Otitis 3: Eksterna - Patofisiology

Patofisiology
Trauma to the ear hole, the accumulation of keratin, or changes in pH can affect the occurrence of inflammation and infection. One study revealed that the bacteria have aerobe share of 91%, anaerobe four percent (4%), and also a mix of infection-four percent (4%). Organism is found most often among others have Pseudomonas aeruginosa (50%), Staphylococcus aureus (23%), anaerobe and gram negative organisms (12.5%), and yeast such as Aspergillus and Candida (12.5%). Increase of pH of pond water can be trusted to make infection may be more severe.

Predispositions Factors
Factors specific predisposes as follows:
a. Changes in skin pH is usually acid canalise be bass.
b. Changes in the environment, especially a combination of increased temperature and humidity.
c. A trauma is often mild or swim because of excessive ear cleaning.

Symptom and alert
Symptoms arising in otitis external diffuse, among others:
a. Redness on the outside of the ear (pinna) and ear hole that used to feel very sore.
b. Scaly skin that is good in and around the ear hole when flake.
c. Discharge from the ear and a little thin like pus.
d. Droop when the ear or jaw
e. At the time of ingest felt pain in the throat
f. Some people also lost their hearing

A diagnostic
a. Press painful tragus
b. Great pain
c. Most of the swelling wall canalise
d. Secret slightly
e. Hearing normal or slightly reduced
f. The absence of a fungus disease
g. There may be a painful adenopati regional press

Otitis external diffuse usually very painful
Stroma covering the bones in the third hole in the ear is very thin so that it allows only minimal swelling. So subjective interference experienced patients are often not comparable with that observed disease investigator.


Clinical manifestations
Eritema skin, secret a greenish skin edema and ear hole is a classical signs of otitis diffuse acute. Stench of secret not occur. Otitis external diffuses can be divided into 3 stages, namely:

a. Stadium "Pre inflammatory"
Stadium began with the loss of this layer of fat is normal and can be caused by the entry of water during the swim, wear clean cotton wool, and pry into your ear hole with the tools blunt. When the fat layer disappears at the time the weather is hot and humid air from the womb corneum increased stratum so that edema occurred intracellular. Edema is caused secret expenditure through orifisum apopilosebasea and layers of fat.
When exposed to hot and humid weather and long time the skin of the ear hole is not protected masers experience and reasonable ekfoliasi of cells epistle of the stratum corneum will not occur. This will cause a tickle, so try to minimize it with a paw or rub the cycle until there were: itching, Lucifer (itch scratch cycle). This will cause trauma to the stratum corneum, and there were predisposes for infection.

b. Stadium acute inflammation
Stadium this happens in 3 levels, namely: light, medium and heavy.
1. Lightweight
At the stadium, the patient experienced malaise when the light touches the tragus or concha moving. On examination the ear skin vagina will appear eritema and edema. When found a layer of clear secret not smell or accumulation of materials rekfoliasi or both. Ear drum looks less shiny.
2. Medium
Found itchiness and pain that are. Lumen ear hole partially closed by edema and exudate. Appear mass "debris" seropurulen cover the lumen and edema can also be seen there is currently little auricular, but does not have adenopati.
3. Heavy
On a more serious cases, patients complain of severe pain when chew and manipulated outside the ear. Although the helix does not seem involved, have found a clear edema periaurikuler and closing the lumen of the ear hole. Secret seropurulen a gray or green and exfoliated the visible mass in the lumen. Skin of the ear hole appear edema, and thick as can be seen papula, especially on top of the rear wall.
There is a decrease in the characteristics of the skin on the wall behind your ear hole (convex sagging), with a smooth and convex. This decrease extends membrane tympani. Otoskopi on using the enlargement, then can be seen papula white milk protruding from the surface and the surface, can also vesicle grayish organized by regions eritema.
Histopatologi showed the infected epidermis, and edema. Gram negative bacillus mainly pseudomonas species culture can almost 100% of your ear like this. When infected solved, it will appear papula small and pustule arising from secret purulent. In many circumstances this neutrofil complications can be obtained from the results secrete undelete it.

c. Stadium chronic infections (inflammation chronicles)
Besides the ear skin of leaves vary in degree, will thick (hiperkeratosis, acanthuses) and edema, which extends into the ear so that will orificium going refinement of the vagina and the ear hole of the ear, and abrasions on the laserasi lobe and conch. Dry mass and exfoliated often closed ear hole and can be found also secret colored gray or brown greenish and the smell fills recesses timpani.
Ear drum is not shiny and thick. Culture of the ear hole would result in the growth of gram negative bacillus (especially Proteus) and sometimes found fungi. Undelete will showed that the colored cells epistle basil and a very large amount.

Histopatology
In the acute otitis external diffuse the picture looks hiperkeratosis epidermis, parakeratosis, acanthuses, erosion, spingiosis, hiperplasia stratum corneum and stratum germinativum, edema, hiperemis, infiltration leukocyte, necrosis, necrosis focal followed in the dermis of healing fibroblast and apparatus gland decreased, the activities secretaries gland reduced.