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KULIAH THT FK 2010
28- 04 – 2010
Sutarno, UHT
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Penyakit Telinga Luar
• !t"e#ato#
• $ry%i&ela%
• Perikon'riti%• !titi% ek%terna
• Her&er% (o%ter oti)u%
• !to#iko%i%• *u&ture #e#+ran ti#&ani
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Penyakit Telinga Tenga"
• !titi% #e'ia kronik
• !titi% #e'ia %ero%a
• Ko#&lika%i otiti% #e'ia
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PS$U!-!TH$AT!
• .en/olan 'i 'aun telinga yg #eru&akanku#&ulan )airan kekuningan 'iantarala&i%an &erikon'riu# 'an tl raan telinga
• .ia%anya ti'ak nyeri, ti'ak ta"u&enye+a+nya
• Tera&i keluarkan %e)ara %teril +e+at
tekan 'gn +antuan %e#en gi&% 1#inggu
• Kalau t'k %e#&urna ka#+u"
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$*3SIP$LAS
• a'ala" inek%i akut &a'a kulit 'an /aringan 'i +aa" kulit yang%e+agian +e%ar 'i%e+a+kan ole"
+akteri Streptococcus pyogenes.
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• a&at ter/a'i &a'a %e#ua u%ia, %e#ua+ang%a ra%, na#un &aling %eringter/a'i &a'a +ayi, anak 'an u%ia lan/ut5
• Aste N, dkk. $ry%i&ela% le+i" %eringter/a'i &a'a &ria 'r&' anita 41
• Sekitar 86 7 $ry%i&ela% ter/a'i 'i kaki'an a/a", %e+agian ke)il 'a&at ter/a'i
'i tangan, &erut 'an le"er %ertate#&at lainnya5
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Ter/a'inya
• Ter/a'i ole" &enye+aran inek%i yang'iaali 'engan &el+agai kon'i%i yang+er&oten%i ti#+ulnya koloni%a%i +ekteri,
#i%alnya luka, koreng, inek%i &enyakitkulit lain, luka o&era%i 'an %e/eni%nya,%erta kurang +agu%nya "ygiene5
• &t ter/a'i &a'a orang yang #engala#i&enurunan 'aya ta"an tu+u" ,#alnutri%i 'll5
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e/ala 'an tan'a
• U#u#nya 'iaali 'engan &ana%,#enggigil, %akit ke&ala, nyeri %en'i,#unta" 'an ra%a le#a"5
• Pa'a kulit na#&ak ke#era"an, +er+ata%tega% 'engan +agian te&i #eninggi, nyeri'an tera+a &ana% &a'a area ter%e+ut,ka'ang +ula yang +eri%i )airan kekuningan
%ero&urulen5 Pa'a kea'aan yang +erat,kulit na#&ak #ele&u" 'an ka'ang ti#+ulero%i kulit #engelu&a%5
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La+oratoriu#
• Ti'ak &erlu 9 , ke)uali untuk&enelitian /eni% ku#an kalau'ilakukan "a%ilnya #enun/ukkan
&eningkatan leko%it "ingga 205000atau le+i"
• Penyakit ini %angat #u'a" 'ikenali
"anya 'engan 'ili"at %a/a5
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Pengo+atan
• Su'a" /arang 'i/u#&ai $ry%i&ela%+erat yang 'i%ertai kon'i%i tu+u"le#a" "ingga #e#erlukan raat
ina&5
• a%e aal "anya 'i&erlukan raat /alan 'an &eraatan 'i ru#a" %ekitar
: – 10 "ari5
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!+at &ili"an uta#adrug of choice
• .en(yl &eni)illine ;00-1200 #g, i5<,%etia& ; /a#, %e'ikitnya 10 "ari5
• Peni)illine Pro)ain 0,;-1,2 /uta unit, i5#,
2= > %e"ari %ela#a 10 "ari5• A#ok%i%ilin 600 #g, 'i#inu# ? @ 1
%ela#a :-10 "ari5 Atau a#&i%ilin 600 #g,
'i#inu# 4 @ 1 %ela#a :-10 "ari5 a&at /uga 'i+erikan ko#+ina%i A#ok%i%ilin 'anClavulanic acid %ela#a 10 "ari5
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!+at lain yg '&t 'igunakan,a5l5
• $ritro#i%in, &5o%, 4 = 260-600 #g%e"ari, %ela#a 10 "ari5 o%i% anak?0-60 #g &er kg +erat +a'an &er "ari,
'i+erikan ?-4 = %e"ari %ela#a 10 "ari5
• Klok%a%ilin atau iklok%a%ilin, &5o%5 4 =260-600 #g %e"ari, %ela#a 10 "ari5
• Sealo%&orin, #i%alnya %ea'rok%il,&5o%, ? = 600 #g %ela#a 10 "ari5
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!+at To&ikal
• Ko#&re% 'engan So'iu# Klori' 0,75
• Sale& atau kri# anti+iotika, #i%5Batriu# Fu%i'at, u&iro%in,ara#i%in, enta#i%in5
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P$*IK!B*ITIS
• *a'ang &' tl raan yg #en/a'ikerangka 'aun telinga
• Penye+a+ trau#a, o&era%i ygterinek%i, ko#&lika%i &%eu'oki%ta
• Tera&i A.
