otitis media supuratif kronis
DESCRIPTION
Bahan Kuliah FKUMM Blok Panca IndraTRANSCRIPT
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OTITIS MEDIA SUPURATIF KRONIK
dr. Indra Setiawan, Sp THT-KL
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OTITIS MEDIA SUPURATIF KRONIK(OMSK)
DefinisiKeradangan / infeksi kronik yang mengenai mukosa dan struktur tulang di dalam kavum timpani dengan perforasi membran timpani dan riwayat otore lebih dari 3 bulan
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ETIOLOGI
• Faktor lingkungan• Malfungsi Tuba Eustachius & massa naso
pharyngeal • Faktor genetik- congenital kolesteatoma• Infeksi hidung dan tenggorok• Penyakit Immun• Kolesteatoma• Infeksi MAE : korek-korek, air kotor masuk
(mandi di kali) • lain : DM, malnitrisi, alergi, KP
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ETIOLOGI CHOLESTEATOMA
(ACQUIRED)
• Tekanan Negative
• Invasi
• Metaplasia
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Kuman Penyebab• Pseudomonas aeroginosa• Staphilococcus aureus• Staphilococcus epidermidis• Klebsiela pneumonia• Bacteroides fragilis• H influenza
Etiologi
OMS Akut
FaktorOMS Kronik
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Gambaran Patologi
• Perubahan pada Membran Timpani
• Perubahan pada mukosa• Perubahan pada tulang
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Perubahan Pada Membran Timpani
• Perforasi sentralPerforasi pada pars tensa
PERFORASI SENTRAL
PERFORASI BENTUK GINJAL
PERFORASI TOTAL
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• Perforasi MarginalPerforasi yang terjadi pada pinggir margo timpani
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• Perforasi atikPerforasi yang terjadi pada pars flaksida
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Perubahan pada mukosa• Hipertrofi : mukosa mengalami pembelahan
sel• Degenerasi : mukosa mengalami degenerasi
granulasi / polip• Metaplasi : mukosa mengalami perubahan sel
kuboid sel epitel terbentuk kolesteatoma
Perubahan pada Tulang• Osteitis• Destruksi• Nekrosis
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Pembagian Klinik
• Tipe Benigna (Tubo-timpanal/mukosa/atikoantral/Hipertropik)
ggn fngs tuba Perforasi sentral Mukosa hipertrofi Granulasi (-) Kolesteatoma (-)
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• Tipe Maligna (Atiko antral)Degeneratif
Metaplastik
Perforasi besar Granulasi / polip (+)
Perforasi atik/marginal Kolesteatoma (+)
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Kolesteatoma• Definisi
Epitel gepeng dan debris tumpukan pengelupasan keratin yg terjebak di dalam kavum timpani atau kavum mastoid
• Teori Terjadinya– Teori Invaginasi– Teori Migrasi– Teori Metaplasi
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• Teori InvaginasiTekanan negatif di dlm kavum timpani menyebabkan tertariknya epitel dari lapisan luar membran timpani ke dlm kavum timpani
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• Teori MigrasiSel epitel masuk ke dlm kavum timpani melalui perforasi
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• Teori MetaplasiSel kuboid sel epitel bertatah
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Diagnosis
Keluhan & Gejala• Otore : pus pada MAE
Kental / busuk Kolest./destruksi tulangEncer Mukosa hipertrofi
• Pendengaran menurun Sekret dalam MAEPerforasiPenebalan mukosaKerusakan osikula
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Pemeriksaan Telinga (Otoskopi)
• Sekret pada MAE• Perforasi membran timpani• Mukosa :
MenebalGranulasi / polipKolesteatoma
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Pemeriksaan Pendengaran• Suara bisik• Tes garpu suara• AudiogramTuli Konduksi/campuran
X-Foto mastoid (Posisi Schuller)• Mastoid : Sklerotik
Rongga kolesteatoma
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SKLEROTIKRONGGA
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POSISI MEYER ATAU OWEN’S - MENILAI DAERAH ATIK - TULANG PENDENGARAN
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TERAPI
Tipe Benigna• Stadium Aktif
– Antibiotik– Cari faktor-faktor penyebab :
Rinogen berantas sumber infeksiEksogen oortoilet, H2O2 3%
• Stadium Tenang– Dianjurkan operasi miringoplasti
Tipe Maligna• Operasi mastoidektomi
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Komplikasi•Mastoiditis Kronik•Labirintitis•Meningitis•Abses Otak
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MASTOIDITIS KRONIK
• Tak dpt dipisahkan dgn OMPK Otomastoiditis Kronik
• Diagnosis : sama dgn OMPK• Terapi : Mastoidektomi
Tujuan Operasi Mastoidektomi• Menghilangkan sumber infeksi• Mencegah terjadinya komplikasi• Mempertahankan fungsi pendengaran
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Mastoidektomi• Rongga Terbuka
– Mastoidektomi Radikal– Mastoidektomi Radikal modifikasi
• Rongga Tertutup– Mastoidektomi simpel (schwatze)– Atiko-Antrotomi
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MASTOIDECTOMYMASTOIDECTOMY
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MASTOIDEKTOMI RADIKAL MODIFIKASI OTITIS MEDIA MALIGNA DENGAN KOKHLEA YANG BAIK.
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• Gambar Mastoidektomi
RADIKAL MURNI
RADIKAL MODIFIKASIATIKOANTROSTOMI
SIMPEL
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KOMPLIKASI• Ekstra kranial : - Abses
Retroaurikularis - Abses Bezold - Abses Mouret
• Intra temporal : - Labirintitis - Parese/Paralise N VII
• Intra kranial : - Abses Ekstra Dura - Meningitis
- Abses Otak
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PARESE N VII PERIFER
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Aspek Sosial OMK
Hubungan penderita OMK denganmasyarakat ada hambatan karena :• Bau (foetor)
– Dijauhi teman– Rasa rendah diri
• Komplikasi– Meningitis– Paralisa N VII
• Tuli– Komunikasi– Pekerjaan / Sekolah
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OTITIS MEDIA SEKRETORIA/SEROSA
Patofisiologi :Obstr tuba Ventilasi kav timpani
terganggu Absorbsi O2 vakum Efusi cairan
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Diagnosis• Keluhan & Gejala
Telinga terasa penuh / tersumbatPendengaran menurunKeluhan lain (Sinusitis, adenoiditis)
• PemeriksaanOtoskopi : Membran timpani retraksi,
Kavum timpani ada cairanTes Pendengaran : Tuli konduksi
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Terapi• Bila ada cairan parasintesis (utk drainage
& ventilasi) pasang gromet.sekret mukous “Glue Ear”
• Mengobati Penyebabnya– Alergi Hindari alergen, desensitisasi– Adenoid > Adenoidektomi– Sinusitis Irigasi sinus
Gromet
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OTITIS MEDIA TUBERKULOSA
Definisi • Keradangan kronik kavum timpani oleh
karena Mikobakt.TBC yg berasal dari Paru
Diagnosis• Keluhan & Gejala
– Otore : sekret bau busuk– Nyeri (-)– Pendengaran menurun
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Pemeriksaan• Otoskopi :
– Sekret serous / purulen– Perforasi multipel
• Tes Pendengaran : Tuli Konduksi / campuran berat
• X-Photo Torak : KP
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Terapi• Lokal : oortoilet• Umum : Anti TBC
Perforasi multipel