Acute Otitis

Media
A C ASE PR ESEN TAT IO N
SU PERVISO R :
D R . H . O SC AR D J AU H AR I , SP. T H T

PR ESEN TED B Y:
EBBEL TAN T IAN IG AM U 2 0 1 0 7 3 002 9
F U AD F IL AR D H I N U G R OHO 2 0 1 0 7 301 37
SU S R ET H A M O N A AR D IAN I 2 0 1 0 73 01 03

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.

Identity and Complaint

Name

: An. A

Age

: 6 years old

Occupation

: Student

Address

: Jl. Koperasi

Chief complaint

: earache on the right ear

Additional complaint

: runny nose, cough, fever since 7 days ago, and hearing loss since 4
days ago (gradually)

History of Present Illness

Patient, 6 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
(Generalized Status)
General appearance

: moderately ill

Awakeness

: compos mentis (E4M6V5)

Pulse rate

: 115 bpm

Respiration rate

: 25 bpm

Temperature

: 38,7 oC

Physical Examination
(Ears)
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)

Physical Examination
(Ears)
Auris sinistra :
Auricle

: normal, no deformities

Canalis acusticus externus:

skin

: hyperemia (-), edema (-)

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 :

Mucous membrane : hyperemis (+), edema (+)

Inferior concha : eutrophy
Discharge
: (+), mukoid, green yellowish
Septum
: normal, no deviation

Left Nose :

Mucous membrane : hyperemis (+), edema (+)

Inferior concha
: eutrophy
Discharge
: (+), mukoid
Septum
: normal

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

: 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

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

Acute Otitis Media

Etiology

Streptococcus pneumoniae (tersering)

Haemophillus influenzae
Streptococcus -hemoliticus group A
Staphyllococcus aureus
Staphylllococcus epidermidis
E. Coli

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

Upper tract infection

Pain inner ear
Fever
Restless
Seizures
Nausea and vomiting
Diarrhea
Holding the affected ear

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

Quo ad sanationam : dubia

Thank you