BULLOUS MYRINGITIS (MYRINGITIS o <2 yo, atau ada sensorineural

BULLOSA HAEMORRHAGICA) impairment → sama kaya otitis

media
 Ada vesikel di superficial layer dari
M.tympani → vesikel diantara epitel
luar dan lamina propia membrane
GRANULAR MYRINGITIS
timpani
 Etiologi → INFEKSI  A specific form of external otitis

o Influenza virus  Jaringan granulasi di lateral

o Mycoplasma pneumoniae membrane timpani hingga ke external

 Terjadi di segala umur → tertinggi di ear canal

anak-anak, remaja, young adults  Pathology :

 Gejala : o Edema jaringan granulasi with

o Sudden onset severe capillaries and diffuse infiltration of

o Unilateral trobbing pain di telinga chronic inflammatory cells

o Disertai ISPA o Large area of granulation tissue

o Bloodstain discharge → often have no covering epithelium

present a couple hours later  Aetiology and Risk Factor

 Tanda : o High ambient temperature,

o Otoscopy → blood fillef, serous or swimming, lack of hygine, iritasi

serosanginous dan benda asing

o Blisters rupture → sekresi  Symptoms

serosangius o Foul-smelling discharge

o Membrane timpani intak o Little or no pain

o Young children → 97% ada middle o Fullness sensation atau iritasi

ear fluid telinga

 Investigations :  Signs :

o Pneumatic otoscopy o Moderate a mount purulent

o Tympanometry secretion

 Therapy : o M. timpani covered with secretions

o Tanpa sensorineural hearing loss →  Treatment

analgesic o Topical treatment → steroids ear

o Kena sampe middle ear → th/ sm drops and antibiotic aor antifungal

dengan otitis media (antibiotic)

 o Solution of 0,5% formalin or o Otitis externa Stage 3 → thickening
trichloroacetic acid applied 1x of external canal skin dan fibrous
seminggu canal stenosis
 Kronik otitis externa occurs after six
months
OTITIS EXTERNA  Diagnosis :

 Karakteristik → edema dan eritema o Based on symptoms : pain, itch,

 Risk factor : edema, eritema dr external canal

o Narrow external auditory meatus dengan purulent otorrhea dan

(herediter, iatrogenic, exsostoses) debris in meatus

o Obstuksi normal meatus  Treatment

o Alergi o Dapan sembuh spontan

o Active chronic otitis media, expose o Aural toilet → umumnya os tidak

P.auriginesa or fungi mau karena sakit tapi most efektif

 Aetiology → situasi yang o Pain → analgesics

mengganggu lipid/acid balance. o Antibiotik broad spectrum →

Umumnya gram negative → neomysin (baik untuk staphylo

secondary infection of Streptococcus kurang untuk pseudo), Polymicin B

aureus, Pseudomonas auriginesa (u/ pseudomonas)

 Pathology o Nyeri → analgesic atau steroid anti

o Pre-inflammatory stage 1 → lost of inflamasi → hidrokortison dan

protective lipid/acid balance lidocaine

(normal pH 4-5) → stratum corneum

edema, blocking kelenjar sebasea
OTOMYCOSIS
dan apokrin → aural fullness dan
gatal, adanya gangguan lapisan  Fungal otitis externa
epitel dan invasi mikroorganisme →  Sering krn secondary to prolonged
edema dan scratching antibiotic dan imunokompromise,
o Acute inflammatory stage 2 diabetes
Progressively thickening  Clinical findings :
exudate,edema, obliteration of o Aspergilus niger (80%)→ black
lumen, pain increase, severe → o Candida → white
auricular change dan servical o Grey, green and yellow
lymphadenopathy  Treatment :
 o Toilet and removal debris o acute → include spontaneous
o Topical antifungal drops (Lacorten- horizontal torsional nystagmus →
Vioform) unidirectional nystagmus with quick
o Steroid dosis tinggi phases of nystagmus beating
(dexamethasone) + sulfur/salisilat + towards the unaffected side
AB gol azol salep  Diagnosis :
o Acute → subjective visual
horizontal (SVH test) most useful
VESTIBULAR NEURITIS o Electronystagmography with

