REFERAT MASTOIDITIS
PEMBIMBING: dr. Arif Tjatur P. Sp.THT
DISUSUN OLEH: Radit ditya Ibra brai!
"#".$ #".$$ $.%&" .%&"
'EPANITERAAN 'EPANITERAAN 'LINI' ILMU TELINGA HIDUNG TENGGORO' FA'ULTAS 'EDO'TERAN UNI(ERSITAS TRISA'TI RUMAH SA'IT ANG'ATAN LAUT Dr. MINTOHARD)O PERIODE $* MEI + $, )UNI %"$*
DAFTAR ISI BAB I
PENDAHULUAN................................................................. ................. ........... ...... 3
BAB II TINJAUAN PUSTAKA............................................... PUSTAKA............................................... .......................... ................... ....... 2 2.1. Anatomi ..................................................... ................................................................................ ........................... ........ 4 2.2. Mastoiditis ...................................................... .................................................................................. ............................ .. 5 2.2.1 Deenisi................................................................. ................. ......... ........... ... ! 2.2.2 Etio"o#i................................................. Etio"o#i................................................................................ ............................... ...... ! 2.2.3 E$idemio"o#i................................................... E$idemio"o#i...................................................................... .......................... ....... ! 1
2.2.4 K"asii%asi........................................................... ...................... & 2.2.5 Patoisio"o#i......................................................... ..................... & 2.2.! 'e(a"a K"inis................................................. ............................ ) 2.2.& Dia#nosis................................................................................ ... * 2.2.) Dia#nosa Bandin#..................................................... ................. 1+ 2.2.* Te,a$i.......................................................... ................................ 1+ 2.2.1+ Kom$"i%asi................................................... ........................... 13 2.2.11 P,o#nosis.................................................................. ................ 14 BAB III KESIMPULAN....................................................................................... 15 DA-TA PUSTAKA............................................................................................ 1!
BAB I PENDAHULUAN
Pen/a%it $ada te"in#a ten#a0 dan mastoid "aim ditem%an di Ame,i%a Se,i%at dan di se",0 dnia. Bee,a$a $ene"itian menn(%an a0a otitis media me,$a%an masa"a0 $a"in# mm %eda $ada $,a%te% $ediat,i% sete"a0 $i"e%. Se(a% $en##naan antiioti% se6a,a "as te,0ada$ otitis media dan mastoiditis $ada $e,ten#a0an 1*3+7an an#%a mo,ta"itas dan $en/"it se,is da,i otitis media te"a0 san#at men,n.
2
