KELAINAN KONGENITAL & TRAUMA

DI BIDANG THT-KL

dr. Muslim Kasim M.Sc, Sp.THT-KL

Percakapan Dokter THT Dan Pasien

Pasien: "Telinga Ku Kemasukan Kacang Hijau..

Dokter: "Mari Periksa!!" (Diperiksa Telinganya Dan Kacang

Tersebut Susah Diambil) Kayaknya perlu di operasi..

Dokter: "Ada Dua Cara Mengeluarkan Biji Tersebut!!"

Pertama bisa dioperasi tapi biaya operasinya 2 Juta..tapi
bisa juga ada yang Gratis!!

Pasien: "Mahal Amat!!"

Kalo Gratis??
 Dokter: "Cuma harus agak bersabar!!

Pasien: "Baiklah!!"
bagaimana caranya dok??

Dokter: "Sirami Telinga Anda 2 Kali Sehari Dan Jika

Jadi TOGE Tarik Keluar.............."
KELAINAN KONGENITAL
KELAINAN PERKEMBANGAN JANIN

ETIOLOGI :
Sulit diketahui
MULTI FAKTOR !!!
- GENETIK / Kromosom
- HIPOKSIA
- INFEKSI : VIRUS, BAKTERI
- TOKSISITAS
- LAIN-LAIN
KELAINAN KONGENITAL TELINGA
PROTRUDING EAR
BATS EAR
MIKROTIA
ANOTIA , ACESSORIES AURICLE
STENOSIS, AGENESIS KANALIS
FISTULA AURIS
Hearing Loss

PENANGANAN :
* Operatif
* Dampak psikologis / kosmetis
* Gangguan fungsi ??? : TT / TD
* Penanganan dini : 4 6 th
KELAINAN KONGENITAL HIDUNG, MULUT DAN
FARING

- CELAH BIBIR, PALATUM

- NASAL FISTULAE, CYST
- DERMOID CYST, GLIOMA
- MENINGOENCEPHALOCELE
- STENOSIS, ATRESIA NARES
- KELAINAN BENTUK HIDUNG
- CLEFT TONGUE, MICROGLOSSI, AGLOSSIA
- MACROGLOSSIA, ANKYLOGLOSSIA
Cleft palate (Celah Langit langit)
Merupakan defek kongenital karena tidak bersatunya
prosessus palatinus, penyambungan antara prosessus
palatinus berjalan dari anterior ke posterior dimana
proses ini dapat berhenti tiba-tiba.
 Penatalaksanaan : Labiognatopalatoplasty
NASAL FISTULA / NASAL CYST
SALURAN BUNTU BERPANGKAL PADA
DAERAH ETHMOID-SEPTUM SETINGGI
GLABELA

SEKRET KERUH

TRUE CYST BERMUARA DI SEPTUM

ATAU VESTIBULUM
DERMOID CYST , GLIOMA
DERMOID : BERISI RAMBUT DAN ADNEKSA

BISA TERDAPAT DI ATAS, DI

BAWAH, ATAUPUN DI DALAM
SINUS FRONTALIS

GLIOMA : BERISI SEL-SEL GLIA YANG SOLID

PADA DAERAH FRONTAL ATAU

PANGKAL HIDUNG
MENINGOENCEPHALOCELE

HERNIASI JARINGAN OTAK DAN DURA

INTRA NASAL ( POLIP ? )
DAPAT EKSTRANASAL DAN MELIBATKAN
OS FRONTAL, ETHMOID, ATAU SEPTUM
DIAGNOSIS : - TOMOGRAPHY
- ARTERIOGRAPHY
- BRAIN SCAN
CHOANAE ATRESIA
DAPAT BERUPA MEMBRANOUS ATAU
TULANG
DAPAT UNI / BILATERAL
PEREMPUAN LEBIH SERING
GEJALA : - POST NASAL DRIP
- HIPO / ANOSMIA
- PASASE UDARA - / -
Post nasal view of unilateral Coanal atresia
KELAINAN BENTUK

DISEBABKAN KELAINAN STRUKTUR

TULANG ATAU KARTILAGO
- HUMP NOSE
- SADDLE NOSE
- DEVIATED NOSE
- BENTUK TIDAK NORMAL
KELAINAN KONGENITAL FARING
SINDR . : - CLEFT PALATE
- MICROGNATHIA
- GLOSSOPTOSIS

