Pemicu 3

BLOK PENGINDERAAN
Clinton Sudjono
405150004
Kelompok 2
Anatomi telinga
 Telinga luar
TELINGA LUAR, terdiri dari :

1. Auricula

- Terdiri dari kartilago elastik

berbentuk ireguler yang dilapisi o/
kulit tipis

- Terdapat concha, helix, lobulus, tragus

- Suplai arteri  a. temporalis

superfisialis dan arteri2 auricularis
post.

- Saraf utama yang ke kulit auricula

 N. auriculatemporalis dan
auriculus magnus
- N. auriculus magnus 
mmpersarafi permukaan kranial
(medial) atau belakang telinga
dan pars post dan perm. Lateral
(depan).

- N. auriculustemporalis 
mmpersarafi kulit di auricula
anterior meatus acusticus
externus
2. Meatus acusticus externus

- Adalah suatu kanal yang mengarah

ke dlm melalui pars tympanica ossis
temporalis dari auricula ke
membrana tympanica

- 1/3 lateral kanal adalah kartilaginosa

dan 2/3 medialnya adalah tulang

- Glandula sebasea dan ceruminosa

pada jaringan subkutan pars
kartilaginea meatus menghasilkan
serumen (earwax)

- Membran tympanica  terdpat pada ujung

medial MAE, perm. Externa di persarafi
o/ n. auriculotemporalis canag dari n.V 3,
perm. Internal di suplai o/ n.
glossopharyngeus N. IX
 Telinga tengah

TELINGA TENGAH

- Rongga telinga tengah atau cavitas timpani berisi udara yang sempit pada
pars petrosa ossis temporalis, cavitas memiliki dua bagian:

• Cavitas timpani propria: ruang yang mengarah ke sebelah dalam

membrna tympanica

• Recessus epitympanicus: ruang di supperior membrana.

2. Tuba auditiva

- Mengubungkan cavitas timpani dengan nasopharynx, tempatnya bermuara ke post

meatus nasi inferior.

- Fungsinya ialah menyamakan tekanan dalam auris media dengan tekanan atmosfer,
sehingga memungkinkan gerakan membrana tymoanica, dengan mmbiarkan udara
masuk dan keluar cavitas tympani, tuba menyeimbangkan tekanan pada kedua sisi
membrana

- Arteri berasal : a. pharyngea ascendens (cabang arteri carotis externa), a. meningea

media dan a. canalis pterygoideus (cabang a. maxillaris)

- Vena : bermuara ke plexus venosus ptrygoideus

- Drainase limfatik : nl. Cervicales profundi
- Nervus : plexus tympanicus
3. Ossicula auditus

- Membntuk rantai mobil tulang keci

yang menyilang cavits tympani dari
membrana tympanica ke fenestra
vestibuli, suatu apertura oval pada
dinding labyrinthus cavitas timpani
yang mengarah ke vesibulum
labyrinthus osseus

- Malleus  nempel pada membrana

tympanica, oleh krna itu malleus bergerak
bersama membrna. Berfungsi sebagai
pengungkit

- Incus  terletak diantara malleus dan stapes

- Stapes  ossicula paling kecil, basis
stapedis melekat pada fenestra vestibuli pda
dinding medial cavitas tympanis
- otot2 yang dihub. Dengan ossicula auditus  dua otot yang mengurangi
atau menahan gerakan ossicula auditus, dan satu otot yang mengurangi
gerakan (vibrasi) membrana tympanica:

• M. tensor tympani: menrik manubrium ke medial, yang menegangkan

membrana tympanica yang mengurngi amplituido osilasinya 
mencegah kerusakan aurisinterna bila dipajankan pasa suara keras.
Disuplai o/ N. mandbularis.

• Stapedius: menarik stapes ke post. Dan memiringkan basisnya pada

fenestra vestibuli  mmperkuat ligamentum anulare dan mengurangi
kisaran osilasi, lig. Juga mencegah gerakan berlebih stapes. Dan
dipersarfi o/ n. fasialis.
 Telinga dalam
TELINGA DALAM

- berisi organ vestibulocochlearis yang di hub. Dengan penerimaan suara dan

mmpertahankan keseimbangan.

