Warung Bebas

Wednesday, 27 July 2011

Chronic Supurative Otitis Media (CSOM)

3 days ago Mbah Dukun posted about Ear disease, Acute Otitis Media. Today, Mbah Dukun posts about complication of Acute Otitis Media. Yes from the title all of you know what Mbah Dukun means, Chronic Supurative Otitis Media. Is it dangerous? find the answer below.

CSOM is chronic inflammation of the middle ear cavum, mastoid and tympanic membrane is intact (perforated) also found an intermittent purulent secretions (othorea).  Secretions may be watery or thick, clear or in the form of pus and lasted more than 2 months. 
CSOM can be divided into two types :
1.  Tubotympany = benign type = rhinogen safe.
Tubotympany characterized by the presence of a central perforation or pars Tens and clinical symptoms that vary depends on wide and severity of disease.  Clinically divided into:
a.  active
In this type, there are secretions of the ear and deafness.  Usually preceded by the expansion of the upper respiratory tract infections through the eustachius tube or after swimming where germs enter through the outer ear canal.  Secretions varied from mucoid to mucopurulent.
b.  not active
From examination the ear found total dry perforation with middle ear mucosa is pale.  Symptoms encountered a mild conductive deafness.  Other symptoms are encountered, such as vertigo, tinnitus, or a feeling of fullness in the ear.
2.  Type aticoantral = wild type = danger =  bone type
In this type were found Cholesteatoma and dangerous.  Aticoantral type is more often about flaccida pars and the trademark is the formation of retraction pockets, which is where the accumulation of keratin to produce Cholesteatoma.
Cholesteatoma can be divided
above two types, namely:
a.  Congenital
b.  Obtained.
In general, there Cholesteatoma in chronic otitis media with perforation marginal, but some are located in the pars flaccida (Attic retraction cholesteatom).

CSOM occurs almost always starts with recurrent otitis media in children, rarely in the adult.  Infection factor usually comes from the nasopharynx (adenoiditis, tonsillitis, rhinitis, sinusitis), reaching the middle ear through the tube of Eustachius.  Eustachius tube abnormal function are predisposing factors which found in children with cleft palate and Down's syndrome.  Presence of tubal pathology, causing reflux of contents nasopharynx which is a factor of the high incidence of CSOM in the United States.  Humoral abnormalities (such as hipogammaglobulinemia) and cell-mediated (such as HIV infection) can manifest as chronic ear secretion.
Causes of CSOM among others:
1.  Environment
2.  Genetic
3.  history of otitis media.
4.  Infection
5.  Upper respiratory tract infection
6.  Autoimmune
7.  Allergy
8.  Eustachius tube disfunction.
Some of the factors that cause persistent tympanic membrane perforation in CSOM:
• Infections that persist in the middle ear mastoid resulting in the production of purulent ear discharge persists.
• The continued obstruction Eustachius tube which reduces the spontaneous closure of the perforation.
• Several large perforations suffered through the mechanism of spontaneous closure of epithelial migration.
• At the edge of the perforation of squamous epithelium can experience rapid growth over the medial side of the tympanic membrane.  This process also prevents the spontaneous closure of the perforation.
Factors that cause middle ear infections become chronic suppurative compound, among others:
1.  Eustachius tube dysfunctions chronic or recurrent.
a.  Nose and throat infections are chronic or recurrent.
b.  Partial or total anatomic obstruction tube Eustachius
2.  Persistent tympanic membrane perforation.
3.  The occurrence of squamous metaplasia or other permanent pathological changes in the middle ear.
4.  Persistent obstruction of the aeration of the ear or mastoid cavity.
5.  There are areas with sekuester or persistent osteomyelitis in the mastoid.
6.  Basic constitutional factors such as allergies, general weakness or changes in the body's defense mechanisms.
CSOM Patogensis not yet fully known, but in this case is the chronic stage of acute otitis media (OMA) with a perforation that has been formed, followed by the release of secretions that keep menerus1.  OMA perforation can occur secondary to chronic uneventful middle ear infection in eg dry perforations.  Some authors claim this as an inactive state of chronic otitis media.

