DISORDERS OF THE EARS, NOSE, AND THROAT (based on T) Flashcards
What are the anatomic characteristics of the Eustachian tube?
Shorter length, 10-degree angle from the horizontal axis, variable angle of the tensor veli palatini muscle to cartilage, greater cartilage cell density, less elastin at the hinge portion, smaller lumen, wider Ostmann fat pad, greater mucosal fold, less cartilage volume.
What is the anatomy of the medial 2/3 of the Eustachian tube?
Posteromedially: cartilage plate with medial and lateral laminae separated by elastin hinge.
Anterolaterally: fibrous tissue and Ostmann’s pad.
How does the Eustachian tube differ between children and adults?
In children, it is more horizontal, narrower, less rigid, and shorter.
In adults, it is more vertical, wider, and rigid, allowing easier drainage of secretions.
What are the clinical manifestations of ear infections?
Bulging tympanic membrane (TM),
limited or absent TM mobility,
air-fluid level behind TM,
otorrhea (ear discharge),
otalgia (ear pain).
What is acute otitis externa?
Infection of the external auditory canal related to water exposure , common in warm, humid climates.
What are the common pathogens in otitis externa?
Aerobes (36%),
fungi (35% - Aspergillus 20%),
anaerobes (29%),
Pseudomonas (32%),
Staphylococcus (21%),
polymicrobial (19%).
What are the clinical manifestations of otitis externa?
Localized furunculosis, diffused ‘swimmer’s ear ,’ pain on manipulation, redness and swelling of the external auditory canal, possible purulent discharge, TM non-visualized
What is the treatment for otitis externa?
Antibiotics, insertion of ear wicks with topical antibiotics or povidone iodine, analgesics (ibuprofen), acetic acid.
What is acute otitis media (AOM)?
An infection of the middle ear, often preceded by a viral respiratory infection , causing congestion and Eustachian tube dysfunction.
What are the peak incidence ages for AOM?
6-11 months, with 20% experiencing at least one episode by age 3.
What are the clinical manifestations of AOM?
Fever, acute onset of signs/symptoms, middle ear effusion (bulging TM, limited TM mobility, air-fluid level, otorrhea) , middle ear inflammation (erythema, otalgia).
What are the stages of otitis media?
HE’S -RC
1. Hyperemia,
2. Exudation,
3. Suppuration,
4. Resolution,
5. Complication (e.g., mastoiditis).
What are complications of otitis media?
Intracranial: extradural/subdural abscess, meningitis, brain abscess, lateral sinus thrombophlebitis, otitic hydrocephalus. Intratemporal: mastoiditis, facial paralysis, petrositis, labyrinthitis.
What is otitis media with effusion (OME)?
Presence of fluid behind an intact tympanic membrane (TM) without acute signs of inflammation
Also known as glue ear
What are the potential causes of OME?
Hearing impairment, HIV, pneumonia, chronic rhinitis.
What is the diagnosis and treatment for OME?
Diagnosis: air-fluid levels and impaired TM mobility on pneumatic otoscopy.
Treatment: myringotomy with ventilation tube insertion.
What are the common pathogens of AOM?
Streptococcus pneumoniae,
non-typeable Haemophilus influenzae,
Moraxella catarrhalis,
Staphylococcus aureus,
gram-negative organisms,
rhinovirus,
RSV.
What are the clinical stages of hyperemia in otitis media?
Hyperemia of the tympanic membrane, vascular engorgement, otalgia, fever, fullness in the ear, and dilated vessels visible on otoscopy.
What is the etiology of mastoiditis as a complication of otitis media?
Persistent infection leads to thickening of the mucoperiosteum, drainage blockage, local acidosis, decalcification, and coalescence of mastoid air cells.
What is the function of ventilation tubes in OME treatment?
A hole is created in the TM to allow fluid drainage; a ventilation tube maintains drainage until the TM regenerates and closes.
What defines chronic otitis media?
Discharge through a perforated tympanic membrane lasting for more than 2 weeks (WHO definition).
What is the prevalence of chronic otitis media in the Asia-Pacific region?
2-4% prevalence (Philippines, Korea, Thailand, Malaysia, Vietnam, China).
What percentage of hearing loss among Filipinos is due to chronic otitis media?
19% of hearing loss among Filipinos is due to chronic otitis media.
What are the common pathogens causing chronic otitis media in the Asia-Pacific region?
(CHRONIC -PS)
Pseudomonas
Staphylococcus.
What defines chronic suppurative otitis media?
A perforated tympanic membrane with persistent drainage from the middle ear lasting more than 6-12 weeks
What is cholesteatoma?
A complication of otitis media characterized by an abnormal skin growth in the middle ear or mastoid area
What is the first-line treatment for initial or delayed antibiotic therapy in otitis media?