1. Labyrinthus osseus

- Adalah suatu seri cavitas yang terdapat didalam capsula oticum pars petrosa ossis
temporalis

- Cochlea  adalah bagian berbentuk selubung pada labyrinthus osseus yang berisi
ductus cochlearis, bagian auris interna yang berhub. dengan pendengaran

- Vestibulum labyrinthus osseus  ruang oval yang berisi sacculus dan utriculus dan
bag. Aparatus keseimbangan

- Canalis semicircularis  terdiri dari 3, yaitu anterior, post, lateral. Berhub dengan
labyrinthus osseum.
2. Labyrinthus membranaceus

- Terdiri dari suatu rangkaian dan ductus yang saling berhub. Yang tergantung pada labyrinthus
osseus.

- Bag. Tersebut memilik endolimf,

- Memiliki dua divisi :
• Labyrinthus vestibularis  utriculus dan saculus dua kantong kecil yang berhub dalam
vestibulum labyrinthus osseus

• Labyrithus cochlearis  ductus cochlearis dalam cochlea.

- Ductus semicircularis  memiliki suatu ampulla pada satu ujung yang memiliki area sensorik,
crista ampullaris  u/ merekam gerakan endolimf dalam ampula yang disebabkan o/ rotasi
kepala bidang ductus.

- Ductus cochlears  berisi endolimf

3. Meatus acusticus internus

- Suatu kanal sempit yang berjalan secara lateral dengan panjang kira2 1 cm dalam pars petrosa
ossis temporalis

- Tertutup diseblah lateral o/ lamina tulang tipis perforata yang memisahkannya dari auris interna
- Melalui lamina ini berjalanya n. facialis, n. vestibulocochlearis, dan pemb. Darah lainya.
Histologi
Telinga luar
external acoustic meatus
• a canal lined with stratified squamous epithelium that extends from
the auricle to the middle ear.
• Near its opening hair follicles, sebaceous glands, and modified
apocrine sweat glands called ceruminous glands are found in the
submucosa
Auris
externa
1. Auricula:
• tlg rawan elastin
• kutis & subkutis tipis
• lobus auriculus (lemak)
2. Meatus/canalis acusticus ext
• liang oval (1/3 luartlg rawan, 2/3 dlmtlg
temporal)
• kulit & submukosa: folikel rambut, gland.
Sebasea, gland. Ceruminosa ep. Berlapis
gepeng yg deskuamasi serumen (coklat,
mirip wax, f:pelindung)
3. M. tympani
• M. fibrosa, >>kolagen
• Diikat oleh fibrokartilago
• Luar: epidermis tipis
• Dalam: ep. Selapis gepeng
• Diantaranya ada 2 lapisan jar. Ikat kolagen
(luarradial, dlmcirculer)
• Pars falsida/membran sharpnell lebih
lemas (unt trepanasi)
• Pars tensatmpt melekat maleolus
Auris
media
1. Cavum tympani
• Ruang udara
• Dilapisi tympanic mucosa  jar ikat tipis  ep
selapis gepeng/ ep bertingkat torak bersilia bersel goblet
2. Ossicula tympani
• Tulang kompak : malleus, incus, stapes
• Hub. Oleh sendi sinovial & m. tenson tympani &
m.stapedius
3. Tuba eustachii
• Sal sempit (cavum tympani-lateropost nasopharynx)
• 1/3 cavum tympani: selapis torak bersilia, T.pars ossea
• 2/3 nasopharynx: TR hyalin, ep bertingkat torak bersilia
bersel goblet
• + kel seromukosa
• F: menyeimbangkan tek udara
4. Celullae antrum mastoid
• Ruang2 udara, muara antrum mastoid
HISTOLOGI TELINGA
Auris interna
1. Labyrinthus 1. Vestibulum
osseus • Dilapisi JI yg membentuk mesotel
• Bagian tulang 2. Canalis semicircularis
• Rongga irreguler 3. Cochlea
• Dilapisi • Tabung spiral dgn modiolus sbg
periosteum poros
• Dibatasi jar ep. • Modiolus trdpt ganglion spiralis
mesenkim (dendrit sel2 bipolar ganglion
• isi: perilymph spiralis m’bentuk sinaps dgn sel2
rambut organ corti & neuritnya
mbntk n.cochlearis)
• 3 ruang: skala vestibule, cochlearis,
tympani
2. Labyrinthus 1. Utriculus & sacculus
membranaceus • Penghubung: d. utriculosaccularis
• Kantong dgn dinding jar halus, ada fibroblast & melanosit
2. Macula
• Sustantekuler: torak, inti oval dibasal, kutikula, mikrovili
• Sel rambut: torak, inti oval, kutikula, stereosilia
• Type I: piriformis/kerucut, inti basis & leher, saraf eferen
• Type II: silindrin, saraf afferent
3. Ductus Semicircularis
(histo idem dgn macula), kinosilia terbenam dlm glikoprotein yg
tebal
4. Ductus & saccus endolimfaticus
(dilapisi ep selapis gepeng(dekat sakus) ep silindris tinggi)
5. Ductus Cochlearis
(isi: endolymph, mrpkn reseptor suara)
6. Organ corti
• Sel hensen
• Sel rambut luar
• Sel phalangeal luar
• Sel tiang luar & dalam
• Sel phalangeal dalam
• Sel rambut dalam
• Sel batas
Cochlear duct
• a part of the membranous labyrinth shaped as a spiral tube,
contains the hair cells and other structures that allow auditory
function
• The cochlear duct itself forms the middle compartment, or scala
media, filled with endolymph. It is continuous with the saccule and
ends at the apex of the cochlea.
• The larger scala vestibuli contains perilymph and is separated
from the scala media by the very thin vestibular membrane
(Reissner’s membrane) lined on each side by simple squamous
epithelium
• The scala tympani also contains perilymph and is separated from
the scala media by the fibroelastic basilar membrane
• The stria vascularis, located in the lateral wall of the cochlear duct
(scala media) produces the endolymph
Fisiologi
Fisiologi
• Pendengaran: persepsi saraf mengenai energi suara.
• Gelombang suara: getaran udara yang merambat & terdiri dari
daerah-daerah pemampatan & penjarangan molekul udara yang
berlangsung secara bergantian.
• Suara ditandai o/:
• Nada
• Intensitas
• Kualitas suara/ warna nada
Pitch discrimination
• the ability to distinguish between various frequencies of incoming
sound waves
• narrow end nearest the oval window vibrates best with high-
frequency pitches
• the wide end nearest the helicotrema vibrates maximally with low
frequency tones
Loudness discrimination
• Depends on the amplitude of vibration
• As sound waves originating from louder sound sources strike the
eardrum, they cause it to vibrate more vigorously
• > greater tympanic membrane defection -> > amplitude of basilar
membrane movement -> >bending of the stereocilia in this region.
• CNS interprets this greater basilar membrane oscillation and hair
bending as a louder sound.
gangguan telinga luar
 Inflamasi Aurikular
Definisi Infeksi / inflamasi pada perikondrium dri telinga bagian luar :
aurikula & external auditory canal
Klasifikasi Erisipelas dari telinga bagian luar
Selulitis telinga luar
Perikondritis
Condritis
Etiologi -Trauma
-frosbite, burns, chemical injury
-infeksi di aurikula
Most • Pseudomonas aeruginosa
common • Staphylococcus aureus
Microorgani • Proteus
me • Escherichia coli
• Streptococcal