• Ko#&lika%i tl raan "an)ur
cauliower ear
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cauliower ear
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!TITIS $KST$*BA
• A'ala" ra'ang liang telinga akut>kroni% ole" karena inek%i +akteri,
/a#ur atau <iru%
• Pre'i%&o%i%i &eru+a"an &H /a'i +a%a,u'ara "angat 'an le#+a+, trau#aringan korek telinga
• !titi% ek%terna akut – !$ %irku#%kri&ta urunkel, +i%ul
– !$ 'iu%a
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!titi% ek%terna%irku#%kri&ta
• Inek%i &a'a &ilo%e+a%eu%urunkel• Ku#an staphilococcus aureus atau
staphilococcus albus
• e/ala nyeri "e+at, %akit &' &enekanan&erikon'riu#, aktu +uka #ulut, +ila#enyu#+at kurang &en'engaran
• Tera&i
– a+%e% a%&ira%i – ' te+al in%i%i, &a%ang 'rain – A. > anti%e&tik lokal, analgetik, kalau &erlu
&enenang
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!titi% ek%terna 'iu%a
• Kulit liang telinga 2>? 'ala#, "i&ere#i%,u'e# tak /ela% +ata%nya
• Ku#an &enye+a+ gol5 &%eu'o#ona%
staphilococcus albus, escherichia coli• &t %ekun'er 'ari !SK • e/ala nyeri tekan tragu%, liang tel
%e#&it, lnn regional '&t #+e%ar, nyeri
tekan, %ekret +au, t'k #engan'ung#u%in• Tera&i +er%i"kan, &a%ang ta#&on A.,
ka'ang &erlu A. %i%te#ik
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!titi% ek%terna #aligna
• Sering &a'a orang tua 'gn PH %eru#enC tinggi *a'ang #elua% %e)ara &rogre%i kela& %u+kuti%, tl raan 'an tulang tl
te#&oral +i%a ru%ak• *a%a gatal, nyeri #akin "e+at, liang telinga
tertutu&, ner<u% a%iali% '&t terkena5
• !%teo#ieliti% &rogre%i ole" &%eu'o#ona%
aerogino%a• Tera&i %elain nya, A. yg te&at, +er%i"kan
luka
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I*IBITIS .UL!SA
• Penye+a+ <iru%, %ering &' e&i'e#ie,#enyerang &' anak-anak
• *a%a %akit yg %angat, +a'an ti'ak
&ana%, ti'ak a'a &enurunan&en'engaran
• T 'an %ekeliling +anyak +ula, #era"#era'ang
• SelDi#iting, +erak"ir 2-? "ari• Tera&i analgetik5 A. untuk &re<enti
%ekun'er inek%i
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iringiti% +ulo%a
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I*IBITIS *ABUL!SA
• Earang, kroni%, ti'ak %akit, ti'ak /ela%&enye+a+nya
• atal, otorea, &en'engaran turun
• $&itel %kua#ou% 'iganti la&i%an /argranula%i , %etela" +erta"un-ta"un'a&at #enyu#+at liang telinga
• Tera&i kau%tik > )auter, in%i%i, A.,k5&5 rating5
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.$BA ASIB L LIAB T$LIBA
• .er<aria%i +en'a #ati, "i'u&, +inatang,ko#&onen tu#+u"an, #ineral 'll
• P' anak ke)il #anik, #ainan, karet
&eng"a&u%,• P' 'ea%a ka&a%, &otongan korek a&i,
&en%il, ke)oa, %e#ut, nya#uk, ku&u ke)il
• Pengeluaran "r% "ati-"ati, &a%ien "r%koo&erati, &' anak k%a%i %angat &enting
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• Ko#&lika%i &engeluaran trau#a
liang telinga 'an T #eru%ak%truktur T > tel tenga"
• .inatang "i'u& #atikan 'ulu
gli%erin• Setela" #ati a#+il &akai &in%et >
iriga%i 'gn air "angat
• Alat lain &engait %eru#en, )una#ke)il
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HERPERS ZOSTER
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HERPERS ZOSTEROTICUS
*a#%ay Hunt Syn'ro#e• A'ala" in<ek%i <iru% &a'a telinga 'ala#,tenga" 'an luar5 eru&akan Gko#&lika%i"er&e% o%ter5
• Penye+a+ Jari)ella (o%ter <iru% JJ,%ering %e+a+kan )a)ar air &a'a anak-anak"er&e% (o%ter 'an &o%t"er&eti) neuralgia&a'a orang 'ea%a5
• Jiru% #enye+ar ke B5 Fa%iali% 'an %yara%en%ori% ke telinga 'engan gangliongenikulatu#5
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• Inek%i uta#a JJ a'ala" )a)ar air <ari)ella,%etela" %e#+u" JJ ti'ak akti 'ala# %i%te#%ara %uatu %aat +i%a akti lagi &a'a orangyang le#a" #i%al karena ke#otera&i,
ra'iotera&i, HIJ, %tre% %ik 'an &%iki% #en/a'i"er&e% (o%ter otiku%,
• .ia%anya rua# 'a&at %e#+u" %en'iri2-4 +ln,ka'ang #a%i" #era%akan &o%t"er&eti) neuralgia
+er+ulan atau +erta"un-ta"un5
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Penularan
• alau &ny ini ti'ak #enular non)ontagiou%, orang 'gn i#unita%le#a" 'an yg &erna" kena )a)ar air,
+ayi, anita "a#il "aru% #en/au"ikontak 'gn &en'erita5
• .ia%a #engenai u#ur ;0 t" le+i",
/arang &' anak-anak5
T ' t ' ' / l
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Tan'a-tan'a 'an ge/ala• e/ala yg #enon/ol %ering %akit 'ala#
telinga, #ula-#ula "ilang i#+ul, %etela"++r& "ari ra%a %akit %ering #enye+arkeluar, ke &inna5
• e/ala 'an tan'a "er&e% (o%ter oti)u% – Le%i kulit yang <e%ikuler, %akit, #un)ul 'i T, liang
telinga, &inna, &alatu#, atau 2>? li'a" +ag anterior
