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Acute Otitis Media

A Case Presentation

Supervisor:

dr. H. Oscar Djauhari, Sp. THT-KL

Presented by:

Julius Candra !"#$-"%#-#"&'

(eor)ia *adia +inardi !"#$-"%#-##"'

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The Case

A -ears old o ca/e to 0*Tclinic 1ith a co/plaint o2 ri)htearache since past das. He 1asalso ha3in) cold, runn nose, 2e3er

since ! 1ee4 das, and hearin)loss since # 1ee4.

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5dentit and Co/plaint

*a/e 6 7

(ender 6 /ale

A)e 6 ears old Occupation 6 pri/ar school student

Address 6 su4au/i

Chie2 co/plaint 6 earache on the ri)ht ear

since das Additional co/plaint 6 runn nose, cou)h, 2e3er

since ! 1ee4s a)o, and hearin) loss since #1ee4s a)o

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Histor o2 Present 5llness

A -ears-old o ca/e to 0*T clinic1ith right earache since past das.

The earache 1as 2elt insidiousl andcontinuousl all da. The pain 1asincreasin) in se3erit, 2ro/ /ild pain atthe e)innin) until se3ere pain at theti/e o2 presentation

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The o also 2elt a sensation offullness at the right ear, and

hearing loss since # 1ee4 prior toad/ission. There 1as a hi)h-)rade2e3er 2ollo1in) this earache. Histor o2ear dischar)e, 2oul-s/ell dischar)e,2acial pain 1as denied.

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T1o 1ee4s e2ore ad/ission, the childsu8ered 2ro/ runny nose, cold, and

fever. The nasal dischar)e 1asello1ish, /u4oid, and /assi3e ina/ount.

Histor o2 pre3ious treat/ent 1as

denied

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Histor o2 pre3ious illness 1as denied

Histor o2 2a/il illness 1as denied

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Phsical 09a/ination

(enerali:ed Status' (eneral condition 6 Appear ill

;od 1ei)ht 6 !" 4)

Hei)ht 6 #!" c/ ;lood pressure 6 #""<%" //H)

Pulse 6 130 beat per minute

=espirator rate 6 !> ti/es per /inute

Te/perature 6 38, 5o

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Phsical 09a/ination

0ars'

Auris de9tra 6

Auricle 6 nor/al

09ternal auditor canal6

hpere/ic -', ede/a -', /ass -', laceration -'secretion -' , ceru/en ?'

T/phanic /e/rane6

5ntact, hyperemic !"#, bulging !"#, light re$e%&

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Phsical 09a/ination

0ars'

Auris sinistra 6

Auricle 6 nor/al, no de2or/ities

09ternal auditor canal6

hpere/ic -', ede/a -', /ass -', laceration -'secretion -' , ceru/en ?'

T/phanic /e/rane 6 intact, ul)in) -', li)ht re@e9

?'

'uning (or) test : *inne test !+#!"# -ebber

lateralitation to the right, sch.abach

prolongedsame to the e%aminer/

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Phsical 09a/ination*ose'

=i)ht *ose 6

Mucous /e/rane 6 hyperemic !"#, edema !"#, /ass -',laceration -', crust -'

5n2erior concha6 eutroph

Dischar)e 6 ?', /u4oid, )reen ello1ish Septu/ 6 nor/al, no de3iation

Air passa)e 6 ?<?

Le2t *ose 6

Mucous /e/rane 6 hyperemis !"#, edema !"#, /ass -',laceration -', crust -'

5n2erior concha6 eutroph

Dischar)e 6 ?', /u4oid

Septu/ 6 nor/al

Air passa)e 6 ?<?

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Phsical 09a/ination

Throat and *ec4' ropharyn%

Posterior pharn9 6 hpere/ic -'

Palatine tonsils 6 T# < T#, cripta dilatation -', detritus-'

3ula 6 s//etrical

Dental 6 no anor/atlities

a%illofacial 6 s//etrical

2ec) 6 /ass -', l/phadenopath -'

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+or4in) Dia)nosis

cute otitis media de%tra, suppurative stage

Therap

Outpatient care Antiiotic 6 A/o9icilin & 9 !$" /) PO 2or das

Antipretic and anal)etic 6 Paraceta/ol & 9 !$"/) PO 2or & B $ das

Topical anticholiner)ic 6 O9/eta:oline HCL nasal

spra ! 9 & spras per nostril 2or & das

Mirin)oto/

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Denition and Ter/inolo)

Otitis /edia represents an in$ammatory conditiono2 the middle ear and mastoid space.

The presence or asence o2 /iddle-ear e8usion

M00' and its duration help 2urther to dene theprocess.

08usion is the liuid resultin) 2ro/ in2ection and/ucosal in@a//ation ,can e serous thin, 1ater',/ucoid thic4, 3iscous', or purulent pus'.