CSOM is more often a recurrent disease.  This chronic condition is more time-based rather than pathology, and staging.  In general, the picture found is:
1.  There is a perforated tympanic membrane in the central part.
2.  Mucosa varies according to disease stage
3.  The bones of hearing can be damaged or not, depending on the severity of infection
4.  Mastoid pneumatization
CSOM most often in childhood.  Most recent mastoid pneumatization occurs between 5-10 years.  When chronic infection persists, the mastoid had sclerotic process, thereby shrinking the size of the mastoid processes.

1.  Discharge Ear (Otorrhoe)
Purulent or mucoid secretions is dependent stage of inflammation.  In CSOM benign type, the liquid that comes out muco pus that do not stink, often as a reaction to irritation of the mucosa of the middle ear by the tympanic membrane perforation and infection.
The exit discharge is usually intermittent.  In the inactive stage CSOM not found adannya ear secretions.  In CSOM wild type, element and mucoid middle ear secretions reduced or lost due to widespread destruction of the mucosal lining.  Secretions are mixed with blood-related presence of granulation tissue and ear polyps and a sign of Cholesteatoma.  If secretions are watery watery without the possibility of tuberculosis leads to pain.
2.  Hearing Loss
Conductive deafness is usually encountered but can also be mixed.  Severity of deafness depends on the magnitude and location of tympanic membrane perforation and mobility sound delivery system into the middle ear.  In CSOM malignant type, usually obtained severe conductive deafness.
3.  Otalgia (Ear Pain)
In CSOM, complaints of pain caused dammed pus drainage.  Pain may mean the threat of complications due to drainage constraints secretions, exposure durameter or lateral sinus wall, or the threat of brain abscess formation.  Pain is a sign of developing complications such as Petrositis CSOM, subperiosteal abscess or lateral sinus thrombosis.
4.  Vertigo
vertigo often appears, is a sign of labyrinthine fistula caused by the occurrence of erosion of the walls of the maze by Cholesteatoma.  Vertigo that arises usually due to a sudden change in air pressure or the sensitive patient.  vertigo can occur simply because a large perforation of tympanic membrane, causing a maze more easily aroused by the temperature difference.  The spread of infection into the labyrinth will also be led to complaints of vertigo.  Vertigo can also occur from complications of the cerebellum.

Clinical signs of malignant type CSOM
1.  Presence of abscess or fistula retroauricular
2.  Granulation tissue or polyps in the ear canal from the tympanic cavity.
3.  Pus is always active or foul smelling (smell Cholesteatoma)
4.  X-ray mastoid Cholesteatoma the picture.