Scott-brown’s otorhinolaryngology, head and neck surgery volume 3

Perichondritis of the external ear Ch.236i
Page 3358-3360
Patologi Hiperplasia dari lapisan kulit :
• -penebalan jaringan subkutan
• -intense inflatration of PMN leukosit
• -penebalan dari perikondium
• -hancurnya kartilago oleh fagosit

Diagnosis • -nyeri yg bersifat tumpul

• -daerah lobul (-) terkena
• -nyeri dan bengkak pada pinna
• A background history of underlying trauma to
the external ear should be sought.
Terapi -prevensi
-first line management
-others forms of management

Scott-brown’s otorhinolaryngology, head and neck surgery

volume 3
Perichondritis of the external ear Ch.236i
 Herpes Zoster Oticus
• is defined as a herpetic vesicular
rash on the concha, external
auditory canal or pinna with a
lower motor neurone palsy of the
ipsilateral facial nerve.
• commonly known as Ramsay Hunt
syndrome
Pathology
• The disease is a reactivated
varicella zoster infection from
dormant viral particles resident in
the geniculate ganglion of the
facial nerve and the spiral and
vestibular ganglia of the VIIIth
nerve
Signs & symptoms
• The VIII th nerve may be involved to
a variable degree, resulting in
hearing loss, tinnitus and/or vertigo
• Auricular pain is often the first
symptom and other cranial nerves
are frequently involved.
• In 14 percent of patients, the rash is
not present initially but develops
several days after the onset of pain
and facial palsy.
• herpes zoster oticus the second
commonest cause of unilateral
facial palsy after idiopathic Bell's
palsy.
Diagnosis Outcomes
• In untreated patients, over 60 percent
develop a complete facial paralysis
within a week and this figure is even
higher in individuals over the age of 50.
• If the palsy is complete, only 10 percent
will get a full return of normal function
• If the palsy is incomplete, 66 percent will
recover completely. Overall,
approximately 50 percent of adults and
80 percent of children will achieve full
recovery

