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anatomy



1:posterior chamber

2:ora serrata

3:ciliary muscle

4:ciliary zonules

5:canal of Schlemm

6:pupil

7:anterior chamber

8:cornea

9:iris

10:lens cortex11:lens nucleus

12:ciliary process

13:conjunctiva

14:inferior oblique muscle

15:inferior rectus muscle



16:medial rectus muscle

17:retinal arteries and veins

18:optic disc19:dura mater

20:central retinal artery

21:central retinal vein

22:optic nerve

23:vorticose vein

24:bulbar sheath25:macula

26:fovea

27:sclera

28:choroid

29:superior rectus muscle

30:retina



As a conscious sense organ, the eyeallows vision. Rod and cone cells inthe retina allow conscious light perceptionand vision including color differentiationand the perception of depth. The humaneye can distinguish about 10 million colors.



The posterior chamber◦ a narrow chink behind the peripheral part of the

iris of the human eye, and in front of thesuspensory ligament of the lens and the ciliary

processes the Posterior Chamber consists of smallspace directly posterior of the Iris but anterior tothe lens.



Schlemm's canal, also known as canal of Schlemmor the scleral venous sinus, is a circular channel inthe eye that collects aqueous humor from theanterior chamber and delivers it into the

bloodstream. On the inside of the canal, nearest to the aqueous

humor, it is covered by the trabecular meshwork,this region makes the greatest contribution to

outflow resistance of the aqueous humor. Named after Friedrich Schlemm (1795-1858), a

German anatomist.



The pupil is a circular opening located in thecenter of the iris of the eye that allows lightto enter the retina

The anterior chamber is the fluid-filledspace inside the eye between the iris andthe cornea's innermost surface, theendothelium.

Aqueous humor is the fluid that fills theanterior chamber.



The cornea is the transparent front part of the eye that covers the iris, pupil, andanterior chamber. Together with the lens,the cornea refracts light, accounting forapproximately two-thirds of the eye's totaloptical power



The iris is a membrane in the eye,responsible for controlling the diameter andsize of the pupil and the amount of lightreaching the retina. "Eye color" is the color of

the iris, which can be green, blue, or brown.In some cases it can be hazel (light brown).In response to the amount of light enteringthe eye, muscles attached to the iris expandor contract the aperture at the center of theiris, known as the pupil. The larger the pupil,the more light can enter.



The lens is a transparent, biconvexstructure in the eye that, along with thecornea, helps to refract light to be focusedon the retina. The lens, by changing shape,functions to change the focal distance of the eye so that it can focus on objects atvarious distances, thus allowing a sharp realimage of the object of interest to be formedon the retina. This adjustment of the lens isknown as accommodation.



retina is a light sensitive tissue lining theinner surface of the eye. Light striking theretina initiates a cascade of chemical andelectrical events that ultimately triggernerve impulses. These are sent to variousvisual centers of the brain through thefibers of the optic nerve.

Rods provide black-and-white vision cones support daytime vision and the

perception of colour.



The macula or macula lutea (from Latinmacula, "spot" + lutea, "yellow") is an oval-shaped highly pigmented yellow spot nearthe center of the retina of the human eye.

Because the macula is yellow in colour itabsorbs excess light that enters the eye andacts as natural sunglasses.

Within the macula are the fovea and foveolawhich contain a high density of cones



The sclera, also known as the white of theeye, is the opaque fibrous, protective, outerlayer of the eye containing collagen andelastic fiber

the conjunctiva is a thin layer covering thesclera. Along with the vessels of theconjunctiva, those of the sclera renders the

inflamed eye bright red.



The choroid is the vascular layer containingconnective tissue, of the eye lying betweenthe retina and the sclera. In humans itsthickness is about 0.5 mm. The choroidprovides oxygen and nourishment to theouter layers of the retina. Along with theciliary body and iris, the choroid forms theuveal tract.



The ciliary body is the circumferential tissueinside the eye which secretes aqueoushumour



the leading cause of blindness in those 40 years or

older



The earliest reference to cataracts can befound in Hindu writings from the 5th century BC

The word Cataract comes from the Greekword meaning “Waterfall” Until the mid 1700’s, it was thought that

cataract was formed by opaque material

flowing, like a waterfall into the eye



The human lens is anaturally clearstructure located

behind the iris andsupported by thezonules

The lens isavascular-It does not

have a vascularsupply



The basic lensconsists of a

central nucleussurrounded bythe cortexcontained within

the lens capsule



The lens is made mostly of water andprotein fibers

The protein fibers are arranged in aprecise manner that makes the lens clear

and allows light to pass through withoutinterference With aging, the composition of the lens

undergoes changes and the structure of the protein fibers breaks down

Some of the fibers begin to clumptogether, clouding areas of the lens, andleading to the loss of transparency



