Otolaryngology, Otitis, Rhinosinutitis Flashcards
Phase of swallowing: Voluntary, chewing
Prepatory oral phase
Phase of swallowing: reflexive phase
Pharyngeal phase
Phase of swallowing: fluid passive, solid is active
Esophageal phase
Problems with prepatory and oral phase: cause and effect
Cause: Tongue thrust and teeth. Effect: choking and aspiration are common
Problems with pharyngeal phase: Cause and effect
Cause: upper pharyngeal sphincter (crisopharyngeus muscle relaxes with swallowing). Effect: choking and aspiration common
Problems with esophageal phase: cause and effect
Solid and/or liquid problems swallowing
Test used to vizualize oral and pharyngeal phases
Barium Swallow
Risk factors for GERD
tobacco, caffeine, EtOH
Common sleep symptom found with GERD
Snoring
Gold standard for Dx hiatal hernia
24Hr probe (not very practical)
Medical management of hiatal hernia
GERD: 1x day PPI; EER: 2x/day PPI
Radiography finding of achalasia
Bird beak on esophagram
Autoimmune disorder with atrophy of smooth muscle and collagen deopsition
Scleroderma
Face is calcified and cannot exhibit expressions
Fixed face (sign of scleroderma)
CREST syndrome
Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasias
Idiopathic inflammatory myopathy of striated muscle
Polymyositis
S&S of polymyositis
Proximal muscle wasting, dysmotility of proximal 1/3 of esophagus, increased CPK
Tx of scleroderma
Reflux control, NSAIDS, steriods, Ca CB
Tx of polymyositis
Reflux control, immunosuppressive and steriods
Diverticulum of esophagus at Killian’s triangle
Zenker’s Diverticulum
Most common cause of esophageal rupture
Instruments during testing
Incomplete esophageal tear from increased pressure (i.e. vomiting)
Mallory-Weis syndrome
Rupturing od all 3 layes of the esophagus
Boerhaave syndrome
What sign is “crunching” over the heart?
Hammers sign
Intermittent dysphagia cuased by the right subclavian artery being behind the esophagus
Dysphagia Lusoria (Bayford syndrome)
Elongated styloid process or ossified stylohyoid ligament, can cause odynophagis and unilateral throat pain
Eagle syndrome
Dysphagia from esophageal webs, iron deficeincy anemia, glossitis, and has an increased rish of squamous cell carcinoma
Plummer-Vinson Syndrome
Tx of Plummer-Vinson Syndrome
Iron supplementation and esophageal dilation
Immediate gagging or cyanosis after birth
Tracheoesophageal fistula
Most common esophageal malignancy and location
Squamous cell carcinoma, middle 1/3 of esophagus
Assoc. w/ Barretts metaplasia from reflux
Adenocarcinoma
Most common cause of acute pharyngitis
Viral
Most common cause of acute bacterial pharyngitis
Group A pyogenes
Causes of chronic pharyngitis
GERD, EER, smoking, allergy, rhinocinusitis
Commonly called hand, foot, mouth disease
Herpangina, from coxsackie A virus
Grading system on tonsil size
0-4 (gone to 100% to mid line)
S&S of peritonsilar abcess
Anterior pillar fullness, uvula shifted from tonsils, no exudate on tonsils
Paradise Criteria
Tonsillectomy guidelines: 7 infx/year for 1 yr, 5infx/year for 2 yrs, 3 infx/yr for 3 years
Non infx reasons for tonsillectomy
sleep disorder breathing, cor pulmonale (from SDB), recurrent or chrontic otitis media
Contraindications for tonsillectomy
Leukemia, hemophilia, systemic disease, cleft palate, acute infx, bifid uvula
Why is snoring important?
All snoring is pathologic
Complications of snoring
Cardiopulmonary disease (RHF), HTN, Failure to thrive)
Dx of obstructive sleep apnea
Polysomnogram shows >5 episodes per an hour
Most common cause of acute otitis externa
Pseudomonas (followed by proteus, staph, strep)
Tx of acute otitis externa
1:cleaning! Ear drops w/ steriod, Cipro+dexamethasone
Difference b/t acute and necrotizing otitis externa
Necro has involvement of osteomyelitis of temporal bone, abnormally high pain for externa appearance, cranial nerve involvement (BAD prognosis)
Tx of necrotizing otitis externa
Control of immunodeficienies and DM
Most common causes of otomycosis
Aspergillus, then candida
Tx of otomycosis
Meticulous debridement, clean with vinegar, antifungal drops
Causes of acute otitis media
Strep pneumo, H Inf, Moraxella Catarrhalis
Risks for acute otitis media
Smoke exposure, day care, nasal intubation, breast fed <2 years
S&S for acute otitis media
HEARING LOSS
When to use myrongotomy with pressure equalization tubes?