Mastoiditis ada"a0 in"amasi ata $,oses $e,adan#an da,i mastoid air cells /an# e,ada di t"an# tem$o,a". Ka,ena mastoid e,de%atan den#an te"in#a ten#a0 ana% ata$n o,an# deasa den#an $en/a%it te"in#a ten#a0 8otitis media a%t9 ata otitis media s$,ati %,onis (#a da$at men/ea%an mastoiditis Ha" ini di%a,ena%an %a,ena adan/a 0n#an anta,a te"in#a ten#a0 dan se"7se" da,a mastoid in"amasi $ada te"in#a ten#a0 (#a da$at mem$en#a,0i mastoid. Keda $e,adan#an ini da$at di an##a$ a%ti ata ina%ti. A%ti me,(% $ada adan/a ine%si den#en $en#e"a,an se%,esi te"in#a ata oto,,0ea a%iat $e,a0an $ato"o#i dasa, se$e,ti %o"esteatoma ata (a,in#an #,an"asi. Ina%ti me,(% $ada se%e"e da,i ine%si a%ti te,da0" den#an e#it tida% ada oto,,0ea.12 Insidensi te,tin##i mastoiditis te,(adi $ada ne#a,a e,%eman# dan $ada ana% %e6i". Kean/a%an $asien e,m, : 2 ta0n den#an m, ,ata7,ata /ait 12 "an. Namn mastoiditis da$at te,(adi $ada m, e,a$n. Men,t $ene"itian insidensi mastoiditis $ada ana% menin#%at di%a,ena%an %,an#n/a ata tida% ee%tin/a te,a$i antiioti% $ada saat e$isode otitis media a%t. Namn insidensi e,%,an# sete"a0 e,a antiioti% m"ai e,%eman#.13 Pato#en /an# $a"in# se,in# men/ea%an mastoiditis /ait Streptococcus pneumonia 2)5; Staphylococcus aureus 1! ; Haemophilus influenza 1! ; Streptococcus pyogenes 14;
dan Pseudomonas aeruginosa 14 ;. Tin##in/a "e
a##,esin/a $ato#en me,$a%an 0asi" da,i an/a%n/a %e#a#a"an da,i te,a$i antiioti% %on
A-at!i T/0i-1a T/-1a da- Ma2tid
Te"in#a ten#a0 ada"a0 ,an# %e6i" /an# e,isi da,a /an# e,ada $ada os petrosus t"an# tem$o,a". Te"in#a ten#a0 di$isa0%an den#an te"in#a "a, o"e0 mem,an tim$ani dan den#an te"in#a da"am o"e0 fenestra vestibuli dan fenestra rotunda. Se6a,a mm te"in#a ten#a0 te,di,i da,i mem,an tim$ani %a<m tim$ani dan recessus epitympani. Pada te"in#a ten#a0 (#a 3
te,da$at ti#a a0 t"an# $enden#a,an. Maleus /an# me"e%at %e dindin# $oste,io, mem,an tim$ani /an# %emdian e,a,ti%"asi den#an incus incus %emdian e,a,ti%"asi den#an stapes dan a%0i,n/a asis stapes e,inse,si %e fenestra vestibuli mement% sat ,antai 6in6in $enden#a,an /an# t0
5!
'ama, 2.1. Anatomi te"in#a dan mastoid.5 Ba#ian $oste,io, recessus epitympani te,da$at adits %e antrum mastoideum. Antrum mastoideum me,$a%an sat %a
se%ita, ant,m mastoid dan te,s menin#%at da"am (m"a0 ma$n %,an sam$ai se%ita, sia $e,tas. Jm"a0 dan %,an da,i se" da,a san#at e,
'ama, 2.2 Dia#,amati% 0n#an anatomi da,i te"in#a ten#a0 dan mastoid air cell.)
%.%
Ma2tiditi2
%.%.$
D/f/-i2i
Mastoiditis ada"a0 $,oses $e,adan#an /an# me"iat%an se"7se" mastoid $ada t"an# tem$o,a". Mastoiditis $ada mmn/a me,$a%an %om$"i%asi da,i otitis media.1
%.%.%
Eti01i$
P,oses ine%si iasan/a di$en#a,0i o"e0 a%to, 0ost dan a%to, mi%,oio"o#i. a. -a%to, Host = 7 Ummn/a mastoiditis i"a $ada ana% ditem%an $ada m, : 2 ta0n den#an 7
,ia/at otitis media. Be,%aitan den#an sistem imn $ende,ita /an# men,n. 5