This loss of transparency, or

opacity formationis called Cataract



Clouding of the lens is a normal part of aging

About half individuals older than 65 have

some degree of clouding of the lens According to one study, after age 75, 39%

of men, and 46% percent of women in theU.S. have visually significant cataracts



Cataracts produce a gradual, painless,progressive loss of vision, and manypatients are unaware of vision problems

Generally do not cause pain, or abnormal

tearing But as the clouding progresses, the cataract

eventually interferes with your vision



Commonly affect distance vision Cause problems with glare In the early stages, stronger lighting and

eyeglasses can help deal with the vision

problems If impaired vision jeopardizes your normal

lifestyle, you might need surgery



Blurred vision Increasing difficulty with vision at night

Glare, especially at night Halos around lights The need for brighter light for reading Double vision in a single eye Fading or yellowing of colors



Due to increase of yellow-brown

pigment in thelens, colorperception also isaffected



These may also be symptoms of other eyeconditions, therefore it is important to seeyour ophthalmologist annually, or if there isa persistent change in vision



Pain, redness, discharge, or irritation in theeye are usually not signs or symptoms of acataract, but may be signs and symptomsof other eye disorders



A cataract isn'tdangerous to the eyeunless the cataractbecomes completelywhite, a conditionknown as an overripe(hypermature) cataract

This can causeinflammation, eye pain

and headache A hypermature cataract

is extremely rare andneeds removal



Responsible for nearly 10% of all visualloss in children worldwide

Approximately 0.03% of newborns havesome form of congenital cataract

Most are not associated with additionaldevelopmental problems

Around one fifth of these patients have afamily history of congenital cataract but in

up to half of all cases there is no familyhistory



In the case of a newborn infant, a cataractcauses the immature visual system to bedeprived of the stimulation needed fornormal development

If left untreated, permanent visual lossmay occur

Unilateral cataracts are more likely to

cause visual loss because of thecompetition between the two eyes



If the cataract is small there may be onlyslight blurring of vision with near normalvisual development

If the cataract is larger, or located more

posteriorly, it can effect visualdevelopment

In some cases this can lead to permanentamblyopia (lazy eye)

Without adequate stimulation centralvision can be permanently effected



Outcome is very much dependent onthe type of cataract

Some congenital cataracts impairvisual development only to a small

degree and may never require surgery If the cataract is only in one eye, there

is a strong tendency for the child to

prefer the healthy eye◦ The eye affected by the cataract rarely

achieves normal vision, therefore removal of the cataract is indicated



Hereditary◦ Autosomal dominant form most common

Genetic and Metabolic Diseases◦ Down syndrome

◦

Marfan’s syndrome◦ Myotonic Dystrophy

Maternal Infections◦ Rubella, Syphilis, Toxoplasmosis, Varicella



Ocular Anomalies◦ Aniridia-Absence of iris at birth

Toxic◦ Corticosteroids, Radiation

Trauma



Exposure to sunlight (UV light) Smoking Diabetes Trauma (blunt or penetrating) Family history of cataracts Corticosteroid therapy Radiation exposure Electrical injury Myotonic dystrophy Uveitis- Ocular inflammation



Everyone is at risk of developing cataractssimply because age is the single greatestrisk factor

By age 65 about half of all Americans havedeveloped some degree of lens clouding



The most commonobjective findingassociated with

cataracts isdecreased visualacuity

This is measured

with an office wallchart or near-visioncard



Acuity refers to the sharpness of vision orhow clearly you see an object

In this test, your eye doctor checks to seehow well you read letters from across the

room Eyes are tested one at a time, while the

other eye is covered. Using the chart with progressively smaller

letters from top to bottom, to determinethe level of vision



This is performedby your doctor tosee if the

decrease in visionis simply due forneed for newglasses, or if thereis another process

at work thataccounts for thedecrease in visualacuity



Dilating drops areplaced in the eyes todilate the pupils wideand provide a better

view to the back of theeyes

It allows theophthalmologist toexamine the lens for signs of a cataract and,if needed, determinehow dense theclouding is



It also allows forexamination of the retina and the

optic nerve. Dilating drops

usually keep yourpupils open for afew hours beforetheir effectgradually wearsoff



Cataract Retinal detachment Macular degeneration

Diabetes mellitus Glaucoma Retinal artery occlusion



Macular degeneration usually causes aslow, progressive loss of central vision

Symptoms of acute vision loss anddistortion result from leakage from

abnormal subretinal vessels Patients should be referred to a retina

specialist immediately



Diabetic retinopathy may also contributeto vision loss

Findings include dot-and-blothemorrhages, microaneurysms, dilatedand tortuous vessels, andneovascularization of the disk and retina

Cataracts often obscure the fundus,

making assessment of diabeticretinopathy difficult



Open-angle glaucoma produces slow,painless visual field loss that usuallybegins peripherally