DISERTAI DENGAN : TULI ; KATARAK; SPINA BIFIDA

OCULTA DAN KELAINAN JANTUNG

1) " PIERE ROBIN SIDROM "

1 : 30.000 KELAHIRAN

2) BURSA THORNWALD'S
KISTE NASOFARING " MIDLINE PERSISTENT
EMBRIONIC" ANTARA NOTO CHORD - ATAP
FARING
GEJALA : KISTE MENGALAMI PERADANGAN :

* OKLUSI PASASE UDARA

* POST-NASAL DISCHARGE
* SAKIT KEPALA
* GANGGUAN RASA KECAP
* KRUSTA NASOFARING
* GANGGUAN T. EUSTACHII

PEM FISIK : KISTE PADA DDG POST NASOFARING

THERAPI : - MARSUPILISASI
- ANTIBIOTIKA
3). CHOANAL ATRESIA

KEGAGALAN MEMBRAN BUCCO - PHARYNGEAL

PD PERTUMBUHAN EMBRIONIC (7-8 MG)
BERSIFAT :

- UNILAT (KA >KI) / BILATERAL

- TERDIRI DARI TLG/MEMBRAN (TLG + 90 % )

- KOMPLIT / INKOMPLIT

- KEMUNGKINAN TENDDENSI FAMILIER

GEJALA :
* ATR. BILATERAL : BAYI DISPNOE/CYANOSIS YANG
HILANG BILA MENANGIS / BERNAFAS VIA
MULUT

* KESULITAN WAKTU MAKAN : MUKA CYANOSIS DAN

DAPAT TERJADI ASPIRASI

* NASAL DISCHARGE KENTAL

PEM. FISIK :
* TEST KATHETER VIA LUBANG HIDUNG

THERAPI : OPERASI
KELAINAN KONGENITAL LARING,
TRAKEA, DAN ESOPHAGUS

LARYNGOMALACIA
LARYNGOCELE
NEUROGENIC DISORDER
ATRESIA, WEB
SUBGLOTTIC STENOSIS
HAEMANGIOMA
STENOSIS, SHORT ESOPHAGUS
TRACHE0ESOPHAGEAL FISTULA
LARYNGOMALACIA
merupakan suatu kelainan dimana terjadi kelemahan
struktur supraglotik sehingga terjadi kolaps dan obstruksi
saluran nafas
EPIGLOTIS LUNAK / LEMBEK DISEBABKAN GGN METABOLISME
CALCIUM

GEJALA : STRIDOR INSPIRATOIR SEGERA SSDH LAHIR

YANG MAKIN BERAT PD SAAT MENYUSUI
SIANOSIS

- EPIGLOTTIS BBTK OMEGA, LEMBEK, MELIPAT / JATUH

MENUTUPI INLET LARING SAAT INSP.
- EMINENTIA ARITENOID ATAU PLIKA ARIEPI-
GLOTIKA DPT MENGALAMI HAL SERUPA
PENANGANAN : * OBSERVASI KETAT
* REGULASI MENYUSUI
* TRAKEOTOMI, BILA PERLU
NEUROGENIC DISORDER
DPT DISEBABKAN KEL. JANTUNG KONGE-
NITAL ATAU TRAUMA LEHER SAAT PARTUS

JK UNILATERAL : TANGISAN LEMAH

BILATERAL : STRIDOR INSPIRATIOR

POSISI PL. VOCALIS PARAMEDIAN

PENANGANAN :
UNILATERAL : OBSERVASI
BILATERAL : TRAKEOTOMI
ATRESIA, WEB LARING
BAYI BERUSAHA KERAS BERNAFAS SEGERA
SESUDAH LAHIR, SIANOSIS
CEPAT MENYEBABKAN KEMATIAN
WEB : DERAJAT OBSTRUKSI VARIATIF
L F O : TERDAPAT WEB / ATRESIA
PENANGANAN :
1. TRAKEOTOMI SEGERA
2. INSISI WEB / ENDOLARYNGEAL
SURGERY DPT DIULANG
 LARYNGOCELE
MERUPAKAN PERKEMBANGAN DARI SACCULUS LARING
YANG BERLEBIH KANTONG
INTERNAL : TERDAPAT PADA PL.VESTIBULARIS
EKTERNAL : MENEMBUS MEMBR. THYROHYOID,
PADA PALPASI TERABA LUNAK

GEJALA : DISFONI, STRIDOR YANG MEMBERAT

SAAT MENANGIS ATAU MENGEDAN
RASA MENGGANJAL DI TENGGOROK

DIAGNOSIS : TOMOGRAPHY
SUBGLOTIC STENOSIS
PADA UMUMNYA DISEBABKAN KELAINAN
PEMBENTUKAN KARTILAGO KRIKOID

GEJALA : - DPT TERJADI STIDOR INSP. / ESKSP.

