OMA Perforasi
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1
LAPORAN KASUSOTITIS MEDIA AKUT
STADIUM PERFORASI AURIKULA DEXTRA
Pembimbing:dr. Sondang BRS, Sp.THT, MARS
Disusun oleh:Nadia Gina Anggraini 2011730071
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OMA : Peringkat ke-1, 10 penyakit
terbanyak THT (2014)
Mendapat pengalaman-
pengetahuan
Menyelesaikan tugas kepaniteraan
Latar belakang
2
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STATUS PASIEN
IDENTITAS
Nama : An. R A
Umur : 6 tahun
Jenis Kel. : Laki-laki
Pekerjaan : -
Alamat : Cipaku RT 01/02, Cisarandi
warun
Tanggal berobat : Rabu, 30 September
2015
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ANAMNESIS
4
Keluhan Utama:
- Keluar cairan dari telinga kanan
- ± 2 minggu SMRS
Keluhan Tambahan:
- Pilek ± 1 minggu SMRS
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ANAMNESIS Cont...
5
Riwayat Penyakit Sekarang Telinga kanan: keluar cairan Kekuningan, kental, berbauRasa penuh dan nyeri pada telinga disangkal Pendengaran berkurang dan berdenging disangkal Pilek ± 1 minggu lalu Bau dari hidung kanan Demam disangkal
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ANAMNESIS Cont...
6
Riwayat Penyakit Dahulu
Pertama kali
Riwayat sakit hidung dan
tenggorok sebelumnya disangkal
DM (-) Asma (-)
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ANAMNESIS Cont...
7
Riwayat Kesehatan Keluarga
Keluhan serupa pasien
disangkal
Riwayat Kehidupan Sosial
Senang berenang
Jarang gosok gigi
Senang jajanan pinggir jalan
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ANAMNESIS Cont...
8
Riwayat Alergi
Udara dingin (-) makanan (-) obat
(-)
Riwayat Pengobatan
Ke puskesmas
Tidak mau minum obat
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PEMERIKSAAN FISIK
Status Generalis
KU : Tampak sakit ringan Kesadaran : Compos mentisTanda vital: TD : 90/80 mmHg,
N : 88x/mnt, RR: 22x/mnt, T : 36,6oCBB : 15 kg
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Normocephal , rambut kehitaman, distribusi
merata
Konjungtiva anemis (-/-)sklera ikterik (-/-)
refleks pupil (+/+) isokor
STATUS GENERALIS
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Lihat status lokalis
Lihat status lokalis
Lihat status lokalis
Lihat status lokalis
Lihat status lokalis
13
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Pemeriksaan Fisik Paru
normochest simetrisretraksi dinding dada (-)
Bagian dada yang tertinggal saat bernapas (-)
Sonor seluruh lapang paru
vesikuler (+/+) ronkhi (-/-) wheezing (-/-)
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Pemeriksaan Jantung
• Inspeksi ictus cordis tidak terlihat
• Batas jantung relatif dalam batas normal
• Bunyi jantung I dan II regular
15
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Pemeriksaan Abdomen
• Abdomen supel• Hepatomegali (-),
splenomegali (-)• Perkusi timpani seluruh
kuadran abdomen• Bising usus (+) normal
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EKSTREMITAS
Superior
Inferior
17
Akral hangat, udem (-/-), RCT < 2 detik
Akral hangat, udem (-/-), RCT < 2 detik
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AD AS
NormotiaHelix sign (-)
Tragus sign (-)
Aurikula
NormotiaHelix sign (-)
Tragus sign (-)
STATUS LOKALIS TELINGA
18
Tanda radang(-)Fistula(-)
Preaurikula
Tanda radang(-)Fistula(-)
Tenang, udem(-)fistel(-), sikatriks (-)
nyeri tekan(-)
Retroaurikula Tenang, udem(-)
fistel(-), sikatriks (-)
nyeri tekan( -)
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AD AS
+ Uji Rinne +
Tidak ada lateralisasi Uji Weber Tidak ada lateralisasi
