acute diffuse otitis externa
TRANSCRIPT
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ACUTE DIFFUSE
OTITIS EXTERNABy
Elena Mahotsaha V M.Izza naufal F
Sri Murti Sari Ningsih Ilham Isnin Dolyanov
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ANATOMY
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Glandular secretions combine with sloughed squamepithelium to form an acidic coat of cerumen, one of the primbarriers to infection of the canal.
The alveoli of the sebaceous and apocrine glands empty short, straight excretory ducts, which drain into follicular caObstruction of any part of the ductal system predispose
infection.
PHYSIOLOGY
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The canal is normally a self-protecting and self-cleansing struccerumen coat gradually works its way past the isthmus to the latethe canal and sloughs externally.
Instrumentation and excessive cleansing of the canal disturb thprotective barrier and may lead to infection.
Individual variations in the anatomy of the canal or the consistecerumen produced may predispose some people to wax accumulati
PHYSIOLOGY
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Diffuse inflammation of the external ear canal, which mayalso involve the pinna or tymphanic membrane.
Rapid onset, within 48 hours in the past 3 weeks..
Hallmark sign of diffuse AOE is tenderness of the tragus,pinna or both, that is often intense and disproportionate to
what might be expected based on visual inspection
(Bailey, 4th ed
DEFINITION
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RISK FACTOR
Previous history of external ear infecton.
Swimming, diving, water activities.
Warm and humid weather.
Use of hearing aid.
DM, AIDS, malnutrition.
instrumenting the canal with a cotton swab or fingernail .
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CAUSATIVEAGENTS
Pseudomonas aeroginosa (50%).
Proteus mirabilis.
Staphylococcus aureus (23%).
Anaerobic and gram negative organisms (12,5%).
Fungal (12,5%).
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If moisture is trapped in the EAC, it may cause maceration of theprovide a good breeding ground for bacteria.
It may occur after swim or take a bath, or in hot humid weather. Oof the EAC by excessive cerumen, debris, surfers exostosis, or a ntortuous canal may also lead to infection by means of moisture rete
Trauma to the EAC allows invasion of bacteria into the damaged skin
This often occurs after attempts at cleaning the ear with a cotton swclip, or any other utensil that can fit into the ear.
Once infection is established, an inflammatory response occurs edema. Exudate and pus often appear in the EAC as well. If seinfection may spread and cause a cellulitis of the face or neck.
PATHOGENESIS
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DIAGNOSIS
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STAGESOFEXTERNALOTITIS
Senturia et al. divided the clinical course of external otitis into the fostages:
1. Pre inflammatory stage
2. Inflammatory stage
-Mild acute inflammatory stage
-Moderate acute inflammatory stage
-Severe acute inflammatory stage
3. Chronic stage
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Name : Mr. S
Age : 22 y.o.
Gender : Male
Occupation : Student
Address : Klaten
Date : 22 Oct 2013
IDENTITY
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Main complaint : pain in the right ear
History of present illness :
Patient presents with right ear pain for the past two dadecrease in hearing, also a fullness sensation. No itching nor disccomplained. Patient often uses the cotton bud to clean his ears. Patie
the history of swimming three days ago. No history of trauma. The pno complaint of the left ear.
Complaints like fever, cough, and common cold were deniednot have any complaints regarding nose or throat.
ANAMNESIS
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History of past illness :
Same symptoms before (-)
History of foreign body insertion (-)
History of allergy (-)
History of trauma (-)
History of DM (-)
History of illness in the family members :
History of similar complaints (-)
History of allergy (-)
ANAMNESIS
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ANAMNESISRESUME
Pain in the right ear for the past two days
Decrease in hearing
Fullness sensation
History of swimming three days ago and the usage of cotton bud
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General status : compos mentis, well nourished
Vital signs :
Blood pressure : 120/80 mmHg
Pulse : 82x/min
Respiration : 18x/menit
Temperature : 36,3 C
PHYSICAL EXAMINATION
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ENT
EXAMINATI
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EAR EXAMINATION
Tragus pain (+),
auricular
movement
tenderness (+),
swelling and
redness of CAE.
