STANDARD MANAGEMENT GUIDE Chronic suppurative otitis media (Omsk) IN INDONESIA

STANDARD MANAGEMENT GUIDE
Chronic suppurative otitis media
(Omsk) IN INDONESIA

By:
Tutut SRIWILUDJENG T.
Dr. Wahidin Sudiro Husodo Mojokerto

MANAGEMENT STANDARD (guideline)Chronic suppurative otitis media (Omsk)● Otorea chronic discharge from the ear is more than 2 months. In patients with a history of chronic otorea this important action is distinguishable on the tympanic membrane perforation with otoskopi examination.● otoskopi examination can be done simply using a light head and ears or funnel otoskop, but can also use more sophisticated equipment that will be more thorough as the examination with a microscope or endoscope.● If the intact tympanic membrane, chronic otorea can be caused among others by otitis eksterne difusa, otomikosis, dermatitis / eczema in the ear canal skin, and malignant otitis ekterna miringitis granulomatous. For the outer ear disorders is done the appropriate treatment, which will be discussed on another occasion.● If the tympanic membrane perforation, diagnosis leads to Omsk. Definition of Omsk is a chronic inflammation of the hands of the ear with tympanic membrane perforation and the secret history of ear discharge (otorea) more than 2 months, either continuous or intermittent. Secret may sereus, mucus or purlen.● In this Omsk need to know about the onset of disease progression, then look for predisposing factors, the existence of constitutional abnormalities (diabetes etc.) focus of infection and a history of previous treatment. Next look for any symptoms / signs of complications.● In Omsk without complications kolesteatom assessed whether there is or not. Without kolesteatom Omsk Omsk referred to as benign and are accompanied kolesteatom called Omsk advanced malignant or danger to a subsequent algorithm Omsk with further complications to the algorithm 2.
Incidence of Omsk● Omsk prevalence in Indonesia in general is 3.8%.● Patients Omsk represents 25% of patients - patients who beroabt in the ENT clinic of the hospital in Indonesia.
PATIENT MANAGEMENT ALGORITHM Omsk



























Figure 1: Overview of the normal tympanic membraneOn examination otoskopi there is usually a reflection of light from the umbo to anaterior below. On examination of the membrane pneumoskopi koson flexible because the tympanic cavity (filled with air).








Figure 2: Some of the clinical picture of benign OmskSome ganbaran otoskopik central perforation (annulus timpanicus still intact)








Figure 3: Some overview Omsk malignantThere is usually posterior perforation with accumulation desquamasi layered flat epithelium that was trapped. Sometimes - sometimes only marked granulation tissue due to immune reaction whenever there is the eroded bone surface by kolesteatomALGORITHM 1: PATIENT MANAGEMENTOmsk Omsk benign AND DANGER





















