Dr. Daniel -- Common Infections in Otolaryngology, Head and Neck Surgery Flashcards
Signs and symptoms of tonsililitis (6)
Severe sore throat Difficult or painful swallowing Headache Fever/chills Enlarged, tender neck nodes Voice change
Etiology of tonsilitis (2)
Viral (EBV)
Bacterial (S. pyogenes)
2 methods of diagnosis for tonsillitis
Physical exam
Culture
5 complications of tonsillitis
Abscess formation Loss of airway Sepsis Nephritis Rheumatic fever
Natural progression of otitis externa
Usually self-limited
2 symptoms of otitis externa
Otalgia
Otorrhea
3 findings of otitis externa
Ear canal edema
Otorrhea
Tender to pinna traction
Pathogenesis of AOE (4 steps)
1) Water exposure
2) Loss of protective barriers (removal of wax, irritation of EAC skin)
3) Accumulation of exfoliated skin debris
4) Obstruction
Lifetime incidence of otitis externa
10% (accounts for 7.5 million annual ototopical prescription in US)
4 most common pathogens associated with otitis externa
1) Pseudomonas aeruginosa (20 - 60%)
2) S. aureus (10 - 70%); often polymicrobial
3) Other gram - organisms
4) Fungal
4 antibiotics options for otitis externa
1) Aminoglycoside
2) Polymyxin B
3) Quinolone
4) A combination of these agents
2 steroids for otitis externa
1) Hydrocortisone
2) Dexamethasone
3 treatment options of otitis externa
1) Antibiotics
2) Steroids
3) Low pH antiseptic (i.e. aluminum acetate solution or acetic acid)
3 pairs of AOE treatments that have equivalent clinical outcomes
1) Antiseptic vs. antimicrobial
2) Quinilone vs. non-quinolone
3) Steroid-antimicrobial vs. antimicrobial alone
NOTE: Regardless of topical agent, about 65 - 90% have clinical resolution within 7 - 10 days
2 Most common pathogens of fungal otitis
1) Aspergillus
2) Candida
Classic pathogenesis of fungal otitis
Prolonged treatment of bacterial otitis externa that alters the flora of the ear canal
2 symptoms and findings of fungal otitis
1) Clogged, itchy or painful ears
2) Thick fungal debris in the external auditory canal
3 generally safe treatments for fungal otitis
1) Clotrimazole
2) Miconazole
3) Tolnaftate
Fungal otitis treatment that has potential for severe damage
Gentian violet
2 treatments for fungal otitis that can cause appreciable elevation of brainstem response thresholds
Drops containing:
1) Acetic acid
OR
2) Propylene glycol
Define otitis media
Inflammatory disease of the mucosal lining of the middle ear
Common group of people affected by otitis media
Children
2 most common pathogens of otitis media
Streptococcus pneumoniae
Haemophilus influenzae in infants
7 symptoms of otitis media
1) Abrupt onset
2) Ear pain
3) Fullness
4) Fever
5) Irritability
6) Vomiting
7) Loose stools
3 reasons for the pathogenesis of otitis media
1) Eustachian tube dysfunction
2) Immunologic compromise
3) Microbial challenge
4 examples of eustachian tube dysfunction causing otitis media
1) Developmental
2) Cleft palate
3) Infectious
4) Environmental (allergies, smoke)
3 examples of immunologic compromise causing otitis media
1) Developmental
2) Immunodeficiency
3) Infectious
3 examples of microbial challenge causing otitis media
1) Viral
2) Bacterial
3) Daycare!