To complete the examination, clinical examination can be performed as
Audiometric examination
In patients with CSOM audiometric examination is usually found to conductive deafness.  But it can also be found there sensorineural deaf, deafness severity depending on the size and location of the tympanic membrane perforation as well as the integrity and mobility
The degree of hearing loss threshold of hearing
Normal: -10 dB to 26 dB
Mild : 27 dB to 40 dB
Moderate: 41 dB to 55 dB
Moderat to Severe: 56 dB to 70 dB
Severe: 71 dB to 90 dB
Total deafness: more than 90 dB.
To evaluate, the following observations :
1.  Perforation usually cause deafness conductive generally no more than 15-20 dB
2.  Damage to the bones of the circuit causing deafness conductive hearing loss 30-50 dB when accompanied by perforation.
3.  Discontinuity of bone behind of intact tympanic membrane causing conductive deafness 55-65 dB.
4.  Weaknesses and low discrimination speech, no matter what the conductive of bone, showed severe damage cochlea.
Radiological examination.
1.  Projection Schuller
Shows the extent of mastoid pneumatization of the lateral direction and over.  This photo is useful for surgery because it shows the position of the lateral sinus and the tegmen.
2.  Projection Mayer or Owen,
Taken from the middle ear and anterior direction.  Will look picture the bones of hearing and tweaking so it can be known whether the bone damage has on structures.
3.  Projection Stenver
Shows a picture along the petrosal pyramid and more clearly shows the internal auditory canal, vestibule and semicircular canals.  These projections put the antrum in cross section so as to show the existence of enlargement.
4.  Projection Chause III
Give an especial longitudinally so that it can show early damage to the lateral wall of tweaking.  Politomografi and or CT scans can depict bone damage because Cholesteatoma.
Bacteria are often found in CSOM are Pseudomonas aeruginosa, Staphylococcal aureus and Proteus.  While the OMSA streptococcus bacteria pneumonie, H.  influenza, and Morexella kataralis.  Other bacteria found in CSOM E.  Coli, Difteroid, Klebsiella, and anaerobes are Bacteriodes sp.
1.  Specific bacteria
Eg Tuberculosis.  Otitis tuberculosis is very rare (less than 1%).  In adults is usually caused by advanced lung infection.  These infections enter the middle ear through the tube.  Tuberculous otitis media can occur in children who are relatively healthy as a result of drinking milk that is not pasteurized
2.  Non-specific bacteria both aerobic and anaerobic.
Aerobic bacteria are often met by Pseudomonas aeruginosa, Staphylococcus aureus and Proteus sp.  Antibiotics are sensitive to ceftazidime and Pseudomonas aeruginosa is ciproflokxacin, and is resistant to penicillins, cephalosporins and macrolides.  While Proteus mirabilis sensitive to antibiotics except for macrolides.  Staphylococcus aureus resistant to sulphonamides and trimethoprim and sensitive to cephalosporin generations I and gentamicin

The principle of treatment depends on the type and extent of infectious diseases, where treatment can be divided into:
1.  Conservative
2.  Surgery

This situation does not require treatment, and advised not to scrape the ears, the water should not enter the ear during bathing, swimming is prohibited and immediately seek treatment when suffering from upper respiratory tract infection.  If the facility allows reconstruction surgery should be performed (miringoplasty, tympanoplasty) to prevent recurrent infections and hearing loss.
The principle of treatment of CSOM is:
1. Clean ear canal and tympanic cavity.
2. antibiotics:
- Topical antibiotics (antimicrobial)
- Systemic.
Topical antibiotics
Antibiotics topically in the ear and a lot of secretions without cleaning first, is not effective.  If the discharge is reduced / no longer progressive but given
drops containing antibiotics and topical drug delivery kortikosteroid.4 Given meant to go to the middle ear, it is not recommended that antibiotics such as neomycin and duration ototoxic not more than 1 week.  How to best selection of antibiotics based on culture, and resistency test.
Ear powder used as:
a.  Acidum boricum with or without iodine
b.  Terramycin.
c.  Asidum borikum chloromicetin 2.5 grams mixed with 250 mg
Topical antibiotic treatment can be widely used for active CSOM combined with ear cleaning.  Topical antibiotics that can be used in chronic otitis media is:
1.  Polymyxin B or polymyxin E
These drugs are bacterisid against gram-negative bacteria, Pseudomonas, E.
Koli Klebeilla, Enterobakter, but the resistant gram-positive, Proteus, B.  fragilis Toxic to kidneys and nervous system.
2.  Neomycin
bactericid drugs on gram-positive and negative, for example: Staphylococcal aureus, Proteus sp.  Resistant to all anaerobes and Pseudomonas.  Toxic to the kidneys and ears.
3.  Chloramphenicol
These drugs are bactericid
Systemic antibiotics
Antibiotics are not more than 1 week and must be accompanied cleaning profus secretions.  In the event of treatment failure, keep in mind that there are reasons of failure in these patients.  Antimicrobials can be divided into 2 groups.  The first class of power killed him dependent measure.  The higher levels of the drug, the more germs were killed, for example with the quinolone class of aminoglycosides.
The second category is a particular concentration of antimicrobial that killed her best resources.  Elevation does not increase the dose of killing power of this class of antimicrobials, such as beta-lactam class.
Systemic antibiotic therapy is recommended in chronic otitis media is.
Pseudomonas: Aminoglycosides ± carbenicillin
P.  mirabilis: Ampicillin or cephalosporin
P.  morganii, P.  vulgaris: Aminoglycosides ± carbenicillin
Klebsiella: Cephalosporin or aminoglycosides
E.  coli: Ampicillin or cephalosporin
S.  Anti-stafilikokus aureus: penicillin, cephalosporin, erythromycin, aminoglycosides
Streptococci: Penicillin, cephalosporin, erythromycin, aminoglycosides
B.  fragilis: clindamycin
Class of quinolone antibiotics (ciprofloxacin and ofloxacin) are able to nalidixic acid derivate that has anti-pseudomonal activity and can be administered orally.  But it is not recommended for children under the age of 16 years.  Cephalosporin Group III generation (cefotaxime, and ceftriaxone seftazidinm) are also active against Pseudomonas, but must be administered parenterally.  This therapy is very good for the OMA, while for CSOM is uncertain enough, although it can cope with CSOM.  Have the effect of metronidazole for anaerobic bactericid.  According to Browsing et al metronidazole can be given with and without antibiotics (cephalexin and cotrimoxazol) on active CSOM, a dose of 400 mg per 8 hours for 2 weeks or 200 mg per 8 hours for 2-4 weeks.
Malignant CSOM
Treatment for Malignant CSOM is surgery.  Conservative medical treatment is only a temporary treatment before surgery.  If there is a subperiosteal abscess, the abscess incision should be done separately before then performed mastoidektomy.
There are several types of surgery or surgery techniques that can be done in CSOM with chronic mastoiditis, either benign or malignant type, among others:
1.Mastoidektomy simple (simple mastoidectomy)
2. radical Matoidectomy
3.radical with modifications mastoidectomy
6. Combined approach tympanoplasty)
The goal is to stop operating permanently infection, tympanic membrane perforation repair, prevent complications or more severe hearing damage, and improve hearing.

