Gangguan Telinga

Telinga luar: Sumbatan serumenBenda asingOtitis eksternaRuptur membran timpaniTelinga tengahOtitis mediaTelinga dalamLabirintitisVertigo

Sumbatan Serumen

Serumen: diproduksi oleh kelenjar minyak di liang telingaLiang telinga separuh bagian luarMencegah tumbuhnya bakteri dan jamurMencegah kerusakan kulit di liang telingaPenumpukan terjadi karena kebiasaan buruk sering mengorek kotoran telingaDiperburuk bila kemasukan air pada saat mandi/ berenangAir membuat serumen bertambah besar

Gejala dan TandaOtalgia= nyeri pada telingaTumpukan serumen tidak mengakibatkan nyeri, kecuali:Menyentuh Tympanic MembraneMengiritasi liang telingaTuliBila menyumbat totalVertigo atau gangguan keseimbanganBila menyentuh membran timpani

Kapan perlu dikeluarkan?Tuli OtalgiaSerumen mengganggu pemeriksaanAnak < 1 tahun

Tata Laksana Obat pelunak serumenAcetic acid 1.5% with waterHydrogen peroxide or Benzalkonium chloridePengeluaran serumen oleh dr THT: Bilas dengan air hangatSuction

Pencegahan Jangan bersihkan liang telinga dengan cotton buds membuat serumen semakin menumpuk di bagian dalam.

Benda Asing di Telinga

Benda Asing di Telinga

Anak-anak: paling seringSuka memasukkan mainan ke hidung, mulut, telingaDewasa: proses pembersihan telinga yang salah, kemasukan serangga, air dll.

Jenis Benda Asing:Serangga Inorganic inertOrganic (kacang)Metallic material

Gejala dan Tanda:1- nyeri (otalgia)2- gangguan mendengar3- telinga terasa penuh 4- keluar cairan dari telinga bila ada otitis eksterna

Anamnesis dan Pemeriksaan Fisik:Kapan benda asing masuk ke telingaUsaha apa yang sudah dilakukan untuk mengeluarkannya

Perhatikan daun telinga, liang telinga dan gendang telingaBila ada gangguan pendengaran: rujuk ke dr THT untuk dilakukan audiogram

Serangga

Pengangkatan Benda AsingTekniknya bergantung pada:TipeLokasiPasien kooperatif atau tidak Anak-anak biasanya harus di berikan sedasi ringan untuk mencegah luka lebih parah.

How to remove the foreign body from the ear?1- Hook2- Suction3- Syringing4- Surgery

Hook

Ear syringe

Contraindications of syringing1- Organic foreign body: it will enlarge with water and cause more pain and become more difficult to remove.

2-Tympanic membrane perforation

3- Alive insect, water will irritate it and it will move more and more and so will be more painful, so here we should kill it first either by putting oil in the ear, paraffin or anesthetic agent then remove it by any available method.

Teteskan antibiotik untuk mencegah infeksi akibat luka terkena instrumen Kadang terjadi otitis eksterna setelah pengangkatan benda asing.

Otitis EksternaPeradangan pada telinga luar:Cuping telingaLiang telinga

Klasifikasi Otitis EksternaOtitis eksterna sirkumskriptaMengenai kulit liang telinga bagian luarGejala dan tanda: Otalgia Furunkulosis (bisul)

Otitis eksterna difusaMengenai kulit liat telinga bagian dalamBisa mrpkn penjalaran dari otitis media yang tidak diobatiGejala dan tanda:Otalgia Furunkulosis Sekret (+)

Ruptur Gendang Telinga

Ruptur Gendang TelingaEtiologyTraumaPhysical abuse red flagBenda asingIrigasi telinga yang terlalu kuatInfeksiOtitis MediaAcute Chronic Otitis MediaBarotrauma (e.g. Scuba Injury)Tanda: Otorrhea: keluar cairan dari telingaRobek gendang telinga

Ruptur Gendang TelingaManagementJaga telinga tetap keringRujuk ke dr THTObat tetes telinga masih kontroversial:Cortisporin Otic Suspension 1 drop qidCiprofloxacin Ophthalmic (Ciloxan) 1 drop qidRobekan besar: operasi