– GFa)e 'ro& karena kele#a"an B Fa)iali% &' %i%i yg %a#a'gn telinga yang terkena5 %&t .ellM% &al%y
– Pen'engaran kurang, gangguan ke%ei#+angan,
– Tinitu%, %en%a%i +ergoyang, Ke"ilangan ra%a &enge)a&
– Kele#a"an B Fa)iali% #enun/ukkan a'anya ti&e loer#otor neuron5 Eika ini ter/a'i "r% %egera 'iru/uk kea"linya untuk %egera 'ie<alua%i guna #en)ega"
ko#&lika%i yang +erlarut-larut5
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iagno%i%
• .er'a%ar a'anya ge/ala 'an tan'a,%e&erti le%i kulit yang <e%ikuler, #iri&)a)ar air
engo atan
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engo atan• !+at anti<iral %e&erti a#<ir a#)i)lo<ir,
<altre@ <ala)y)lo<ir 'an (o<ira@ a)y)lo<ir,
#engurangi ge/ala 'an #e#+antu &enye#+u"an5
• Korti)o%teroi', %&t &re'ni%one, <aliu#'ia(e&a#, %)o&a)e tran%'er#al %)o&ola#ine
&at)" atau anti"i%ta#in %&t anti<ert #e)li(ine%ering 'i&akai #engurangi <ertigo 'an tinitu%5
• Pe#+e'a"an, untuk 'eko#&re%i n Fa)iali%#ungkin "aru% 'ilakukan5
• e/ala %ering %e#+u" %en'iri, teta&i a'a yang#eneta&, #i%al kurang &en'engaran 'an&arali%i% a)iali%
• Kalau &erlu analgetik 'an o+at to&ikal
J k i
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Jak%in
• Jak%in JJ +eri%i <iru% yg %u'a"'ile#a"kan5 ata klini% #e#+uktikan<ak%in +i%a eekti %ela#a le+i" 'ari 10ta"un 'ala# #en)ega" inek%i <ari)ella
'an /ika #a%i" /uga terkena +ia%anyaringan5
• Pa'a t" 200;, FA AS #enyetu/uio%ta<a@ untuk &en)ega"an &enyakit
rua# %ara, 'iran)ang untuk #en'a&atkanre%&on keke+alan untuk orang 'ea%a5
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OTOMIKOSIS
• Inek%i /a#ur 'i liang telinga• Pre'i%&o%i%i kele#+a+an tinggi
• Penye+a+ Pityrosporum, aspergilus,kan'i'a al+ikan%
• e/ala gatal, k'ng &enu", ka'angtan&a kelu"an
• Tera&i +er%i"kan telinga – Lar5 A%a# a)etat 27 'l# alko"ol
– Io'iu# &o<i'on 67
– Tt% tel A. N %teroi'
– !+at anti /a#ur star
RUPTURE MT
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RUPTURE MT• .ata%an le%i atau ro+eknya T aki+at korek
telinga, trau#a, +arotrau#a
• Kriteria 'iagno%i%
– Pen'engaran turun, tinitu%, ro+eknya T, 'ara" &' T
– K"a% te&i ro+ekan ti'ak rata, +entuk +intang > +ulan%a+it
• Tera&i
– .er%i"kan, &a%ang ta#&on %teril
– Anti+iotika
• Penyulit !A• La#a Peraatan 1-4 #inggu
• Progno%i% +aik
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e#+rana Ti#&ani nor#al
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Penyakit telinga tenga"
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T +ulging!tore-
&urulen
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Gangguan Tuba Eustachius
Perasat alsalva, Perasat !oynbee
• Tu+a ter+uka a+nor#al – Ter+uka teru%u'ara re%&ira%i #a%uk, T
ti&i% atro, gerak %e%uai naa%
– Kelu"an telinga &enu" atau autooni – Tera&i Kalau &erlu o+at &enenang atau
&a%ang "rommet
• !+%truk%i tu+a – Kon'i%i• *a'ang na%oaring, a'enoi', tu#or na%oaring
– &t ter/a'i )airan otiti% #e'ia %ero%a – Su#+atan +i%a ole" Oa Ba%oaring, ta#&on
.ello), %ikatrik aki+at o&era%i AT$ star
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!TITIS $IA
Pera'angan %e+agian atau %eluru"#uko%a telinga tenga", tu+a$u%ta)"iu%, antru# #a%toi' 'an %el-
%el #a%toi'
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Pe#+agian
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Pe#+agian• !titi% #e'ia ter+agi ata% otiti% #e'ia
%u&urati 'an non-%u&urati, #a%ing-#a%ing #e#iliki +entuk akut 'ankroni%5
• !titi% #e'ia akut ter#a%uk ke'ala# /eni% otiti% #e'ia %u&urati5
• Ter'a&at /uga /eni% otiti% #e'ia
%&e%ik, yaitu otiti% #e'iatu+erkulo%a, otiti% #e'ia %ilitik, 'anotiti% #e'ia a'"e%i<a5
!titi 'i ' k k i
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• !titi% #e'ia &a'a anak-anak %ering'i%ertai inek%i &a'a %aluran&erna&a%an ata%5
• Pa'a &enelitian ter"a'a& 112 &a%ienISPA ;-?6 +ulan, 'i'a&atkan ?07#engala#i otiti% #e'ia akut 'an 87%inu%iti%5
• $&i'e#iologi %eluru" 'uniater/a'inya otiti% #e'ia +eru%ia 1 t"n%ekitar ;27, %e'angkan anak-anak+eru%ia ? t"n %ekitar 8?75
• i AS 'i&erkirakan :67 anak #engala#i
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• i AS, 'i&erkirakan :67 anak #engala#i#ini#al %atu e&i%o'e otiti% #e'ia%e+elu# u%ia ? ta"un 'an "a#&ir
%etenga" 'ari #ereka #engala#inya tigakali atau le+i"5
• i Inggri% %eti'aknya 267 anak ala#i#ini#al %atu e&i%o'e %e+elu# u%ia 10ta"un5
• *e%iko keka#+u"an otiti% #e'ia ter/a'i&a'a +e+era&a aktor, antara lain u%ia Q6
t"n, otiti% &rone &a%ien yang #engala#iotiti% &erta#a kali &a'a u%ia Q; +ln, ? kali'ala# ; +ln terak"ir, inek%i &erna&a%an,&erokok, 'an laki-laki5