Optic nerve damage and subsequent lossof peripheral vision occur at normal aswell as elevated intraocular pressures

With progressive optic nerve damage and

visual field loss, central vision is the last tobe affected



Cataracts are the most treatable cause of decreased vision in the United States

For most patients, observation and

frequent eyeglass prescription changesare sufficient When activities of daily living, such as

driving, reading, working, and self-care

are affected surgery should be discussed



Cataract Surgery should be consideredwhen changes in eyeglasses no longer help,quality of life is jeopardized, and cataractremoval is likely to have an impact on vision



Think about how the cataract affects yourdaily life◦ Can you see to do your job and drive safely

◦ Do you have problems reading or watching

television?◦ Is it difficult to cook, shop, climb stairs or take

medications?◦ How active are you? Does lack of vision affect

your level of independence?◦ Are you afraid you'll trip or fall or bump into

something?



Sometimes a cataract should be removedeven if it doesn't cause major problems withvision◦ If it is preventing the treatment of another eye

problem, such as age-related maculardegeneration, diabetic retinopathy or retinaldetachment



If you have cataracts in both eyes anddecide to have surgery, your eye doctortypically removes the cataract in one eye ata time

This allows time for the first eye to healbefore the second eye surgery



Cataract surgery is the most common operationperformed on patients over 65 years of age

More than 95% of patients have improved visionafter surgery

Benefits include improvement in uncorrected andbest-corrected visual acuity, improvedbinocularity, depth perception, and increasedperipheral vision to enhance patients' ability todrive, read, work, and manage their ownmedications



Advances in surgical technique and moresophisticated technology have helpedmake surgery a safe and effectivetreatment for cataracts

Prior to surgery, your eye doctor measuresthe size and shape of your eye todetermine the proper lens implant power

This measurement is made with a painlessultrasound test



Two things happenduring cataractsurgery — the

clouded lens isremoved, and a clearartificial lens isimplanted



Duringphacoemulsification, phaco forshort, thesurgeon makes asmall incision,

where the corneameets theconjunctiva



Some IOLs are rigidplastic and implantedthrough an incision thatrequires several stitches

(sutures) to close However, many IOLs are

flexible, allowing asmaller incision thatrequires no stitches



Patients are usually examined 1 day, 1week and then one month after the surgerydate



This condition occurswhen the back of thelens capsuleeventually becomes

cloudy and blurs vision PCO can develop

months or years aftercataract surgery

Occurs approx. 20%

percent of the time



Treatment for PCO is simple and quick Laser capsulotomy is a quick, painless

outpatient procedure that usually takes lessthan five minutes

Capsulotomy means "cutting into thecapsule" and YAG is an abbreviation of yttrium-aluminum-garnet, the type of laserused for the procedure



A technique inwhich a laser

beam is used tomake a smallopening in theclouded capsule

to let light passthrough



Afterward, patients typically stay in thedoctor's office for about an hour to makesure the eye pressure is not elevated

In some people, particularly those whohave glaucoma or are extremelynearsighted, YAG laser surgery can raiseeye pressure

Other complications are rare but caninclude swelling of the macula and adetached retina



Most cataracts occur with age and can't beavoided altogether

Regular eye exams remain the key to earlydetection

You can take steps to help slow or preventthe development of cataracts



Do not smoke◦ Smoking produces free radicals, increasing

your risk of cataracts.

Eat a balanced diet◦ Include plenty of fruits and vegetables.

Ultraviolet light protection since UV lightmay contribute to the development of cataracts

Diabetes Control



Researchers are continuing to explore newways to prevent and treat cataracts, suchas developing medications that wouldreduce or eliminate the need for surgery

Until then, cataract surgery is the methodto restore vision



Sufficient rise in intraocular pressure tocause visual damage



Congenital Glaucoma Primary Glaucoma 1- Open angle 2- closed angle Secondary Glaucoma Absolute Glaucoma



Features Buphthalmos

corneal diameter 12 mm < 1 yr Tears of descemet’s membrane Corneal haze Increased A/C depth Optic disc cupping



Angle closure Acute

Very painful

Reduced visionNausea vomiting

Can be triggered by dilating drops



Lens Intumescence Dislocation Phacolytic Trauma Uveitis

Neovascular



Blind Painful

Treatment Enucleation Laser/Cryotherapy Absolute alcohol



Medical

Beta blockers (Timolol) Carbonic anhydraze inhibitors

Azopt and Trusopt Sympathomimetics

Propine and Apraclonidine Parasympathomimetics (pilocarpine) Prostaglandin Derivatives (Xalatan)



LaserSurgical◦ Trabeculectomy

◦ Trabeculoplasty

◦Sclerostomy



is a disorder of the eye inwhich the retina peels

away from its underlyinglayer of support tissue. It isa medical emergency.



