EYES, EARS, NOSE AND THROAT

1. EYES, EARS, NOSE AND THROAT conjunctivitis • Most common eye disease • May be acute or chronic • Most cases caused : 1- bacterial (gonococcal and chlamydial ) 2-viral infection • Other causes : allergy and chemical irritants

2. Bacterial Conjunctivitis • Gonococcal Conjunctivitis • Acquired through contact with infected genital secretions. • Manifested by a copious purulent discharge • Involvement of corneal leads to perforation • Dx confirmed by stained smear and culture of the discharge.

3. Treatment • Topical antibiotic :erythromycin or bacitracin • Single IM dose of ceftriaxone ,1g ,is effective • When the cornea is involved , a 5-day of parenteral ceftriaxone ,1-2g daily ,is required.

4. viral Conjunctivitis • Adenovirus is the most common cause • Associated with :pharyngitis, fever, malaise and preauricular adenopathy. • Characterized by :red palpebral conjunctiva and copious watery discharge • Treatment : local sulfonamide therapy , hot compresses

5. Allergic Conjunctivitis • No pain , vision changes • Marked pruritus • Bilateral watery eyes • Treatment :antihistamine or steroid drops

6. Herpes Zoster Ophthalmicus • Frequently involves the ophthamic division the trigeminal nerve. • Eruptions preceded by :malaise, fever, headache and burning and itching in the peri-orbital region. • Rash ccc v vesicular pustular crusting

9. Ocular manifestations: • Conjunctivitis • Keratitis • Episcleritis • Anterior uveitis • Elevated intraocular pressure • Treatment :high dose oral acyclovir

10. Uveitis • Inflammation of the iris , ciliary body and /or choroid • Characterized by : pain , miosis, photophobia • Diagnosis made by slit lamp examination • Flare & cells seen in aqueous humor • Seen in IBD, sarcoidosis • Treatment underlying disease

11. Glaucoma • A group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness • 2 types : • Angle –closure glaucoma • Open-angle glaucoma

12. Angle closure glaucoma • Severe pain • Decreased peripheral vision • Presence of halos around lights • Fixed mid-dilated pupil • Tonometry reveals elevated intraocular pressure • Treatment : IV mannitol , acetazolamide, laser iridotomy for cure

13. Cataract • Lens opacity • Blurred vision ,progressive over months or years • No pain or redness • Treatment :surgery

14. Macular degeneration • Age-related • Painless loss of visual acuity • Dx by altered pigmentation in macula • No Tx , but patient often retains adequate peripheral vision

16. Retinal detachment • Blurred vision in one eye becoming w0rse ( “ a curtain came down over my eyes”) • No pain or redness • Detachment seen by ophthalmoscopy • Tx = urgent surgical reattachment

17. OTITIS EXTERNA • Presents with otalgia • Pruritus • Purulent discharge • h/o recent water exposure or mechanical trauma • Examination reveals : erythema and edema of the ear canal and pulling on pinna or pushing on tragus cause pain

18. Pseudomonas is usual cause • Treatment: • Protection of the ear from additional moisture • Otic drops containing a mixture of aminoglycoside antibiotic and anti-inflammatory corticosteroid( eg. Neomycin sulfate , polymyxin B , and hydrocortisone

19. Malignant External otitis • Persistent external otitis in the diabetic • Caused by pseudomonas aeruginosa • May evolve into osteomyelitis of the skull base • Presents with persistent foul aural discharg, granulations in the ear canal ,deep otalgia, progressive cranial nerves palsies • CT confirmed the dx by demonstrating of osseous erosion

20. Treatment • Medical : antipseudominal antibiotic often for several months • Surgical debridement

21. Acute Otitis Media • Bacterial infection of the mucosally lined air-containing spaces of the temporal bone. • Precipitated by a viral upper respiratory tract infection. • Most common in infant and children • Most common pathogens : streptococcus pneumonia, haemophilus influenzae and streptococcus pyogenes

22. Patient presents with otalgia, aural pressure, decreased hearing and fever. • Typical findings : erythema and decreased mobility of the tympanic membrane. • Treatment: • First –choice antibiotic either amoxicillin or erythromycin. • Amoxicillin-clavulanate useful alternative

23. Vertigo Syndromes • Benign positional vertigo • Sudden,episodic vertigo with head movement lasting for seconds. • Treatment : hallpike maneuver B. Viral labyrinthitis • Prececed by viral respiratory illness • Vertigo lasting days to weeks • Treatment : meclizine

24. Meniere’s disease • Dilation of membrane labyrinth due to excess endolymph • Characterized by classic triad :hearing loss, tinnitus and episodic vertigo lasting several hours. • Treatment : thiazide, anticholinergic or surgery

25. Acoustic neuroma • CN VIII schwannoma commonly affects vestibular portion but can also affect cochlea. • Patient presents with : vertigo, sudden deafness and tinnitus. • Dx = MRI of cerebellopontine angle • Tx = local radiation or surgical erection

26. EPISTAXIS • Bleeding from Kiesselbach’s plexus, a vascular plexus on the anterior nasal septum. • Predisposing factors : • Nasal trauma (nose picking, foreign bodies, forceful nose blowing) • Rhinitis, drying of the nasal mucosa ,deviation of the nasal septum, alcohol , bone spurs, antiplatelet medication.

27. Treatment = direct pressure, topical nasal constriction (phenylephrine 0.125-1% solution), consider anterior nasal packing if unable to stop.

28. SINUSITIS • Result of impaired mucociliary clearance and obstruction of the osteomeatal complex. Edematous mucosa causes obstruction of the sinus drainage tract, resulting in the accumulation of mucous secretion in the sinus cavity that becomes secondarily infected by bacteria.

29. A . Acute sinusitis • Patient presents with : purulent rhinorrhea, headache, pain on sinus palpation,fever, halitosis. • Most common pathogens : S. pneumoniae, H. influenzae, Moraxella catarrhalis. • Tx : Bactrim , amoxicillin, decongestants

30. B. Chronic sinusitis • Same clinical presentation as for acute. • Lasts longer > 3 months • Common pathogens : Bacteroides, Staph. Aureus, Pseudomonas , Streptococcus spp. • Dx = CT scan showing inflammatory changes or bone destruction. • Tx = surgical correction of obstruction , nasal steroids • Complication : meningitis, abscess formation,orbitalinfection,osteomyelitis

31. PHARYNGITIS • Group A Strep throat • High fever • Severe throat pain w/o cough • Edematous tonsils with white or yellow exudate • Unilateral cervical adenopathy

32. Diagnosis • H&P 50 % accurate • Rapid antigen test • Throat swab culture is gold standard • Tx: penicillin to prevent acute rheumatic fever

33. Membranous ( diphtherial ) • High fever • Dysphagia • Drooling can cause respiratory failure • Dx : pathognomonic gray membrane on tonsils extending into throat • Tx : Antitoxin

34. Fungal (candida) • Dysphagia • Sore throat with white ,cheesy patches in oropharynx (oral thrush)seen in AIDS and small children • Dx : clinical or endoscopy • Tx : nystatin ,clotrimazole

35. Adenovirus • Fever • Red eye • Sore throat • Dx : clinical • Tx : supportive

36. Herpangina ( coxsackie A) • Fever • Pharyngitis • Body ache • Tender vesicles along tonsils, uvula and soft palate • Dx : clinical • Tx : supportive