Amoxicillin (80-90 mg/kg/day in 2 divided doses),
Amoxicillin-clavulanate (90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate), or
Ceftriaxone (50 mg IM/IV for up to 3 doses).
What is an alternative treatment for otitis media if the patient is allergic to penicillin?
Cefdinir (14 mg/kg/day in 1-2 doses),
Cefuroxime (30 mg/kg/day in 2 divided doses),
Cefpodoxime (10 mg/kg/day in 2 divided doses), or
Ceftriaxone (50 mg IM/IV per day for 1-3 days).
What is the recommended treatment for otitis media if the initial antibiotic fails after 48-72 hours?
Amoxicillin-clavulanate or Ceftriaxone for up to 3 doses
Alternative: Clindamycin with or without a third-generation cephalosporin
What defines bacterial rhinosinusitis?
Sudden onset of 2 or more symptoms: nasal blockage, discolored nasal discharge, or cough lasting less than 12 weeks.
What is the usual progression to bacterial rhinosinusitis?
Begins as an upper respiratory tract infection that progresses to a secondary bacterial infection.
What are common pathogens causing bacterial rhinosinusitis?
SO MUCH HATE SIYA
Streptococcus pneumoniae,
Haemophilus influenzae,
Moraxella catarrhalis,
Staphylococcus aureus.
What is the treatment for bacterial rhinosinusitis?
Penicillin.
What are common symptoms of pharyngo-tonsillitis?
Sore throat, dysphagia, odynophagia, fever, tender and enlarged cervical lymphadenopathies.
What are the common viral pathogens causing pharyngo-tonsillitis?
APIR
Adenovirus,
Parainfluenza
Influenza
RSV.
What are the common bacterial pathogens causing pharyngo-tonsillitis?
BACTERIA - GSM-H
Group A Streptococcus (GABHS),
Streptococcus pyogenes,
Moraxella catarrhalis
Haemophilus influenzae type B (HiB),
What are the complications of bacterial pharyngo-tonsillitis?
Peritonsillar abscess, retropharyngeal abscess, neck abscesses, rheumatic fever/rheumatic heart disease, acute glomerulonephritis (post-streptococcal GN).
What are the clinical features of bacterial pharyngo-tonsillitis?
High fever, intense pharyngeal and tonsillar inflammation with pain, edema, exudates, and painful/enlarged cervical lymph nodes.
What are the features that suggest bacterial rather than viral pharyngo-tonsillitis?
Absence of conjunctivitis, hoarseness, diarrhea, coryza, and presence of enlarged cervical lymph nodes.
What is the most common cause of infectious mononucleosis?
Epstein-Barr Virus (EBV).
What are the clinical manifestations of infectious mononucleosis?
Sore throat, fever, swollen glands, pus on tonsils, hepatosplenomegaly.
What is the peak incidence of infectious mononucleosis?
Adolescent period (15-19 years old).
What is the diagnostic finding on a peripheral smear for infectious mononucleosis?
Atypical lymphocytosis with atypical mononuclear cells.
What is the treatment for infectious mononucleosis?
Non-specific and symptomatic treatment.
Why is infectious mononucleosis called the ‘kissing disease’?
It is commonly transmitted through saliva, especially during kissing.
What is epiglottitis?
An inflammatory, edematous disease of the epiglottis and adjacent structures.
What are the clinical manifestations of epiglottitis?
High-grade fever, sore throat, dyspnea, and rapidly progressive respiratory obstruction.
What is the most common finding in epiglottitis that may cause respiratory arrest?
Rapidly progressive respiratory obstruction.
What is the pathogen commonly associated with epiglottitis?
Haemophilus influenzae type B.
What are the methods for diagnosing epiglottitis?
History and clinical findings.
What is a key caution during intubation in a patient with epiglottitis?
Inflammation increases the risk of bleeding, which may lead to cardiac arrest.
What is acute laryngotracheobronchitis or croup syndrome?
An upper airway obstruction caused by inflammation of the larynx and trachea.
What are the clinical manifestations of croup syndrome?
Barking cough
inspiratory stridor,
respiratory distress, and
hoarseness.
What is the diagnosis method for croup syndrome?
Clinical diagnosis.
What is the typical cause of croup syndrome?
A viral infection, such as influenza or parainfluenza.
What does inflammation in croup syndrome lead to?
Mucus production and noisy breathing.
What are the chest x-ray findings in croup syndrome?
Chest x-rays are typically normal.
What is the steeple sign in croup syndrome?
Radiographic narrowing of the subglottic larynx and trachea area.
What is the origin of the term ‘croup’?
Derived from the Anglo-Saxon word ‘kropan’ or the old Scottish word ‘roup,’ meaning to cry out in a hoarse voice.
