EENT _ Lecture by xiaohuicaicai

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									  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
    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:
I.  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
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 air-
  containing 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
•   High fever
•   Severe throat pain w/o cough
•   Edematous tonsils with white or yellow exudate
•   Unilateral cervical adenopathy
 Diagnosis
I.   H&P 50 % accurate
II. Rapid antigen test
III. Throat swab culture is gold standard
• Tx: penicillin to prevent acute rheumatic fever
 Membranous ( diphtherial )
I.     High fever
II.    Dysphagia
III.   Drooling can cause respiratory failure
      Dx : pathognomonic gray membrane on tonsils
       extending into throat
      Tx : Antitoxin
• Fungal (candida)
I.   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
 Adenovirus
I.     Fever
II.    Red eye
III.   Sore throat
IV.    Dx : clinical
V.     Tx : supportive
 Herpangina ( coxsackie A)
I.     Fever
II.    Pharyngitis
III.   Body ache
IV.    Tender vesicles along tonsils, uvula and soft palate
V.     Dx : clinical
VI.    Tx : supportive

								
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