. -a%to, Mi%,oio"o#i Pato#en /an# se,in# ditem%an $ada mastoiditis /ait = Streptococcus pneumonia me,$a%an $ato#en /an# $a"in# se,in# ditem%an • • • • • • • • • •
%.%.#
$ada mastoiditis a%t den#an $,e
Epid/!i01i
Insidensi te,tin##i mastoiditis te,(adi $ada ne#a,a e,%eman# dan $ada ana% %e6i". Kean/a%an $asien e,m, : 2 ta0n den#an m, ,ata7,ata /ait 12 "an. Namn mastoiditis da$at te,(adi $ada m, e,a$n. 14
%.%.&
'0a2ifi3a2i
Mastoiditis te,a#i atas a%t s a%t dan %,oni% /a%ni =14 1. Mastoiditis a%t te,a#i atas = a. Mastoiditis a%t den#an $e,iosteitis 8 mastoiditis insi$ient9 den#an %a,a%te,isti% $,"en $ada ,on##a mastoid. . Mastoiditis %oa"esen 8Mastoiditis a%t osteotis9 den#an %a,a%te,isti% 0i"an#n/a se$ta t"an# anta,a se"7se" da,a mastoid. Keadaan ini da$at men/ea%an te,ent%n/a ,an# ases dan dise%si $s %edae,a0 se%ita,n/a. 2. Mastoiditis s%,oni% /ait ine%si mastoid dan te"in#a "o #,ade /an# meneta$ /an# men/ea%an de%st,%si se$ta t"an#. 3. Mastoiditis %,oni% me,$a%an ine%si s$,ati se"7se" da,a mastoid /an# e,"an#sn# se"ama 0itn#an "an 0in##a ta0n. Mastoiditis %,oni% mmn/a e,0n#an den#an otitis media s$,ati %,oni% dan %0ssn/a den#a $ement%an %o"esteatoma. %.%.4
Patfi2i01i
Mastoiditis a%t mmn/a me,$a%an %om$"i%asi da,i otitis media. Ha" ini di%a,ena%an %a,ena adan/a 0n#an anta,a te"in#a ten#a0 dan se"7se" da,a mastoid in"amasi $ada te"in#a 6
ten#a0 (#a da$at mem$en#a,0i mastoid. Ji%a ine%si $ada te"in#a ten#a0 e,"an(t $ada mastoid a%an te,(adi a%m"asi $,"en.1* Pen/matan ant,m o"e0 in"amasi m%osa menim"%an ine%si da,i se"7se" da,a den#an 6a,a men#0amat a"i,an dan den#an men#0a"an#i a"i,an da,a %ema"i da,i sisi te"in#a ten#a0. Mastoiditis da$at menems ant,m dan me"as %est,%t, se%ita,n/a se$e,ti menin#ens sins si#moid otot ste,no%"eidomastoid
a,te,i %a,otis inte,na
te,set"a0 /an# men/ea%an tin##in/a mo,iditas mastoiditis dan men(adi $en/a%it /an# da$at men#an6am n/aa.41+ Be,dasa,%an $,o#,esi ata nana0 da"am se". Ta0a$ 3 7 Ne%,osis t"an# /an# disea%an o"e0 0i"an#n/a osteotis /an# a%an me,sa% t,ae%"a t"an# /an# mement% se"7se" mastoid $ada %ondisi ini diset mastoiditis %oa"esen. Mastoiditis %oa"esen $ada dasa,n/a me,$a%an sat em$iema $ada t"an# tem$o,a". Ps /an# di0asi"%an mn#%in men#a"i, me"a"i ,te = 819 $en/a",an me"a"i ant,m se6a,a a"ami /an# men#0asi"%an $en/em0an s$ontan 829 %e "ate,a" 0in##a %e $e,m%aan $,osess mastoides /an# men/ea%an ases s$e,iostea" 839 se6a,a ante,io, mement% ases di e"a%an# dan te"in#a ata dianta,a otot ste,no%"eidomastoid da,i "e0e, /an# men#0asi"%an ases Bezold 849 se6a,a media" %e se" da,a $et,os $ada t"an# tem$o,a" /am# diset $et,ositis dan 859 $oste,io, %e t"an# o%si$ita" /an# men/ea%an osteomie"itis da,i %a"
*
Se$e,ti %ean/a%an ine%si ai% a%to, 0ost ma$n a%to, mi%,oio"o#i mem$en#a,0i $e,%eman#an da,i mastoiditis. -a%to, 0ost te,mas% imnitas m%osa anatomi t"an# tem$o,a" 7
imnitas sitemi%. Sedan#%an a%to, mi%,oio"o#i /ait ,esistensi antimi%,oa %emam$an $ato#en menems (a,in#an ata $em"0 "o%a" dan me%anisme $e,"indn#an di,i mi%,oa.14
%.%.*