- TDK TDPT KELAINAN SUARA

PENANGANAN :
- TRAKEOTOMI, BILA PERLU
- OBSERVASI LARYNGOTRACHEOPLASTY
HAEMANGIOMA LARING
GEJALA UTAMA : PERDARAHAN, BATUK DARAH

GEJALA LAIN TERGANTUNG DARI LETAKNYA

DIAGNOSIS DITEGAKAN MELALUI ENDOSKOPI

PENANGANAN : - TRAKEOTOMI
- CRYOSURGERY SEGERA
- LASER SURGERY
STENOSIS, SHORT EOSOPHAGUS
SHORT ESOPH. : SEGMEN BAG BWH TDK TERBENTUK
- GEJALA REFLUKS AS.LAMBUNG : 30 %
- DIAGNOSIS : * RADIOGRAPHY
* ENDOSKOPI : MUKOSA GASTER
TERLETAK TINGGI
- DD / : SLIDING HIATUS HERNIA
- PENANGANAN : REFLUKS ESOFAGITIS

STENOSIS ESOPHAGUS :
- GEJALA : DISFAGIA, VOMITUS
- DIAGNOSIS : RADIOLOGI, ENDOSKOPI
- PENANGANAN : BOUGINASI
TRACHEOSOPHAGEAL FISTULA
TERDAPAT HUBUNGAN TRAKEA - ESOFAGUS

GEJALA : DIDAPATKAN SEGERA SSDH DISUSUI

- BATUK, TERSEDAK
- SESAK, SIANOSIS

DIAGNOSIS : - RADIOGRAPHY
- BRONCHOSCOPY
- EOSOPAGOSCOPY

DD/ : KELAINAN DIDAPAT O.K TRAUMA / KEGANASAN

PENANGANAN : THORACOTOMY UNTUK PEMISAHAN

DAN REKONSTRUKSI
Kelainan kongenital ditelinga
Fistula pre aurikelar
Mikrotia
Stenosis / agenesis kanal
Gangguan pendengaran sensorineural tidak
nampak early identificcation
 Why is early identification of
hearing loss important?
Hearing loss is the most common birth condition
 Incidence of Congenital Conditions
(Per 10,000)
35

30
Number per 10,000

25

20

15

10

0
Hearing loss Cleft lip or Down Limb defects Spina bifida Sickle cell PKU
palate syndrome anemia
Congenital Condition Type
 Prevalence of Hearing Loss

Prevalence estimates vary across studies

Estimated that 1 to 3 per 1000 infants will have
permanent sensorineural hearing loss3, 4
1/1000 from the well baby nursery
10/1000 from the NICU
Rate increases to 6/1000 by school age4
Need for surveillance
What does it sound like to have a hearing
loss?

Severe hearing loss

Moderate hearing loss

Mild hearing loss

Normal hearing
 Why is early identification of
hearing loss important?

Previous methods for detecting hearing loss have

been ineffective
High risk screening failed to identify ~ 50% of the
infants with hearing loss
Large retrospective cohort study5, 6: mean age of
diagnosis 21.6 months
Similar findings reported in US7,8,9
Newborn hearing screening is
effective
Large, good-quality cohort study conducted in
UK10
53,781 babies; 25,609 born during NHS era
2-step screening (OAE + ABR)
Sensitivity = 0.92
Specificity = 0.98
Lower refer rates with qualified examiners11
 Why is early identification of
hearing loss important?
Hearing loss is the most common birth condition

Previous methods for detecting hearing loss have

been ineffective

Undetected hearing loss can delay speech,

language, social & academic development
 Vocabulary Development
in Infants12, 13
400
NH Boys
350 NH Girls
Number of Expressive Words

