EENT Flashcards
Acute Otitis Media
Infection of the middle ear made evident by infected fluid and inflammation of the mucosa lining
Presentation:
- Otalgia, bulging of tympanic membrane, marked erythema, fever
Diagnosis:
- Bulging tympanic membrane
Treatment:
- Amoxicillin 45mg/kg BID x5-7 days in 2 years and older without history of recurrent AOM or antibiotics use in the last 30 days (<2 years, recurrent AOM or if TM is perforated, treat with antibiotics x 10 days)
- Augmentin or Ceftriaxone if recent AOM, recent antibiotic use or treatment failure.
Acute Otitis Externa
Inflammation of the external auditory canal
- Also referred to as “swimmers ear”
Presentation:
- External otalgia, discharge, pruritus and possible hearing loss if sufficient pus present
Treatment:
- Polymyxin B-Neomycin-Hydrocortisone suspension drops QID x7 days AND.OR ofloxacin Otic drops BID x 7 days.
- NO neomycin, gentamycin, tobramycin (ototoxic) if the tympanic membranes intaqctness is not able to be confirmed.
Hearing loss
The problem may be with outer, middle or inner ear
- All hearing loss associated with outer and middle ear results in conductive hearing loss
- All hearing loss associated with the inner ear results in sensorineural hearing loss
Conductive hearing loss:
- Caused by something that stops the sound from getting through the outer or middle ear
- Example: Cerumen impaction
Sensorineural hearing loss:
- Occurs when there is damage to the ear’s inner structure
- Example: Ménière’s disease, acoustic neuroma, labyrinthitis
Weber and Rinne Hearing tests
Used to determine if conductive or sensorineural hearing loss present
WEBER: Tuning fork placed midline/forehead
- Sensorineural hearing loss: Sound localizes to unaffected ear
- Conductive hearing loss: Sound localizes to affected ear
RINNE:
- Normal: Air conduction > Bone conduction
- Abnormal: Bone conduction > Air conduction
Presbycusis: Progressive, symmetric hearing loss over years in the elderly
- Concern with loss of cognitive function due to hearing loss
Conjunctivitis
Inflammation of the conjunctiva, typically benign or self limiting
- Can be infectious (bacterial or viral) or allergic in nature
- Very contagious and spreads through direct contact (secretions or contaminated objects)
Presentation:
- Pruritic red eyes with discharge
- Bacterial conjunctivitis: Purulent discharge (yellow, white or green)
- Allergic conjunctivitis: Itchy eyes
- Viral conjunctivitis: Viral Prodrome with profuse tearing
Treatments:
- Antibiotics should be reserved for bacterial infection/contact lens wearers
- Fluoroquinolones are first in line with contact lens wearers due to the high incidence of pseudomonas infection
Subconjunctival Hemorrhage
Bright red blood, sharply demarcated area of the eyeball surrounded by normal conjunctiva
Risk factors:
- Anticoagulation therapy, trauma, history of coughing or vomiting, hypertension and diabetes
Treatment:
- Does not require treatment, blood reabsorbs in 2 to 3 weeks
Hordeolum
Acute inflammation of the eyelid
Presentation:
- Presents with painful swelling or a nodule
- May be internal (caused by inflammation of the meibomian gland) or external (eye lash follicle)
Treatment:
- Generally resolves spontaneously in 1 to 2 weeks
- Warm/moist compress for 5-10 minutes BID to QID
- Discontinue eye makeup during recovery
Chalazion
Slow growing inflammation of the eyelid
Presentation:
- Painless localized eyelid swelling
- Not infectious
- Caused by obstruction of a sebaceous gland
- Hordeola may evolve into a chalazion after acute inflammation resolves
Treatment:
- May take several weeks to months to resolve
- Warm/moist compress for 5-10 minutes BID to QID
- Refer to ophthalmologist for possible I&D if lesions persist >2 months
Hordeolum HURT… Chalazion is CHILL
Blepharitis
- Common chronic inflammation of the eyelid
- Classified as anterior or posterior blepharitis
- Posterior: More common, affects the inner part of the eyelid
- Anterior: Occurs at the base of the eye lashes
Presentation:
- Erythema, swollen, pruritic eyelid(s), crusting, blurred vision that can be blinked away
Treatment:
- Warm compresses to lid for 5-10 minutes at a time, 2-4. Times a day
- Lid massage
- Artificial tears
- Bacitracin or erythromycin ophthalmic ointment up to 4x a day for 1 month
Corneal Abrasion
Common eye injury, scratch to the cornea, often as a result from trauma or from a foreign body.
