Otitis Media Akut / Aom Child

8/12/2019 Otitis Media Akut / Aom Child

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Terkadang cairan tersebut akan keluar dengan sendirinya, namun pemeriksaan dokter tetap

diperlukan untuk penanganan dan pengobatan lebih lanjut. Pasalnya, jika dibiarkan radang pada

telinga tengah bisa menyebabkan tuli atau kehilangan pendengaran dan komplikasi. Apalagi jika

gendang telinga robek, bisa menyebabkan tuli permanen.

Bahkan, radang telinga yang sudah kronis juga bisa menyebabkan meningitis atau radang selaput

otak. Dampak lainnya adalah kerusakan pada saraf wajah yang bisa menyebabkan perubahan bentuk

wajah, gangguan keseimbangan dan sebagainya.

Radang telinga bisa ditandai dengan rasa nyeri dan panas pada telinga. Selain itu, juga adanya

pembengkakan jaringan akibat lendir yang berkumpul di belakang telinga. Jika lendir dan nanah

bertambah banyak, pendengaran akan terganggu karena gendang telinga dan tulang-tulang kecil

penghubung gendang telinga dengan organ pendengaran di telinga dalam tidak dapat bergerak

bebas.

Jika tekanan makin kuat, bisa merobek gendang telinga dan mengakibatkan gangguan pendengaran

atau tuli yang sifatnya permanen. Robeknya gendang telinga tersebut bisa ditandai dengan

keluarnya cairan nanah dari telinga atau biasa disebut congek.

Namun, ada radang telinga yang bisa sembuh dengan sendirinya. Hal ini bisa terjadi jika

penderitanya memiliki memiliki daya tahan tubuh baik dan daya serang kumannya rendah. Bahkan,

gendang telinganya bisa tetap utuh dan fungsi pendengaran kembali normal.

Radang telinga bisa menimpa siapa saja, tapi anak-anak lebih rentan terkena penyakit tersebut.

Pasalnya, sistem kekebalan tubuh anak masih dalam tahap perkembangan. Selain itu, saluran

eustachius pada anak lebih lurus secara horizontal dan lebih pendek, sehingga infeksi saluranpernapasan atas (ISPA) lebih mudah menyebar ke telinga tengah. Selain itu, adenoid atau organ di

tenggorokan bagian tas yang berperan dalam kekebalan tubuh anak relatif lebih besar dari orang

dewasa, sehingga mereka lebih mudah terkena radang telinga.

Berdasarkan penelitian, hampir 70 persen anak-anak pernah mengalami radang telinga tengah.

Bahkan beberapa di antaranya mengalami gangguan pendengaran akibat terlambat diobati. Ada

atau tidaknya peradangan pada telinga sang buah hati, bisa bunda ketahui jika mereka mengeluh

adanya rasa nyeri pada telinga, demam tinggi, gelisah, sulit tidur, atau jika mereka menjerit waktu

tidur. Anak-anak biasanya juga mengalami gangguan pendengaran, sehingga mereka tidak

menyahut ketika dipanggil.

Bunda, jika radang telinga anak tidak sembuh atau berlanjut lebih dari dua bulan, dikhawatirkan

berubah menjadi radang telinga tengah kronis (otitis media kronis). Hal ini disebabkan terlambatnya

memberi pengobatan, atau pengobatan yang tidak efektif. Kondisi ini bisa menyebabkan rusaknya

telinga tengah dan gendang telinga, serta mengurangi pendengaran.

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Otitis media is a very common problem in general practice.

It is a term which describes two conditions which form part of a continuum of disease: acute

otitis media (AOM) and otitis media with effusion (OME). Both occur mainly in childhood

and may be caused by bacterial or viral infection.

Most children will have a self-limiting illness and many will not present to a doctor. A few

will have recurrent or chronic problems and may require referral.

As children grow bigger, the angle between the Eustachian tube and the pharynx becomes

more acute and so coughing or sneezing tends to push it shut. In small children, the less acute

angle facilitates infected material being transmitted down the tube to the middle ear.

Epidemiology

More than two-thirds of children experience one or more attacks of AOM by the age of 3and about half experience more than three episodes:

[1]

The peak age of incidence is 6 to 24 months and decreases with age. It is less common atschool age.

[2]

Otitis media occurs more in the winter than summer months, as it is usually associated witha cold.

[3]

It can occur in adults but this is most unusual.

Risk factors[4][5]

Boys are slightly more likely than girls to develop AOM. Children with older siblings at school or nursery are exposed to infections that may be

brought home.[6]

Use of a dummy increases risk. Presumably the sucking and swallowing opens the Eustachiantube and puts the middle ear at risk.

Children who suffer with many colds or respiratory infections are more likely to developOME.

Parental smoking is thought to be associated with an increase in both acute and chronicotitis media.

Presentation

Symptoms

AOM is a condition in which there is inflammation of the middle ear, frequently in

association with anupper respiratory tract infection(URTI). It commonly presents with:

Pain Malaise Irritability Fever Vomiting

The fever is often very high and may be associated with febrile convulsions.
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Signs

Examination may reveal:

Fever may be very high. Red and possibly bulging eardrums. Sometimes the outer ear glows red. Hearing loss being present but not usually noticed in an acutely unwell child.

A well-recognised complication is that a child who is screaming and in a great deal of pain

finally settles and the ear starts to discharge green pus. The eardrum has burst, releasing the

pressure and relieving the pain.

PatientPlus o

Chronic Suppurative Otitis Media Otitis Externa and Painful, Discharging Ears Otalgia (Earache) Otitis Media with Effusion in Children

Differential diagnosis[4]

Otitis externa(OE). Post-auricular adenitis. Referred pain (especially from teeth). Herpetic infection of the ear.. Foreign bodyin the external canal. Temporomandibular joint pain. Trauma.