 Common cause of spontan vertigo frenzel lense

 Sudden, spontaneous, isolated, total o Caloric testing → gambarin canal

or subtotal loss of afferent vestibular paresis 3-4 hari setelah onset akut

input from one labyrinth o MRI → not require unless a central

 Etiologi : cause for px symptoms

o Viral infection of vestibular nerve  Th/ : corticosteroid + antiviral

o Viral infection → neuronal loss in o Methylprednisolone but not

vestibular ganglia and atrophy valacyclovir → significant

vestibular sensory epithelial improvement (test using caloric

o Most common → latent infection of testing)

superior vestibular ganglia by HSV-1

 Clinical manifestations :
BENIGN PAROXYSMAL POSITIONING
o Acute spontaneous vertigo →
VERTIGO (BPPV)
associated nausea, vomiting, and
postural imbalance  Serangan singkat dari vertigo,
o Vertigo increases intencity over a berhubungan dengan nystagmus
hours → mendingan bila keep the  Dipicu oleh adanya perubahan posisi
head still and eyes shut kepala berhubungan dengan
o To stand and walk → px feel gravitasi
unsteady dan berbelok kearah  Etiologi :
labyrinth yang terkena → but still o Adanya otokonia → sel rambut
can stand without needing support kanalis semi sirkularis (SCC)
when their eyes open menghasilkan respon tidak tepat
o Fukuda or Unterberger test positive terhadap perubahan posisi kepala
berhubungan dengan gravitasi
 o Otoconia are crystals of calcium o Epley manouvre KI for → severe
carbonate → normally found in neck disease, high-grade carotid
gelatinous otolithic membrane di stenosis
utrikula dan sakula o Epley manouvre → induces
o Free floating otocania → into duct remission from symptoms
of SCC → canalolithiasis o Px remain upright for 24 hours after
o Free floating attach to cupula → th/
cupulolithiasis o Avoid sleeping on affect side for a
o Complication of head trauma or following week
vestibular neuritis → symptoms o Px severe, intractable symptoms →
within days after head trauma don’t respond to repeated
o Occur during progressive inner ear manouvre → surgical occlusion of
disease → Meniere’s disease, posterior SCC is highly effective for
Cogan’s syndrome relieving symptoms
 Epidemiologi : woman > Man, affect o Lateral SCC BPPV and posterior
all groups but most common elderly SCC BPPV doesn’t respond to the
 Clinical Manifestations : Epley maneuver  using a han-
o Brief recurrent episodes of vertigo held vibrator applied to the
following changes in head position mastoid during the maneuver
with respect to gravity → rolling
over the bed, getting in or out of
the bed, pitching head forward OTOSKLEROSIS

while bending over (tying  Hereditary disorder affecting

shoelace), pitching head for endocardial bone of otic capsule
looking up  disorder of resorption and deposition
o Each episode → 10-20s bone
o Nausea, vomiting  “clinical” otosclerosis → lesion involve
o Characteristic clinical sign → stapes bone/ stapediovestibular joint
nystagmus following a Dix-Hallpike → conductive hearing impairment
manouvre  “histologic” otosclerosis → stapes,
 Th/: stapediovestibular joint, cochlear
o Relocating otoconia into vestibule endosteum not involve →
using Epley Manouvre followed by asymptomatic
Dix-Halpley Manouvre
 “cochlear” otosclerosis → pure of fibrocytes dan diganti dengan
sensorineural hearing imparment due sel eosinofilik amorf → hialinisasi
to otosclerosis in ear without spiral ligament → sensorineural
conductie hearing impairment → otic hearing impairment
capsule involve but stapes don’t o adaanya remodeling tulang di
 Histopathology focus otosklerotik yng sudah
o Blue mantle → an areas of otic mencapai ligament → difuse ke
capsule contain more basophilic spiral ligament → ganggu fluid
o Resorption of endochondral bone dan ion homeostasis di koklea →
with enlargement of perivascular sensorineural hearing impsirment
space followed by immature bone  Diagnosis :
(woven bone) o Otoscopy → red vascular blush
o Active otosclerotic foci → (excessive vascularity within the
proliferation of blood vessels vascular mucosa over an
o Contain connective tissue stroma otosclerotic focus near oval
made of fibroblast and histiocytes window)
o Thickening of the structure that o Radiology
affected  Th/:
 Focus otosclerotic : o Flouradiation of drinking water
o Active or Spongiotic → increased o Oral flourides
of vascularity and cellularity as well o Conventional hearing aids
as bone resorption and bone
formation
o Inactive “sclerotic” → consist of
dense mineralized bone
 Conductive hearing impairment →
correlated with narrowing and
impairment of annular ligament, esp
posterior stapediovestibular joint
space
 Sensorineural hearing impairment:
o otosclerotic reaches the
endosteum of cochlea → atrophy
of spiral ligament and impairment