This case presentation describes a 7-year-old male patient presenting with acute otitis media in his right ear. His symptoms included earache, runny nose, cough, fever, and gradually worsening hearing loss over the past 7 days. On examination, his right ear showed bulging of the tympanic membrane with reduced light reflex and conductive hearing loss. The working diagnosis was acute suppurative otitis media of the right ear. Treatment included antibiotics, analgesics, and myringotomy to drain pus from the middle ear. Acute otitis media is usually caused by bacteria invading the middle ear after the eustachian tube becomes blocked. It progresses through occlusion, hyperemic, suppur
This case presentation describes a 7-year-old male patient presenting with acute otitis media in his right ear. His symptoms included earache, runny nose, cough, fever, and gradually worsening hearing loss over the past 7 days. On examination, his right ear showed bulging of the tympanic membrane with reduced light reflex and conductive hearing loss. The working diagnosis was acute suppurative otitis media of the right ear. Treatment included antibiotics, analgesics, and myringotomy to drain pus from the middle ear. Acute otitis media is usually caused by bacteria invading the middle ear after the eustachian tube becomes blocked. It progresses through occlusion, hyperemic, suppur
This case presentation describes a 7-year-old male patient presenting with acute otitis media in his right ear. His symptoms included earache, runny nose, cough, fever, and gradually worsening hearing loss over the past 7 days. On examination, his right ear showed bulging of the tympanic membrane with reduced light reflex and conductive hearing loss. The working diagnosis was acute suppurative otitis media of the right ear. Treatment included antibiotics, analgesics, and myringotomy to drain pus from the middle ear. Acute otitis media is usually caused by bacteria invading the middle ear after the eustachian tube becomes blocked. It progresses through occlusion, hyperemic, suppur
This case presentation describes a 7-year-old male patient presenting with acute otitis media in his right ear. His symptoms included earache, runny nose, cough, fever, and gradually worsening hearing loss over the past 7 days. On examination, his right ear showed bulging of the tympanic membrane with reduced light reflex and conductive hearing loss. The working diagnosis was acute suppurative otitis media of the right ear. Treatment included antibiotics, analgesics, and myringotomy to drain pus from the middle ear. Acute otitis media is usually caused by bacteria invading the middle ear after the eustachian tube becomes blocked. It progresses through occlusion, hyperemic, suppur
Medical Faculty of Unika Atma Jaya Jakarta Syamsudin, S.H. Regional General Hospital, Sukabumi Period 22 October 2011 17 November 2012
a. Identity : Name : A Age : 7 tahun Sex : Male Race : Javanese Address : Jl. Koperasi
Chief complaint Additional complaint
: earache on the right ear
: runny nose, cough, fever since 7 days ago, and hearing loss
since 4 days ago (gradually)
History of present illness : Patient, 7 year old, male, comes to the ENT clinic with complain of pain on his right ear. Seven days ago he got fever (38,5 degree Celcius), cough, and runny nose. The colour of the secrete was clear and serous. He had taken medication for cold and flu but his symptoms did not improve. After four days, it became green yellowish, mucoid.. He becomes more irritable than usual, pulling his right ear. He had hearing loss gradually since 4 days ago. This complain occurs for the first time. Pain in the ear suddenly appeared, continuous all day and made him uncomfortable and irritable. History of past illness : Upper respiratory tract infection infrequently since he was infant.
Physical Examination 1. General status General appearance Awakeness Blood Pressure Pulse rate Respiration rate Temperature
: moderately ill : compos mentis (E4M6V5) : 110/70 mmHg : 115 beat per minute : 25 bet per minute : 38,7 oC
2. ENT Status *Auris dextra : - Auricle
: hyperemia (-), oedema (-)
- Retroauricular
: normal, no deformities
- Canalis acusticus externus :
skin
: hyperemia (-), oedema (-)
discharge
: (-)
serumen
: (+) minimal
- Tymphanic membrane : intact, bulging (+), light reflex reduced (+), hyperemis - Rinne test (-), Webber lateralitation to the right, prolonged Schwabach. (Conductive Hearing Loss on Right ear) *Auris sinistra : - Auricle
: in the middle : anterior and posterior pharyngeal arcus normal, hyperemia (+) : T2/T2, hyperemis (-), cripta dilatation (-), detritus (-)
*Maxillofacial
: symmetric
*Neck
: unpalpable lymph node / unpalpable lymph node
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 i. Outpatient ii. Paracetamol tab 6 x 250 mg per oral, if temperature > 37,8 C iii. Amoxicillin tab 3 x 250 mg per-oral, for 7 days iv. Myringotomy
Acute Otitis Media
I. Etiology - Streptococcus pneumoniae (tersering) - Haemophillus influenzae - Streptococcus -hemoliticus group A
- Staphyllococcus aureus - Staphylllococcus epidermidis - E. Coli
II. Pathophysiology Middle ear usually in steril mode, otherwise the microbes take place in pharynx. There is a connection between cavum tympani by eustachius tube. There are barrier systems to prevent invasion microbes to the middle ear which are, cillia, muramidase (enzym that products mucous), antibody and humoral factors, PMN, and phagocytic cells. There is a condition where function of the tube impaired can cause those barriers malfunctioned. So the microbes colonized at middle ear and infects it. III. Staging
a. Occlusion Retraction of tympanic membrane because of negative pressure in middle ear. This negative pressure created by air absorbtion. Sometimes, we could find normal tympanic membrane or in livid color. Maybe the effusion has been occured, but cant be recognized. This stage is hard to be distinguish with serous otitis media which caused by virus or allergic reaction. b. Hyperemic Vascular dilatation in tympanic membrane so the tympanic membrane in reddish/hyperemic looks or oedema. Secretes may hard to be noticed, and painful perception is present. c. Suppurative The mucous in middle ear in oedema state and the epithelium destroyed, so the middle ear now filled by purulent exudate. This can couse tympanic membrane bulging to the outside. Pain at ear, heart rate, temperature of the body raise. If the pressure in the middle ear cant be reduced, can caused iscemic condition of the tympanic membrane because of pressure to the capillaries. Necrotic at tympanic
membrane cause the tympanic membrane looked as flabby and yellowish color. This is the site where rupture could take place. d. Perforated Late in giving antibiotics therapy, tympanic membrane will be rupture and pus drains out from the middle ear. Child will be calm now, reduce in body temperature, and sleep well. e. Resolution If the tympanic membrane still intact, the condition of tympanic membrane slowly back to normal. If there is a perforation, secretes will reduced and dried. Resolution will takes place without medication if the immune system still in good performance.
IV. Clinical Findings
Clinical findings of acute otitis media are based on stage and patients age. Usually, in child there will be a history of common cold before otitis media takes place. Clinical findings in child: pain inside the ear, high body temperature, restless, seizures, nausea, vomiting, diarrhea, and holding the affected ear. In adults, pain, fullness in the ear, and hearing loss occured.
V. Management a. 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
b. Hyperemic
- Antibiotic: amoxicillin 40 mg/kgBB/day in 3 doses, ampicillin 50-100
c. Supurative - 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
d. Perforation
- H2O2 3% 5 drops 3 dd 1 3-5 days
- Antibiotic local (ear drops)
e. 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.
VI. Complication Mastoiditis, subperiosteal abscesses, meningitis, brain abscesses.