3 methods of diagnosis of otitis media
1) Red TM with bulging and loss of normal landmarks
2) Spontaneous perforation possible in first 24-48 h –> alleviation of pain
3) Pneumatic otoscopy to determine the presence of fluid in middle ear
3 treatment options of otitis media
1) Antibiotics
2) Drainage
3) Myringotomy
3 first line antibiotics for otitis media
1) Amoxicillin
2) Macrolides (10% pneum. resistance)
3) TMP/SMX (25% pneum. resistance)
4 antibiotics in cause of first line treatment failure
1) Amoxicillin/clavulanate
2) 2nd gen cephalosporins (i.e. cefuroxime axetil, cefactor)
3) TMP/SMX and macrolildes
4) Fluoroquinolones
3 fluoroquinolones to treat otitis media
Grepafloxacin
Levofloxacin
Sparfloxacin
Treatment course of otitis media antibiotics
10 - 14 days
Complication of otitis media
acute mastoiditis
3 classes of sinus infections
1) Acute bacterial sinusitis
2) Subacute bacterial sinusitis
3) Recurrent acute bacterial sinusitis
Define acute bacterial sinusitis (2)
Bacterial infection lasting less than 30 days in which symptoms resolve completely
Persistent and worsening upper resp. symptoms for longer than expected 7 day course of a viral illness, but for less than 3 weeks
Define subacute bacterial sinusitis
Bacterial infection lasting between 30 - 90 days in which symptoms resolve completely
Define recurrent acute bacterial sinusitis
Episodes lasting less than 30 days and separated by intervals of at least 10 days during which the patient is asymptomatic
3 things that result in healthy sinuses
1) Adequate ventilation through patent ostia
2) Adequate mucociliary clearance
3) Adequate local and systemic immune defense
3 most common acute sinusitis pathogens
1) Strep pneumoniae
2) H. influenzae
3) M. catarrhalis occasionally
2 rare pathogens of acute sinusitis
1) Staph aureus
2) Anaerobes
3 first line antibiotics for acute sinusitis
1) Amoxicillin
2) erythromycin
3) TMP/SMX
5 second-line antibiotics for acute sinusitis
1) Clarithromycin, azithromycin
2) Amoxicillin/clavulanate
3) Cefuroxime axetil, cefprozil, cefactor
4) Ciprofloxacin, levofloxacin
5) Clindamycin
Compare the treatment outcomes for acute sinusitis
For patients with uncomplicated acute sinusitis, less expensive first-line agents = as effective as costlier second-line agents
Usual course of disease for viral otitis and sinusitis
8 - 10 days
Usual course of disease for otitis and sinusitis due to aerobes
10 days to less than 3 months
Usual course of disease for otitis media and sinusitis due to anaerobes
Over 3 months
Define chronic sinusitis
Symptoms of sinusitis persisting beyond 3 months without improvement
Most common pathogen associated with chronic sinusitis
H. influenzae
4 most common pathogens for refractory chronic sinusitis
1) S. aureus
2) Anaerobic bacteria
3) Gram-negative organisms
4) Polymicrobial infection in general
Pathogen commonly cultured from chronic sinusitis patients who have received multiple courses of antibiotics over a prolonged period
Pseudomonas aeruginosa
2 local complications of sinusitis
1) Polyps
2) Mucoceles
6 orbital complications of sinusitis
1) Periorbital cellulitis
2) Periorbital cellulitis with chemosis
3) Orbital cellulitis
4) Subperiosteal abscess
5) Orbital abscess
6) Cavernous sinus thrombosis
3 intracranial complications of sinusitis
1) Meningitis
2) Peridural abscess
3) Brain abscess
3 lower respiratory tract complications of sinusitis
1) Cough
2) Pneumonitis
3) Asthma
5 classes of periorbital/orbital cellulitis/abscess
I - inflammatory edema (pre-septal) II - Orbital cellulitis (post-septal) III - Subperiosteal abscess IV - Orbital abscess V - Cavernous sinus thrombosis
2 benign salivary gland diseases
1) Sialolithiasis
2) Parotitis
2 treatments for sialolithiasis
1) Stone removal
2) Sialogogues
Common pathogen of parotitis
S. aureus
2 treatments for parotitis
1) Sialogogues
2) Antibiotics
3 malignant salivary gland diseases
1) Pleomorphic adenoma (most common)
2) Adenoid cystic carcinoma (CNVII involvement)
3) Mucepidermoid carcinoma