Toddlers with Hearing Loss

300

250

200

150

100

50

0
12 mos 14 mos 16 mos 18 mos 24 mos
Age

Delays in babble also observed 14,

15
Reading Comprehension in Children with
Mild-Mod Loss 16

140
Reading Comprehension Standard Score

Normal Hearing
120 Hearing Loss

100

80

60

40

20

0
Grade 1 Grade 4
Academic Grade
 Why is early identification of
hearing loss important?
Early identification and intervention can make a
difference
Effects of Age of Identification on Language
Development17
Prospective, longitudinal study of early-identified
infants
30 children with mild-profound hearing loss (HL)
compared to 96 normal hearing (NH) controls
Children identified < 3 months had stronger
language development at 12-16 months than those
identified > 3 months
Children with HL were delayed compared to NH
infants
Effects of Age of Identification on Language
Development18
Language Quotients at Three Years of Age
by Age of Identification Category

100
Average range
90
Language Quotient Score

80
70
60
50
40
30
20
10
0
0-6 mos 7-12 mos 13-18 mos 19-24 mos 25-34 mos
Ages of Identification
Evidence that Early Matters
8-year follow up to Wessex (UK) trial10
120 children with permanent HL (from population-
based cohort of 157,000 infants)
Speech-language outcomes at school age (Mean =
7.9 years)
Children with HL confirmed < 9 mos had better
receptive and expressive language scores than later
identified children
Speech scores were equivalent in the 2 groups
 Early Hearing Detection and
Intervention (EHDI)
Endorsed by:
AAP, National Institutes of Health, Maternal and Child
Health, Centers for Disease Control, Joint Committee on
Infant Hearing & in 2008, the USPSTF
As of 2005, all 50 states implemented statewide EHDI
programs
As of 2006, an average of 95.7% of newborns were
screened nationally
 Status of Hearing Screening
in Nebraska (as of 10/08)

99.5% of newborns are being

screened
68/69 hospitals are screening
Refer rate is 2.3%
54 infants with permanent HL
were diagnosed in 2007

Contact:
jeffrey.hoffman@dhhs.ne.gov
 Hearing Screening Techniques
Otoacoustic emissions (OAE)

Auditory brainstem response (ABR)

Two stage screening (OAE + ABR)

Otoacoustic Emissions
Sounds are presented to
the ear canal and a small
microphone measures the
response in the ear canal
Average test time is
5-15 minutes/baby
Auditory Brainstem Response
Sounds are presented and
surface electrodes
measure brainstem activity
Average test time 20
min/baby
 OAE + ABR
All babies are screened using OAEs
Those babies who fail the OAE screening receive an
ABR screening prior to leaving the hospital
Average test time/baby (25-35 min)
Reduces refer rate; useful when follow up is likely to
be difficult or costly
Initial cost of equipment is higher than OAE or ABR
screening alone, but follow-up costs are less
Counseling Parents
Effective communication of results to families has
an influence on follow up behaviors
Balance between reassurance and importance of
follow up testing
Your child may or may not have a hearing
lossbut lets be sure about it. If further testing
shows hearing loss, the earlier we get started
helping the child, the better.
Counseling Parents Following
Screening
 Follow Up Testing
Referral for follow-up testing
Repeat OAE and/or ABR screening
If a hearing loss is still suspected
Referral to a pediatric audiologist
Experienced in testing infants & children
Has appropriate equipment to test infants
Frequency specific ABR to estimate degree and
configuration of hearing loss
Early testing can avoid need for sedation
Counseling Parents Following
Diagnosis
 Components of a Comprehensive
Audiological Evaluation
History
Assessment of hearing sensitivity (ABR)
Rule out middle ear pathology; refer to ENT
physician if appropriate
Initiate amplification
Refer to local early intervention program
Provide support via other parents of children
with hearing loss
PCP helps to coordinate childs follow up care
in their practice
 JCIH 2007 Follow Up Guidelines2
EHDI systems should be family-centered
Families should have:
Access to information on all treatment options
Counseling regarding hearing loss
Child and family should have:
Immediate access to hearing technologies
Amplification
Hearing aids can be fitted as
young as 1 month of age
Early Identification needs to be paired with early,
appropriate and consistent interventions.
3 year old with moderate-severe loss:
Inconsistent Intervention

Child A
3 year old with moderate-severe loss:
Consistent early identification

Child B
3 year old with mild-moderate loss:
Identified at 3 years, 3 months
Pre-intervention sample

Child C 3
years
5 year old with mild-moderate loss:
Identified at 3 years, 3 months
Post- intervention sample

