Transcript EENT , Lecture - auafifthsemester.org

EYES, EARS, NOSE AND THROAT
conjunctivitis
 Most common eye disease
 May be acute or chronic
 Most cases caused :
1- bacterial (gonococcal and chlamydial )
2-viral infection
 Other causes : allergy and chemical irritants
Bacterial Conjunctivitis
A. Gonococcal Conjunctivitis
 Acquired through contact with infected genital
secretions.
 Manifested by a copious purulent discharge
 Involvement of corneal leads to perforation
 Dx confirmed by stained smear and culture of the
discharge.
Treatment
 Topical antibiotic :erythromycin or bacitracin
 Single IM dose of ceftriaxone ,1g ,is effective
 When the cornea is involved , a 5-day of parenteral
ceftriaxone ,1-2g daily ,is required.
viral Conjunctivitis
 Adenovirus is the most common cause
 Associated with :pharyngitis, fever, malaise and
preauricular adenopathy.
 Characterized by :red palpebral conjunctiva and
copious watery discharge
 Treatment : local sulfonamide therapy , hot
compresses
Allergic Conjunctivitis
 No pain , vision changes
 Marked pruritus
 Bilateral watery eyes
 Treatment :antihistamine or steroid drops
Herpes Zoster Ophthalmicus
 Frequently involves the ophthamic division the
trigeminal nerve.
 Eruptions preceded by :malaise, fever, headache and
burning and itching in the peri-orbital region.
 Rash ccc v
vesicular
pustular
crusting
Ocular manifestations:
 Conjunctivitis
 Keratitis
 Episcleritis
 Anterior uveitis
 Elevated intraocular pressure
 Treatment :high dose oral acyclovir
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Uveitis
Inflammation of the iris , ciliary body and /or choroid
Characterized by : pain , miosis, photophobia
Diagnosis made by slit lamp examination
Flare & cells seen in aqueous humor
Seen in IBD, sarcoidosis
Treatment underlying disease
Glaucoma
• A group of diseases that can damage the eye’s optic
nerve and result in vision loss and blindness
• 2 types :
1. Angle –closure glaucoma
2. Open-angle glaucoma
Angle closure glaucoma
• Severe pain
• Decreased peripheral vision
• Presence of halos around lights
• Fixed mid-dilated pupil
• Tonometry reveals elevated intraocular pressure
• Treatment : IV mannitol , acetazolamide, laser
iridotomy for cure
Cataract
• Lens opacity
• Blurred vision ,progressive over months or years
• No pain or redness
• Treatment :surgery
Macular degeneration
• Age-related
• Painless loss of visual acuity
• Dx by altered pigmentation in macula
• No Tx , but patient often retains adequate peripheral
vision
Retinal detachment
• Blurred vision in one eye becoming w0rse ( “ a curtain
came down over my eyes”)
• No pain or redness
• Detachment seen by ophthalmoscopy
• Tx = urgent surgical reattachment
OTITIS EXTERNA
• Presents with otalgia
• Pruritus
• Purulent discharge
• h/o recent water exposure or mechanical trauma
• Examination reveals : erythema and edema of the ear
canal and pulling on pinna or pushing on tragus cause
pain
• Pseudomonas is usual cause
• Treatment:
Protection of the ear from additional moisture
II. Otic drops containing a mixture of aminoglycoside
antibiotic and anti-inflammatory corticosteroid( eg.
Neomycin sulfate , polymyxin B , and
hydrocortisone
I.
Malignant External otitis
• Persistent external otitis in the diabetic
• Caused by pseudomonas aeruginosa
• May evolve into osteomyelitis of the skull base
• Presents with persistent foul aural discharg,
granulations in the ear canal ,deep otalgia, progressive
cranial nerves palsies
• CT confirmed the dx by demonstrating of osseous
erosion
Treatment
• Medical : antipseudominal antibiotic often for several
months
• Surgical debridement
Acute Otitis Media
• Bacterial infection of the mucosally lined aircontaining spaces of the temporal bone.