Ruptur Gendang TelingaPrognosisBiasanya sembuh spontan dalam 4-6 minggu

Otitis Media AkutEpidemiologiInsidensAnak usia < 1 th: 62%Anak usia s/ 3 th: 83%1.5 kejadian per tahun

Faktor Risiko: Otitis Media berulang atau efusi yang terus menerus.Age < 5 yrs (5 fold relative risk)Otitis prone (4x) (see below)Day care (4x)Respiratory Illness (4x)Smokers in home (3x)Bottle Propped babies (2x)Males (2x)Pacifiers

Patofisiologi Sumbatan tuba eustakius + invasi kuman peradangan telinga tengah ( OMA)Anak sering mengalamiinfeksi sal nafas sering OMABayi plg sering OMA krn : tuba eustakius pendek, lebar, lebih horizontal

kuman : streptokokus hemolitikus, stapilokokus auereus, pneumokokus, h. influenza, E coli, streptokokus anhemolitikus, proteus vulgaris, pseudomonas aeroginosa

Stadium :stadium oklusi tuba : Mt retraksiStadium hiperemis : Mt hiperemis, oedemStadium supurasi : Mt bulging, anak tampak sangat sakitStadium perforasi : Mt ruptur, anak tenangStadium resolusi : Mt normal kembali

gejala :nyeri telingasuhu tubuh tinggiAda riwayat batuk pilek sebelumnyaGgn pendengaran / rasa penuhPada bayi / anak : gelisah, diare, kejangBila Mt ruptur sekret (+) anak tenang

terapi : tergantung stadium AB nasal decongestan analgetik miringotomi ( stad supurasi ) aural toilet ( stad perforasi )

Bila tidak terjadi resolusi > 3 bulan OMSKPengobatan terlambat diberikanTerapi tidak adekuatVirulensi kuman tinggiDaya tahan tubuh rendah / gizi kurangHygiene buruk

OTITIS MEDIA SUPURATIV KRONIS ( OMSK )OMP = CongekYi : infeksi kronis ( > 3 bln ) telinga tengah dgn perforasi Membrana timpani, sekret terus menerus / hilang timbul, sekret mungkin encer, kental, bening atau nanah

Letak perforasi penting untuk menentukan tipe / jenis OMSKPerforasi sentral : di pars stensaPerforasi marginal : sbgn tepi perforasi mengenai anulus timpanikus atau sulkus timpanikusPerforasi atik : di pars flasida

Gejala : perforasi Mt, sekret (+) / (-), adanya polip / granulasi / kolesteatoma di meatus akustikus eksternus

jenis OMSKOMSK

tipe beniga / mukosa / amantipe maligna / tulang / berbahayaPerforasi sentral- perforasi marginal /atik / sub totalJarang timbul komplikasi berbahaya- sering timbul komplikasi berbahayaKolesteatoma (-)- kolesteatoma (+)Terapi : medikamen- terapi : operasi : mastoidektomi dgn / tanpa timpanoplasti

komplikasi OMSK terjadi akibat : penyebaran hematogen, erosi tulang, jalan yg sudah ada.komplikasi OMSK

ekstrakranialintrakranialMastoiditis- abses ekstraduralPetrositis- trombosis sinus lateralisParesis fasialis- abses subduralLabirinitis- meningitisAbses subperiosteal / absesretroaurikular- abses otakAbses bezold- hydrosefalus otitis

OTITIS MEDIA SEROSA = OTITIS MEDIA EFUSIkeadaan terbentuknya sekret di telinga tengah secara tiba-tiba akibat ggn fungsi tuba :BarotraumaVirus / infeksi sal nafas atasAlergi idiopatik

gejala / tanda :Kurang pendengaranTelinga rasa tersumbat Diplakusis binauralis (suara sendiri terdengar lebih nyaring pada telinga yg sakit)Spt ada cairan pd telingaNyeri tinitus VertigoOtoskopi : Mt retraksi, tampak permukaan cairan dlm kavum timpaniTest penala : tuli konduktiv

Terapi : Medikamentosa:Nasal dekongestanAntihistamin ( jika disebabkan oleh alergi )Perasat valsalvaJika 1- 2 minggu gejala menetap myringotomy k/p pasang gromet ( pipa ventilasi

VertigoMahmoud Aldari

Vertigo OverviewVertigo is the feeling that you or your environment is moving or spinning. It differs from dizziness in that vertigo describes an illusion of movement. When you feel as if you yourself are moving, it's called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo.

