Literature Review Acute Otitis Media / Otitis Media Akut

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    LITERATUREREVIEW:ACUTE OTITIS MEDIA

    Pembimbing : dr. Daniel Widjaja, Sp.THT-KL

    Penyaji : Regina Varani (2012-061-093)

    Mariani Devi (2013-061-027)

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    EMBRIOLOGITELINGA

    Pembentukan telinga dimulai pada usia22 haripenebalan ectoderminvaginasiotic pitotocysts

    Ventral (saculus dan duktus kokhlearis) dan Dorsal (utrikulus,

    kanalis semisirkularis dan duktus endolimfatik)

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    Moore K. Clinically Oriented Anatomy 6th

    Edition. 2010. Lippincott

    William & Wilkins

    ANATOMI

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    TUBAEUSTACHIUS

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    ANATOMI MEMBRAN TIMPANI

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    LETAKPERFORASI

    Sentral : pada pars tensa

    Marginal : sebagian tepi perforasi langsung

    berhubungan dengan anulus / sulkus timpanikum

    Atik : perforasi di pars flaksida

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    DEFINISI

    Gejala dan tanda inflamasi pada telinga tengah dengan onset

    yang akut, disertai dengan efusi telinga tengah

    Inflamasi dan pus pada telinga tengah disertai dengan gejala

    dan tanda infeksi telinga.

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    EPIDEMIOLOGI

    Usia puncak insidensi adalah 6 12 bulan

    pertama kehidupan

    Angka kejadian menurun seiring bertambahnya

    usia

    Mudah berulang pada usia muda

    Kurang lebih 80% anak anak mengalami OMApaling tidak satu kali sebelum usia 3 tahun

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    ETIOLOGI

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    FAKTORRISIKODANPREDISPOSISI

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    PATOFISIOLOGI

    INFEKSI

    TUBA EUSTACHIUS

    TELINGA TENGAH

    REAKSI INFLAMASIEdema mukosa, Penyumbatan

    kapiler, dan Infiltrasi leukosit PMN

    LINGKUNG

    AN

    FAKTOR HOST

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    STADIUM

    Stadium oklusi tuba eustachius

    Stadium hiperemis

    Stadium supurasi

    Stadium perforasi Stadium resolusi

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    MANIFESTASIKLINIS

    Nonspecific symptoms : Otalgia

    Irritability

    Fever

    Headache

    Cough

    Rhinitis

    Anorexia

    Vomiting

    Diarrhea

    Ear rubbing or pulling

    Sign : Bulging membrane timpani

    Eritema membrane timpani

    Acute perforation, otorrhea

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    CDC

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    PNEUMATICOTOSCOPY

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    MANAGEMENTOFAOM

    Spontaneous resolution: 70-90% children within 7-14

    days

    AB may be delayedin:

    otherwise healthy children 6 months2 yo with mild otitis in

    whom the diagnosis is uncertain

    children > 2 yo with mild symptoms or in whom the diagnosis

    is uncertain

    Delaying AB therapy

    treatment-related costs and side effects

    emergence of resistant strains.

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    INITIALMANAGEMENT

    OBSERVATIONS

    Ensure follow-upand begin AB therapy if the child worsens

    or fails to improve within 48-72 hours of onset of symptoms

    wait-and-see prescription (WASP)

    1/3 childrenrescue AB for persistent or worsening AOMABuse could potentially be reduced by 65% in eligible children.

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    MANAGEMENT: OBSERVATIONS

    Symptomatic treatment PAIN management (in the first

    two days after diagnosis)

    Acetaminophen (15 mg/kg/4-6 hours) and Ibuprofen (Motrin; 10

    mg/kg/6 hours).

    Antipyrine/benzocaine otic suspension (Auralgan)

    local analgesia

    NOT routinely recommended:

    Antihistamineshelp with nasal allergies, may prolong MEE

    Oral decongestantsmay be used to relieve nasal congestion

    Neither AH nor decongestants improve healing or minimize

    complications of AOM

    Corticosteroid use has NO benefit in AOM.

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    AAP 2013

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    MANAGEMENT: ANTIBIOTICS

    Most beneficialchildren < 2 years with bilateral AOM

    and in children with otorrhea. (AAP 2013, AFP 2007)

    AB is recommended for: (CDC, AAP 2013)

    All children < 6 months

    Children > 6 months with severe infection (moderate or

    severe otalgia for at least 48 hours, or temperature > 39C).

    Children < 2 yo with bilateral AOM without severe signs or

    symptoms (mild otalgia

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    MANAGEMENT: ANTIBIOTICSELECTION(AFP 2007)

    FIRST LINE THERAPY: High-dosage amoxicillin (80 to 90

    mg/kg/day, divided into two daily doses for 10 days)

    NOT recommended in children:

    With concurrent purulent conjunctivitis, after AB therapy

    within the preceding month, taking amoxicillin as

    chemoprophylaxis for recurrent AOM or UTI, and with

    penicillin allergy.

    Penicillin allergy with NO history of urticaria or anaphylaxis

    Cephalosporins. (AAP 2013)

    POSITIVE historyMacrolides (azithromycin [Zithromax],

    clarithromycin [Biaxin]) or clindamycin [Cleocin].

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    MANAGEMENTOFPERSISTENTAOM

    Persistent AOM NO CLINICAL IMPROVEMENT

    (within 48-72 hours)

    REASSESS & EXCLUDE other causes of illness

    IF symptomatic treatment onlyInitiate AB therapy

    First line ABSecond-line therapy

    High-dose amoxicillin/clavulanate (Augmentin), cephalosporins,

    macrolides.

    Parenteral ceftriaxone administered daily over three daysin

    children with emesis or resistance to amoxicillin/clavulanate.

    For children who do not respond to second-line AB

    Clindamycin and Tympanocentesis.

    Levofloxacin (Levaquin)not approved by FDA

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    AAP 2013

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    MANAGEMENT: OPERATIVE(E-MEDICINE)

    Tympanocentesis

    Myringotomy

    Myringotomy with ventilation tube (Tympanostomy)

    Mastoidectomy

    http://emedicine.medscape.com/article/859316-

    treatment#a1156

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    RECURRENTAOM

    Occurrence of 3 or > episodes of AOM in 6-month period, oroccurrence of 4 or > episodes of AOM in 12-month periodthat includes at least 1 episode in the preceding 6 months.

    Management

    Watchful waiting.

    Minimizing risk factorsexposure to cigarette smoke, pacifier use,bottle feeding, daycare attendance

    AB Prophylaxis (Long-term, low-dose AB) recurrence, but notwidely accepted recommendations

    Surgery:

    Tympanostomy tubescontroversial Adenoidectomy, without myringotomy and/or tympanostomy tubes

    did not episodes of AOM when compared with chemoprophylaxis orplacebo.

    Adenoidectomy + tympanostomy tubesmay have benefit.

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    AOM MANAGEMENTAFP 2007

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    Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and Treatment of Otitis Media. Am Fam Physician. 2007

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    PREVENTIONS

    Pneumococcal vaccines

    Annual influenza vaccines

    Exclusive breastfeeding

    Lifestyle changes Xylitol*

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