Ear Nose and Throat - Lectures
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Transcript Ear Nose and Throat - Lectures
Disorders of the Ear, Nose, Throat
& Mouth
Chapter 11
Pathology
EARS
Otitis Externa- a painful inflammation of the
membranous lining of the auditory canal and/or
contiguous structures.
Refers to acute and chronic inflammatory process
It may be diffuse or localized
Is largely benign and self-limiting
Invasive otitis externa is a potentially life threatneing
situation
EARS
OE continued
Epidemiology
10-20% more common in the summer months
Patho- inflammation is most commonly
caused by microbial infection. Colonization
of the external ear is prevented immune and
anatomic mechanisms
EARS
Management and Treatments
Pain meds
Heat or ice
Keep dry- no swimming for 7 days
Treatment for basic OE
Irrigation if indicated
Pain drops
Antibiotic drops
Ciprodex, Floxin Cortisporin
May need a wick if very swollen
EARS
Otitis Media- OM- inflammation of the
structures in the middle ear.
Otitis media with effusion –OME involves
the transudation of plasma from middle ear
blood vessels leading to chronic fluid; this
can be chronic
Acute Otitis Media-AOM is infection in the
middle ear
EARS
OM
Epidemiology
Accounts for 2-3% of all family practice office visits.
Number of visits increases in the winter. More
common in colder weather and in children.
Contributing factors include; allergies, rhinitis,
pharyngitis due to swelling of upper airway
membranes. Most common factor is upper airway
infections (colds), caused by many different viruses.
Influenza, RSV, pneumovirus, adenovirus
EARS
OME symptoms
Stuffiness, fullness, decreased hearing, pain is
rare, may have popping. Rarely vertigo
Usually a history of recent URI, allergies
Rhinitis
Rhinitis or coryza –inflammation of the nasal
mucosa with congestion, rhinorrhea, sneezing,
pruritus, post nasal drip
Allergic
Seasonal or perennial
Nonallergic
Infectious, irritant related, vasomotor, hormone-related,
associated with medication, or atrophic
May be chronic or acute
Most common types
Viral
Perennial (hay fever)
Rhinitis
Epidemiology/Causes
Actual prevalence is undocumented, but is very common
Occurs at least as much as the common cold
Estimated 40-50 million American adults suffer
Seasonal allergic rhinitis parallels pollen production
fall/spring
Allergy occurs in all age groups
Most common in adults 30-40 years
Non allergic rhinitis may be acute or chronic
Chronic maybe associated with bacterial sinusitis
Rhinitis
Rhinitis – symptoms
Viral-malaise, HA, substernal tightness, rare
fever, sneezing and coughing
Allergic-itching of all upper air way mucosa,
watery eyes, sore throat, sneezing, coughing
Vasomotor-watery nasal discharge, nasal speech,
mouth breathing, nasal obstruction that switches
sides
Rhinitis
Treatments
Allergic rhinitis
Avoid the triggers
Antihistamines
Allegra, Claritin, Clarinex, Zyrtec, Astelin
Nasal steroids
Flonase, Nasonex, Nasacort
Leukotriene receptor antagonists
Singular
Desensitizing immunotherapy
Atrophic- bacitracin to nares, saline, irrigation
Sinusitis
Sinusitis is an inflammation of the mucous
membranes of one or more of the paranasal sinuses;
frontal, sphenoid, posterior ethmoid, anterior
ethmoid, and maxillary
Acute-abrupt onset of infection and post-therapeutic
resolution lasting no more than four weeks
Subacute with a purulent nasal discharge persist despite
therapy, lasting 4-12 weeks
Chronic, with episodes of prolonged inflammation with
repeated or inadequately treated acute infection lasting
greater than 12 consecutive weeks
Sinusitis
Clinical presentation
Gradual onset of symptoms
Pain over the affected sinus, with increasing pain
Pain is worse with coughing
Area of pain corresponds the sinus affected
Develop over at least 2 weeks of URI symptoms
Nasal congestion, runny nose, pressure, cough, sore
throat, eye pain, malaise, and fatigue, headache,
cough, fever
Sinusitis
Sinusitis Management
Usually viral
Supportive care is most helpful
Sinus rinse
Few meds are helpful
Sudafed, nasal spray, expectorants,
Rarely use steroids or antihistamines
Localized sinus infections are self limited
Sinusitis
Sinusitis patient education
Should focus on the worsening of symptoms
Avoid all contributing factors
Smoke, allergens, antihistamine
Increase fluids
Pharyngitis
Pharyngitis and tonsillitis are generalized
inflammatory process of both infectious and
non infectious etiology
Most cases are viral and self-limiting
Most cases of pharyngitis are contagious
All cases of tonsillitis are contagious
Pharyngitis
Testing
Viral throat swab cultures are used to detect herpes virus
as well other viral infections…
Tzanck smear of a exudate is used to detect HSV, and
herpes zoster
Blood test may be used for viruses
HSV, EBV, CMV
Candida – KOH potassium hydroxide- looking for
hyphal yeast
Mono spot for mono
CBC for infectious pharyngitis
X-ray may be needed to assess for abscess
Pharyngitis
Management depends on the cause
Home care with symptom management
Antibiotics for bacterial causes
Diflucan, nystatin
Be sure and assess immune status if no known cause is found
Viral illnesses
See therapeutics handout
Antifungal for candida
Voice rest, humidification, saline, viscous Xylocaine, gargles,
cool mist, lozenges, sprays, Acetaminophen, codeine, warm
compresses for lymph nodes
May use antivirals in some cases- IE; Flu- use Tamiflu
Abscess- hospital IV antibiotics and maybe surgery
Temporomandibular Joint
(TMJ) Disease
TMJ is a collective term that refers to disorders
affecting the masticatory musculature and
associated structures. Sometimes know as
temporomandibular disorder. TMD is a cluster or
related disorder that have many features in
common.
