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8/12/2019 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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