Child C 5 years
Risk Indicators for permanent congenital, delayed
onset or progressive hearing loss2
Caregiver concerns*
about hearing, speech, language, development
Family history*
of permanent childhood hearing loss
NICU stay > 5 days or any of following (regardless
of length of stay):
ECMO assisted ventilation*
Ototoxic medications (gentimycin, tobramycin)
Loop diuretics (furosemide, Lasix)
Hyperbilirubinemia reguiring exchange transfusion

JCIH, 2007 * = greater risk for delayed onset HL

Risk Indicators for permanent congenital, delayed
onset or progressive hearing loss2
In Utero infections
CMV*, herpes, rubella, syphilis, toxoplasmosis
Craniofacial anomalies
Syndromes* involving hearing loss
Neurofibromatosis, osteopetrosis, Usher, Waardenburg,
Alport, Pendred, Jervell & Lange-Nielson

* = greater risk for delayed onset HL

Risk Indicators for permanent congenital, delayed
onset or progressive hearing loss2
Neurodegenerative disorders
Hunter syndrome
Sensory motor neuropathies (Frieidrich ataxia, Charcot-
Marie-Tooth)
Culture positive postnatal infections associated
with HL*
Herpes, varicella, meningitis
Head trauma (basal skull, temporal bone)*
Chemotherapy*

* = greater risk for delayed onset HL

 Medical Workup
Complete prenatal & perinatal history
Family Hx of onset of HL < age 30
Physical for stigmata, ear tabs, cleft
palate, cardiac, sketetal, microcephaly
Refer to ENT/CT of temporal bones
Refer to Genetics and Ophthalmology
Other: CMV, EKG, Developmental evaluation
 CI Candidacy Criteria
3-6 month trial with hearing
aids; lack of benefit
Profound loss 90+dB (12 to 18
mos); >18 mos, Severe-to-
Profound 70 dB+
No medical contraindications
Rehab setting encouraging
auditory
Family factors (motivation,
expectations)
 Goals of Early Intervention
Home based services
Optimally, providers have experience & training with the population
and work to:
Establish partnerships with families
Promote family competence & confidence in parenting child
Support family in providing a language-rich environment in
everyday routines
Support family to become informed decision makers for the child
Conduct ongoing assessments of outcomes
Adjust interventions as necessary to optimize outcomes
Promote family access to formal and informal supports
Provide culturally competent services
Trauma
 TRAUMA TELINGA LUAR
HEMATOM AURIS ( OTHAEMATOM )
- PD UMUMNYA DISEBABKAN TRAUMA LANGSUNG
- PERDARAHAN ANTARA KULIT TL. RAWAN
GELEMBUNG KEBIRUAN, FLUKTUASI +
- DIBIARKAN : RESORPSI MENGERUT
- PENANGANAN : ASPIRASI, BALUT TEKAN

TRAUMA KANALIS AKUSTIKUS & MEMBRAN TIMPANI

- DAPAT OLEH TRAUMA LANGSUNG
- TDK LANGSUNG : LEDAKAN, TEKANAN
- GEJALA : NYERI, TULI, DPT DISERTAI PERDARAHAN
- PERFORASI : TEPI IREGULER DISERTAI BERCAK PDRH;N
- PENANGANAN : JANGAN DIKOREK, JANGAN KENA AIR,
JANGAN OBAT TETES, JANGAN BERSIHKAN
BEKUAN DARAH
TRAUMA MAKSILOFASIAL
PENYEBAB : KLL, OLAH RAGA, PERKELAHIAN, DLL
DAPAT MENGENAI JAR. LUNAK ATAU TULANG
YANG HARUS MENDAPAT PERHATIAN :
1. JALAN NAFAS : TRAKEOTOMI ?
2. PERDARAHAN
3. TANDA TANDA SHOCK
4. KELAINAN LOKAL DAN LAINNYA
PERDARAHAN PADA UMUMNYA BERASAL DARI
A.FASIALIS ATAU A.TEMPORALIS SUPERFISIALIS
PENEKANAN ATAU LIGASI
DIAGNOSIS TRAUMA MAKSILOFASIAL
ANAMNESIS : - JENIS BENDA PENYEBAB
- ARAH TRAUMA

