Otomikosis dhana.pptx

7/27/2019 Otomikosis dhana.pptx

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Pradhana F Wicaksana

12798


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IDENTITAS Nama : Ny Sum

Tanggal Lahir : 12 Juli 1979

Umur : 34 tahun

Jenis Kelamin : Perempuan

Alamat : Bubutan, Purwodadi

Purworejo

No. RM : 096914

Tanggal Masuk : 15 Juli 2013


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KELUHAN UTAMA

Gatal Pada

Telinga Kanan


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RIWAYAT PENYAKIT SEKARANG

H1SMRS OS mengeluh telinga kanan terasa gatal,Nyeri. Tanpa disertai gangguan pendengaran. Namuntelinga terasa seperti tersumbat.

OS mengatakan telinga kanan sering terasa gatal, seringdikorek menggunakan cotton bud. OS mememeriksakandiri ke dokter, waktu itu hanya dibersihkan kotorannya,dan dikasih obat. Keluhan membaik. Diagnosis waktu itu

OS tidak tahu. Keluhan keluar cairan dari telinga kanan disangkal,

keluhan telinga kiri disangkal, keluhan hidung dantenggorok disangkal.


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RIWAYAT PENYAKIT DAHULU

OS pernah menderita keluhan serupa pada kedua

telinga bulan april lalu.

Riwayat asma, rhinitis alergi, dermatitis atopi

disangkal.


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STATUS LOKALIS

TELINGA KANAN KIRI

Auricula Nyeri tekan (-) dbn

Plano mastoideum dbn dbn

Gld. Lymphatica dbn dbn

Canalis auditoris

externa

Hifa/ Debris (+)

discharge(-), edema (-),

serumen minimal

hiperemis(-),

discharge(-), edema (-),

serumen minimal

Membrana tympani intak, cone of light di arah

jam 7. tidak ada perforasi

intak, cone of light

diarah jam 5, tidak ada

perforasi


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STATUS LOKALIS

HIDUNG KANAN KIRI

Discharge tidak ada tidak ada

Concha dbn dbn

Septum dbn dbn

Tumor tidak ada tidak ada

Sinus paranasal dbn dbn


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STATUS LOKALIS

OROPHARYNX KANAN KIRI

Palatum dbn dbn

Uvula dbn dbn

Tonsila palatina dbn dbn

Tonsila lingualis dbn dbn

Dinding belakang dbn dbn


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STATUS LOKALIS

OROPHARYNX KANAN KIRI

Palatum dbn dbn

Uvula dbn dbn

Tonsila palatina dbn dbn

Tonsila lingualis dbn dbn

Dinding belakang dbn dbn


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RESUME ANAMNESIS DANPEMERIKSAAN FISIK

Anamnesis :

Nyeri telinga kanan (+)

Telinga terasa gatal (+)

Telinga terasa tersumbat (+)

Pemeriksaan fisik

Otoscopi : Debris/ hifa berwarna putih di Canalis auditory

Dextra


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DIAGNOSIS

AD Otomycosis


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PENANGANAN

Evakuasi kotoran cerumen

Medikamentosa

Ketoconazole 1 x 200 mg

Loratadine mg 10

1 x 1

Edukasi: hindari masuknya air ke dalamtelinga, hindari mengorek telinga, rutinkontrol.


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Anatomy Of The Ear


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DEFINITION

OTOMYCOSIS => FUNGAL OTITIS EKSTERNA

Inflammatory process of the external ear canal due to infection withfungi.

The Most commonly:

1. Aspergillus

2. Candida

3. Pityrosporum


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PATHOGENESIS

Spora orHyfa in the

air

EnteringEAC

Moisture,warmth,

darkness

FungalgrowthOtomycosis


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EPIDEMIOLOGY

The most commonly in tropical country.

In various studies, it has been predicted that

incidence of otomycosis happened in the late of

summer


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Predisposition Factor

- Low productivity of Cerumen

- High Humidity, Increased temperature, moisture-

water entering ear while

- Localized trauma caused by cotton buds

- Ear plug instruments

- Immunocompromised - history of steroid and antibiotics use


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ANAMNESIS

Pruritus, pain, feeling something in the ears, discharge,discomfort.

Activities related by water for example: swimming, diving .etc.

(S. pneumoniae, H.influenza),


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Physical Examination

Inflamation sign on ear canal (hyperemia,ulceration ,tighten)

Debris (white/gray/dirty yellow/black or wet

blotting paper filling)

(S. pneumoniae, H.influenza),


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Laboratory Diagnosis

The clinical diagnosis of otomycosis should be

supplemented by microscopy and culture of debris

material.

Fungal structures is seen in KOH. AspergillusNiger septha hyphae, sporulating vesicles and

abundant black spores are seen.

Fungal spesific monoclonal antibodies has been

performed as rapid and sensitif diagnostic


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MANAGEMENT


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MANAGEMENT Drying and cleaning of external auditory canal carefully.

Acidity agent

Topical Therapy

- Keratolytic Agent

- Antifungal drugs :

Amphotericin B (3%)

Nystatin

FluconazoleEconazole cream (1%) very effective in vivo treatment

within 1-3 weeks.

Clotrimazole cream,powder or solution (1%)


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Salicylic acid, griseofulvin and ketoconazole are less

effective ?

Tolnaftate 1% solution (tinactin) should be used to avoid

ototoxicity if tymphanic membrane is perforated.


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Immunocompromised Individual

Topical

Antifungal

No of

Cases

1st

followup

2nd

followup

3rd

followup

4th

followup

Clotrimazole 180 Good Good Good NAD

Fluconazole 20 No

response

Good Good NAD

A Clinical study of Otomycosiswww.iosjournal.org


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COMPLICATION

Perforation of Tymphanic Membrane OMS


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Prognosis and Preventive Care

Risk of recurrence is high if the factors which

caused the original infection are not corrected.

Avoiding sudden maneuvers in the external

auditory canal

Avoid excessive moisture


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MATURNUWUN

Otomikosis dhana.pptx

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