Vertigo CausesVertigo can be caused by problems in the brain or the inner ear.Vertigo can be Central or Peripheral.

Vertigo Causescont.Benign paroxysmal positional vertigo (BPPV)Is the most common form of vertigo.Characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction,This type of vertigo is rarely serious and can be treated.

Vertigo Causescont.inflammation within the inner ear (labyrinthitis or vestibular neuritis)characterized by the sudden onset of vertigo and may be associated with hearing loss.The most common cause of labyrinthitis is a viral or bacterial inner ear infection.

Vertigo Causescont.Meniere's diseasetriad of symptoms:Episodes of vertigo.Ringing in the ears (tinnitis).Hearing loss.Acoustic neuroma.A type of tumor of the nerve tissue.Symptoms include:Vertigo.One-sided ringing.Hearing loss.

Vertigo Causescont. Blood flow to the base of the brain.Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo.As a symptom in multiple sclerosis.Head trauma and neck injury.Migraine.Complications from diabetes.diabetes can cause arteriosclerosis which can lead to lowered blood flow to the brain, causing vertigo symptoms.

Clinical PresentationVertigo implies that there is a sensation of motion either of the person or the environment.This should not be confused with symptoms of lightheadedness or fainting.symptoms include a sensation of disorientation or motion.In Addition:nausea or vomiting.Sweating.abnormal eye movements.

Clinical Presentation cont.The duration of symptoms can be from minutes to hours.Symptoms can be constant or episodic.Onset may be due to a movement or change in position.History of recent head trauma. any new medications the patient is taking.The person may have hearing loss and a ringing sensation in the ears.The person might have visual disturbances, weakness, difficulty speaking, a decreased level of consciousness, and difficulty walking,

Vertigo Diagnosis Important Points in History:if the patient feels any sensation of motion, which may indicate that true vertigo exists. Report any nausea, vomiting, sweating, and abnormal eye movements.how long the patient has symptoms and whether they are constant or come and go. Do the symptoms occur when moving or changing positions? Is the patient currently taking any new medications? Has there been any recent head trauma.Are there any other hearing symptoms? Specifically, report any ringing in the ears or hearing loss.Does the patient have other neurological symptoms such as weakness, visual disturbances, altered level of consciousness, difficulty walking, abnormal eye movements, or difficulty speaking?

Vertigo Diagnosis Cont.Investigation:CT scan if a brain injury is suspected to be the cause of vertigo. Blood tests to check blood sugar levels.use of an electrocardiogram (ECG) to look at heart rhythm may also be helpful.

Central vs. Peripheral Vertigo

Central VertigoPeripheral VertigoOnsetGradualUsually SuddenTinnitus, hearing lossAbsentPresentNeighborhood signs (Diplopia, cortical blindness, dysarthria,)PresentAbsentNystagmusPure, vertical, suppress with fixation, & multidirectionalMixed, horizontal, suppress with fixation, & unidirectional

Vertigo TreatmentThe choice of treatment will depend on the diagnosis.Identifying and eliminating the underlying cause.Bacterial infection of the middle ear requires antibiotics.For Meniere's disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.Vestibular rehabilitation exercises.Particle repositioning maneuver.

Vertigo MedicationsCommonly prescribed medications for vertigo include the following:Meclizine hydrochloride (Anticholinergic )Diphenhydramine (Antihistamine)Scopolamine transdermal (Anticholinergics/Antispasmodics)Promethazine hydrochloride (Antihistamine)Diazepam

Thank You !No question plz

Labyrinthitis means an inflammation of the inner ear structure called the labyrinth. Sometimes the term labyrinthitis refers to other causes of inner ear problems that have no inflammation because those problems produce similar symptoms.*