tatalaksa keluhan nyeri di bidang
TRANSCRIPT
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TATALAKSA KELUHAN NYERI DI BIDANG T.H.T.K.L
Dr. dr. YUSSY AFRIANI DEWI, Sp.T.H.T.K.L(K)., M.Kes., FICS
Fakultas Kedokteran Universitas Padjadajran
RS. Dr. Hasan Sadikin Bandung
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Nyeri
Odinofagia
Otalgia
Nyeri pada wajah
Keganasan kepala leher
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Odinofagia
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Odinofagia Tonsilitis Faringitis Kandida Quinsy
Herpes Zoster
LPR Perokok Iritasi
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Anamnesis
Durasi? Keluhan
sebelumnya? Riwayat operasi?
Satu atau dua sisi?
Keluhan penyerta?
Menelan makanan,
cairan, saliva? Halitosis?
Pengobatan sebelumnya?
Paparan di tempat kerja?
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Pemeriksaan status lokalis • Tonsil dan sekitarnya
• Pembesaran (bilateral/unilateral), detritus tonsilitis?
• Riwayat tonsilektomi (fossa tonsilaris) peritonsiler selulitis?
• Peritonsiler (kemerahan, edema) abses peritonsiler?
• Faring
• Hiperemis faringitis?
• Plak putih kandida?
• Ulserasi
• Menelan/drooling saliva
• Trismus (M.Pterygoid) quinsy?
• KGB
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Akut Tonsilo-Faringitis
Self limiting, 70% virus
viral simptomatik cairan, antipiretik/analgetik
Bakteri (Streptokokus) febris, nausea, vomite Antibiotika (penisilin/eritomisin/amoksisilin)
Disfagia rawat
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Pilihan Antibiotika > 18 thn
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Pilihan Antibiotika < 18 thn
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Kandida
• Kandida antifungal
(nystatin, oral?)
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Abses Peritonsiler (Quinsy)
• Komplikasi bakterial tonsilitis
• Odinofagia hebat & gangguan menelan
• Otalgia ipsilateral
• Nyeri saat menggerakkan leher
• Pembesaran KGB
• Perubahan suara
• Trismus
• Insisi drainase, AB IV, cairan
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Abses Ruang Leher Dalam Tersering: Retrofaring, submandibular,
parafaring, bezold
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Abses Retrofaring
• Etiologi: ISPA, TBC, trauma, benda asing
•Gejala: demam, disfagia, odinofagia, nyeri leher, limfadenopati, snoring
• Terapi: AB IV, simptomatis, penyebab
• Penisilin + metronidazole
• B-laksamase: sefalosporin generasi 2 + klindamisin + 10 hari
• Insisi drainge
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Abses Submandibular
• Etiologi: infeksi gigi
• Gejala: demam, disfagia, odinofagia, lidah terdorong keatas, dasar mulut edema, trismus, dispnea
• Terapi: AB IV, simptomatis, penyebab
• Penisilin + metronidazole
• Bebaskan jalan nafas TC
• Insisi drainage
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Abses Parafaring
• Etiologi
• Gejala: demam, nyeri, disfagia, odinofagia, trismus, kaku
leher, edema, hiperemis
• Terapi: AB IV, simptomatis, penyebab
• Penisilin + metronidazole
• Insisi drainage
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Laringofaringeal Refluks
• Anamnesis: RSI
• Pemeriksaan: RFS
• Terapi:
• Faktor risiko terkontrol
• Konservatif: PPI
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Parotitis
• Keluhan: periode
prodromal
pembesaran edema
prasternal
• Parotitis epidemika
• Sindroma Sjogren
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Parotitis
Virus
• Suportif
• Simptomatik
• Istirahat
• Isoprinosine, Vit A, analgetic-antipiretik
Bakteri
• Antibiotika
Autoimune
• Kortikosteroid
Imunodefisiensi
• Manajemen etiologi primer (HIV, TB, DM)
• Imunomodulator
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Otalgia
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Otalgia
Otitis Eksterna Otitis Media Perforasi MT Disfungsi Tuba
Eustachius
Mastoiditis Ramsay Hunt
Syndroma TMJ Disorder Neoplasma
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Anamnesis
Pinna, CAE, seolah jauh Akut (< 2 mgg), kronis
(> 2 mgg)
Sejak kapan? Progresivitas
Lokasi (terlokalisir/menyebar)
Menetap/hilang timbul
Keluhan penyerta Riwayat trauma
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Pemeriksaan
Status Lokalis
CAE, aurikula, preaurikula,
retroaurikula benjolan, hiperemis, nyeri
Penekanan tragus
Otoskopi
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Pemeriksaan Penunjang
Timpanometri
Audiometri nada murni
Tes fungsi tuba eustachius
Radiologis
Keseimbangan
Laboratorium
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Diagnosis
Banding
Telinga Luar
OE
Otomikosis
Neoplasma
Telinga Tengah
Miringitis
Disfungsi Tuba
Eustachius
OM
Herpes Zoster Otikus