• Precipitated by a viral upper respiratory tract infection.
• Most common in infant and children
• Most common pathogens : streptococcus pneumonia,
haemophilus influenzae and streptococcus pyogenes
 Patient presents with otalgia, aural pressure, decreased
hearing and fever.
 Typical findings : erythema and decreased mobility of
the tympanic membrane.
 Treatment:
 First –choice antibiotic either amoxicillin or
erythromycin.
 Amoxicillin-clavulanate useful alternative
Vertigo Syndromes
A. Benign positional vertigo
•
Sudden,episodic vertigo with head movement lasting
for seconds.
• Treatment : hallpike maneuver
B. Viral labyrinthitis
• Prececed by viral respiratory illness
• Vertigo lasting days to weeks
• Treatment : meclizine
Meniere’s disease
• Dilation of membrane labyrinth due to excess
endolymph
• Characterized by classic triad :hearing loss, tinnitus
and episodic vertigo lasting several hours.
• Treatment : thiazide, anticholinergic or surgery
Acoustic neuroma
• CN VIII schwannoma commonly affects vestibular
portion but can also affect cochlea.
• Patient presents with : vertigo, sudden deafness and
tinnitus.
• Dx = MRI of cerebellopontine angle
• Tx = local radiation or surgical erection
EPISTAXIS
• Bleeding from Kiesselbach’s plexus, a vascular plexus
on the anterior nasal septum.
• Predisposing factors :
a. Nasal trauma (nose picking, foreign bodies, forceful
nose blowing)
b. Rhinitis, drying of the nasal mucosa ,deviation of the
nasal septum, alcohol , bone spurs, antiplatelet
medication.
Treatment = direct pressure, topical nasal constriction
(phenylephrine 0.125-1% solution), consider anterior
nasal packing if unable to stop.
SINUSITIS
•
Result of impaired mucociliary clearance and
obstruction of the osteomeatal complex. Edematous
mucosa causes obstruction of the sinus drainage
tract, resulting in the accumulation of mucous
secretion in the sinus cavity that becomes
secondarily infected by bacteria.
A . Acute sinusitis
• Patient presents with : purulent rhinorrhea, headache,
pain on sinus palpation,fever, halitosis.
• Most common pathogens : S. pneumoniae, H.
influenzae, Moraxella catarrhalis.
• Tx : Bactrim , amoxicillin, decongestants
B. Chronic sinusitis
• Same clinical presentation as for acute.
• Lasts longer > 3 months
• Common pathogens : Bacteroides, Staph. Aureus,
Pseudomonas , Streptococcus spp.
• Dx = CT scan showing inflammatory changes or bone
destruction.
• Tx = surgical correction of obstruction , nasal steroids
• Complication : meningitis, abscess formation,orbital
infection,osteomyelitis
PHARYNGITIS
A. Group A Strep throat
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High fever
Severe throat pain w/o cough
Edematous tonsils with white or yellow exudate
Unilateral cervical adenopathy
 Diagnosis
H&P 50 % accurate
II. Rapid antigen test
III. Throat swab culture is gold standard
• Tx: penicillin to prevent acute rheumatic fever
I.
 Membranous ( diphtherial )
I.
II.
III.
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High fever
Dysphagia
Drooling can cause respiratory failure
Dx : pathognomonic gray membrane on tonsils
extending into throat
Tx : Antitoxin
• Fungal (candida)
Dysphagia
II. Sore throat with white ,cheesy patches in
oropharynx (oral thrush)seen in AIDS and small
children
III. Dx : clinical or endoscopy
IV. Tx : nystatin ,clotrimazole
I.
 Adenovirus
I.
II.
III.
IV.
V.
Fever
Red eye
Sore throat
Dx : clinical
Tx : supportive
 Herpangina ( coxsackie A)
I.
II.
III.
IV.
V.
VI.
Fever
Pharyngitis
Body ache
Tender vesicles along tonsils, uvula and soft palate
Dx : clinical
Tx : supportive