Tendency of complications of otitis media gets depends on the pathological abnormalities that cause otorrhoea.  Nevertheless resistant organisms and lack of effective treatment, would lead to complications.  usually obtained in patients with CSOM complications malignant type, but an acute otitis media or an acute exacerbation by a virulent bacteria in CSOM benign type can cause complications.
Serious intra-cranial complications more often seen in acute exacerbation of CSOM associated with Cholesteatoma.
A.  Complications of middle ear:
1.  Persistent tympanic membrane perforation
2.  Erosion of bone loss
3.  Facial nerve paralysis
B.  Ear complications in
1.  Labyrinth fistula
2.  Labyrinitis suppurative
3.  Nerve deafness (sensorineural)
C.  Complications of Extradural
1.  Extradural abscess
2.  Lateral sinus thrombosis
3.  Petrositis
D.  Complications to the central nervous system
1.  Meningitis
2.  Brain abscess
3.  Hindrocephalus otitis
Complication of middle ear infections trip to the intra-cranial must pass through three kinds of trajectories:
1.  From the middle ear cavity to the brain membrane
2.  Penetrate the lining of the brain.
3.  brain expansion.

Saturday, 23 July 2011


Today Mbah Dukun share information about kind of ear disease. what is that, mbah? it's called ACUTE OTITIS MEDIA. maybe you've never heard about this disease, but you might have it before. Okey mbah dukun start to explain. Just click options below

 Acute otitis media is an inflammation of the mucosa of the middle ear cavity, eustachius tube, and aditus ad antrum caused by bacterial or viral infection with clinical symptoms of ear pain, fever, and even hearing loss, tinnitus and vertigo.  generally takes place within 3-6 weeks.


