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BLOK PENGINDERAAN
CLARISSA TAN
405120024
FISIOLOGI PENDENGARAN DAN KESEIMBANGAN
• Others:
• In utero infection (CMV, herpes, toxoplasmosis or rubella
PEMERIKSAAN
Branchial fistula-
http://www.surgicalnotes.co.uk/files/imag
es/branchialfistula.jpg
SYNDROMIC HEARING IMPAIRMENT
Autosomal Dominant Hearing Impairment
Crouzon Syndrome •cranial synostosis, hypertelorism,
exophthalmos, parrot-beaked nose, short upper
lip, hypoplastic maxilla, and a relative mandibular
Prognathism.
•One-third of affected persons have a conductive hearing loss secondary to
external or middle ear abnormalities, and there is frequently an associated
sensorineural component
•Other feature: meningiomas, spinal cord dorsal
root schwannomas, and posterior subcapsular
cataracts
Neurofibromatosis 2 NF2 is a central form of neurofi bromatosis characterized by bilateral vestibular
(NF2) schwannomas
Kriteria Diagnosis :
(1)bilateral internal auditory canal/
cerebellopontine angle tumors;
(2) a first-degree
relative with NF2 and a unilateral eight nerve
tumor;
(3) a first-degree relative with NF2 and
2 of the following: neurofi broma, meningioma,
glioma, schwannoma, or juvenile posterior subcapsularlenticular opacity
SYNDROMIC HEARING IMPAIRMENT
Autosomal Dominant Hearing Impairment
Stickler Syndrome (STL) •disorder of collagen connective tissue
= hereditary arthro- characterized by marfanoid features, spondyloepiphyseal
ophtamopathy dysplasia, joint hypermobility, midface hypoplasia, severe myopia, and varying
degrees of Robin sequence (cleft palate, micrognathia, and
glossoptosis)
•15% of affected
patients also have a mixed hearing loss
Waardenburg Syndrome Sensorineural deafness and pigmentation defects of the hair, skin, and iris.
(WS). Common to the various WS types
is a defi ciency of melanocytes, which are neural
crest derivatives. pigmentation defects &the high
incidence of deafness, secondary to the loss of
melanocytes from the stria vascularis
SYNDROMIC HEARING IMPAIRMENT
Autosomal Resessive Hearing Impairment
Pendred Syndrome (PS) •most common syndromic form of deafness,
•Associated with developmental abnormalities of the cochlea,
congenital sensorineural hearing loss, and diffuse
thyroid enlargement (goiter).
•Hearing loss usually profound
but can be variable in onset, rapidly progressive,
and even unilateral
•Goiter typically presents in mid-childhood, may be at birth.
The thyroid defect involves organifi cation of iodine can be diagnosed by
administering perchlorate, which releases unbound iodide from thyroid
follicular cells
X-linked Syndromic Hearing Impairment
Alport Syndrome (AS) •The deafness was a feature of a previously described familial
nephropathy that caused uremia in males but spared females\
•Considered affected if there are 3 of the following:
(1) a positive family history of hematuria or chronic renal failure;
(2) Electron microscopic renal biopsy evidence of AS;
(3) characteristic eye signs of anterior lenticonus,
white macular fl ecks, or both;
(4) high frequency sensorineural hearing loss
TULI KONGENITAL (SEBAGAI GENETIC SYNDROME)
S O A P
-Hearing loss + -Pemeriksaan klinis: Branchio-Oto-Renal Hearing aid, support
Terdapat kelainan terdapat kelainan Syndrome (BOR)) to parents.
