Ear, nose and throat Flashcards
What are the systemic risk factors for oral candidiasis?
Infancy or old age
Immune deficiency (cancer, HIV)
Broad-spectrum antibiotics, systemic steroids
Nutritional deficiency, for example, iron or B-vitamin deficiency
What are the local risk factors for oral candidiasis?
Dentures Dry mouth ICS Poor oral hygiene Smokine Candida infection elsewhere In a newborn, maternal vaginal yeast infection Mouth injury
Describe (oral) pseudomembranous candidiasis (thrush).
White patches on the tongue and other mucosal surfaces that can often be wiped off, leaving behind red areas that may bleed slightly.
Mostly in infants
Management for oral candidiasis?
Miconazole 2% gel
Nystatic liquid
Amphotericin B lozenge
Describe angular cheilitis (stomatitis).
Painful erythema and fissuring of the corners of the mouth.
Causes of angular cheilitis
Infections: Candida, S. aureus and Streptococcus species
Iron, B12, folate deficiency, Crohn disease
Describe otitis externa
AKA ‘swimmer’s ear’
Inflammation of the external ear canal that often follows water exposure and maceration of the skin.
Form of cellulitis
Which structures does otitis externa involve?
External auditory canal, with acute inflammation and variable oedema
What are the risk factors for otitis externa?
External auditory canal obstruction High environmental humidity, warm environment Swimming Local trauma (manual ear wax cleaning) Allergy, skin disease (dermatitis) Immunosuppression Prolonged use of topical antibacterials
Describe localised otitis externa (furunculosis)
Localised infection in the hair follicles in the cartilaginous portion of the external auditory canal
Symptoms of otitis externa
Pain
Pruritus
Hearing loss
Aural fullness
Signs of otitis externa
Inflammation, erythema, oedema of the external ear
Tenderness on manipulation of the tragus or auricle
Discharge (otorrhoea)
Fungal debris
Non-pharmacological Mx of otitis externa.
Keeping external ear canal dry
By doctor using suction or cotton wool
At home, using dry aural toilet 6-hourly with rolled tissues
Pharmacological Mx of otitis externa
Analgesia
Eardrops - Corticosteroid + antibiotic ± antifungal. Eg. kenacomb otic (triamcinolone + neomycin + gramicidin + nystatin)
Describe otitis media
Infection involving the middle ear space and is a common complication of viral respiratory illnesses
This infection can be bacterial or viral.
Risk factors for otitis media
Younger age Recent URTI Attending day care/sick contacts FHx of otitis media Low SES Exposure to smoking (household smoking)
What are the symptoms of otitis media?
Otalgia Irritability Sleep disturbance Fever Otorrhoea Nausea/vomiting
What are the signs of otitis media?
Bulging of the tympanic membrane
Myringitis (erythema of the tympanic membrane)
Otorrhoea (tympanic membrane perforation)
Management of acute otitis media
Supportive therapy Analgesia Reassuring patient and explaining self-limiting nature Discussing risks of Abx Review is 24-48 hours Consider Abx and grommets
What are the indications for Abx use in acute otitis media?
<6 months old
<2 years with bilateral infection
Systemically unwell (not just fever)
Otorrhoea or perforated tympanic membrane
ATSI
Immunocompromised
No improvement after 48 hours of supportive therapy
Which Abx is used for acute otitis media?
Amoxicillin 15 mg/kg, oral TD, 5 days (up to 500 mg)
What are the indications for grommets in otitis media?
Effusion lasts >3 months
Recurrent bacterial infections
Hearing loss with risk of speech/language problems