The main cause of acute otitis media (AOM) is the invasion of pyogenic bacteria into the middle ear in a state that is normally sterile.  Common bacterial causes of AOM include hemolytic streptococcus, Staphylococcal aureus, Pnemococcus.  In addition, occasionally found also Haemofilus influenza, Escherichia coli, Streptococcus anhemolitikus, Proteus vulgaris and Pseudomonas aurogenosa.  Haemofilus influenza is often found in children aged under 5 years old.  Upper respiratory tract infections are recurrent and tubal dysfunction eustachii also be the cause of the AOM in children and adults.

Acute otitis media most commonly suffered by children ages 3 months-3 years.  But not infrequently also the adults.  Children are more often exposed to AOM due to several things, including:
1.  Child's immune system is not perfect
2.  Tuba eusthacius children are shorter, wider and lies horizontally
3.  Adenoid children relatively larger and situated adjacent to the mouth of the fallopian tubes so that disrupt the opening of the eustachii tube eusthachii.  Adenoids are easy to track the spread of infected bacteria and viruses into the middle ear.


AOM trigger factors can be initiated by the occurrence of upper respiratory tract infection accompanied by the repeated disruption of the body by the cilia of the tubal mucosa eusthachii, enzymes and antibodies that cause negative pressure resulting in bacterial invasion of the mucosa of the nasopharynx into the middle ear through the eustachii tube and settled in  in the middle ear becomes acute otitis media.

There are 5 stages of acute otitis media (AOM) based on changes in middle ear mucosa, namely:
1.  tubal occlusion Stadium
Marked with a picture of the tympanic membrane retraction due to negative middle ear pressure.  Sometimes the tympanic membrane appears normal or pale cloudy color.  Effusions may have occurred but difficult to detect.

2.  Hiperemia Stadium


Dilated blood vessels that appear in some or all of the tympanic membrane accompanied by edema.  Secretions are beginning to form serous exudate is still so difficult to assess.

3.  Suppuration Stadium
Severe edema of the mucosa of the middle ear accompanied by the destruction of superficial epithelial cells and the formation of purulent exudate in the tympanic cavity causing the tympanic membrane protruding toward the outer ear canal (bulging).  Clinical symptoms, the patient seems to ache, pulse, fever, and pain in the ear intensified.  In the circumstances further, ischemia can occur due to the pressure of growing purulent exudate, thrombophlebitis in the veins of small even to necrosis of the mucosa and submucosa.

4.  Perforation Stadium
Rupture of the tympanic membrane so that the pus out of the middle ear into the outer ear canal.  Sometimes the secret expenditures are pulsation.  This stage is often caused by late delivery of antibiotics and the high virulence of germs.

5.  Resolution Stadium
Characterized by a gradual normal tympanic membrane perforation of the tympanic membrane to close the back and no purulent secretions.  This occurs if the tympanic membrane was intact, good endurance and low-virulence bacteria.


Diagnosis AOM should meet the following 3 things:
1.  sudden onset (acute)
2.  The discovery of signs of effusion (effusion: fluid collection in a body cavity) in the middle ear.  Effusions evidenced by observing the following signs:
a.  Deployment tympanic membrane
b.  Limited / lack of movement of the tympanic membrane
c.  The existence of the shadow of fluid behind the tympanic membrane
d.  Discharge from the ear
3.  Signs / symptoms of inflammation of the middle ear as evidenced by the presence of either one of the following signs:
a.  Redness of the tympanic membrane
b.  Ear pain that interferes with sleep and normal activity
Children with AOM may experience ear pain, discharge from the ear, decreased hearing, fever, difficulty eating, nausea and vomiting and cranky.  However these symptoms are not specific to that diagnosis AOM AOM can not be based on history alone.  Middle ear effusions examined with otoscope to see clearly the situation in the tympanic membrane / tympanic membrane is bulging, erythema and even yellow and dingy and the presence of yellowish fluid in the ear canal.  If confirmation is required, generally performed with a pneumatic otoscope (an instrument used to see the tympanic membrane which is equipped with a small air pump to assess tympanic membrane response to changes in air pressure).  Movement of the tympanic membrane is less visible with this examination.  This examination can be used as additional tests to confirm the diagnosis of AOM.  But generally AOM can already be enforced by ordinary otoscope examination.  Middle ear effusions can also be proved by tympanosyntesis (stabbing of the tympanic membrane).  But this examination is not performed on any child.  Among other indications of the need tympanosyntesis AOM in infants younger than 6 weeks with a history of intensive care in hospital, children with immune disorders, children who are not members of the response to some antibiotics or with very severe symptoms and complications.