Management
• improved outcomes were obtained if
individuals were commenced on
acyclovir and prednisolone within three
days of the onset of symptoms
• treatment of intravenous acyclovir plus
steroids produced a 90 percent recovery
Otitis eksterna

• generalized condition of the

skin of the external auditory
canal that is characterized
by general edema and
erythema associated with
itchy discomfort and usually
an ear discharge.
Pathophysiology
• 1. pre-inflammatory
• the protective lipid/acid balance of the ear is lost and the stratum
corneum becomes oedematous, blocking off the seba- ceous and
apocrine glands producing aural fullness and itching.
• With further oedema and scratching, there is disruption of the
epithelial layer
• 2. acute inflammatory (mild, moderate or severe); 3. chronic
inflammatory.
• progressively thickening exudate, further oedema, obliteration of the
lumen (mild, little or no obliteration; moderate, subtotal obliteration;
severe, complete obliteration) and increasing pain
• 3. chronic inflammatory.
• thickening of the external canal skin and fibrous canal stenosis
 Diagnosis Treatment

• pain, itch, oedema and • Aural toilet

erythema of the • Topical medication
external auditory canal • Severe: Glycerol and
with purulent otorrhoea ichthammol
and debris in the
meatus • Systemic antibiotic
• Prevention:
• avoidance of water
penetration into the ear
• Ear molds when
showering / swimming

Acute otitis externa. Ear canal is red and edematous, and discharge is present
Benda asing pada telinga
Penyebab : Komplikasi :
• Kapas korek kuping
• Serangga
• Perforasi membran
• manik-manik timpani
• Kertas • Dislokasi / fraktur tulang
• mainan kecil pendengaran
• Penghapus • Nekrosis jaringan sekitar
• Kacang

Symptoms
• Asimtomatik
• Nyeri/Discharge
• Dewasa : kapas cotton bud,
kecoa yg masuk  rasa tdk
nyaman
Scott-Brown’s otorhinolaryngology, head and neck surgery, 7th ed.
Scott-Brown’s otorhinolaryngology, head and neck surgery, 7th ed.
Fistula Pre-aurikular
• Telinga luar terbentuk dari arkus pertama tuberkel
kartilago yang mengalami fusi membentuk pinna.
• Fistula terbentuk krn fusi yang tidak lengkap dan
masuknya jaringan epitel membentuk lapisan kulit yang
melapisi fistula.
• Dapat terjadi karena keturunan.
• Temuan klinis :
• Fistula jelas saat lahir dan sering bilateral.
• Mungkin ada discharge sebasea.
• Jarang memberikan masalah.
• Dapat terjadi infeksi episodik berulang  abses.
• Resolusi spontan tidak terjadi krn fistula dilapisi dengan epitel
skuamosa.

Gleeson M, Browning GG, Burtin MJ, Clarke R, Hibbert J, Jones NS et al,

editors. Scott-Brown’s Otolaryngology, 7th ed. p.970, 1267-8.
Fistula Pre-aurikular
• Tatalaksana
• Tidak ada infeksi dapat
dibiarkan.
• Ada infeksi : eksisi.
• Operasi harus mengangkat
semua sisa epitel skuamosa.
• Sulit dieksisi dan sering
kambuh setelah ditangani.
• Dianjurkan memantau secara
aktif saraf wajah dan
menghindari infiltrasi anestesi
lokal.

Gleeson M, Browning GG, Burtin MJ, Clarke R, Hibbert J, Jones NS et al,

editors. Scott-Brown’s Otolaryngology, 7th ed. p.970, 1267-8.
Cerumen Props
• Cerumen : Kombinasi dari hasil sekresi sebacea & apokrin yg tercampur dgn
debris epitel
• Akumulasi cerumen  mengganggu clinical view membran timpani, gangguan
pendengaran, ketidaknyamanan / sumber infeksi
• Pembersihan serumen dgn cotton swabs dpt mendorong cerumen lbh dalam
• Cara pembersihan serumen  metode irigasi, bekerja baik pda serumen yg
lembek.