CALM PHASE benign Omsk (Omsk CALM)● Omsk benign divided into quiet and active phases. Phase terebut is quiet if Omsk Omsk type mucosa in the dry state. In these circumstances the edge of the perforation may be commercialized epithelialization through polyclinics actions hurt Dena perforation edge is sharp or by applying a caustic substance such as nitras argenit 25%, 12% acetic acid trichlor, absolute alcohol, etc..● satisfactory treatment results achieved when the tympanic membrane to close the conductive deafness was not found. If there is conductive deafness, especially if perforation settled then ideally performed with or without mastoidektomi timpanoplasti.● Check the dilanjurkan is rongent examination and audiometric examination.● Examination rongent Schuler mastoid position, although not to be done as a routine examination, if carried out will be able to assess the level of development penumatisasi mastoid and describe extent of disease.● pure tone audiometry may show conductive deafness. When there are deaf mixture indicates the possibility of complications have occurred to labrin. Hearing as much as possible done as a Baian of diagnosis meyeluruh an Omsk, useful, among others, to see the development of diseases and drug side effects when used either topically or ototoksik drug systemic drugs.
ACTIVE PHASE benign Omsk (Omsk ON)● Treatment of Omsk active phase must assess the condition of each case. Must be arranged in an optimal secret drenase example by giving 3% peroxide ear wash, in addition to systemic and topical antibiotics.● Systemic Antibiotics. Antibiotics should be given to each active phase and adapted to the germs that cause. Patoen Omsk mainly gram negative bacteria, namely Pseudomonas aeroginosa that no longer snsitif against classical antibiotics such as penicillin G, Amoxicillin, Erythromycin, Tetracycline and chloramphenicol. Contrimoksazol also less potential but still better.● systemic first-line antibiotic is amoxicillin. However, antibiotics can also be directly elected in accordance with the clinical situation, assess the appearance keular secretions and the history of previous treatment. Bluish green secret germ indicate Pseudomonas as the cause, yellow secretions deaf often caused by Staphylococus, foul-smelling secretions often contain groups of anaerobic bacteria.● Contrimoksazol or ampicilin-sulbaktam can be used when there is no suspicion against Pseudomonas bacteria as a cause. From previous studies most of the bacteria are still sensitive to Fluroquinon (Ofloxacin or Ciprofloxacin) so that it can be used in adults when there is no suspicion of anaerobic bacteria as the cause.● If there is suspected to be selected anaerobic metronidazole Clindamycin or Kloramfenicol. When difficult to determine the germs that cause, to use a mixture of trimethoprim + Sulfametoxazol or Amoxicilin + Clavulanat. In people over age 18 can be selected ari Ciprofloxacin or Ofloxacin.● If within 7 days of clinical improvement does not appear, should be cultivated mikrobiologik examination in order to vote if more appropriate antibiotic. Microbiological examination secret ear, if it can be done will really help determine the appropriate antibiotics, but treatment with first-line antibiotics do not have to wait for the results of this examination.● Treatment with systemic antibiotics alone sometimes - sometimes not effective because of the Omsk usually have mucosal changes occur that cause a relatively systemic keaadaan.● In the election amtibiotika must remember several things:● PadaOMSK there have been many changes - changes that persist, spontaneous resolution of difficult terjai sting and usually there ganggauan vascularization in the ear so hard to achieve the goals of systemic antibiotics optimally.● chronicity with the phase of active and quiet phases that alternately can occur throughout life. Required antibiotics on each active phase.● The long-term problems of resistance and side effects, in addition to cost-effective than the drugs used.● topical antibiotics. Antibiotic eye drops can be used as first-line drugs and the drug tungal. The advantage of topical antibiotics is to provide an adequate dose, but its consumer should be careful. Topical antibiotics such as gentamicin, neomycin, soframisin, even if chloramphenicol is ototoksik entrance to the inner ear through venestra venestra rotundum or ovale.Eardrops Oloxacin proven to be safe, not toxic to the labyrinth, have high-effectiveness as a single drug for the treatment of Omsk therefore irekomendasikan as first-line drugs for both adults and children - children. . Must iingat true that ear drops are not used as a prophylactic drug Omsk.● Treatment terhaap focus on the nose and throat infections.● If after treatment for three months otorea settled then ideally performed mastoidektomi and timpanoplasti.
Omsk HAZARD● Omsk hazard type is progressive, expanding koleteatom will mendestruksi bone in its path. Secondary infection will cause the state of local septic and cause what I kolesteatom and surrounding tissue sehingggga also causes soft tissue destruction that threatened to the occurrence of complications - complications.● Treatment of one - which is the act of surgery for eradication kolerteaom. Depending on the extent of damage and choice of surgeon can be done several surgical options. The action is selected when the anterior otikotomi kolesteatom still very limited in especial. If kolesteatom not be cleaned completely with the above actions, to choose a variety of techniques veriasi kolesteatoma eradication is usually followed reconstruction measures of hearing function at the same time, for example timplanoplasti collapsed wall (canal wall down tympanoplasty) or mastoidektomi intact wall (canal wall up tympanoplasty) or antikoantroplasti or timpanoplasti open - closed (open and close method tympanoplasty) and so forth.
COMPLICATIONS Omsk● Omsk Complications usually occur on the type of hazard / squamous but also can occur in the active phase of the mucosal type (Omsk benign).● Complications were divided into complications of intra-temporal and complications interakarnial. Namely intra-temporal Kompliaksi subperioestal abscess, labirinitis, facial paresis, petrositis; and complications of abscess intrakarnial extra dura, perisinus abscess, lateral sinus thrombophlebitis, meningitis, brain abscess and meningitis otikus.● suppurative otitis media either acute or chronic, has the potential to become serious because of the complications that can threaten health and cause death. The occurrence of complications depends on the cause pathological abnormalities otorea. Generally, complications occurred in patients with malignant type Omsk, tetapisuat acute otitis media or an acute exacerbation of virulent bacteria in Omsk as of benign can cause complications.● Patients with complications intrakarnial Omsk or intra-temporal should be treated and referred to a specialist neurological or nervous children. Antibiotics high doses of the type that can penetrate the brain barrier given intravenously for 7-15 days and microbiological examination secret ear. Tergantug from the patient's condition can be done in mstoidektomi drenase purulent material in local or general anesthesia may also be accompanied by action neurosurgical operations.
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