Sama dengan pemeriksa Uji Schwabach Sama dengan
pemeriksa
19
STATUS LOKALIS TELING
A
Hiperemis (-)sekret (+) banyak
mukopurulenserumen (-)massa (-)
MAE
Hiperemis (-)serumen (-)
sekret (-)massa (-)
Hiperemis (-), Perforasi (+)
reflex cahaya (-)
Membran timpani Hiperemis (-),
intak, reflex cahaya (+) jam 7
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Status Lokalis Hidung
20
Dextra RHINOSKOPI ANTERIOR Sinistra
Tenang Mukosa Tenang
+ Sekret -
Eutrofi Konka inferior Eutrofi
Deviasi (-) Septum Deviasi (-)
(-) Massa (-)
(-) Passase udara (+)
(+) kapas Korpus alineum (-)
Uji penciuman: 2 cm / 12 cm dengan bubuk kopiHiposmia cavum nasi dextra ec. Corpus alineum
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Status Lokalis Sinus Paranasal
21
INSPEKSIpembengkakan
(-/-)
PALPASInyeri tekan (-)
TransiluminasiSinus maksilaris : Terang / Terang (seperti bulan sabit pada fossa orbita)Sinus frontalis : Terang / Terang (seperti sarang tawon pada os frontalis)
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Status Lokalis Tenggorok
23
NASOFARING (Rhinoskopi posterior)
Konka superior Hipertrofi (-) Sekret (-)
Torus tubarius Hipertrofi (-) Sekret (-)
Fossa Rossenmuller Hipertrofi (-) Sekret (-)
Plika salfingofaringeal Hipertrofi (-) Sekret (-)
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Status Lokalis Tenggorok
22
DextraPemeriksaan
OROFARINGSinistra
Mulut
Tenang Mukosa mulut Tenang
Bersih, basah Lidah Bersih, basah
Tenang Palatum molle Tenang
Caries (+)
Tanggal (+)
Lubang (+)
Gigi geligi
Caries (+)
Tanggal (+)
Lubang (+)
Simetris Uvula Simetris
Tonsil
Tenang Mukosa Tenang
TIIA Besar TIIA
tidak melebar Kripta tidak melebar
- Detritus -
- Perlengketan -
Faring
Tenang Mukosa Tenang
- Granula -
- Post nasal drip -
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Tes Pengecapan
Manis Normal
Asin Normal
Asam Normal
Pahit Normal
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Status Lokalis Tenggorok
24
LARINGOFARING (Laringoskopi indirect)
Epiglotis Hiperemis (-) Ulkus (-) Edema (-)
Plika ariepiglotika Hiperemis (-) Ulkus (-) Edema (-)
Plika ventrikularis Hiperemis (-) Ulkus (-) Edema (-)
Plika vokalis Simetris (+) Adduksi (+) Abduksi (+)
Rima glotis Hiperemis (-) Ulkus (-) Edema (-)
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Dextra Nervus Sinistra
hiposmiaI. Olfaktorius
Penciuman normal
Visus normal
(+) isokor
II. OptikusDaya penglihatan
Refleks pupil
Visus normal
(+) isokor
(+)
(+)
(+)
(+)
(+)
III. OkulomotoriusMembuka kelopak
mata
Gerakan mata ke
superior
Gerakan mata ke
inferior
Gerakan mata ke
medial
Gerakan mata ke
Laterosuperior
(+)
(+)
(+)
(+)
(+)
(+)
IV. TroklearisGerakan mata ke
lateroinferior
(+)
Pemeriksaan Maksilofasial
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Dextra Nervus Sinistra
(+)
(+)
(+)
V. TrigeminusTes sensoris
Cabang oftalmikus (V1)Cabang maksila (V2)
Cabang mandibula (V3)
(+)
(+)
(+)
(+)VI. Abdusens Gerakan mata ke
lateral(+)
(+)
(+)
(+)
normal
VII. FasialisMengangkat alis
Kerutan dahiMenunjukkan gigi
Pengecapan lidah 2/3 anterior
(+)
(+)
(+)
normal
normal
VIII. Vestibulokoklearis
Tes garpu talanormal
Pemeriksaan Maksilofasial
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Dextra Nervus Sinistra
(+)
normal
IX. Glossofaringeal
Refleks muntah Pengecapan lidah 1/3
posterior
(+)
normal
(+)
(+)
(-)
simetris
X. Vagus Refleks muntah Refleks menelan
Deviasi uvulaPergerakan palatum
(+)
(+)
(-)
simetris
(+)
(+)
XI. AssesoriusMemalingkan kepala
Kekuatan bahu
(+)
(+)
(-)
(-)
XII. HipoglossusTremor lidah Deviasi lidah
(-)
(-)
Pemeriksaan Maksilofasial