SEMBU PATOGENESIS
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$TI!L!I
ALL$*IIBF$KSISU.AT
AB
B TU.A T$K B$KAJ TIP
$FUSI OME
H
OMA
SEM
BUH OME
OMS
K
TU.A T, IBF$KSI -
TU.A
T
IBF$KSIR
OMA, OME,OMSK
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!A
• P' anak #akin %ering terkena ISPA, #akin+e%ar ke#ungkinan '&t !A
• P' +ayi !A 'i&er#u'a" ole" tu+a yg&en'ek 'an "ori(ontal
• Penye+a+ uta#a +akteri &iogenik, %&t5Stre&tokoku% "e#olitiku%, Stalokoku%aureu%, Pneu#okoku%
•Ka'ang 'i'a&at He#olu% inDuen(a,#scherichia colli, Stre&tokoku%an"e#olitiku%, Proteu% <ulgari% 'anP%eu'o#ona% aerogeno%a
star
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Sta'iu#
• !klu%i tu+a $u%ta)"iu%
• Hi&ere#i%
•Su&ura%i
• Perora%i
• re%olu%i
star
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T 'an !%ikel
star
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!TITIS $IA SUPU*ATIF K*!BIS !SK, !Perorata, Oongek
• Inek%i kroni% 'i telinga tenga" 'gn&erora%i T 'an %ekret yg keluar teru%
#eneru% atau "ilang ti#+ul, #ungkinen)er atau kental, +ening atau nana"
• ari !A!SK, %etela" 2 +ulan
• Faktor tera&i terla#+at, tera&i t'ka'ekuat, <irulen%i ku#an tinggi, 'ayata"an &a%ien ren'a" gi(i kurang,
"igiene +uruk star
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Letak &erora%i
• Sentral, 'i&ar% ten%a, %eluru" te&i&erora%i #a%i" a'a T
• arginal, 'i, %e+agian te&i &erora%ilang%ung +er"u+ungan 'gnanulu%atau %ulku% ti#&aniku#
• Atik, 'i &ar% Dak%i'a
star
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Eeni% !SK
• .er'a%ar +a"ayanya
– Ti&e a#anti&e #uko%a ti&e +enigna
– Ti&e +a"aya ti&e tulang ti&e #aligna
• .er'a%ar aktita% %ekret
– Akti
– Tenang
star
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Ti&e a#an
• Pera'angan ter+ata% &a'a #uko%a
• Ti'ak #engenai tulang
•Perora%i %entral• Earang ti#+ul ko#&lika%i +er+a"aya
• Ti'ak ter'a&at kole%teato#a
star
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Ti&e #aligna
• Pera'angan ti'ak ter+ata% &a'a#uko%a
• Ti&e +a"aya, ti&e tulang
• Perora%i #arginal atau atik
• Sering ti#+ul ko#&lika%i +er+a"aya
• Ka'ang ter'a&at kole%teato#a &'&erora%i %u+total
star
Tan'a klinik !SK
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Tan'a klinik !SK+er+a"aya
• Perora%i #arginal atau atik
• A+%e% atau %tel retroaurikuler
•Poli& > /ar granula%i• Kole%teato#a
• Sekret +er+entuk nana" +er+au k"a%
• Ter'a&at +ayangan kole%teato#a&a'a oto #a%toi'
star
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Kole%teato#a
• Suatu ki%ta e&itelial, yg +eri%i'e%kua#a%i e&itel keratin5e%kua#a%i ter+entuk teru% lalu
#enu#&uk %e"ingga kole%teato#a+erta#+a" +e%ar
• I%tila" lain kerato#a, %ua#ou%
e&itelio%i%, kole%teato%i%, e&i'er#oi'kole%teato#a, ki%ta e&i'er#oi',e&i'er#o%i%5
star
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Teori ter+entuknya
• Teori in<agina%i
• Teori #igra%i
• Teori #eta&la%i• Teori i#&lanta%i
Kole%teato#a a'ala" e&itel kulit yg
+era'a &a'a te#&at yang %ala"
star
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Penye+a+ keka#+u"an
• &erora%i T yg &er#anen,
• %u#+er inek%i 'i aring, na%oaring,"i'ung, %inu% &arana%al,
• %u'a" ter+entuk /aringan &atologikyg ire<er%i+el 'l# rongga #a%toi',
• gi(i 'an "igiene kurang
star
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iagno%i%
• .er'a%ar &e#erik%aan klini% 'an THT, teruta#a oto%ko&i, te%gangguan &en'engaran
• Foto *ontgen #a%toi', kultur 'an u/ire%i%ten%i ku#an
star
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Tera&i !SK
• Ti&e a#an kon%er<ati, #iringo&la%ti
– Kon%er<ati A., lokal H2!2, Tete% telinga
– iringo&la%ti %etela" 2 +ulan kering
• Ti&e +a"aya – &e#+e'a"an#a%toi'ekto#i
– .ila a'a a+%e% %u+&erio%teal retroaurikuler,'ilakukan in%i%i a+%e% 'ilakukan %en'iri,ti'ak +er%a#aan #a%toi'ekto#i5
star
!&era%i &e#+e'a"an &'
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!&era%i &e#+e'a"an &'!SK
• a%toi'ekto#i %e'er"ana
• a%toi'ekto#i ra'ikal
• a%toi'ekto#i ra'ikal 'gn #o'ika%i
• iringo&la%ti
• Ti#&ano&la%ti
• Ti#&ano&la%ti 'gn &en'ekatangan'a
star
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!TITIS $IA S$*!SA
• !titi% #e'ia #u%ino%a
• !titi% #e'ia eu%i
• !titi% #e'ia %ekretoria
• !titi% #e'ia #u)oi' glue ear
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.ata%an
• Kea'aan ter'a&atanya %ekret yangnon &urulen 'itelinga tenga", Tutu"
• .ila tan&a tan'a inek%i! eu%i – $n)er ! %ero%a
– Kental>%&t le# ! #ukoi' glue ear