The most common is pain in the muscles of mastication,
the preauricular and the TMJ
Is a sub classification of musculoskeletal disorder
Temporomandibular Joint
(TMJ) Disease
Epidemiology
75% of people have at least one sign of joint dysfunction
and 33% have at least one symptom, like face pain
Only about 5% are in need of treatment
Differentiate contributing factors
Predisposing factors- increase the risk
Initiating factors- cause the onset
Perpetuating factors- interfere with healing
Temporomandibular Joint
(TMJ) Disease
Symptoms
Pain in the preauricular area/or TMJ
Pain, jaw noise, ear symptoms, rarely jaw dislocation
Chewing aggravates
Pain in face or head
Dull pain in temple are
Tinnitus
Sinus symptoms
FB sensation in ear canal
Decreased hearing
Neck or shoulder pain
Visual disturbance
Limited jaw opening
Jaw popping
Temporomandibular Joint
(TMJ) Disease
Questionnaires for screening- Example questions
Do your jaws make noise
Does using your jaw cause you pain
Have you had jaw joint problems before
Does you jaw ever get stuck
Is opening your mouth difficult or cause pain
With ringing in the ear does opening or closing you
mouth change the sound
Do you have frequent headaches, neck aches, or tooth
aches
Temporomandibular Joint
(TMJ) Disease
Physical finding
Complete exam to exclude other problems
Observation of gait, balance, unusual habits
Palpate the muscles of mastication using
bimanual technique
Start with the mouth closed then open
Temporomandibular Joint
(TMJ) Disease
Management
Involves understanding and treating the whole patient
Goals for management- reduction of pain, restorations of acceptable
function
Initial TX designed to be palliative and promote healing, with selfhelp techniques and pharmacotherapy
Adjustment of diet
Education and alteration of oral habits (gum chewing)
ICE/ HEAT
Medications such as pain meds, anti-inflammatory meds, injection of
trigger points
Most care will be given by the specialist
TMJ
Follow up and referral
Refer to a specialist is best idea for real TMJ
disease
Gingivitis
Inflammation of the gingiva
It may be characterized by edema, erythema,
bleeding, and occasionally pain
Gingivitis is usually reversible with
appropriate therapy
Periodontitis
An inflammatory disease of the supporting
tissues of the teeth caused by specific
microorganisms or groups of specific
microorganisms, resulting in progressive
destruction of the periodontal ligament and
alveolar bone with pocket formation,
recession, or both.
Oral Trauma
What happened
Tooth/jaw/lip/tongue hurt
What hit you
How long ago
Where are the teeth
Oral Trauma
Teeth
Avulsed (knocked out, loose)
Fractured
Chipped
Intrusion
Jaw/face: feel for “crunchy” sensation
Mucosal/tongue injury
Tooth Anatomy
Avulsed Teeth
Fractured Teeth
Intrusion
Tongue/Mucosal Trauma
Oral Trauma
Teeth
Avulsion
Primary teeth
Out, leave out
Loose, straighten or is very loose remove
Permanent teeth
Out, leave out, wash gently, tooth kit
Loose, leave alone
Fracture, keep fragment, store as above
Oral Trauma
Tongue
Well approximated, nothing
Bleeding direct pressure with gauze
Gaping need repair
Mucosal
Well approximated, nothing
Gaping and vermillion border need repair
Oral Trauma
Dental injuries
Dentist for most injuries
Baby teeth may need nothing
Tongue/Mucosa
Most need nothing
Doctor if gaping or severe bleeding
Nose Bleeds
Nose Bleeds
How much blood, how long
What has been done to stop bleeding
Trauma
Blunt
Picking
Upper respiratory infection/Allergies
History of Bleeding
Nose Bleeds
Nose
Fracture (usually at bridge)
Active bleeding
Which side? Always the same?
Throat
Neurologic
Vision
Nose Bleeds
Pinch x 10-20 minutes
Ice
Nose plugs
Don’t blow nose
Afrin if available
No picking