Telinga Dalam
Ggn Saraf Pendengaran
Labirintitis
Meniere
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Diagnosis Banding • Organ Lain
• Tonsilitis, faringitis, Abses Peritonsiler
• Laringitis
• Sinusitis
• Bells Palsy
• TMJ Disorder
• Infeksi Leher Dalam
• Organ Lain
• Parotitis
• Karsinoma KL
• Fraktur Maksilofasial
• Infeksi & Neoplasma Basis Cranii
• Angina Pektoris
• Neuralgia
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Trauma Daun Telinga
Trauma tajam: laserasi: hentikan perdarahan, bila terkena tulang
rawat hecting, antibiotika
Trauma tumpul: insisi drainage, balut tekan
Trauma termal:
Panas (luka bakar), tergantung derajat
Dingin (frostbite), antibiotika & analgetik
Luka bakar kimia: irigasi menggunakan air, kompres dingin,
rekonstruksi pada kasus berat
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Inflamasi Aurikula
• Analgetik (NSAID/steroid)
• Insisi drainage
• Kuretase
• Rekonstruksi aurikula
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Infeksi Telinga Luar (OE)
Etiologi
• Akut
• Kronis
• Maligna
Tatalaksana
• Antibiotika tetes (ofloxacin, aminoglikosida, polymyxin, fluoroquinolone, as. Asetat) & streroid
• Ibuprofen
• Antibiotika Oral (infeksi kulit)
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Infeksi
Telinga Luar
(OE)
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Infeksi Telinga Luar (Herpes Zoster)
Defisini
• Herpes Zoster Otikus
• Sindroma Ramsay Hunt
Tatalaksana
• Antivirus (acyclovir,
famciclovir, valacyclovir)
• Steroid (prednisone)
• Antianxietas (diazepam –vertigo)
• Analgetika
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Infeksi Telinga Luar (Herpes Zoster)
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Infeksi
Telinga
Tengah
Otitis Media Akut
• Oklusi
• Presupurasi/hiperemis
• Supurasi
• Perforasi
• Resolusi
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Stadium OMA
Oklusi
• Pendengaran berkurang
• Otoskopi: RC menurun, MT buram
Presupurasi/hiperemis
• Pendengaran berkurang, berdenging, rasa penuh di telinga
• Otoskopi: MT hiperemis, RC -
Supurasi
• Nyeri hebat, febris
• Otoskopi: MT buldging, sangat hiperemis
Perforasi
• Nyeri berkurang, suhu mulai turun
• Otoskopi: MT perforasi, sekret + darah
Resolusi
• Otoskopi: sekret mengering, MT menutup
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OMA
Tatalaksana
• Oklusi (Tetes hidung efedrin), antibiotika
• Presupurasi (antibiotika, analgetic, tetes hidung)
• Supurasi (Antibiotika, simptomatik, miringotomi)
• Perforasi (antibiotika, H2)2 3%)
• Paracetamol/ibuprofen
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Miringitis Bulosa
• Virus
• Nyeri hebat tanpa demam, penurunan pendengaran, bula pada MT dan CAE kemerahan
• Mencegah infeksi sekunder: antibiotika, analgetic, simptomatik
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Barotruma
• Nyeri, rasa tertekan, pendengaran berkurang, vertigo, perforasi MT
• Dekongestan, steroid, mukolitik
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Abses Bezold
• Komplikasi OM supuratif
• Gejala: demam, otalgia, otore, leher kaku,
edema tip mastoid-sterno, paresis fasialis
• Terapi: AB IV, simptomatis, penyebab
• Ab spektrum luas
• Insisi drainage
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Nyeri
Wajah
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Klasifikasi Diagnosis dengan Keluhan Nyeri
Nyeri Wajah
• Sinusitis
• Trigeminal Neuralgia
• Trauma
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Rinosinusitis
Akut (viral)
• Anti histamin
• Dekongestan
• Steroid topikal
• Analgetik
• Mukolitik
• Cuci hidung
Akut (bakteri)
• Anti histamin
• Dekongestan
• Steroid topikal
• Analgetik
• Mukolitik
• Cuci hidung
• Antibiotika
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Rinosinusitis
Kronis
•Steroid (topikal dan/sistemik)
•Antibiotika (eks akut)
•Cuci hidung
•Anti histamin
•Pembedahan
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Nyeri pada Keganasan Kepala Leher
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Klasifikasi
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Tipe Nyeri (Nociplastic)
Nyeri pada nervus sentral & perifer, paparan lama terhadap nociceptive atau neuropati
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Faktor
Risiko
• Tumor
• Pengobatan
• Pasien
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Pemberian
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Tatalaksana • Nyeri >3 sampai 6 bln
• WHO
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Jenis
Obat
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Jenis Obat
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Pemberian
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