case oe ges vb
DESCRIPTION
ggeessTRANSCRIPT
CASE PRESENTATION
SUPERVISOR:DR. OSCAR DJAUHARI, SP. THT
PRESENTED BY:VICTOR BANDANA 2012.061 .049
GESTANO 2012.061 .054
Otitis Externa
Ear Nose Throat - Head and Neck DepartmentMedical Faculty of Unika Atma Jaya JakartaSyamsudin, S.H. Regional General Hospital,
SukabumiPeriod September 22nd 2014 – October 18th
2014
PATIENT’S IDENTITY
Name : Mr. MGender : MaleAge : 35 years oldOccupation : BussinessmanRace : JavaneseAddress : SukabumiWeight : 65 kgHeight : 170 cm
HISTORY
Chief Complaint : Severe right ear pain. Additional Complaint : Right ear fullness, fluid came out from right ear, mild
decreased hearing. History of Present Illness A 35-years-old male came to ENT clinic with a chief
complaint of rapid-onset severe right ear pain and fullness. The patient complains of otorrhea and mild decreased hearing in the right ear. He reports that his symptoms started after swimming 2 days ago. No fever is reported.
HISTORY
History of Past IllnessHistory of previous illness was denied History of Family IllnessHistory of family illness was denied
PHYSICAL EXAMINATION
General condition : Appear calmBody weight : 65 kgHeight : 170 cmBlood pressure : 120/80 mmHg Pulse : 88 beats per minuteRespiratory rate : 20 times per
minuteTemperature : 36,9 oC
ENT ExaminationEarRight earAuricle : normalExternal auditory canal :
hyperemic (+), edema (+), mass (-), laceration (-) secretion (-), cerumen (-), pain on tragus (+)
Tymphanic membrane : Can’t visualized due to the swelling
Left earAuricle : normalExternal auditory canal:
hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) , cerumen (-)
Tymphanic membrane: Intact, bulging (-), light reflex (+)
Otoscopy Right Ear
NoseRight nose Mucous membrane:
hyperemic (-), edema (-), ,mass (-), laceration (-), crust (-) Inferior conchae : eutrophy Septum : no deviation Air passage : normalLeft nose Mucous membrane:
hyperemic (-), edema (-),secretion (-), mass (-), laceration (-), crust (-) Inferior conchae : eurtrophy Septum : no deviation Air passage :normal
ENT Examination
OropharynxPosterior pharynx : hyperemic (-)Palatine tonsils : T1 / T1, hyperemic (-), detritus
(-)Uvula : symmetrical Dental : no abnormatlities Maxillofacial : symmetrical Neck : no lymphadenopathy
ENT Examination
WORKING DIAGNOSIS
♂, 35 years old with Acute Otitis Eksterna AD
DIFFERENTIAL DIAGNOSISTraumaTumor
WORK-UP
Laboratory:Complete blood count
TREATMENT
Cleansing with 2% acetic acidTopical AntibioticAnalgetic Education for aural toilet
LITERATURE REVIEW
Otitis externa commonly infection (usually bacterial, occasionally fungal)
May associated noninfectious systemic or local dermatologic processes
Characteristic symptom : Discomfort, limited to the CAE Erythema and swelling of the canal with variable
discharge
Definition
Otitis externa is an infection of the outer ear canal.
Also called swimmer's ear.
Anatomy and Physiology of the External Auditory Canal
Precipitants and Etiology of Otitis ExternaMoisture
- Swimming- Perspiration- High humidity
Water contaminated with bacteria
High environmental temperatures
Mechanical removal of cerumen
Insertion of foreign objects- Cotton swabs- Fingernails- Hearing aids- Ear plugs
Other trauma to ear canalChronic dermatologic
disease- Eczema- Psoriasis
- Seborrheic dermatitis- Acne
Etiology
The most common cause OE bacterial infection
Fungal overgrowth 10 percent of cases
BACTERIAL OTITIS EXTERNAOverview
External auditory canal ↓
Normal bacterial flora ↓
Remains free of infection ↓
Defenses disrupted ↓
New pathogenic flora develops ↓
Dominated by Pseudomonas aeruginosa & Staphylococcus aureus.
BACTERIAL OTITIS EXTERNA
OE with a bacterial etiology more intense than other
Otalgia may be severe enough to require systemic analgesics such as codeine and nonsteroidal anti-inflammatory drugs (NSAIDs)
Significant swelling of the canal is common
BACTERIAL OTITIS EXTERNA
Once the external auditory canal has been cleansed as much as possible and a wick inserted if swelling is severe, topical antibacterial therapy should be started.
Topical agents acidification with 2 % acetic acid usually effective
Steroids ear drops ↓ inflammation & edema resolve symptoms more quickly
Clinical Presentation
OtalgiaOtorrheaItching Swelling in ear canalCrusting around the ear canal opening.Sometimes swelling or pus may decrease
hearing
DiagnosisCause Characteristic
Otitis Externa
Acute bacterial Scant white mucus, but occasionally thick
Chronic bacterial Bloody discharge, especially in the presence of granulation tissue
Fungal Typically fluffy and white to off-white discharge, but may be black,
gray, bluish-green or yellow; small black or white conidiophores on
white hyphae associated with Aspergillus
Otitis media with perforated tympanic membrane
Acute Purulent white to yellow mucus with deep pain
Serous Clear mucus, especially in the presence of allergies
Chronic Intermittent purulent mucus without pain
Cerebrospinal fluid
leak
Clear, thin and watery discharge
Trauma Bloody mucus
Osteomyelitis Otorrhea with odor
Treatment
Prevention of Recurrence
Avoiding precipitants
Treat any underlying chronic dermatologic disorders
Otitis Externa Maligna
Diabetes most significant risk factor (90% of patients)
50% of cases of malignant external otitis (MEO) preceded by traumatic aural irrigation in patients with diabetes.
Physical examination
Inflammatory changes The pain is out of proportion Marked tenderness is present in the soft tissue
between the mandible ramus and mastoid tipGranulation tissue is present at the floor of the
osseocartilaginous junctionOtoscopic examination may also reveal exposed
boneThe cranial nerves (V-XII) should be examinedMental status examination Fever is uncommon
Laboratory Studies
Leukocyte count
Erythrocyte sedimentation rate
Serum chemistry
Culture and sensitivities from the external auditory canal
Imaging Studies
CT scanning and MRI ↓
For evaluating the anatomic extent of soft tissue inflammation, abscess formation, and intracranial complications
Treatment
Treatment includes :meticulous glucose controlaural toiletsystemic and ototopic antimicrobial therapy