INSPEKSI : LUKA, ASIMETRI, GGN FUNGSI HIDUNG,

GGN OKLUSI, PARESIS FASIAL, DLL

PALPASI BIMANUAL : * REGIO FRONTAL

* ORBITAL RIM, ZIGOMA
* REGIO NASAL, MAKSILA
* MANDIBULA, TMJ

RADIOLOGI : SPESIFIK, CT SCAN, MRI

PENANGANAN TRAUMA MAKSILOFASIAL
TRAUMA JAR. LUNAK

HEMATOM : KONSERVATIF / INSISI

VULNUS : * HECTING DENGAN APROKSIMASI

YG BAIK PADA TEPI LUKA
* DIKERJAKAN DALAM 24 JAM
* ANTIBIOTIK ADEKUAT
* HECTING DIANGKAT DLM 4 6 HR
FRAKTUR OS NASAL
DAPAT BERUPA ANGULASI, DEPRESSED

DIAGNOSIS : - DEFORMITAS
- KREPITASI
- EPISTAKSIS, DPT SEPTAL HEMATOM
- SUMBATAN HIDUNG
- Ro : SPOT NASAL LATERAL, WATERS

PENANGANAN : * REPOSISI SBLM 10 HARI

* FIKSASI INTERNA / EKSTERNA
FRAKTUR OS FRONTALIS
DPT BERSIFAT DEPRESSED / LINEAR / COMMINUTED

DPT TIMBUL LIQUORHOE JIKA MENGENAI DDG

POSTERIOR YG MEROBEK DURAMATER

DIAGNOSIS : Ro WATERS, SCHEDEL PA & LATERAL

PENANGANAN :
- EKSPLORASI, REPOSISI, FIKSASI
- DURAPLASTI
- PERHATIKAN DUCT. FRONTONASAL,
N. SUPRAORBITAL, N.SUPRATROCHLEAR
FRAKTUR OS MAKSILARIS
KLASIFIKASI :
- LE FORT I : SETINGGI PROC. ALVEOLARIS
- LE FORT II : FRAKTUR PIRAMIDAL
- LE FORT III : CRANIOFACIAL DISJUNCTION

MUTLAK PALPASI BIMANUAL

GEJALA : MALOKLUSI, EPISTAKSIS, HIPESTESI N. V2

EDEM INFRAORBITAL, LIQUORHOE

DIAGNOSIS : Ro WATERS, SCHEDEL LATERAL & PA

PENANGANAN : WIRING, MINIPLATE

FRAKTUR ZYGOMA
GEJALA : - DEPRESSED PD DAERAH TSB
- PERIORBITAL EKIMOSIS
- DIPLOPIA
- HIPESTESI N. V2

DIAGNOSIS : Ro WATERS : HEMATOSINUS

ARC. ZYGOMA : SUBMENTOVERTEX

REPOSISI SECARA TERBUKA : TEKNIK GILLIES

BLOW OUT FRACTURE
TRAUMA TUMPUL BOLA MATA YANG MENYEBABKAN
FRAKTUR PADA LANTAI ORBITA

GEJALA : - ENDOFTALMOS
- EKIMOSIS ORBITA, SKLERA, KONJUKTIVA
- DIPLOPIA
- HIPESTESI N. V2

Ro WATERS : * FR. LANTAI ORBITA, HERNIASI

* HEMATOSINUS

PENANGANAN : REPOSISI TRANSANTRAL, INFRAORBITAL

FRAKTUR MANDIBULA
GEJALA UTAMA ADALAH MALOKLUSI

GARIS FRAKTUR DAPAT TERJADI SINGLE / MULTIPLE

PADA, PROC. ALVEOLARIS, SIMPHYSIS, CORPUS,
RAMUS

DIAGNOSIS : Ro SCHEDEL LATERAL, PANORAMIX

PENANGANAN FUNGSI MENGUNYAH

TRAUMA LARING, TRAKEA, ESOFAGUS
DAPAT BERUPA TRAUMA INTERNAL / EKSTERNAL
INTERNAL : - VOCAL ABUSE
- INHALAN, REFLUKS
- INTUBASI, BENDA ASING
EKTERNAL : DAPAT BERUPA TRAUMA TAJAM
ATAU TUMPUL YANG MERUSAK
RANGKA ATAU STRUKTUR INTERNAL

GEJALA : * DISFONI, STRIDOR, DISPNEU

* DISFAGIA, ODINOFAGI

PENANGANAN DISESUAIKAN DENGAN PENYEBABNYA

 End of slide.