Often children who are unwell have a slightly red eardrum but in AOM it is very red.

Investigations[4]

Usually no investigation is required. Culture of discharge from an ear may be indicated in chronic or recurrent perforation or if

grommets are present.[7]

Audiometry should be performed if chronic hearing loss is suspected; however, not duringacute infection.

CT or MRI may be appropriate if complications are suspected.

Management[8]

The majority of cases of AOM will resolve spontaneously without specific treatment. A

review of recently published guidelines concluded that whilst adequate analgesia should be

prescribed in all cases, antibiotics should be avoided in mild to moderate cases and when

there is diagnostic uncertainty in patients aged 2 years and under.

Patients who should be considered for antibiotics include:[7][9]
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Patients with symptoms persisting for more than 2-3 days. Children aged under 2 with bilateral AOM or bulging drum and four or more symptoms. Children of any age with otorrhoea. Patients at high risk of complications - eg, significant heart, lung, renal, liver, or

neuromuscular disease, immunosuppression, or cystic fibrosis and young children who were

born prematurely.

The Health Protection Agency recommends a five-day course of amoxicillin or erythromycin

for patients allergic to penicillin.[9]

Culture of fluid obtained from the middle ear reveals pathogenic bacteria in up to 70% of

cases. Streptococcus pneumoniaeandHaemophilus influenzaetogether comprise 60-80% of

these.[1]

Antihistamines, decongestants and echinacea have been found to be of no use.[2]

Further management[7][10]

Hospital admission should be considered for:

Any child younger than 3 months with suspected AOM about whom you are concerned. Children younger than 3 months of age with a temperature of 38C or more. Children aged 3-6 months or more with a temperature of 39C. Suspected complications such as meningitis, mastoiditis, or facial paralysis. Children who appear systemically very unwell.

Referral should be considered for:

Children with persistent symptoms not responding to antibiotics. Children with discharging or perforated ears whose condition has not fully resolved after 2-3

weeks.

Children with recurrent AOM (defined as three or more episodes in six months or four ormore episodes in one year).

Children with impaired hearing following AOM. If aged under 3 with OME, bilateral effusionsand hearing loss of less than 25 decibels but with no speech, language or developmental

problems, observe initially. Otherwise, refer for consideration of grommets (NB: this is

different from referral for grommets for prophylactic reasons - see 'Prevention', below).

Children under the age of 3 who go on to develop OME with bilateral effusions and hearingloss of less than 25 decibels but with no speech, language or developmental problems may

be observed initially. Children over the age of 3 who go on to develop OME or with language

or behavioural problems may benefit from surgical intervention such as theinsertion of

grommetsand should be referred for a specialist opinion.[11]

Complications[7]

Most cases of AOM will resolve spontaneously with no sequelae. Perforation of the eardrum in not uncommon and progression tochronic suppurative otitis

mediamay occur.

Labyrinthitis,meningitis,intracranial sepsis orfacial nerve palsyare very rare and occur inless than 1 in 1,000.
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Recurrent episodes may lead to scarring of the drum with permanent hearing impairment,chronic perforation and otorrhoea,cholesteatomaormastoiditis.

In a small child with a high temperature there is a risk offebrile convulsions.This is discussedmore fully in its own article.

Prognosis[4]

With the exception of the few complications given above, there is usually complete resolution

in a few days.

Prevention

In recurrent (either three or more acute infections of the middle ear cleft in a six-month

period, or at least four episodes in a year) strategies for managing the condition include the

assessment and modification of risk factors where possible, repeated courses of antibiotics for

each new infection and antibiotic prophylaxis. The latter should not be started withoutspecialist advice (due to concerns over antibiotic resistance).[7]

Limited evidence suggest that insertion of ventilation tubes (grommets) result in a mean

reduction of 1.5 episodes of AOM in the first six months. Prevailing advice is to refer for this

option if this is requested by the parents.[7]

There is evidence that pneumococcal vaccine provides some protection against otitis

media.[1]

http://www.patient.co.uk/doctor/acute-otitis-media-in-children

1. Taylor S, Marchisio P, Vergison A, et al;Impact of pneumococcal conjugate vaccination onotitis media: a systematic review. Clin Infect Dis. 2012 Jun;54(12):1765-73. Epub 2012 Mar

15.

2. Cherpillod J;Acute otitis media in children. Int J Gen Med. 2011;4:421-3. Epub 2011 Jun 2.3. Zemek R, Szyszkowicz M, Rowe BH;Air pollution and emergency department visits for otitis

media: a case-crossover study in Edmonton, Canada. Environ Health Perspect. 2010

Nov;118(11):1631-6.

4. Donaldson J;Acute Otitis Media, Medscape, Dec 20115. Aziz N et al,Inflammatory Diseases of the Middle Ear, Medscape, Sep 20126. Heikkinen T, Chonmaitree T;Importance of respiratory viruses in acute otitis media. Clin

Microbiol Rev. 2003 Apr;16(2):230-41.

7. Otitis media - acute;NICE CKS, July 20098. Toll EC, Nunez DA;Diagnosis and treatment of acute otitis media: review. J Laryngol Otol.

2012 Oct;126(10):976-83. Epub 2012 Jul 19.

9. Antibiotic Guidelines,Health Protection Agency (2012)10.Position Paper;OME (Glue Ear) / Adenoids and Grommet Insertion; ENT UK, 200911.Surgical management of children with otitis media with effusion (OME),NICE Clinical

guideline (February 2008)
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Documents

Otitis Media Akut / Aom Child