G/ja0a '0i-i2
'e(a"a %"inis e,
Dia1-2i2
Dia#nosis dite#a%%an e,dasa,%an anamnesis $eme,i%saan isi% ma$n $eme,i%saan $enn(an#. Pada anamnesis ditem%an adan/a %e"0an se$e,ti %e"a,n/a 6ai,an da,i te"in#a demam n/e,i $ada te"in#a 0i"an#n/a $enden#a,an. Pada $eme,i%saan isi%
ditem%an
e,itema>%eme,a0an dan "na% $ada e"a%an# dan te"in#a dan ano,ma"itas da,i mem,ane tim$ani. Pada ana% "ei0 da,i 2 ta0n $inna iasan/a de
P,osed,
ini
memt0%an
anestesi mm
den#an
%entn#an
mendete%si
%o"esteatoma retraction pocet (a,in#an #,an"asi $o"i$ ata enda asin#. Sea0 s$esimen da,i te"in#a ten#a0 tan$a adan/a %ontaminasi da,i meats a%sti%s e%ste,na a%an di"a%%an $eme,i%saan #,am $ea,naan ta0an asam %"t, ae,o>anae,o. Bio$si di"a%%an (i%a te,da$at %e6,i#aan ,adomiosa,%oma ne,o"astoma /an# da$at e,maniestasi se$e,ti otitis media
8
s$,ati %,oni% ata mastoiditis %,oni% /an# iasan/a e,0n#an den#an "m$0n/a sa,a %,ania". 1+ Peme,i%saan ,adio"o#i ?t7S6an
di"a%%an nt% meni"ai $e,"asan da,i mastoiditis.
Ma#neti6 esonan6e Ima#in# 8 MI9 a#s da"am meni"ai (a,in#an "na% dan mastoid se,ta %om$"i%asin/a.11
'ama, 2.3.Des%t,%si t"an# $ada ?T %o,ona".
'ama, 2.4. MI $ada Mastoiditis det,a. A%m"asi 6ai,an $ada mastoid %anan 8 $ana0 $ti09. Sea"i%n/a $ada mastoid %i,i no,ma" te,isi da,a 8 $ana0 me,a09
%.%.,
Dia1-2i2 Ba-di-1
A. Ana% = 112 1. adomiosa,%oma 2. Histiositis 3. Le%emia 9
4.Kaasa%i s/nd,ome B. Deasa =112 1. @titis E%ste,na -"minan 2. Histiositis 3. Metastati6 disease
%.%.6
T/rapi
1. Te,a$i Medi%amentosa13 a. Indi%asi = 7 Tida% adan/a #ama,an %ete,"iatan int,a6,ania" 7 Tida% adan/a "%tasi $osta,i%"a, 7 Tida% adan/a tanda $ada ?T7s6an /an# menn(%%an des%t,%si da,i se" 7 . Metode
da,a mastoid. @titis media s$,ati ti$e (ina% dan tan$a %o"esteatoma
Peme,ian antiioti% $a,ente,a" e,dasa,%an 0asi" %"t, dan sensiti
2. Te,a$i o$e,asi13 a. Indi%asi = 7 Kom$"i%asi int,a%,ania" 7 Adan/a "%tasi $osta,i6"a, dan ases s$e,iostea". 7 Mastoiditisa%t %oa"esen 7 Ke#a#a"an te,a$i medi%amentosa den#an antiioti% ade%at se"ama 4) 7&2 (am. 7 @to,,0ea /an# meneta$ "ei0 da,i 2 min## a"a$n den#an antiioti% /an# ade%at Ko"esteatoma
7 . Metode 1. P,osed, in
10
Dia#,am 2.1. St,ate#i Pen#oatan Mastoiditis
11
%.%.$".$ '!p0i3a2i
Kom$"i%asi da,i mastoiditis /ait = 124
•
Hi"an#n/a $enden#a,an %acial nerve palsy &ranial nerve involvement @steomie"itis Pet,ositis Lai,initis 'radenigo syndrome 7 @titis media n/e,i ,et,o7o,ita" dan %e"m$0an ne,<s
•
adsen (ntracranial extension 7 Menin#itis ases se,e,a" ases e$id,a" em$iema
• • • • • •
• •
sd,a" T,omosis sins si#moid Te,ent%n/a ases = 7 &itelli abscess= ases /an# me"as %e t"an# o%si$ita". 7 Ases s$e,iostea" = ases anta,a $e,iostem da t"an# mastoid /an# men#0asi"%an #ama,an %0as te"in#a /an# menon(o">$,ot,de. 7 Bezold)s abscess = ases (a,in#an "na% se$an(an# sternomastoid sheathC Bezold abscesses me,$a%an %om$"%asi /an# san#at (a,an# dan iasan/a ditem%an $ada o,an# deasa den#an *ell+pneumatized mastoid tip.