Ter/a'inya )airan 'l# ka<
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Ter/a'inya )airan 'l# ka<ti#&ani
• ! %ero%a tran%u'at > &la%#a karena+e'a tek "i'ro%tatik
• ! ukoi' %ekre%i akti 'r kelen/ar >
ki%ta 'l# #uko%a tel tenga"• Faktor yg +er&eran ung%i tu+a
terganggu a'enoi' "i&ertro,
a'enoi'iti%, cleft$palate, tu#or 'ina%oaring, +arotrau#a, %inu%iti%, riniti%,'e%ien%i i#unologik atau #eta+olik5Faktor alergi %+g aktor ta#+a"an
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Pe#+agian
• !titi% e'ia Sero%a akut
• !titi% e'ia Kronik
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!titi% e'ia Sero%a akut
• Ter+entuknya %ekret 'i tel tenga"%e)ara ti+a-ti+a, 'i%e+a+kan ole"gangguan ung%i tu+a5
• Penye+a+ – P' +arotrau#a
– Jiru% &' /ln naa% ata%
– Alergi &' /ln naa% ata%
– i'io&atik
e/ala
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e/ala
• Pen'engaran +erkurang
• *a%a ter%u#+at &' telinga• Suara %en'iri le+i" nyaring atau
+er+e'a &' telinga yg %akit
• *a%a a'a )airan yg +ergerak %aat&o%i%i ke&ala +eru+a"
• Se'ikit nyeri %aat &er#ulaan tu+a
ter%u#+at +arotrau#a• Tinitu%, <ertigo > &u%ing ka'ang a'a
'l# +entuk ringan
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Pe#erik%aan
• !to%ko&i
– T retrak%i
– Ka'ang ta#&ak gele#+ung u'ara atau
&er#ukaan )airan 'l# ka< ti#&ani
• Tuli kon'uk%i te%t 'gn gar&utala
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Pengo+atan
• e'ika#ento%a 'an &e#+e'a"an
• Ja%okon%triktor tete% "i'ung,anti"i%ta#in, &era%at <al%a<a +ila
tak a'a inek%i /ln naa%
• 1-2 #g ge/ala #a%i" #eneta& #iringoto#i atau #iringoto#i R
&a%ang &i&a <entila%i ro##et
!titi% e'ia Sero%a Kronik
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!titi% e'ia Sero%a Kronik• Sekret ter+entuk %e)ara +erta"a& tan&a
ra%a nyeri, ge/ala-ge/ala +erlang%ungla#a5
• Le+i" %ering ter/a'i &a'a anak-anak
• Pa'a orang 'ea%a, unilateral, tan&a&enye+a+ yg /ela% &ikirkan Kar%ino#aBa%oaring
• Sekret +ia%anya kental glue ear5
• &t %+g ge/ala %i%a 'ari !A yg ti'ak%e#+u" %e#&urna
• &t /uga aki+at inek%i <iru%, alergi atau
gangguan #ekani% tu+a
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e/ala klinik
• Pera%aan tuli C #enon/ol 40-60 '.
• !to%ko&i T ut", retrak%i,%ura#kuning ke#era"an > kea+u-
a+uan
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Tera&i
• #iringoto#i, &a%ang &a%ang &i&a<entila%i ro##et
• Ka%u% yg #a%i" +aru +i%a 'i)o+a 'gn
'ekonge%tan tete% "i'ung 'anko#+ina%i 'ekonge%tan 'gnanti"i%ta#in &er o%
• Se+ag a"li an/urkan #e'ika#ento%a ?+ln, /ika tak +er"a%il o&era%i
• Bilai 'an o+ati aktor &enye+a+
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Ko#&lika%i
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Ko#&lika%i!TITIS $IA SUPU*ATIF
Akut
• A+%e% %u+-&erio%teal, #eningiti%,a+%e% otak
• .ila A. a'ekuat, ko#&lika%i ter%e+utti'ak ter/a'i 'an ke+anyakan %aat iniko#&lika%i t%+ #eru&akan ko#&lika%i
'ari !SK
Penye+aran &enyakit
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y & y• He#atogen
– !%teotro#+o&le+iti%, ko#&lika%i ter/a'i &'"ari ke 1-10, ge/ala &ro'ro#al t'k /ela%, ''tel tenga" utu" ta&i tulang 'an la&5 &erio%tal#era'ang, #u'a" +er'ara" &' o&era%i
• elalui ero%i tulang, – ++r& #inggu 'ari aal &enyakit, /l
&ro'ro#al inek%i lokal #en'a"ului, P'o&era%i la&5 tl5 ru%ak
• elalui /alan yg %u'a" a'a – Pa'a aal &enyakit, a'a %erangan la+irintiti%
atau #eningiti% +erulang, &' o&era%i a'a /lnyg +ukan karena ero%i star
Ko#&lika%i !SK
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Ko#&lika%i !SK A'a#% 'kk, 18
A5 i tel tenga"
15 Perora%i T &er%i%ten
25 $ro%i tl &en'engaran
?5 Parali%i% ner<u% a%iali%
.5 i tel 'ala#
15 %tula la+irin
25 la+irintiti% %u&urati
?5 tuli %yara
star
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O5 $k%tra'ural
15 a+%e% ek%tra'ural25 tro#+o%i% %inu% laterali%
?5 &etro%iti%
5 Ke SSP
15 eningiti%
25 A+%e% otak
?5 Hi'ro%ealu% otiti%
star
Ko#&lika%i Sou(a 'kk, 1
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&
• Intrate#&oral
– i tel tenga" &are%i% n5 a%ili%, tl &en'engaranru%ak, &erora%i T
– *ongga #a%toi' &etro%iti%, #a%toi'iti%koale%en
– i tel 'ala# la+irintiti%, tuli%ara>%en%orineural
• $k%trate#&o&ral
– Intrakranial a+%e% ek%tra'ura, %u+'ura, a+%e%
otak, #eningiti%, tro#+oDe+iti% %inu laterali%,"i'ro%ealu% otiku%
– $k%trakranial a+%e% retroaurikuler, a+%e%.e(ol'M%, a+%e% (igo#atiku%
Perubahan tingkah lakustar
Ko#&lika%i S"a#+oug",
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Ko#&lika%i S"a#+oug",200?