Recurrent otitis media, poor response to Abx, persistent effusion >3months
S&S of serous otitis media
Hearing loss W/O pain
Plan for adult with unilateral persistent middle ear fluid
Must undergo inspection of nasopharynx
S&S of chronic otitis media
Tympanic membrane perforation, conductive hearing loss, >6 weeks of otitis media
Common cause of CHRONIC otitis media
Pseudomonas
Complications of chronic otitis media
Facial nerve paralysis, sinus thrombophlebitis, mastoiditis, Meningitis
Slow progressive hearing loss and ringing in ears cuased by abnormal reabsorption/deposition of bone in all 3 layers of otic capsule and ossicles
Otosclerosis
Cause of labryinthitis
Bacterial infx that progresses into labyrinth from otitis media or meningitis
Complications of labrynthitis
Permanent hearing loss and vestibular dysfunction
Viral infection of vestibular nerve
Vestibular neuronitis
S&S of vestibular neuronitis
Vertigo lasting days-weeks, no hearing loss, NYSTAGMUS
Cold water associated, smooth protusions of medial osseau canal
Exostoses (surfers ear)
White “pearly” mass in middle ear, caused by squamous epithelium in the middle ear with accumulation of keraton debri
Cholesteatoma
Inflammation of the nose and sinuses
Rhinosinusitis
Dx of rhinosinusitis
2 or more major criteria, 1 major criteria +2 minor criteria
Major criteria of rhinosinusitis
Facial pain, nasal obstruction, hyposmia, purulence on examination, fever
Minor criteria of rhinosinusitis
headache, fatigue, dental pain, cough
Acute rhinosinusitis: definition and cause
lasts up to 4 weeks. Rhinovirus, strep, H flu, Moraxella Cattarrahlis
Chronic rhinosinusitis: definition and causes
6 weels or more. (usually polymicrobial) S. aureus, anaerobes, gram negatives and pseudomonas
Recurrent acute rhinosinusitis: definition
4 or more times a year with resolution b/t attacks
Imaging for rhinosinusitis
NO XRAY, Non-contrast coronal CT is gold standard, MRI for complicated cases
Tx of acute rhinosinusitis
Empirically: amox+clavulanate (augmentin), bactrim, doxycycline, clarithromycin, cipro for 7-10 days
Tx of chronic rhinosinusitis
Culture based is preferable: 1st) amox+clavulanate OR 2nd/3rd gen cephalosporin, 2nd)quinolones (cipro, levo, moxi) OR clarithromycin
Use what in chronic rhinosinusitis for culture documented resistant S. Pneumonia
Clindamycin
Chronic rhinosinusitis in children
can be treated with PPI due to GERD/EER
How to thicknes/Thin mucus
acidic mucus in thick, alkaline (baking soda) mucus is thinned
Decongestants
Phenylephrine, pseudoephedrine (stronger)
Why are leukotrienes important to nasal allergic inflammation?
More potent than histamine trigger
Tx of leukotrienes
Antagonist (Singulair)
MOA of corticosteriods
Stabilizes mast cells so do not degranulate, inhibits chemotaxis of inflammatory cells
Use of corticosteriods in allergies
Short use is good for severe mucosal congestion
Contraindications for corticosteriods
DM, PUD, glaucoma, severe hypertension
Why is informed consent needed for high dose steriods?
Avascular necrosis and other side effects
rhinosinusitis associated diseases
GERD, EER, cystic fibrosis, cilia dysfunction, fungal rhinosinusitis
Associated with cilia dysfunction
Kartageners syndrome: situs invertus, bronchiectasis, sinusitis, male infertility
What is produced in fungal rhinosinusitis and no other rhinosinusitis?
IL-5 and IL-13
S&S of chronic rhinosinusitis
Eosinophil inflammation, epithelial damage, basal membrane thickening (SAME AS ASTHMA)
Tx of fungal rhinosinusitis
Amphotericin B
Complications of rhinosinusitis
Cavernous sinus thrombophlebitis, abcess, meningitis, sinocutaneous fistula