'ama, 2.5. Mastoiditis den#an ases s$e,iostea" %.%.$$ Pr1-2i2
Pe,%i,aan an/a% $asien den#an acute surgical mastoiditis da$at %ema"i sem$,na (i%a tida% te,da$at %ete,"iatan ne,<s asia"is
12
BAB III 'ESIMPULAN
13
Mastoiditis ada"a0 $,oses $e,adan#an /an# me"iat%an se"7se" mastoid $ada t"an# tem$o,a". Mastoiditis mmn/a me,$a%an %om$"i%asi da,i otitis media. Ha" ini di%a,ena%an %a,ena adan/a 0n#an anta,a te"in#a ten#a0 dan se"7se" da,a mastoid. Mastoiditis isa a%t s a%t ma$n %,oni%. Dia#nosis dite#a%%an e,dasa,%an anamnesis $eme,i%saan isi% ma$n $eme,i%saan $enn(an#. Pada anamnesis ditem%an adan/a %e"0an se$e,ti %e"a,n/a 6ai,an da,i te"in#a demam n/e,i $ada te"in#a 0i"an#n/a $enden#a,an. Pada $eme,i%saan isi%
ditem%an
e,itema>%eme,a0an dan "na% $ada e"a%an# dan te"in#a dan ano,ma"itas da,i mem,ane tim$ani. Pada $eme,i%saan otos%o$i mem,an tim$ani iasan/a me,a0 menon(o" %ass. Pada mastoiditis %,oni% mem,ane tim$ani $e,o,asi %eme,a0an edema dan sensiti
di"a%%an nt% meni"ai $e,"asan da,i mastoiditis.
Ma#neti6 esonan6e Ima#in# 8MI9 a#s da"am meni"ai (a,in#an "na% dan mastoid se,ta %om$"i%asin/a. Mastoiditis
da$at
te,(adi
$ada $asien7$asien
imnos$,esi ata me,e%a /an#
mene"anta,%an otitis media a%t /an# dide,itan/a. Kom$"i%asi $en/a%it otitis media dan mastoiditis 8a%t dan %,oni%9 da$at me"iat%an $e,a0an7$e,a0an "an#sn# da"am te"in#a ten#a0 dan mastoid ata ine%si se%nde, $ada st,%t, di se%ita,n/a. Te,a$i mastoiditis da$at e,$a te,a$i medi%amentosa /ait $eme,ian antiioti%a ma$n te,a$i den#an o$e,asi /ait mastoide%tomi. Kee,0asi"an te,a$i te,#antn# sda0 ada%a0 %om$"i%asi ata %ete,"iatan int,a%,ania".
DAFTAR PUSTA'A
14
1.
De
PP
et
a".
2+13.
Mastoiditis.
A
,om
0tt$=>>emedi6ine.meds6a$e.6om>a,ti6"e>2+5!!5&7o>.n6i.n"m.ni0.#o<>$med>1&2354+2 A66esed 1 Mei 2+14F 4. B,oo% It0a% et a". 2+14. Pediat,i6 mastoiditis. A>emedi6ine.meds6a$e.6om>a,ti6"e>*!!+**7o
Basi6
Ino,mation.
A
,om
0tt$s=>>.6"ini6a"%e/.6om>to$i6s>oto"a,/n#o"o#/>mastoiditis.0tm"424!2! A66esed 1 Mei 2+14F 13. ao AM As0o, B 'aad AA. 2+12.U$dated mana#ement st,ate#ies o, mastoiditis and mastoid as6ess. E#/$tian Jo,na" o Ea, Nose T0,oat and A""ied S6ien6es 82+129 13 434).
15
