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Otitis Eksterna Difusa
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DIFFUSE ACUTE OTITIS EXTERNA
Case Report
Suriya Devi
Parveender Kaur
Paranita Ferronika
Nur Haida Mat Ali
I. IdentityI. Identity
NameName : Ms.A : Ms.A
Sex Sex : Female: Female
Age Age : 27 y.o: 27 y.o
0ccupation 0ccupation : Housewife: Housewife
Address Address : Salakan Selomartani: Salakan Selomartani
M.R number M.R number : 1-27-39-19: 1-27-39-19
II. AnamnesisII. Anamnesis
Chief ComplaintChief Complaint : :Pain on left earPain on left earPresent historyPresent history : :
Since 2 days ago, Ms A felt pain on her left ear Since 2 days ago, Ms A felt pain on her left ear with pulsating sensation accompanied by pain with pulsating sensation accompanied by pain upon palpation on her ear after manipulating her upon palpation on her ear after manipulating her ear with cotton bud. She was experiencing fever. ear with cotton bud. She was experiencing fever.
The was no discharge, itching, hearing loss or The was no discharge, itching, hearing loss or ringing sound. She did not experience flu or cough ringing sound. She did not experience flu or cough prior to her ear pain. No complains on her right prior to her ear pain. No complains on her right ear.ear.
Past HistoryPast HistoryNo history of allergy, asthma and Diabetes Mellitus.No history of allergy, asthma and Diabetes Mellitus.
Family history Family history No family history similar to patient’s complaintNo family history similar to patient’s complaint
III. Resume anamnesis
• History of manipulated ear canal (+)
• Otalgia on the left ear (+)
• Pulsating sensation (+)Pulsating sensation (+)
• Subfebrile (+)Subfebrile (+)
III. PHYSICAL EXAMINATIONIII. PHYSICAL EXAMINATION
GENERAL STATUS : GENERAL STATUS : General condition : Good General condition : Good
ConciousnessConciousness : Compos Mentis : Compos Mentis
VITAL SIGN :VITAL SIGN : Blood Pressure : 120/80 mmHgBlood Pressure : 120/80 mmHg Pulse : 80 x/minPulse : 80 x/min Respiration : 20 x/minRespiration : 20 x/min Temperature : 37,7 degree celciusTemperature : 37,7 degree celcius
External Ear ExaminationExternal Ear ExaminationInspection: Hyperemis (-), Edema (-)Inspection: Hyperemis (-), Edema (-)Palpation: Tragus pain (+), auricular pain (+)Palpation: Tragus pain (+), auricular pain (+)
Neck Examination: Neck Examination: Inspection:Inspection: normalnormalPalpation:Palpation: lymph node enlargement (+)lymph node enlargement (+)
Otoscopic Examination: Otoscopic Examination: Edema (+), narrowing ear canal (+), hyperemia (+)Edema (+), narrowing ear canal (+), hyperemia (+)LOCAL STATUS : See on white boardLOCAL STATUS : See on white board
Diffuse Acute Otitis Externa Sinistra Diffuse Acute Otitis Externa Sinistra
IV. DIAGNOSISIV. DIAGNOSIS
V. TherapyV. Therapy
Ciprofloxacin 2 x 1Ciprofloxacin 2 x 1
Otopain 2 x gtt IIIOtopain 2 x gtt III
Kalium Diclofenac 2 x 1Kalium Diclofenac 2 x 1
VI. Plan
VII. Problem
Control after 3 days
Standard treatment of AOED
THANK YOU
DIFFUSE ACUTE OTITIS EXTERNA
Definition :
An infective dermatitis, usually starting in or near the external auditory canal and sometimes spreading to involve the whole auricle (Gray,1992)
Bacterial infection of the ear canal caused by disruption of normal skin or cerumen barrier due to imbalance of moisture and temperature (Bailey, 2001)
Diffuse inflammation of external ear canal, which may also involve the pinna or tympanic membrane within 48 hours (Rosenfeld et al. 2006)
PATHOGENS COMMONLY ASSOCIATED
• Pseudomonas aeruginosa (20%-60%)
• Staphylococus aureus (10%-70%)
• Staphylococcus epidermides
• Streptococus pyogens
Anatomy of External Ear
HISTOLOGY
High humidity and high temperature
intracellular edema
cartilaginous portion of the stratum corneum absorbs water
cerumen decreases
increases the pH and reduce the water repellent
covering the canal skin
blockage of the apopilosebaceous units
Manipulation of the ear
PATHOPHYSIOLOGY
itcing
proliferation of bacteria inlocally macerated skin
pain ensues as the swollen soft tissue of the canal distract the periosteal lining of the bony canal
purulent discharge begin, the auricle and periauricle soft tissue
may become involved
vulnerable to maceration, allowing bacteria to enter the apopilosebaceous unit
Kryzer TC, Lambert PR, 2000
Linstrom CJ, Lucente FE, Joseph EM , 2001
PREDISPOSING FACTORS
• High humidity and high temperature
• Trauma (Instrumentation and excesscive cleansing of the canal, swimming)
• Individual variation in the anatomy of the canal
• Water quality (in terms of bacterial load)
S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa
Elements of the diagnosis of diffuse acuteotitis externa
1. Rapid onset (generally within 48 hours) in thepast 3 weeks, AND
2. Symptoms of ear canal inflammation thatinclude:● otalgia (often severe), itching, or fullness,● WITH OR WITHOUT hearing loss or jaw pain,*AND
3. Signs of ear canal inflammation that include:● tenderness of the tragus, pinna, or both● OR diffuse ear canal edema, erythema, orboth● WITH OR WITHOUT otorrhea, regionallymphadenitis, tympanic membrane erythema,or cellulitis of the pinna and adjacent skin
*Pain in the ear canal and temporomandibular joint regionintensified by jaw motion.
S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa
Classification of
TreatmentTreatment
TREATMENT OTITIS EXTERNA
PreventionPrevention
Water precautionsProphylactic dropsEnvironmental control (eg, hot tubs)Avoiding neomycin drops (if allergic)Addressing allergy to ear molds or water protectorAddressing underlying dermatitisSpecific preventive measures for diabetics or immunocompromised state
(Otolaryngology–Head and Neck Surgery, Vol 134, No 4S, April 2006)
COMPLICATION
• Cellulitis
• Erysipelas
• Perichondritis
• Chondritis
• Chronic non resolving rate