• Intrate#&oral – Perora%i T, #a%toi'iti% akut, &are%i% n5
Fa%iali%, la+irintiti%, &etro%iti%
• $k%trate#&oral – A+%e% %u+&erio%teal
• Intrakranial
– A+%e% otak, tro#+oDe+iti%, "i'ro%ealu%otiku%, e#&ie#a %u+'ura, a+%e% %u+'ura
K lik i 'i t l t "
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Ko#&lika%i 'i tel tenga"
• "a#&ir %elalu a'a tuli kon'ukti
• alau T utu", /ika rantai tl&en'engran &utu% tuli kon'uki
+erat
• era/at ketulian ti'ak#engga#+arkan ke&ara"an
&enyakitnya kole%teato# '&t#eng"antarkan /uga
P i i li
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Pare%i% n a%iali%
• P' !A karen &enye+ran inek%ilang%ung ti'ak &erlu tin'akan'eko#&re%i, ke)uali gagal %e)ara
#e'ika#ento%a N a'a &enekanan• P' !K, keru%kan tl o ero%i ole"
kole%teato#, /ar granula%iinek%i &'
kanali% a%iali%"aru% %egeratin'akan 'eko#&re%i
K lik i 'i t l ' l
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Ko#&lika%i 'i tel 'ala#
• Leat or rotun'u#, !A 48 /a#%etela" &engo+atan ti'ak +aik tek'l# tel tenga" tinggi #iringoto#i
• Penye+aran ole" karena 'e%truk%iatau inek%i lang%ung ke la+irin gangguan ke%ei#+angan 'an
&en'engaran <ertigo, #ual,#unt", tuli %ra
Fi t l l +i i N l +i i titi
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Fi%tula la+irin N la+irintiti%
• !SK 'e%truk%i%tula la+irintiti% tuli total, #eningiti%
• Perlu te% %tula R ni%tag#u% >
<ertigo, +i%a neg +ila la+irin %'"#ati > tertetu& /ar &atologi%
• OT S)an
• o&era%i
l +i i titi
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la+irintiti%
• eneral <ertigo +erat 'an tuli %ara+erat
• Sirku#%kri&ta <ertigo %a/a atau tuli
%ara %a/a
• &t %ero%a, 'a&t %u&urati
K lik i k k t ' l
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Ko#&lika%i ke ek%tra'ural
• Petro%iti% )uriga kalau a'a 'i&lo&ia n JI
• Tro#+o&le+iti% %inu% laterali% &' (a#an&ra A., %ekarang /arang
• A+%e% ektra'ural antara 'ura#ater 'antulang, nyeri telinga "e+at 'an nyerike&ala, &erlu oto *o &o%i%i S)"uller
• A+%e% %u+'ural 'e#a#, nyeri ke&ala,&enurunan ke%a'aran &ung%i lu#+alakan +e'akan 'gn #eningiti%
Ko#&lika%i ke SSP
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• eningiti% &aling %ering, '&t 'ari !A >!K, kaku ku'uk, %u"u naik, #ual,#unta", nyeri ke&ala "e+at5 !+ati 'ulu#eningiti%nya, +aru o&era%i tel
• A+%e% otak '&t 'i %ere+elu#, lo+u%
te#&oral, #eru&akan &erlua%anlang%ung, u#u#nya 'i'a"ului a+%e%ek%tra'ural, #a%toi'ekto#i %etela" KU
#e#+aik• Hi'ro%ealu% otiti% e'e#a &a&il,
#enyertai !A>K, nyeri ke&ala #eneta&,
'i&lo&ia, #ual, #unta"
Penatalak%anaan
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e a a a %a aako#&lika%i intrakranial
• Haru% 'i&er"atikan 2 "al
– Penanganan yg eekti t"& ko#&lika%i
– Penye#+u"an inek%i &ri#er
• Ealin ker/a%a#a 'gn +ag %ara N+e'a" %ara %e/ak &e#erik%aan
P$!AB TATA LAKSABA !SK
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.uku a/ar UI
otore kronis
otoskopi
MT utuh
Oe dIfusaOtomikosis
Dermatitis
OE Maligna
Miringitis granulosa
MT Perforasi
Onset, progresivitas,
PredisposisiPeny. istemik
!okus infeksi
"i#ayat pengo$atan
%ari &l'tanda kompl.