1.  Antibiotics
AOM is generally a disease that will heal by itself. About 80% of AOM cured in 3 days without antibiotics.  Use of antibiotics does not reduce complications, including decreased hearing.
If symptoms do not improve within 48-72 hours or there is worsening of symptoms, antibiotic given.  American Academy of Pediatrics (APP) which categorize AOM observable and should be treated with antibiotics as following;
a. <6 months of Antibiotics
b. 6 months - 2 years of Antibiotics
c. > 2 years of antibiotics if symptoms are severe. if symptoms are mild, do observations

Mild Symptoms if mild ear pain and fever <39 C in 24 last hour.  While the severe symptoms are moderate to severe ear pain or fever 39 C.
Options observation for 48-72 hours can only be performed on children age 6 months-2 years with mild symptoms during the examination or diagnosis of doubtful in children over 2 years.  Analgesia should still be given during the observation.
The first choice of antibiotics in AOM is amoxycilin. American Academy of Family Physicians (AAFP) recommends dosing 40mg/kgweight/daystandards in children with low risk (age> 2tahun, not in intensive care, had not received antibiotic treatment within 3 last month).  While high doses administered 80mg/kgweight/day in children with high risk (age <2 years, in treatment, there is a history antibiotics in the last 3 months and are resistant to giving amoxycilin low dose).  Meanwhile, The Centre for Disease Control and Prevention (CDC) recommends antibiotic therapy on the AOM as follows:

Otitis media with bulging tympanic membrane  High-dose amoxycilin (80 - 100mg/kgweight/day per oral) for 7 days
Otitis media without bulging tympanic membrane  Delays antibiotics, (Spontaneously cured)
recurrent otitis media  delays antibiotics, used influenza vaccine
Otitis media bacterial resistance e.c against high-dose amoxycilin  High-dose clavulanate amoxycilin (80-90 mg / kg / day orally for 7 days), cefuroxime axetil (30 mg / kg 2 times / day orally); ceftriaxone (IM 50mg/kgweight/day during 3 days)

Delays antibiotics and antibiotic treatment settings performed to otitis media without bulging because, generally, it recover spontaneously without antibiotic treatment. Setting prescribing can be done by administering acetaminophen in case of otalgia and fever, and if after giving it, a fever still on going and no improvement of clinical symptoms for 3 days, so amoxycilin just given in high doses.  Antibiotics in the AOM will produce symptAOMtic improvement in 48-72 hours.  In the first 24 hours occurred stabilization, while the 24 second hours began repairs.  If the patient does not improve in 3 days or re-emerged in 14 days there may be other diseases or treatment provided is not adequate / inadequate or has even happened bacterial resistance to antibiotics. If the patient is allergic to alternative antibiotics Penicilin class used were cefuroxime axetil, ceftriaxone injection (2-3x50mg/kgweight/day) or second-generation cephalosporins such as cefdinir, cefpodoxime or cefuroxime. Another option is a class of macrolides such as azithromycin and clarithromicyn.
2.  Analgesia / pain relief
Besides antibiotics, treatment should be accompanied AOM pain relievers. Analgesia is commonly used is simple analgesia such as paracetamol or ibuprofen.  However, it should be noted that the use of ibuprofen should be ensured that the children do not have indigestion Since the granting of ibuprofen can aggravate the situation.

Acute otitis media is not treated promptly with antibiotics can be continued become chronic otitis media (COM) and mastoiditis.  Another complication that can periosteal abscess occurs as up to meningitis and brain abscess even can also result in permanent hearing loss due to rupture tympanic membrane and if it has to disrupt auditory function will also cause problems in speech and language in children.