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Dextra Pemeriksaan Sinistra
Pembesaran
(-)Tiroid
Pembesaran
(-)
Pembesaran
(-)Kelenjar submental
Pembesaran
(-)
Pembesaran
(-)Kelenjar submandibula
Pembesaran
(-)
Pembesaran
(-)
Kelenjar jugularis
superior
Pembesaran
(-)
Pembesaran
(-)Kelenjar jugularis media
Pembesaran
(-)
Pembesaran
(-)
Kelenjar jugularis
inferior
Pembesaran
(-)
Pembesaran
(-)Kelenjar suprasternal
Pembesaran
(-)
Pembesaran
(-)
Kelenjar
supraklavikularis
Pembesaran
(-)
PEMERIKSAAN LEHER
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RESUME
28
Otore telinga kanan, dimulai 2 minggu yang lalu Mukopurulen, banyak, berbau Pilek 1 minggu, bau dari hidung kanan Sering berenang, sering mengorek telinga
MAE AD sekret mukopurulen, bau MT AD perforasi, refleks cahaya (-) Nasal Dextra: sekret (+) kehijauan Nasal Dextra: korpus alineum (+) kapas
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DIAGNOSIS BANDING
1. Otitis Media Akut Stadium Perforasi AD + korpus
alineum cavum nasi dextra
2. Otitis Media Supuratif Kronis AD + korpus
alineum cavum nasi dextra
DIAGNOSIS KERJA
Otitis Media Akut Stadium Perforasi AD + korpus
alineum cavum nasi dextra
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RENCANA TERAPI
30
Syrup Klaneksi forte 2 x cth I
Syrup Cetirizine generik 1 x cth I
Syrup Ambroxol 2 x cth I
Obat tetes telinga H2O2 1% 3 x 5
tetes pada telinga kanan
Ekstraksi korpus alineum pada
nasal dextra
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SARAN
Mentup telinga dengan kapas saat mandi
Menghindari kegiatan berenang
Tidak mengorek telinga dengan benda
apapun
Nutrisi bergizi: (buah & sayuran)
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PROGNOSIS
Quo ad vitam
ad bonam
Quo ad functionamad bonam
Quo ad sanationam ad bonam
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TINJAUAN PUSTAKA OTITIS MEDIA AKUT
33
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ANATOMI
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35ANATOMI
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Pendek, lebar dan letaknya horizontal
Adenoid anak relatif lebih besar
TUBA EUSTACHI
US
39
FUNGSI
VENTILASI
DRAINASE
PROTEKSI
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40
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Fisiologi Pendengaran
41
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Energi bunyi ditangkap aurikula
Membran timpani bergetar
Amplifikasi getaran
Rangkaian tulang pendengaran
Stapes menggerakka
n foramen ovale
Perilimfe skala
vestibuli bergerak
Membrana Reissner mendorong endolimfa
Gerak relatif membran basalis
dan membran tektoria
Rangsangan mekanik defleksi stereosilia
sel-sel rambut
Depolarisasi sel rambut
Potensial aksi saraf auditorius
Nukleus auditorius
Korteks serebri (area 39-40) di
lobus temporalis
4842
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Fisiologi Keseimbangan
Gerakan Kepala dan tubuh
Perpindahan cairan endolimfa di labirin
Silia sel rambut menekuk
Perubahan permeabilitas membran sel
Depolarisasi
Merangsang pelepasan
neurotransmiter eksitator
Impuls sensorik melalui saraf aferen
Pusat keseimbangan otak
(area 41-42)
4943
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DEFINISI
Otitis media adalah peradangan sebagian atau seluruh mukosa telinga tengah, tuba eustachius, antrum mastoid dan sel-sel mastoid
44
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KLASIFIKASI
OTITIS MEDIA
Non Supuratif
Otitis media serosa
Otitis media efusi
Supuratif
Akut Kronik
45
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ETIOLOGI