(omplikasi )
OM(
(omplikasi *
(olesteatoma ) (olesteatoma *
+-O"ITM+
+-O"ITM+ / star
AL!*ITA 1
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.uku a/ar UI OM( $enigna
(olesteatoma )
OM( Tenang
timulasi epitelisasi tepi perforasi
OM( +ktif
OM( 0+1+2+
Otore netap3 / mg
%u4i tel, +0 sistemik,
+0 topikal
Otore netap 3 5$ulan
+0 $erdasar p6
mikro$iologi
Ideal7 Mastoidektomi *tim ano lastiIdeal7 timpanoplasti
Perf nutup Perforasi netap
"o Mastoid
+udiogram
Tuli konduksii
Tdk sem$uh
Pilihan7
+tikotomi anterior
Timpanoplasti dd utuh
Timpanoplasti dd runtuh +tiko antroplasti
Timpanoplasti $uka, tutup
AL!*ITA 2
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.uku a/ar UI
Omsk*komplikasi
(omplikasi intrtemporal
+$ses su$periosteal
a$irintitis
Paresis fasialPetrositis
(omplikasi intrakranial
+$ses ekstra dura
+$ses perisinus
Trom$ofle$itis sinus lateral
Meningitis +$ses otak
Meningitis otikus
"a#at inapPeriksa sekret telinga
+0 iv dosis tinggi, 8)/9 hari
(onsul spesialis anak'saraf anak
Mastoidektomi anestesi lokal ' umum
Operasi $edah saraf
+0 dosis tinggi
Mastoidektomi
Dekompresi : ;II
Petrosektomi
star
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Teria
Kasih
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ABUAB P$B$BA*AB
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ABUAB P$B$BA*AB TULI
• Anato#i
• Fi%iologi
• Au'iologi
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Fi%iologi &en'engaran
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Fi%iologi &en'engaran• $nergi +unyi T getar
• Tl &en'engaran #eneru%kan 'an#enga#&lika%i 'aya ungkit,&er+an'ingan TTingka& lon/ong
• %ta&e% #enggetarkan tingka& lon/ong• &erili#a &' %kala <e%ti+uli +ergerak
• #e#+ran *ei%%ner n'orong en'oli#a
• gerak relati antara #e#+ran +a%ilari%'an #e#+ran tektoria5
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• *ang%angan #ekanik'eDek%i %tereo%ilia
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g g%el-%el ra#+ut
• kanal ion ter+uka
• &ele&a%an ion +er#uatan li%trik 'ari+a'an %el
• &ro%e% 'e&olari%a%i %el ra#+ut
• le&a%kan neurotran%#iter keala# %ina&%i%
• ti#+ulkan &oten%ial ak%i &' %araau'itoriu%
• nukleu% au'itoriu% %a#&ai ke kortek%&en'engaran area ?-40 'i lo+u%te#&orali%
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Au'iologi
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Au'iologi
• Il#u yg &ela/ari %eluk +eluk ung%i&en'engaran, yg erat "u+ungannya'gn "a+ilita%i 'an re"a+ilita%inya
• Au'iologi #e'ik – Au'iologi 'a%ar te% &enala, te% +er+i%ik,
au'io#etri na'a #urni
– Au'iologi k"u%u% au'io#etri o+yekti,te% untuk tuli anorganik, au'iologi anak,au'iologi in'u%tri
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Oara Pe#erik%aan
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Pen'engaran
• P@ "antaran u'ara N "antaran tulang
• Alat gar&u tala kuantitati,au'io#etri na'a #urni kualitati
• Ba'a yg 'i'engar 20 – 185000 H(,%e"ari-"ari 600-2000H(
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Te% &enala
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Te% &enala
• Tes Rinne +an'ingkan "antaranlalaui u'ara 'an lalui tulang
• Tes !eber +an'ingkan "antaran
tulang kiri 'an kanan• Tes Sch"abach +an'ingkan
"antaran tulang orang yg 'i&erik%a'gn orang yg &en'engarannya
nor#al• Tes Bing te% oklu%itragu% 'itekan
• Tes Stenger untuk tuli anorganik
&ura-&ura tulistar
Au'io#etri na'a #urni
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• Ba'a #urni &ure tone +unyi yang
"anya &unya %atu rekuen%i, 'inyatakan'l# /u#la" getaran &er 'etik
• .i%ing +unyi yang &unya +anyak
rekuen%i – Narrow band %&ektru# ter+ata%
– %hite noise %&ektru# lua%
• Frekuen%i /u#la" getaran &er 'etik'inyatakan 'gn Hert(
• Inten%ita% +unyi 'inyatakan 'l# '.decibell
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• Abang #engar iala" +unyi na'a #urni
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g g yyg terle#a" &' rekuen%i tertentu yg #a%i"'a&at 'i'engar ole" telinga %e%eorang
• Ni$ai n%$ au#i%etri& yaitu inten%ita%na'a #urni yang t4rke)il &a'a %uaturekuen%i tertentu yg #a%i" 'a&at 'i'engar
ole" telinga rata-rata orang 'ea%a #u'ayg nor#al
• Bota%i &' au'iogra# – AO gari% luru%, &enu"
– .O gari% ter&utu%-&utu%
– Tel kiri +iru
– Tel kanan #era" star
Eeni% 'an 'era/at ketulian
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E /
• Eeni%
– Bor#al
– Tuli kon'ukti, %en%orineural, )a#&uran
• era/a' ketulian
– 3ang 'i"itung "anya AO %a/a
– ulu in'ek% Flet)"er a#+ang 'engarrek 600, 1000, 2000, 'i /u#la", 'i+agi
? – Ke&u%takaan +aru 'ita#+a" Frek 4000
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a& 'an #a%king
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a& 'an #a%king
• A'a ga& a&a+ila – Antar AO 'an .O a'a &er+e'aan C10 '.
