Post on 01-Jun-2018
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Case Presentation
Supervisor:
dr. H. Oscar Djauhari, Sp. THT-KL
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THE CASETHE CASE
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The CaseThe Case
a 55-years old man came tohospital with difcultyin s!i"in#
and droppin# o$ the ri#htcorner o$ his !outh since 5 daysago. He had a history o chronic
suppurative otitis !edia o hisright ear.
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IdentityIdentity
Name : Mr. !ge : 55 years old
"ccupation : #a$or
!ddress : %u&a$umi
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History o 'resent IllnessHistory o 'resent Illness
'atient had secretion co!in# out o$ his ri#htear. It comes out intermittently since % !onthsa#oand the "atest &as ' !onth a#o.%ecretion was (e""o&ish in color( s"i#ht"(thic) in consistency and has $ou" s!e"".
'atient went to general practitioner $eore $utwith no impro)ement.
* da(s a#o( patient noticed a drop o$ hisri#ht !outh corner and di+cu"t( in s!i"in#.
'atient elt this symptom eca!e &orse alongwith time. Earache &as asent. *e)er andpain on other places were a$sent. Hearing loss+,. Tinnitus +,. History o trau!a -.
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History o 'ast IllnessHistory o 'ast Illness
%ince months ago( patient hadsecretion coming out o his right earintermittently.
/ months ago went to the communityhealth centre and was gi)en oralmedication $ut the discharge stillcame out.
!llergic +-Hypertension +-
0ia$etes Mellitus +-
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'hysical 12amination'hysical 12amination
+3enerali4ed %tatus+3enerali4ed %tatus3eneral appearance: moderately ill!wa&eness : compos mentis
lood 'ressure : 667897 mmHg
'ulse rate : 7 $eat per minute;espiration rate: /7 $et per minute
Temperature : oC
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'hysical 12amination'hysical 12amination
+1ars+1ars
/i#ht ear :
!uricle : normal
Canalis !cousticus 12terna : hyperemic +-( edema +-(dischar#e 0 !ini!a", (e""o&ish and puru"ent(cholesteatoma +-( odorous s!e"" 0 laceration +-( cerumen +-
Tymphanic mem$rane : !ar#ina" per$oration, cone o$ "i#ht - ;etroauricular : deormities +-( edema +-( hyperemic +-
;inne test +-( ?e$er "atera"i1ation to the ri#ht( pro"on#edSch&aach.
Le$t ear :
!uricle : normal Canalis !cousticus 12terna : hyperemic +-( edema +-(
discharge +-( cholesteatoma +-( odorous smell +-( laceration
+-( cerumen +-
Tymphanic mem$rane : intact( $ulging +-( cone o light +,
;inne test +,( ?e$we no laterali4ation( %chwa$ach test same with thee2aminer.
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'hysical 12amination'hysical 12amination
+Nose+Nose/i#ht 2ose :
Mucous mem$rane : within normalrange
Concha: eutrophy
Ca)um : discharge+-(mass+-(crust+-
%eptum : normal
Le$t nose :
Mucous mem$rane : within normal range Concha : eutrophy
Ca)um : discharge+-(mass+-(crust+-
%eptum : normal
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'hysical 12amination'hysical 12amination
++Nasopharyn2( "ropharyn2(Nasopharyn2( "ropharyn2(
Ma2iloascial( and Nec&Ma2iloascial( and Nec&2POP
Mucous mem$rane : hyperemic +-( edema+-
!rcus anterior : u)ula in themiddle( mass +-
'haryn2 : hyperemic +-
Tonsil : T6-T6( hyperemic +-
3a4i""o$acia" : !symmetrical
2ec) : lymphadenopathy +-( +-
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'hysical 12amination'hysical 12amination
+*acial Ner)e+*acial Ner)e
5acia" 2erve E4a!ination +right 8let
*acial e2pression : asymmetrical( right
side o aceslightly dropped
;aising eye$row : difcult 8 normal
Closing eyes : let $ehind 8 normal
%miling : let $ehind 8 normal
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?or&ing 0iagnosis?or&ing 0iagnosis
Chronic suppurati)e otitis mediao the right ear with a
complication o right acial ner)e
paralysis.
6or)up
acteria culture and sensiti)ity testrom the ear discharge
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MedicationMedication
Topical !nti$iotic : o@o2acin
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L7TE/AT8/E /E97E6L7TE/AT8/E /E97E6
'art II
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Chronic %uppurati)e "titisChronic %uppurati)e "titis
Media +C%"MMedia +C%"M0eAnition
a persistent or intermittent inected dischargethrough a nonintact tympanic mem$rane +ie(peroration or tympanostomy tu$e
Chronic peroration o the tympanicmem$rane can occur without suppuration inactive; CSO3
1pidemiology pre)alent in de)eloping countries and is more
common in lower socioeconomic groups in thede)eloped world.
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Chronic %uppurati)e "titisChronic %uppurati)e "titis
Media +C%"MMedia +C%"M'athogenesis
most cases: C%"M occurs as a conseBuence o anepisode o !"M with peroration( with su$seBuentailure o the peroration to heal.
continued presence o a middle ear eusion degeneration o the A$rous layer o the tympanicmem$rane.
Pseudomonas aeruginosa, Staphylococcus aureus(and the Proteus species.
two main mechanisms $y which a chronic
peroration can lead to continuous or repeatedmiddle ear inections: 0irect contamination rom e2ternal ear $ecause the
protecti)e physical $arrier o the tympanic mem$rane is lost. The loss o Dgas cushionE in pre)enting re@u2 o
nasopharyn2 secretion results in the increased e2posure o
the middle ear to nasopharyn2 $acteria.
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Clincal *indingsClincal *indings
S
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0ierential 0iagnosis0ierential 0iagnosis
cholesteatomachronic granulomatous conditions
?egener granulomatosis
myco$acterial inection
histiocytosis
sarcoidosis
necroti4ing otitis e2terna ormalignant neoplasm
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TreatmentTreatment
2O2S8/=7CAL 3EAS8/ES !ural toilet
Topical anti$iotics
%ystemic anti$iotics
S8/=7CAL 3EAS8/ES
TympanoplastyTympanomastoid surgery
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ComplicationsComplications
Se>ue"ae Tympanosclerosis
!telectasis o tympanic mem$rane
7ntrate!pora" Co!p"ications
Mastoiditis
'etroisitis *acial Ner)e 'aralysis
%uppurati)e #a$yrinthitis
7ntracrania" Co!p"ications
Meningitis
Intracranial a$scess #ateral sinus throm$osis
"tic Hydrocephalus
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*acial Ner)e*acial Ner)e
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0ierential 0iagnosis o0ierential 0iagnosis o
*acial 'aralysis*acial 'aralysis
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THA2K