Laryngeal Papilloma

Inul Daratista, dangdut singer, came to Mbah Dukun,s house. She complained to mbah dukun about her voice. use laryngoscope direct methode, mbah dukun found something in Inul's laryng. what is that? it called Laryngeal Papilloma. Do you wanna know about Laryngeal Papilloma? just click options below.

1. Definition
2. Etiology
3. Histopatology
4. Clinical manifestations
5. Diagnose
6. Therapy and treatment (management)
7. Complications

Laryngeal papilloma is a benign proliferative squamous epithelial cell larynx which most often found. Papillomavirus is the type of tumor that develops rapidly, although not malignant. These tumors can migrate to the oral cavity, nose, trachea and lungs, but the most common location is larynx.

There are two types of laryngeal papillomas: one is the laryngeal papilloma juvenilis usually multiple and tend to be aggressive. The other is a solitary senile larynx papilloma and less aggressive but can develop into malignant.

The cause of laryngeal papilloma is a " human papilloma virus ' ( HPV ) types 6.11 which infect epithelial cells. It is estimated that the spread of the disease is present at birth from mothers exposed by " genital warts ".
In the normal mucosa cells adjacent to the papilloma, also contain viral DNA that can be activated recurrent lesions. Papilloma in children is more often multiple and recur than adults. While the papilloma in adults is usually single but it tends to become malignant with a specific subtype found that HPV 16.


Macroscopic : eksofitik lesions, such as cauliflower, gray or red and bleed easily. This type of lesion is aggressive and easily relapse, but may disappear  spontaneously.
Microscopic: showing a group of connective tissue stroma and blood vessels such as the fingers are coated with a layer of squamous epithelial cells or parakeratotik keratotic surface. Sometimes a picture appeared that bermitosis cells.

clinical manifestations
Initial symptoms are the form of hoarse voice phonation disorders, disfoni even afoni. If the papilloma is large enough can cause respiratory problems such as cough, shortness, and stridor inspiration. In children, the bias occurs misdiagnosis, because often show symptoms of hoarseness, stridor, and respiratory distress after failed treatment of severe asthma or bronchitis.

Found symptoms of hoarseness until afoni arise even respiratory distress. At the sound of crying children can appear abnormal. Found also a history of progressive hoarseness changes slowly, especially in patients who have a history of the parents had suffered Condyloma akuminata.
physical examination
Usually there is stridor on inspiration and direct laryngoscopy examination of the tumor that resembles the picture looks cauliflower, red, brittle, and bleed easily

Differential Diagnoses
1. Vocal cord polyp.
2. Vocal cord cyst.
3. Vocal cord nodules
4. bronchial asthma
5. bronchitis
6. laryngomalaise

Laryngeal papilloma therapeutic goal is to maintain the airway, maintaining voice quality and eliminates the mass of papilloma and prevent recurrence.
a. Surgery
Some techniques used include: tracheostomy, laryngofissure, microlaryngoscope and extirpation by forceps, microcauter, microlaryngoscope with diathermy or ultrasound, cryosurgery, CO2 surgical laser.
b. medical
Drugs used: antivirus, hormone ( diethylstilbestrol ), steroids, and topical podophyllin
c. immunologically
using interferon
d. photodynamic therapy
This therapy uses dihematoporfirin ether which are activated with the appropriate wavelength (630 nm ).

Post-operative care including total voice rest during the first week, spoke softly during the second week, and gradually to normal in the third week. To speed healing and prevent mucosal dryness is important given the cold mist inhalation (cool mist ) during the first week.

In general, laryngeal papillomas in children may heal spontaneously when puberty, but can be extended to the trachea, bronchus, and lung, believed to tracheostomy or extirpation due to action is not perfect.


Prognosis is generally good, early diagnosis and appropriate treatment is a factor thought to affect recurrence. The cause of death is usually due to spread to the lungs.


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