Presentation on theme: "MATERI THT-KL TIM UKMPPD UNIV MALHAYATI BANDAR LAMPUNG."— Presentation transcript:
MATERI THT-KL TIM UKMPPD UNIV MALHAYATI BANDAR LAMPUNG
Acute otitis media Th: – Occlusion tubal: topical decongestan (ephedrin HCl) – Presuppuration: AB for at least 7 days (ampicylin/amoxcylin/ erythromicin) & analgetic. – Suppuration: AB, myringotomy. – Perforation: ear wash H2O2 3% & AB. – Resolution: if secrete isn’t stopped → AB is continued until 3 weeks.
Sign of OE: Hurt if auricle is pulled backward or tragus is pressed Acute localized otitis externa (furuncle) – Etiology: Staph. Aureus, Staph. Albus. – Localized in an obstructed sebaceous gland or hair follicle. – Only occur in outer cartilaginous portion of ear. – No connective tissue below skin → very painful – Th/: topical AB. If bulging & soft → incision & drainage Acute diffuse otitis externa (swimmer’s ear) – Etiology: Pseudomonas (usually), Staph albus, E. Coli. – Dark, warm, humid conditions → promote bacterial growth – Swollen (narrow), draining (exudate), tender canal. – Very painful – Th/: Topical AB, sometimes need systemic AB.
Atopic sign: – Allergic shiner Dark shadow below the eyes due to nasal obstruction causing secondary vein stasis – Allergic crease Horizontal line at the lower third dorsum nasi caused by repeted rub – Facies adenoid Mouth open with high arch palate → disrupted teeth growth – Cobblestone appearance at posterior pharyngeal wall – Geographic tongue
Malignant otitis externa (necrotizing OE) – Elderly diabetics or immunocompromised. – OE → cellulitis, chondritis, osteitis, osteomyelitis → cranial neuropathies. – The canal may be swollen & tender, red granulation tissue is seen posteroinferiorly at the junction of cartilage with bone, one-third inward. – Itch rapidly followed by pain, secrete, & swelling of canal ear. – Th/: topical & systemic antibiotics & aggressive debridement
Sore Throat Acute tonsillitis: – Viral: similar with acute rhinits + sore throat – Bacterial: GABHS, pneumococcus, S. viridan, S. pyogenes. Detritus → follicular tonsillitits Detritus coalesce → lacunar tonsillitis. Sore throat, odinophagia, fever, malaise, otalgia. Th: penicillin or erythromicin Chronic tonsillitis – Persistent sore throat, anorexia, dysphagia, & pharyngotonsillar erythema – Lymphoid tissue is replaced by scar → widened crypt, filled by detritus. – Foul breath, throat felt dry.
Audiologic Testing in Pediatric Behavioral observation audiometry – Behavioral reflex audiometry: to observe reflex evoked by sound → eye widening, grimacing, auropalpebral reflex, moro reflex, cessation reflex. – Behavioral response audiometry (5-6 month) → to evoke spesific response: moving head toward sound. Play audiometry (2-5 year) – a kid is trained to do spesific task (games) when hearing sound stimulus. Brainstem evoked response audiometry: – BERA is a series of scalp-recorded electrical potentials generated in the auditory nerve and brainstem during the first 10 to 20 ms after the onset of a transient stimulus. – Can be used in infant, children, adults, & comatose patient.
Tympanometry: – To assess middle air condition by placing probe tone in ear canal to sense the pressure based on the sound energy reflected from middle ear. Otoacoustic emission: – objective, noninvasive, and rapid measures used to determine cochlear outer hair cell function. – Evoked OAE are acoustic signals generated by the cochlea in response to auditory stimulation. Pure tone audiometry: – The audiogram is a graph that depicts threshold as a function of frequency. Threshold is defined as the softest intensity level that a pure tone (single frequency) can be detected 50% of the time.
Epistaksis Anterior epistaxis: – Bleeding arises from kisselbach plexus or a. ethmoidalis anterior – it may be precipitated by infection or minor trauma & easy to stop. – Direct digital pressure for 10-15’ on the lower nose compresses the vessel on the septum & will arrest the bleeding. – If bleeding source is seen cauterise with AgNO3. – If it’s still bleeding apply anterior tampon for 2 x 24 hours.
Posterior epistaxis – Bleeding arises from a. ethmoidalis posterior or a.Sphenopalatina and often difficult to stop – affect patient with hypertension or arteriosclerosis. – Therapy: apply bellocq/posterior tampon for 2-3days.
Mastoiditis Acute mastoiditis – the result of extension of acute otitis media into the mastoid air cells with suppuration & bone necrosis. Symptoms: – Pain, otorrhoea (usually creamy & profuse), increasing deafness. Signs: – fever, tenderness over mastoid antrum, swelling in the postauricular region, pinna is pushed down & forward, the tympanic membrane is either perforated and the ear discharging, or it is red and bulging. Investigation: CT scanning shows opacity & air cell coalescence. Treatment: – Antibiotics IV. If the organism is not known and there is no pus to culture, start amoxycillin & metronidazole immediately. – Cortical mastoidectomy. If there is a subperiosteal abscess or if the response to antibiotics is not rapid and complete, cortical mastoidectomy must be performed.