ENT/ opthal Flashcards
what is ottitis media and signs and symptoms of it.
acute inflammation of the inner ear
generally see a bulging tympanic membrane due to build up
lines with respsiratory mucosa and commensally colonised–> vulnerable as the airway.
Signs and symptoms= ear pain, reduced hearing, balance issues, dizzyness, otorrhea (if membrane rupture) UTRI signs.
infants may be unable to feed, repeatedly touching the ear, crying.
risk factors for Acute ottittis media and investigations
age, FH, day care attendance, bottle feeding, exposure to smoke
Breast feeding is protective
peak incidence is under 2 years old.
Ix: otoscope, visual inspection of ears and throat, tuning form for hearing loss,
pathophysiology of AOM
usually started by inflammation of some sort- viral is common
inflammation obstructs the eustasion tube
this causes an increace in the negative pressure of the middle ear (you will gt pain + conductive hearing loss) and build up of secretions. This allows bacteria to thrive and cause an infeciton.
this causes a bulging tympanic membrane due to the purulent secretions- this causes severe otalgia and fever.
common causative organisms of AOM and treatment oft it
S. puemoniae (most common)
H. influenza
Rx:
try and Rx conservatively
Symptoms lasting more than 4 days or not improving after 48 hours
Systemically unwell
Immunocompromised patient
Child less than 2 years with bilateral otitis media
OAM w/ perforation ± otorrhea
1st line = amoxicillin
Alternative => erythromycin, clarithromycin (macrolides) or cefuroxime, ceftriaxone (cephalosporins)
indications for surgery-
recurrency- (insertion of tympany tube)
tympanocentesis (aspiration) - if no response to rx
severe pain + pus- myringotomy (incision in membrane)
complications of AOM
conductive hearing loss
labrynthitis
vestibular dysfunction
rupture of tymp membrane
cholesteatoma
mastoiditis (most common- spread to bone)
recurrency- can lead to chronic supperative otitis media
what are the two types of chronic ottitis media
Chronic suppurative otitis media (CSOM) –> drainage from middle ear through perf membrane (6-12/52) - common in children
Chronic ottitis media with effusion (COME) –> chronic effusion in tympanic cavity abscence of infection (more than 3/12) - common in tottlers
CSOM is infective, COME is not
signs and symptoms of CSOM and COME Rx of each and a special consideration to have for COME
CSOM–> painless otorrhea, hearing loss. Rx with ciprofloxacin + dex drops. graft if failure
COME–> fullness/ pressure in the ear, hearing loss 20-40Db. Rx with tympanostomy tubes.
in adults COME should promt high suspicion of nasopharyngeal malignancy.
Cholesteatoma what is it and what does it do.
Special form of chronic otitis media in which keratinizing squamous epithelium grows from the TM or the auditory canal into the middle ear mucosa or mastoid
abnormal epithelium in abnormal location –> lots of inflam destroying other structures around it.- bone erosion, facial nerve palsies, sigmoid sinus thrombosis
types of cholesteoma
aquired- chronic infecitions
congenital- born with it (being born with cleft lip inc risk 100X)
subdivision of aquired:
primary- eustachian tube dysfunction - tymp membrane retracts inwards
2’- migration of epithelium inwards through a perf TM.
invesigations + management of cholesteoma
Ix: imaging to ax bone destruction- mastoid x-ray. Temporal CT scan.
audiometric tests
Mx: surgary is always indicated–> tympanomastodctomy –> excise cholesteoma –> repair middle ear.
overview of otitis externa- including causative organisms + the different types
inflam of skin and subdermis of external ear canal +/- pinna or tympanic membrane.
acute- <6/52 - pseudamonas aeruginosa, staph aureus.
chronic >3/12 fungal- asperguillus/ candida albicans.
malignant- progressive infection causing osteomyelitis.
risk factors for OE and S+S
Acute- skin conditions, otitis media, trauma, foreign body, water exposure
Chronic- DM/ immunodef, prolonged abx use
malignant- immunodef, age, radiotherapy, ear surgery.
S+S itch/ pain, discharge or dry scaly skin, hearing loss, granulation tissue in canal, facial nerve palsy.
Rx of otitis externa
Acute- keep dry, avoid swimming, dry after showering
acetic acid ear drops for 7 days. if indicated Abx for 7-14/7 +/- dex drops.
chronic- swab, clean, antifungals/ biotics as appropriate (topical)
tonsilitis overview , Risk factors, aetiology, S+S
an acute infection of the parencyma of palatine tonsils
RF- 5-15 yers - contact with infected people
Viral mostly- rhinovirus, bacterial is less common but important to pick up.