Ballenger’s Otorhinolaryngology 17 Head and Neck Surgery 2009

gangguan telinga tengah
Acute Otitis Media
= a viral or bacterial
infection of the mucosal
lining of the middle ear
and mastoid air-cell
system.
• characterized by an
otoscopically abnormal
tympanic membrane
• clinical presentation is
usually with otalgia and
systemic illness

Scottbrown
Acute Otitis Media
History
• local symptoms: ear ache, impaired
hearing, otorrhea, tinnitus
• general symptoms: fever, irritability,
nocturnal agitation, gastrointestinal
signs (abdominal pain, diarrhea,
vomiting, anorexia)
Physical Examination
• Inspection of the eardrums
• to establish or exclude the diagnosis of
acute otitis media
• help to estimate the gravity of the illness
• Both eardrums should be inspected and
compared.
• – Cerumen or detritus can be removed
with Q-tips soaked in oil, a cerumen loop
or, preferably, a vacuum aspirator
• The ear should not be rinsed by means of
a syringe. For patients with acute otitis
media, the latter procedure is very
painful.
Scottbrown
Acute Otitis Media
Diagnosis
• Normal tympanum: pearl grey and
transparent, with a clear light reflex
• an injected tympanum can indicate
early acute otitis media, but can also
be caused by crying or by a common
cold.
• A clear difference in redness
between left and right tympanum
supports the diagnosis of acute otitis
media
• Findings that confirms the diagnosis
of acute otitis media:
• an intensely red tympanum
• perforation of the tympanum with
otorrhea (within an acute clinical
picture)
• a bulging tympanum indicates the
presence of liquid in the middle ear
under pressure.
• Anamnestic data play an increasingly
important role, the more so when
the image of the tympanum is
unclear or difficult to judge
Scottbrown
 Otitis Media Serosa
Definisi Akumulasi mukus di telinga bagian tengah dan terkadang
di sistem udara sel mastoid yang bersifat kronik

Etiologi -infeksi - disfungsi tuba eustasia

-Alergi – patologi di nasofaringeal

Gejala Klinis -kehilangan pendengaran

-telinga terasa penuh
-pulsatile or crackling tinnitus
-nyeri di telinga dan pusing

Scott-brown’s otorhinolaryngology, head and neck surgery

volume 3
Otitis media with effusion in adults
Diagnosis -timpanometri
-radiologi
-klinikal

Komplikasi -atelectasis of the tympanic membrane

-serious intracranial complications : meningitis coexisting
with OME
-sensorineural hearing lose <- Chronic OME
Terapi Autoinflation= valsava manufer
Medikasi
Surgical
 Chronic Otitis Media
• = the chronic accumulation of
mucus within the middle ear
and sometimes the mastoid
air cell system.
• The time that the fluid has to
be present for the condition
to be chronic is usually taken
as 12 weeks.

Scottbrown
Scottbrown
Mastoiditis
•  inflammation with the mastoid air-cell system
• Extension of infection & inflammation during acute otitis media
• Traditional teaching  preceed by 10-14 days of middle ear symptoms

• Etiology
• 20% dont grow bacteria
• S. Pneumoniae, S. Pyogenes, P. Aeruginosa, S. Aureus (common)
• H. Influenza (< common); M. Catarrhalis, P. Mirabilis (rare)

• Epidemiology
• Disease of childhood
• 28 % < 1yo; 38%  4yo; 8%  8-18yo; 4%  > 18 yo
• US  1..2 – 2% per 100,000
• Symptoms
• Systemic signs of infection
(fever & malaise)
• Mastoid tenderness &
localized reactive
lymphadenopathy
• In children
• Erythema &/ edema of
everlying mastoid soft
tissue
• Otalgia & irritability
• In adult
• Local pain & tenderness
• Otorrhea (30%)
• Signs
• Red/buldging tympanic
memb
• Retro-auricular swelling
• Tenderness is typically
sited over MacEwen’s
triangle
• On palpation through
conchal bowl)
• Pinna protrusion
• Sagging of post wall of ext
auditory canal
• Examination • DD
• Full blood count, CRP, blood • AOM
culture • Otitis externa
• CT scan of mastoid • Furunculosis
• Reveal osteitis, abscesses, intracranial • Reactive lymphadenopathy
complications
• Undiagnosed cholesteatoma
• Wegener’s granulomatosis