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Denition and Ter/inolo)

Otitis /edia 1ith e8usion OM0' can occur as a postin@a//ator response to Acute Otitis Media AOM'2ro/ a 3iral in2ection, or ecause o2 0ustachian-tue

ds2unction. Chronic suppurati3e otitis /edia CSOM' is

characteri:ed persistence o2 purulent otorrheathrou)h a t/panic /e/rane TM' per2oration ort/panosto/ tue TT' that is unresponsi3e to/edical therap

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Duration

4'

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0pide/iolo)

The onset o2 AOM durin) the rst ear o2 li2e isi/portant ecause the /ajorit o2 children 1ith/ultiple recurrences o2 AOM ha3e their rst episode

e2ore the a)e o2 #! /onth Associated 1ith upper respirator in2ections =5s'.

Pre3alence is si/ilar et1een os and )irls.

Children 1ho li3e in cro1ded households or lo1socioecono/ic conditions or 1ho ha3e poor /edical

care or oth also ha3e een 2ound to ha3e anincreased incidence in oth acute and chronic OM

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0tiolo)

AOM is a co/plication o2 eustachian tueds2unction that occurred durin) an acute 3iralupper respirator tract in2ection

Streptococcus pneumoniae (most often)

Haemophillus inuenzae

Branhamella catarrhalis

Streptococcus β-hemoliticus group A

Staphyllococcus aureus E. Coli

S!

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=is4 Eactor

A)e oun)er', 0T in in2ants and children is shorter, /orehori:ontal, and 2unctionall less /ature co/pared 1ith that inadults.

Aller)ies

*asal ostruction sinusitis, adenoid hpertroph, nasal ornasopharn)eal tu/ors'

Cranio2acial anor/alities e9. Cle2t palate, de2or/it o2 the/id2ace, s4ull ase, nose< paranasal sinus, Do1n sndr, etc'

09posure to en3iro/ental s/o4e or irritants

09posure to )roup da care

Ea/il histor o2 recurrent acute otitis /edia (0=D

5//unodecienc

*o reast2eedin)

pper respirator tract 5n2ection

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Patophsiolo)

- Ds2unction 0T

5n@a//ation

Mucosal ede/a, capillar en)or)e/ent, inltration PM*

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Sta)in)

Occlusion

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Suppurati3e

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=esolution

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Clinical Eindin)s

Child

pper tract in2ection

Pain inner ear

Ee3er

=estless

Sei:ures

*ausea and 3o/itin)

Diarrhea

Holdin) the a8ected ear

Adults

pain

2ullness in the ear

hearin) loss occured

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Mana)e/ent

Occlusion

To open the closed eustachius tue, so the pressure in /iddleear can e reduced.

Decon)estan Child F #!.o6 HCl ephedrine ".$G in phsiolo)icsolution, Child#! th6 HCl e2edrine#G in phsiolo)ic solution'

Antiiotics

Hpere/ic

Antiiotic6 a/o9icillin >" /)<4);;<da in & doses, a/picillin $"-#"" /)<4);;<da in > doses, eritro/icin >" /)<4);;<da.

Decon)estan

Anal)etics

Antipiretics

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Mana)e/ent

Suppurati3e

Antiiotics6 a/o9icillin >" /)<4);;<da in & doses,a/picillin $"-#"" /)<4);;<da in > doses, eritro/icin

>" /)<4);;<da. Mrin)ot/

Anal)etics

Antipiretics

Per2orated

H!O! &G $ drops & dd # &-$ das

Antiiotic local ear drops'

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Mana)e/ent

=esolution

52 the resolution didnIt ta4e place, secretes 1ill drainedout the per2oration in t/panic /e/rane. The

antiiotics continued 2or & 1ee4s. 52 & 1ee4s pasts andsecretes stills, /astoiditis should e in di8erentialdia)nosis

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Co/plication

Mastoiditis, superiosteal ascesses, /enin)itis,rain ascesses.

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=e2erences

Anato/ and Phsiolo) o2 the *ose and ParanasalSinuses 6 Sno1 J;, ;allan)er JJ. ;allen)erIsOtorhinolarn)olo) Head and *ec4 Sur)er %th.

Ontario !""&. 08endi H, editor. Boies" Bu#u A$ar %enya#it &H&. 0d

4e-%. Ja4arta6 Penerit ;u4u Kedo4teran 0(C #.

Lal1ani AK, editor.Current 'iagnosis &reatment intolaryngology - Hea* +ec# Surgery. SA6

Mc(ra1-Hill !"". Cu//in)s et al, editor. tolaryngology - Hea* an*

+ec# Surgery . 0d 4e-&. SA6 Mos-ear ;oo4 #.

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