Within normal
limit
Intact tymphanic
membrane, cone
of light visible
Intact tymphanic
membrane, cone
of light visible
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NOSE EXAMINATION
Inspection
Deformity (-)
Nasal septum deviation (-)
Concha inferior D/S within normal limit
Discharge D/S (-)
Palpation
Tenderness (-)
Crepitation (-)
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THROAT EXAMINATION
Inspection
Cavum oris within normal limit
Uvula in the middle, edema (-)
Arcus pharynx simetris
Tonsils hypertrophy (-)
Pharyngeal wall hyperemic (-),
granulation (-)
Palpation
Lymph node enlargement (-)
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TUNING FORK EXAMINATIONRight Ear Left Ear
Rinne AC < BC AC > BCWeber Lateralization to the RIGHT
Swabach Increase Same withexaminer
Conclusion Conductive hearing loss of rightear
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ACUTE DIFFUSE OTITIS EXTERNA AURIS DEXTRA
DIAGNOSIS
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Medication :
Otopain ear drop 3 x 4 gtt AD (Polymyxin B sulfate + Neomycin sulFludrocortisone acetate + lidoqain Hcl)
Na diclofenac tablet 2 x 50 mg
Education :
Keep the ear in dry condition.
Dont use cotton bud to clean the ears.
Follow up in three days.
TREATMENT
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Therapy
PROBLEM
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DISCUSSION
Treatment and Management
Primary treatment of diffuse otitis externa :
1. Removal of debris from EAC
2. Administration medication to control edema and infection
3. Avoidance of contributing factors
4. Management of pain
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REMOVALOFDEBRISFROM EAC
Removal of debris from the ear canal improves the effectiveness of tmedication.
Gentle cleaning with soft plastic curette or a small suction tip under vision is appropriate
Irrigation with a mix of peroxide and warm water may be useful for
debris from the canal, but only if the tympanic membrane is intact
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ADMINISTRATIONMEDICATIONTOCONTROLED
ANDINFECTION
Treatment of Diffuse
Otitis Externa
Topical
Oral Medications
Antibiotic
Aminoglycoside and
quinolone
Ear pad
Quinolone
Ciprofloxacin
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CONT..
An aminoglycoside combined with a second antibiotic and a topical (eg, neomycin-polymyxin B-Hydrocortisone) used to be the most coprescribed topical preparation.
Otic antibiotic and steroid combinations have shown to be hughly suin treatment, with cure rates of 87-97 %.
Use of aminoglycoside antibiotic eardrops in the presence of a perfoventilation tube may cause problems. Amonoglycoside eardrops maototoxic if they enter the middle ear
Floroquinolones are not associated with autotoxicity and ofloxacin iscases of perforated tympanic membrane.
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CONT..
Most persons with OE do not require oral medications. Oral antibiotgenerally reserved for patients with fever, immunosuppression, diabadenopathy, or an infection extending outside the ear canal. We canbroad-spectrum antibiotics (cephalosporins first gen or fluoroquino
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AVOIDANCEOFCONTRIBUTINGFACTORS
Elliminate any self-inflicted trauma to ear canal.
Avoid frequent washing of the ears with soap.
Avoid swimming in polluted waters.
Ensure that ear canals are emptied of water after swimming or bath
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MANAGEMENTOFPAIN
Simple nonsteroid anti-inflammatory drugs (NSAIDs) reduce inflammirritation.
Acetaminophen is appropriate for most patient
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SUMMARY
Have been reported, patient, male, 22 years old, based on history physical examination diagnosed with otitis externa diffusa auricular dpatient treated by Otopain (Polymyxin B sulfate + NeomyFludrocortisone acetate + lidoqain Hcl ) and Na-diclofenac and edprevent reccurent infections.
Otopain eardrop was given to the patient because the membrane
was intact and the edema was not blocking the ear canal.
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TERIMA KASIHBy
Elena Mahotsaha V M.Izza naufal F
Sri Murti Sari Ningsih Ilham Isnin Dolyanov