• Oklusi tuba Eustachius• Bakteri piogenik
46
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FAKTOR RESIKO
• Usia, adanya adenoid, predisposisi
genetik
• Lingkungan, alergi, sosioekonomi
rendah
• Riwayat ISPA
• Musim gugur dan musim dingin
• Riwayat keluarga (+)
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ISPA Edema mukosa saluran nafas
Edema mukosa tuba eustachius
Fungsi tuba eustachius terganggu
Fungsi silia tidak efektif
mencegah invasif kuman
Akumulasi sekret
Pertumbuhan kuman
Proses supurasi cavum timpani
OTITIS MEDIA
PATOGENESIS
48
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OKLUSI
HIPEREMIS
SUPURASI
PERFORASI
RESOLUSISTADIUM PENYAKIT
50
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OKLUSI TUBA EUSTACHIUS
Retraksi membran timpani
Membran timpani normal atau keruh pucat, terjadi efusi
Sulit dibedakan otitis media
serosa virus - alergi
STADIUM PENYAKIT
51MT Normal
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STADIUM HIPEREMIS
Membran timpani
hiperemis
Edema mukosa
Sekret eksudat serosa
STADIUM PENYAKIT
52
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STADIUM SUPURASI
Eksudat purulen
Bulging membran timpani
Klinis sakit beratOtalgia bertambah
hebat
Nekrosis mukosa
membran timpani
53
STADIUM PENYAKIT
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STADIUM PERFORASI
Ruptur membran timpani
Otore Klinis tenang, suhu menurun, tidak
gelisah
60
STADIUM PENYAKIT
54
MT rupture
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STADIUM RESOLUSI
Perforasi menutup kembali
Sekret berkurang -mengering
Membran timpani utuhDaya tahan tubuh baikVirulensi kuman rendah
55
Penyembuhan OMSK
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• Bersifat akut < 3 minggu
• Bulging membran timpani• Bayangan cairan di membran timpani• Otore purulen
• Hiperemis membran timpani• Otalgia
MANIFESTASI KLINIS
56
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OKLUSI Dekongestan, Antibiotik
Miringotomi
STADIUM HIPEREMISAntibiotik
DekongestanAnalgetik
STADIUM SUPURASIAntibiotik
Miringotomi
STADIUM PERFORASI
H2O2 3% selama 3-5 hari
Antibiotika
STADIUM RESOLUSIAntibiotik 3 minggu
PENATALAKSANAAN
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INDIKASI MIRINGOTOMI
• Persisten pain, recurrent otalgia
• Efusi telinga tengah dengan hiperemia dan
bulging
• Severe earache
• Terapi konservatif gagal
• Immunologically compromised
• OMA pada neonatus
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KOMPLIKASI
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Intrakranial
Ekstratemporal
Intratemporal
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KOMPLIKASI
INTRATEMPORAL
Perforasi membran timpani
Erosi tulang pendengara
n
Paresis nervus fasialis
Labirinitis supuratif
PetrositisTuli
sensorIneural
Mastoiditis akut koalesen
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KOMPLIKASI
EKSTRATEMPORAL
Abses subperiosteal
Abses ekstradural
Trombosis sinus lateralis
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KOMPLIKASI
INTRAKRANIAL
Abses otak Meningitis Hidrosefalus otikus
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Gambaran Klinis Komplikasi OMSK
Abses Otak
Parese N. VII
Fistula e.c. Mastoiditis
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Dasar diagnosa Otitis media akut Kasus
1. Riwayat ISPA
2. Otalgia
3. Otore purulen
4. Demam, rewel dan gelisah
5. Gangguan pendengaran
6. Awitan akut < 3 minggu
7. Tanda inflamasi dan efusi kavum timpani
ANALISA KASUS
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