– ini#al 2 rekuen%i yang +er'ekatan
• a%king %uara #a%king +eru&a%uara +i%ing, 'i+erikan &a'a telingayang ti'ak %e'ang 'i&erik%a – Barro +an'noi%e #a%king au'io#etri
na'a #urni
– "ite noi%e #a%king au'io#etri tutur
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Penyakit yang %e+a+kanketulian
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ketulian
• Tuli kon'ukti
– Telinga luar Atre%ia, %eru#en, !$%irku#%kri&ta, o%teo#a liang telinga,
– Telinga tenga" tu+a katar, !,oto%klero%i%, ti#&ano%klero%i%,"e#oti#&anu#, 'i%loka%i tl&en'engaran
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• Tuli &er%e&ti > %en%orineural
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& &
– Koklea a&la%ia, la+irintiti%, intok%ika%i
%tre&to#i%in, kana#i%in, gara#i%in,neo#i%in, kina, a%eto%al, alko"ol, tuli#en'a'ak, trau#a ka&iti%, trau#aaku%tik
– *etrokoklea neurino#a aku%tik, tu#or%u'ut &on% %ere+elu#, #ielo#a#ulti&el, )e'era otak, kelainan otakyang lain
– Pre%+iaku%i% &enurunan ke#a#&uan#en'engar &a'a u%ia lan/ut
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St ' IS!
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Stan'ar IS!
0 - 26 '. Bor#al
C26 - 40 '. tuli ringan
C40 - 66 '. tuli %e'angC66 - :0 '. tuli %e'ang +erat
C:0 - 0 '. tuli +erat
C0 '. tuli %angat +erat
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!TITIS $IA S$*!SA
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!TITIS $IA S$*!SA
• !titi% #e'ia #u%ino%a
• !titi% #e'ia eu%i
• !titi% #e'ia %ekretoria
• !titi% #e'ia #u)oi' glue ear
.ata%an
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.ata%an
• Kea'aan ter'a&atanya %ekret yangnon &urulen 'itelinga tenga", Tutu"
• .ila tan&a tan'a inek%i! eu%i – $n)er ! %ero%a
– Kental>%&t le# ! #ukoi' glue ear
Ter/a'inya )airan 'l# ka<
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ti#&ani
• ! %ero%a tran%u'at > &la%#a karena+e'a tek "i'ro%tatik
• ! ukoi' %ekre%i akti 'r kelen/ar >
ki%ta 'l# #uko%a tel tenga"• Faktor yg +er&eran ung%i tu+a
terganggu a'enoi' "i&ertro,a'enoi'iti%, cleft$palate, tu#or 'ina%oaring, +arotrau#a, %inu%iti%, riniti%,'e%ien%i i#unologik atau #eta+olik5Faktor alergi %+g aktor ta#+a"an
Pe#+agian
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Pe#+agian
• !titi% e'ia Sero%a akut• !titi% e'ia Kronik
!titi% e'ia Sero%a akut
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!titi% e'ia Sero%a akut
• Ter+entuknya %ekret 'i tel tenga"%e)ara ti+a-ti+a, 'i%e+a+kan ole"gangguan ung%i tu+a5
• Penye+a+ – P' +arotrau#a
– Jiru% &' /ln naa% ata%
– Alergi &' /ln naa% ata% – i'io&atik
e/ala
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• Pen'engaran +erkurang
• *a%a ter%u#+at &' telinga• Suara %en'iri le+i" nyaring atau
+er+e'a &' telinga yg %akit
• *a%a a'a )airan yg +ergerak %aat&o%i%i ke&ala +eru+a"
• Se'ikit nyeri %aat &er#ulaan tu+a
ter%u#+at +arotrau#a• Tinitu%, <ertigo > &u%ing ka'ang a'a
'l# +entuk ringan
Pe#erik%aan
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Pe#erik%aan
• !to%ko&i – T retrak%i
– Ka'ang ta#&ak gele#+ung u'ara atau
&er#ukaan )airan 'l# ka< ti#&ani• Tuli kon'uk%i te%t 'gn gar&utala
Pengo+atan
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Pengo+atan
• e'ika#ento%a 'an &e#+e'a"an• Ja%okon%triktor tete% "i'ung,
anti"i%ta#in, &era%at <al%a<a +ila
tak a'a inek%i /ln naa%• 1-2 #g ge/ala #a%i" #eneta&
#iringoto#i atau #iringoto#i R
&a%ang &i&a <entila%i ro##et
!titi% e'ia Sero%a Kronik
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• Sekret ter+entuk %e)ara +erta"a& tan&ara%a nyeri, ge/ala-ge/ala +erlang%ungla#a5
• Le+i" %ering ter/a'i &a'a anak-anak
• Pa'a orang 'ea%a, unilateral, tan&a
&enye+a+ yg /ela% &ikirkan Kar%ino#aBa%oaring
• Sekret +ia%anya kental glue ear5
• &t %+g ge/ala %i%a 'ari !A yg ti'ak%e#+u" %e#&urna
• &t /uga aki+at inek%i <iru%, alergi ataugangguan #ekani% tu+a
e/ala klinik
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e/ala klinik
• Pera%aan tuli C #enon/ol 40-60 '.• !to%ko&i T ut", retrak%i,
%ura#kuning ke#era"an > kea+u-
a+uan
Tera&i
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Tera&i
• #iringoto#i, &a%ang &a%ang &i&a<entila%i ro##et
• Ka%u% yg #a%i" +aru +i%a 'i)o+a 'gn
'ekonge%tan tete% "i'ung 'anko#+ina%i 'ekonge%tan 'gnanti"i%ta#in &er o%
•Se+ag a"li an/urkan #e'ika#ento%a ?+ln, /ika tak +er"a%il o&era%i
• Bilai 'an o+ati aktor &enye+a+
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