• Complications
• Intracranial complications (6-17%)
• Treatment • Treatment
• Modern antimicrobials + • Myringotomy with/-out
radiographic monitoring ventilation tube placement
• Early performance of • Culture of aspirate & high-dose
myringotomy IV antibiotics
• Mastoid surgery • Abscess drainage with/-out
(mastoidectomy) cortical mastiodectomy
• Indication  failure of • If failure to improve,
improvement despite aggressive subperiosteal abscess formation,
medical management, complication developments
development of other
intracranial complications
• Goal of surgery  drainage of
mastoid, removal of granulation
tissue, restoration of normal
ventilatory pathways
• + continuation of antibiotic
theraoy postoperatively for
weeks

Bellanger's otorhinolaryngology 17th

Scott-Brown’s otorhinolaryingology, head & neck surgery
 Miringitis Bullosa
Bullous myringitis (myringitis bullosa haemorrhagica) adalah temuan vesikel
pada lapisan superfisial membran timpani.
Menyerang Semua umur, tp lebih sering pd  anak-anak, remaja, & dewasa
muda
Etiologi : Infeksi virus influenza / Mycoplasma pneumoniae
Patologi : Vesikel terjadi diantara outer epithelium dan lamina propria dari
membran timpani
Gejala :
• Sudden onset, biasanya unilateral, nyeri berdenyut
• Biasanya tjd saat/setelah infeksi saluran pernapasan atas
• Bercak darah dpt muncul dalam beberapa jam
• Gangguan pendengaran (konduktif &/ sensorium)
Tanda :
• Otoskopi  lepuhan berisi darah, serous/serosanginous yg melibatkan
membran timpani& kadang aspek medial
• Jika lepuhannya ruptur  ada sekresi sanginous
• Membran timpani intak.
Scott-Brown’s otorhinolaryngology, head and neck
surgery, 7th ed.c
Diagnosis : Tatalaksana
• PFvesikel pada lap. Superfisial
membran timpani • Tanpa keterlibatan telinga
Investigasi : tengah & tuli sensorineural
• Inspeksi dgn mikroskop
> analgesik
• PF nervus kranial (t.u n.facialis)
• Pneumatic otoscopy &
tympanometry  cek telinga
tengah ada cairan/tdk
• Pure-tone audiogram  deteksi
gangg.pendengaran sesorineural
Diagnosis banding :
• Acute otitis media
• herpes zoster oticus

Scott-Brown’s otorhinolaryngology, head and neck surgery, 7th ed.

 Perforasi Membran Timpani
• Traumatic perforation of the
tympanic membrane  dapat
tjd karena:
• Transmisi langsung dari adanya
gaya yg mengganggu saat trauma
tulang temporal
• Pecahnya membran karena
trauma ledakan, misil/airbags
• Penetrasi partikel debris pada
membran timpani
Terapi :
1. Hindari terkena air /
kontaminasi lain.
2. Perforasi membran karena
trauma tulang temporal 
sembuh sendiri dalam 10 mgg
3. Bedah  pertimbangkan
jika perforasi nya bertahan
hingga 3 bulan/lebih.
Scott-Brown’s otorhinolaryngology, head and neck
surgery, 7th ed.
 Tympanosclerosis
• the deposition of acellular Treatment
hyalin within the TM or middle • Tympanoplasty
ear submucosa as a result of
OM or trauma • ossicular reconstruction
• On otoscopic examination,
white crescent- or horseshoe-
shaped plaques are seen in the
TM

Ballenger’s Otorhinolaryngology
Penulisan resep

LI 6
• R/ Hidrogen Peroxide 4% Ear drop fl.1
S 4 dd 2 gtt AS (cuci telinga)

• R/ Gentamisin 5ml Ear Drop fl.1

S 4 dd 4 gtt AS (Habiskan)
 Daftar Pustaka
• Netter FH. Atlas of human anatomy. 4th ed. Canada:Saunders;2006
• L. Mescher, Anthony. Junquera’s Basic Histology Text and Atlas. 20th
edition. United State: The McGraw-Hills; 2010
• Di Fiore’s atlas of Histology 11th edition
• Sherwood L. Human physiology: from cells to systems. 7th Ed.
Belmont, USA: Brooks/Cole; 2010
• Ballenger’s Otorhinolaryngology 17 Head and Neck Surgery 2009
• Scott-Brown’s otorhinolaryingology, head & neck surgery edisi 1
• Scott-Brown’s otorhinolaryingology, head & neck surgery edisi 2
• Scott-Brown’s otorhinolaryingology, head & neck surgery edisi 3