophagia
Drooling
Tripoding/sword-swallowing
Pt resists lying on back
Prefers leaning forward

Stat to OR for evaluation/intubation

Bacterial tracheitis

More common in order children to teens


Staph aureus/Diphtheria
Fever/ resp distress/Dysphagia/Odynophagia
Worsening over hours
Difficult to distinguish from epiglottis
Doesnt matter, management is same:
OR intubation
Abx, worry more about Staph coverage if child is older.

Bacterial superinfection of Croup


Symptoms 5-7 days
Worsening quickly over hours
Increasingly high fevers
Toxic appearance

Terima Kasih

Tonsilitis akut

Tonsilitis Lakunaris

Tonsilitis Folikularis

Acute
bacterial
tonsillitis

Candidiasis

Faringitis Bakteri (Scarlet Fever)

Laringitis Kronis Ringan