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The Case
PART I
The Case
A 6-years old boys came to hospital with an earache of his right ears. He had a history of upper
tract infection.
: An. A
Age
: 6 years old
Occupation
: Student
Address
: Jl. Koperasi
Chief complaint
Additional complaint
: runny nose, cough, fever since 7 days ago, and hearing loss since 4
days ago (gradually)
Physical Examination
(Generalized Status)
General appearance
: moderately ill
Awakeness
Pulse rate
: 115 bpm
Respiration rate
: 25 bpm
Temperature
: 38,7 oC
Physical Examination
(Ears)
Auris dextra :
- Auricle
- Retroauricular
: normal, no deformities
discharge : (-)
serumen : (+) minimal
- Tymphanic membrane
- Rinne test (-), Webber lateralitation to the right, prolonged Schwabach. (Conductive
Hearing Loss on Right ear)
Physical Examination
(Ears)
Auris sinistra :
Auricle
: normal, no deformities
discharge : (-)
serumen : (+) minimal
Tymphanic membrane : intact, bulging (-), light reflex (+), colour grey
Retroauricular
: normal, no deformities
Rinne test (+), Webber lateralitation to the right, Schwabach same with
the examiner.
Physical Examination
(Nose)
Right Nose :
Left Nose :
Physical Examination
(Throat and Neck)
Throat :
Uvula
Pharynx
Tonsil
: in the middle
: anterior and posterior pharyngeal arcus normal, hyperemia (+)
: T2/T2, hyperemis (-), cripta dilatation (-), detritus (-)
Maxillofacial
: symmetric
Neck
Working Diagnosis
Acute Otitis Media supurative stage auris dextra
Workup
Blood count including differential count of white blood cells
Culture of pus of the middle ear
Therapy
Outpatient
Paracetamol tab 6 x 250 mg per oral, if temperature > 37,8 C
Amoxicillin tab 3 x 250 mg per-oral, for 7 days
Myringotomy
Pathophysiology
Middle ear : steril mode
There is a connection between cavum tympani by eustachius tube.
There are barrier systems : cillia, muramidase (enzym that products mucous), antibody and
humoral factors, PMN, and phagocytic cells.
The barrier impaired invasion of microbes to the middle ear
STAGE
Occlusion
Hyperemic
Suppurative
Perforated
Resolution
Clinical Findings
Child
Adults
pain
fullness in the ear
hearing loss occured
Management
Occlusion
To open the closed eustachius tube, so the pressure in middle ear
can be reduced.
Decongestan (Child < 12y.o: HCl ephedrine 0.5% in physiologic
solution, Child>12 th: HCl efedrine1% in physiologic solution)
Antibiotics
Hyperemic
Antibiotic: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin 50-100
mg/kgBB/day in 4 doses, eritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics
Management
Suppurative
Antibiotics: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin 50-100 mg/kgBB/day in 4 doses,
eritromicin 40 mg/kgBB/day.
Decongestan
Analgetics
Antipiretics
Perforated
H2O2 3% 5 drops 3 dd 1 3-5 days
Antibiotic local (ear drops)
Management
Resolution
If the resolution didnt take place, secretes will drained out by the perforation in tympanic membrane.
The antibiotics continued for 3 weeks. If 3 weeks pasts and secretes stills, mastoiditis should be in
differential diagnosis
Complication
Mastoiditis, subperiosteal abscesses, meningitis, brain abscesses.
PROGNOSIS
Quo ad vitam : dubia
Quo ad functionam : dubia
Thank you