L38 - Common ENT Inflammatory Diseases Flashcards
Classification of Rhinitis?
Classify by cause:
- Infective
- Allergic
- Others
List the pathogens that cause infective rhinitis?
1) URTI Viruses
2) Bacteria – common ones in upper respiratory tract:
a) Haemophilus influenzae
b) Streptococcus pneumoniae
c) Staphylococcus aureus
d) Moraxella catarrhalis
e) Mycobacteria
3) Others: Fungi, Protozoa, Parasites
How to distinguish allergic or infective cause of rhinitis by P/E?
Infective = Cloudy, white discharge from swollen inferior turbinate not to be confused with nasal polyps
Allergic = Red, swollen inferior turbinate
Pathogenesis of chronic allergic rhinitis?
Type I hypersensitivity involving IgE
Allergen at nasal epithelium
> Mast cell degranulation
> release inflammatory mediators i.e. Histamine
causing sneezing, epistaxis
> Late-phase response involve cellular infiltration (i.e. eosinophils) to cause chronic nasal obstruction
List some causative agents of rhinitis apart from infective or allergic cause.
Others:
- Occupational: intermittent, persistent
- Drug-induced: aspirin, others
- Hormonal (pregnancy)
List the paranasal air sinuses? Convergence point of all sinuses?
Sinuses (on both sides = 8 in total):
Maxillary
Ethmoid
Frontal
Sphenoid
All converge at middle meatus
Pathogenesis of sinusitis?
Functional / anatomical impairment of normal mucociliary clearance on the Respiratory epithelium
> > Swelling of osteomeatal complex
Investigations for sinusitis and typical findings?
1) Endoscopy = swollen, edematous tissue + purulent discharge
2) CT = opaque sinuses and air-fluid level present
Complications of sinusitis?
Orbital cellulitis
Orbital abscess
Cavernous sinus thrombosis
Which part of the ear is most commonly infected?
Outer ear = common
Middle ear = less common
Inner ear = rare
Describe the physiological protective mechanism against external ear infections?
Ear wax Inhibit growth of bacteria and fungi (waterproof, acidic): made of: - Desquamated cells - Cerumen from ceruminous glands - Sebum
Pars tensa epithelium migrates outwards to external ear canal»_space; ear wax made at inner ear canal is constantly pushed out with no accumulation
Pathogenesis of otitis externa?
Inflammatory reaction in ear canal skin (e.g. pathogens, scratching)
> > swelling, blocking rapid cell turnover
> > more dead skin produced
> > Germs breed on moist dead skin, toxic pus fills ear canal
> > Increase inflammation, viscous cycle
Investigation and expected findings for otitis externa?
Direct endoscopy:
- Bacterial = red, edematous ear canal with abundant pus and dead skin
- Fungal = black spores, edematous ear canal with lots of hyphae
2 forms of otitis media?
1) Acute Otitis media
2) Chronic Suppurative Otitis media = Residual perforation, can be active/ discharging or Inactive/ dry
Symptoms, pathogen and typical endoscopic finding of acute otitis media?
pain, fever, hearing loss, discharge
Viral / bacterial (Streptococcus pneumoniae, Haemophilus influenzae) (asso. with URTI)
Red, congested, engorged eardrum, bulging due to pus accumulation behind
Complications of acute otitis media? (5)
1) Tympanic membrane rupture with pus discharge from middle ear
2) Pus Into mastoid cavity = mastoid abscess (bulge behind ear)
3) Facial nerve palsy (affected side = drooping, no wrinkles, cannot close eyes)
4) CN VI palsy (lateral rectus) – cannot abduct eye
5) Brain abscess
List the most common pathogens that cause tonsilitis?
Bacterial:
- Streptococcus pyogenes
- Staphylococci
- Pneumococci
- Haemophilus influenza
- Syphilis (Treponema pallidum)
- Corynebacterium diphtheriae)
- Mycobacterium tuberculosis
Viral: rhinovirus, adenovirus, EBV
Others: Candida
Clinical features of tonsilitis?
Fever Sore throat Odynophagia (painful swallowing) Trismus (jaw spasm/ pain) Otalgia (= pain referred to ear)
Describe the normal appearance of tonsil in children and adults?
Children = Large tonsils
Adults = atrophied, not very visible
* large tonsils in adults is abnormal*
Compare the appearance of tonsilitis caused by bacteria vs viral?
Bacterial: red swollen tonsils, throat redness, whitish spots, swollen uvula, gray furry tongue**
Viral: red swollen tonsils, throat redness (normal uvula, no white spots, normal tongue)
Give one complication of tonsilitis? List symptoms?
Quinsy/ Peritonsillar abscess
Severe sore throat Low grade fever Dysphagia Inflammation of peritonsillar area with medial displacement of tonsil Bilateral airway obstruction → stridor Severe trismus
Requires drainage of abscess
Which region of the larynx is most commonly affected by croup?
Subglottis
List common causative pathogens of Sialoadenitis?
Salivary gland infection: Viral: - Mumps - Coxsackievirus - HIV - Echovirus
Bacterial:
- Staphylococcus
- Mycobacterium tuberculosis
- Syphilis (Treponema pallidum)
Noninfectious inflammatory: Sjogren’s (autoimmune)
Pathogenesis of sialadenitis?
1) Ascending salivary duct infections: related to dehydration, debilitation
2) Secondary to salivary duct obstruction (submandibular gland more likely obstructed by stones than parotid gland)
Give one example of parotid gland infection.
Parotiditis e.g. viral: mumps
Presentation of secondary ductal obstruction of submandibular gland?
Blockage by stone
> > Viscous saliva, more mucus
Lateral pharyngeal space infection is secondary to which infections?
Spread of infection from adjacent structures
Odontitis, pharyngitis, tonsillitis, parotitis, otitis, mastoiditis
Submandibular space infection is secondary to which infections?
Dental root abscess 50-90%
Symptoms and primary infections causing retropharyngeal space infection?
Fever, sore throat, dysphagia, neck stiffness
Odontitis, peritonsillar abscess, cervical vertebral osteomyelitis, perforated pharynx