Presentation:
- Severe eye pain
- Difficulty opening eye
- Sensation of foreign body
Diagnosis:
- Using fluoresce in dye stain (after topical anesthetic used)
Treatment:
- Non-contact lens user:
- Erythromycin and sulfacetamide ophthalmic ointment
- If symptoms have no fully resolved in 1 to 3 days, refer to an ophthalmologist
- Contact lens users:
- Treat with Fluoroquinolones to cover against pseudomonas
- options include Ciprofloxacin and ofloxacin eye drops, or gentamicin ophthalmic ointment
- Refer to an ophthalmologist
- Update tetanus if indicated
- If (surface) foreign body is observed, after topical anesthetic is applied, may be removed with cotton-tipped applicator or with normal saline irrigation
Pingueceula & Pterygium
Pinguecula: Yellowish raised growth on the conjunctiva, next to the cornea
Pterygium: Yellow TRIANGULAR thickening of the conjunctiva that extends ACROSS the cornea surface on the nasal side
Presentation:
- Most common symptoms are redness and irritation
- May cause astigmatism
Risk factors:
- Exposure to ultraviolet (UV) light
Treatment:
- Treat symptomatically with artificial tears or other ocular lubricants
- Refer to ophthalmologist if vision is impaired
Arcus Senilis
Deposition of cholesterols and neutral fat in the cornea causes Arcus senilis
Presentation:
- Gray or white visible arc above and below the outer part of the cornea and may become a complete ring
Risk factors:
- Common in people as they age
Treatment:
- Does NOT affect vision and there is no treatment
Acute angle-closure glaucoma
Narrowing of the anterior chamber angle blocks the drainage of the aqueous humor leading to increased intraocular pressure
Risk factors:
- Family history, age >60 years old, female gender, hyperopia, certain medications such as some anticholinergic agents, some antihistamines and some diuretics.
Presentation:
- Vision loss, headache, severe eye pain, decreased peripheral vision and visual acuity, halos appear around lights, photophobia, nausea and vomiting.
Treatment:
- If acute angle-closure glaucoma is suspected, refer to the ER because it requires emergency care by an ophthalmologist
Age related macular degeneration (AMD)
Leading cause of vision loss (specifically central vision loss) in individuals > 50 years of age and most common in individuals 65 years and older.
Presentation:
- Vision loss, blurred vision, difficulty with dim lighting, straight lines appear wavy and seeing spots.
- Dry AMD: Most common type and causes gradual vision loss
- Wet AMD: Less common however is more severe and progresses more rapidly
- May begin unilaterally and evolve to both eyes
- Lines may look bent or wavy (Amster grid may appear distorted)
Treatment:
- Refer to ophthalmologist if AMD is suspected
Rhinosinusitis
Inflammation of the nasal cavity and paranasal sinuses
Viral presentation:
- Rhinorrhea, nasal congestion and sinus pressure
Treatment:
- Expected to resolve within 10 days and should be managed with supportive care
- OTC analgesics and saline nasal irrigation, intranasal glucocorticoids (Flonase)
Bacterial presentation:
- Onset with high fever, Purulent nasal discharge for <4 weeks and severe nasal congestion, sinus pressure, facial pain for at least 10 days or symptoms that seem to improve and then worsen.
Treatment:
- Amoxicillin (without risk factors for resistance), amoxicillin-clavulanate
- Alternative options: Doxycycline, clindamycin, Levofloxacin
Epistaxis
Nose bleed, common and generally non-concerning
Presentation:
- Acute nosebleed
- Anterior nose bleed: More common and occur in the Kiesselbach’s plexus
- Posterior nose bleed: more difficult to manage, can cause hemorrhage
Treatment:
- If anterior bleed can be visualized, cautery may be used.
- Never cauterize both nares to avoid septal necrosis
- Nasal packing may be used if cautery is unsuccessful
- Brisk bleeding, despite the use of proper packing techniques suggest a posterior bleed
- If packing was successful, have the patient follow up with ENT in 24 to 48 hours or present to the ER if bleeding occurs.
Bacterial Pharyngitis
Most common bacterial cause is Group A Streptococcus
Presentation:
- Fever, SUDDEN onset of sore throat, tonsillitis exudates, tender lymph nodes
Diagnosis:
- Rapid strep test, throat culture
Treatment:
- Penicillin x10 days
- Azithromycin/Clindamycin if penicillin allergy.
Infectious Mononucleosis
Acute illness due to Epstein-Barr Virus, mainly occurring in adolescents and young adults
Presentation:
- Fever, pharyngitis, lymphadenopathy (generally the posterior chain of lymph nodes), and fatigue
- Splenomegaly can occur (in up to 50% of patients) and rarely splenic rupture or airway obstruction due to swelling
Diagnosis:
- Monospot (may be falsely negative early in infection)
Treatment:
- Acetaminophen or NSAIDS are first line
- Corticosteroids are reserved for patients with concern for airway obstruction
- Educate 3-4 week minimum of NO contact sports to reduce risk of splenic rupture
- Confirm splenomegaly is resolved with Ultrasound before resuming sports.
Epiglottitis
Inflammation of epiglottis
- most common bacterial cause if Group A Streptococcus (GAS)
Presentation:
- Fever, stridor, drooling, muffled “Hot potato” voice, respiratory distress, anxiety.
- Can progress to airway obstruction, therefore managing the airway is most important
Treatment:
- Get emergency airway assistance
- Do not attempt direct visualization
- Defer plain radiographs
- Keep patient upright and deliver supplemental oxygen