kongenital lain kongenital
(malformasi aurikular, -Pemeriksaan fungsi
lubang di ginjal
leher/branchial -Audiometri
fistule, lubang di didapatkan gangguan
preaurikular) pendengaran
Serous /
toxic
Labirintitis
suppurative
Klasifikasi
serous suppurative
•respon inflamasi steril thdp •Krn infeksi bakteri ke telinga
toksin bakteri dalam
•Cairan perilymphnya acidofilic •Kumpulan leukosit PMN di
•Dibagi lg mjd : ruang perilympatic
•Mild serous labyrinthitis •Progresif inflamasi>>
# perubahan sitologik nekrosis membran labirin
•Severe : degenerasi organ
corti
• Etiologi
• Etiologi secara pasti belum jelas
• Viral infections seperti flu (upper respiratory infection)
• Viral (Rubella ,Cytomegalovirus most common)
• Bacterial infection biasanya karena infeksi telinga tengah
(otitis media,meningitis)
• Komplikasi cholesteatoma
• Gejala klinis
• Nausea
• Vomiting
• Nistagmus
• Sakit kepala
• Tinitus
• Letih
• Unsteady (vertigo)
LABIRINTITIS
• Kepala berubah posisi cairan mengalir sepanjang vestibula dan canalis
semilunaris cupula bergerak ketika cairan bergerak/mengalir memicu
rangsang sinyal pada otak (respon diterima dari telinga dalam ,tulang sendi,otot
dan mata) perubahan pada posisi Tubuh
• Pada labirinitis respon dari telinga dalam berantakan sinyal telinga dalam
berbeda dengan tulang sendi,otot,mata GANGGUAN KESEIMBANGAN
(VERTIGO) hilang dalam beberapa minggu
Patofisiologi
• Early stage dr kedua tipe ini tdpt sensorineural hearing loss tp
struktur kedua koklea lengkap (rambut, sel ganglion,dll) bukan
sebab anatomis
Histopatologi:
• degenerasi organ corti
• early encapsulation of the tectorial membrane
• degenerasi stria vascularis
• infiltrasi round cell
• degenerasi kistik sel rambut dg infiltrasi round cell pd
auditory & vestibular labyrinth
• Cytomegalovirus : degenerasi kokleosakular, hydrops
endolymph. Fibrosis, fibro-oseus, ploriferasi epitelia
sensoris & supporting cell, sel sensoris hilang &
degenerasi neuronal
• Mumps : tuli, vertigo
• Herpes Zoster oticus (Ramsay hunt syndrome): rasa
terbakar pd daerah telinga dan wajah. Terdapat
hearing loss, vertigo & paresis facial
• Otosifilis : kongenital / didapat. Akibat treponema
palidum. Gejala : hearing loss tiba2/progresif.
Dg/tanpa gejala vestibular
Tatalaksana
• Antibiotic + steroid
• Terapi yg sesuai dpt memperbaiki tuli sensorineural yg disebabkan
suppurative labyrinthitis
LABIRINTITIS
S 0 A P
1.Telinga Sakit CT-SCAN and MRI Labirintitis - Meclizine
(serious case) - Diazepam
2.Telinga Berbunyi - Do not drive, work
at height or operate
heavy machinery
3.Vertigo - Bed Rest till
dizzines leaves
OTOSKLEROSIS
• Kelainan herediter lokal yg mengenai tulang endokondral pada
kapsula otik berupa gangguan resorpsi dan deposisi tulang
• Lesi terdiri atas : area resorpsi tulang, formasi tulang baru, proliferasi
vaskular, dan stroma jaringan ikat
• Etiologi: idiopatik
• Predisposing factor:
– Endolymph overproduction atau malabsorpsi → HT endolimfatik → pembesaran
labyrinthus membranaceus → endolympatic hydrops
– Kelainan telinga dalam & tulang temporal: sifilis, mumps, Cogan’s syndrome,
trauma, OMSK → gambaran klinis Meniere’s disease → Meniere’s syndrome
o Vertigo spontan bbrp tahun setelah onset hearing loss → delayed
endolymphatic hydrops
o Serangan vertigo bersamaan dgn onset hearing loss pd telinga yg normal →
contralateral delayed endolymphatic hydrops (disebabkan autoimun)
– Ruptur labyrinthus membranaseus → kebocoran perylimph yg kaya potassium ke
perylymph → Meniere’s attack
ETIOLOGY
• Viral infection of the vestibular nerve.
VESTIBULAR NEURITIS
CLINICAL MANIFESTATION:
• acute spontaneous vertigo (increases in intensity over a period of hours -- minimized by keeping
the head still and the eyes shut.)
• nausea
• vomiting
• postural imbalance.
• Unsteady and may veer towards the side of the affected labyrinth
CLINICAL SIGNS:
• spontaneous horizontaltorsional nystagmus (unidirectional -- may not be detected on a standard
neurological examination)
• partial or complete ocular tilt reaction towards the affected side
VESTIBULAR NEURITIS
DIAGNOSIS
• Subjective visual horizontal (SVH)
• Electronystagmography.
• Caloric testing (for canal paresis)
• Brain MRI (central cause)
DIFFERENTIAL DIAGNOSIS
• Cerebellar infarction
• Labyrinthine infarction
• Autoimmune inner ear disease
• Meniere’s disease
• Multiple sclerosis
VESTIBULAR NEURITIS
MANAGEMENT OPTIONS
• Corticosteroid
• Antiviral
• Vestibular rehabilitation therapy (postural and visual stability)
COMPLICATIONS
• CVI
• bilateral sequential vestibular neuritis
• Meniere’s disease
VESTIBULAR NEURITIS
S O A P