S+S- pain on swallow, fever, tonsillar inflammation, sudden onset sore throat, cough, rhititis, coryzal symptoms.
what are the centor criteria to tell if tonsilitis is bacterial
Fever > 38
pus
attendance within 3 days of symptoms
indlammation of the tonsils
no cough
Ix and Mx of tonsilitis
Throat culture and rapid strep antigen test (culture takes a while)
Rx: if no strep- analgesics
if strep - analgesics, steds
if less than 5 amoxicillin
over 5- penicillin/ clarithromycin.
if chronic- tonsilectomy.
pharyngitis overview, RF, epidaemiology
inflammation of the pharynx +/- exudate
Risk factors- Grp A strep in nose/ contact
sexual activity/ abuse
ingestion of non-domestic meats
immunodef
epidaemiology- bacterial - grp a strep common in winter/ spring. viral summer/ autumn- Ebv, adenoirus, flu
signs and symptoms of pharyngitis
if no cough, nasal congestion, discharge- bacterial
painful throat
pharyngeal exudate
cervical adenopathy
fever
headache, N+V, abdo pain.
IF + Rx of pharyngitis
Ix: rapid grp A strep antigen
culture
serum mono-spot for EBV
Rx: analgesics, abs if relavent
tolsilectomy
laryngitis overview, RF+ aetiology.
inflam of the larynx (croup)- oedema of the true vocal chords.
acute (<3/52) or chronic.
RF: URTI, HIB + diptheria vaccene absence. travel, immunodef, long abx/ inhailed steds, heavy vocal use, tobacco
Almost always viral- parainfluenza
S+S of laryngitis, Ix + Rx
hoarse voice, dry cough, fever, lymphnode enlargement, accessory resp muscle use in narrowed airways, insp stridor
Ix: laryngoscopy
biopsy
swab + culture
Mx:
secure airway if compromised,
supportive care, cough suppression
what is infectious mononucleosis
AKA EBV/ glandular fever
found in saliva
more severe symptoms in teenagers or young adults.
- symptomatic infection with EBV is called infectious mononucleosis.
(if treated with abx- amox/ cephlasporins get a really itchy rash)
S+s Ix and Mx of mono
S+S= fever, sore throat, faigue, lymphadenopathy, tonsillar enlargement, splenomegaly.
Ix: heterophile antibodies (add them to horse/ sheep RBC and if they react then +ve test)
EBV IgM- suggests acute infection
IgG- suggests immunity.
Mx: self limiting, 2-3 weeks and gets better, no contact sports (spleen) no alcohol.
can get splnic rupture, chronic fatigue, glomerulonephritis
what are nasal polyps, RF, who does it occur in, S+S
benign growths in the nose or sinuses- hand like teardrop/ grapes
RF= asthma, aspirin sensitivity, allergic fungal sinusitis, CF, vit D def.
occurs in young + middle ages adults.
S+S= irritation/ swelling >12/52
runny nose
persistant stuffiness
postnasal drip
dec smell
loss of taste/ smell
facial pain/ headache
pain in upper teeth
pressure over forehead
snoring
nosebleeds
pathopahysiology, Ix, Rx of nasal polyps
nasal mucosa becomes inflaimed, polyps fill with inflammatory fluid. (assoc with allergy/ infection)
Ix: physical, nasal endoscopy, imaging CT if deeper.
allergy tests/ CF tests. Blood fro vit D
Mx: nasal corticosteds, oral/ injectable steds. dupilumab injection - reduced size.
antihistamines for prevention of recurrence. surgery to remove
complication and prevention of nasal polyps
complications-
OSA
asthma flares
sinus infections
Prevention-
manage allergies + asthma
avoid nasal irritants
good hygene
humidifiers
nasal rinse OTC.
what is rhinosinusitis what is its characteristic disease pattern
usually caused by URTI. this causes impaired ciliary clerance- proliferation in the sinuses
double worsening- i.e the disease gets better and then worse again
need a triple symptoms to diagnose- purulent nasal discharge, facial fullness, nasal obstruction.
Rx is co-amoxiclav or amoxacillin
conjunctivitis, definition, RF + DD
inflammation of the conjunctiva (lining inside of eyelids + sclera. _ most common cause of pink eye.
its V contageous
RF: exposure to someone with it.
environmental insults
allergen exposure,
one eye infection.
important DD is subconjunctival haemorrhage
aetiology of conjunctivitis
Bacterial infection–> purulent discharge (eyelids can stick together)
staph aureus, strep pneumonia, H influenza, Neisseria gonorrhoeae
can also get viral- much more watery discharge (adenovirus, vzv.
in young adults or newborns can also get chlamydia- (from vagina to eye) - needs urgent treatment to save eyesight.
most causes are adenovirus.
signs and symptoms of conjunctivitis + Ix + Rx
pink eye, discharge, crust, chaemosis, burning, photophobia, itching, bilateral, normal vision.
Ix:
rapid adenovirus immunoassay
culture, usually a clinical diagnosis.
Rx:
viral is usually self limiting, - wash with sterile water and wipe ONCE with cotton wool ball
rarely give Abx for bacterial
eyedrops and antihistamines can help if allergic.