flashes of light (photopsia) - very brief in theextreme peripheral (outside of center) part of vision

a sudden increase in the number of floaters a ring of floaters or hairs just to the temporal side

of the central vision a slight feeling of heaviness in the eye Although most posterior vitreous detachments do

not progress to retinal detachments, those that doproduce the following symptoms: veil or curtain vision central visual loss



Surgical:◦ Scleral bucklingPost op: must be in prone position

◦ Silicone Oil injectionPost op: must be in supine or lowfowler’s

◦

Cryopexy and LaserPhotocoagulation



Auricle is mostlyskin-lined cartilage

External auditory

meatus◦ Cartilage: ~40%

◦ Bony: ~60%

◦ S-shaped

◦

Narrowest portion atbony-cartilage junction



EAC is related tovariouscontiguous

structures◦ Tympanic

membrane

◦ Mastoid

◦ Glenoid fossa

◦ Cranial fossa

◦ Infratemporal fossa



Innervation: cranial nerves V, VII, IX, X, andgreater auricular nerve

Arterial supply: superficial temporal,posterior and deep auricular branches

Venous drainage: superficial temporal andposterior auricular veins

Lymphatics



Bacterial infection of external auditory canal Categorized by time course

◦ Acute

◦ Subacute

◦ Chronic



“swimmer’s ear” Preinflammatory stage Acute inflammatory stage

◦ Mild

◦ Moderate◦ Severe



Edema of stratum corneum and plugging of apopilosebaceous unit

Symptoms: pruritus and sense of fullness Signs: mild edema Starts the itch/scratch cycle



Progressiveinfection

Symptoms◦ Pain◦ Increased pruritus

Signs◦ Erythema

◦

Increasing edema◦ Canal debris,

discharge



Severe pain,worse with earmovement

Signs◦ Lumen obliteration

◦ Purulent otorrhea

◦ Involvement of

periauricular softtissue



Most common pathogens: P. aeruginosa andS. aureus

Four principles◦ Frequent canal cleaning

◦ Topical antibiotics◦ Pain control

◦ Instructions for prevention



Chronic inflammatory process Persistent symptoms (> 2 months) Bacterial, fungal, dermatological etiologies



Unrelenting pruritus Mild discomfort Dryness of canal skin



Similar to that of AOE Topical antibiotics, frequent cleanings Topical Steroids Surgical intervention

◦ Failure of medical treatment

◦ Goal is to enlarge and resurface the EAC



In 1861 Prosper Meniere described asyndrome characterized by deafness,tinnitus, and episodic vertigo. He linked thiscondition to a disorder of the inner ear.

In 1938 Hallpike and Cairns described theunderlying pathology of Meniere’s diseaseas being endolymphatic hydrops but theprecise etiology still remains elusive.



Anatomical-abnormalities

Genetic-autosomaldominant

Immunological-immune complexdeposition

Viral-serum IgE toherpes simples virustypes I and II, Epstein-Barr virus and CMV

Vascular-associatedwith migraines

Metabolic-potassiumintoxication



Normal membranous labyrinthDilated membranous labyrinth

in Meniere's disease (Hydrops)



Women>Men

In the US: 50% of patients have a positive family history.

The estimated prevalence is 150 cases per 100,000 population

40’s and 50’s



The diagnosis of Meniere disease is madebased on a careful history and physical exam.

If the work-up is normal and the classic

symptoms continue, the diagnosis of Meniere

disease is made.



Most important part of the diagnosis Pattern of symptoms Association between hearing loss, tinnitus, and

vertigo



Examination results vary, depending upon the phase

of disease. During remission, physical examinationfindings may be completely normal, particularly if thepatient is symptom free.

During an acute attack, the patient has severevertigo.

Patients are sometimes diaphoretic and pale. Vital signs may show elevated blood pressure, pulse,

and respiration.. Spontaneous nystagmus directed toward affected ear

is typical during an acute attack.



No lab studies are specific for Meniere disease. A CBC, urinalysis, chemistry panel, and alcohol and

drug screening may be helpful if other causes are

considered. If an infectious cause is suspected, consider blood

cultures, urine culture, and a cerebral spinal fluid (CSF)

examination.



Diuretics or diuretic-like medications (eg,hydrochlorothiazide) actually decrease the fluid

pressure load in the inner ear. These medications

help prevent attacks but do not help once an

acute attack has started.



Anti-inflammatory properties of steroids are helpfulin endolymphatic hydrops. This is probably due to

reduced endolymphatic pressure. Steroids

actually can reverse vertigo, tinnitus, and hearing

loss.



Aminoglycosides are a class of antibiotics that werediscovered serendipitously to be preferentially toxicto the vestibular end organ.◦ Destruction of the vestibular end organ renders the

brain insensitive to the fluctuations in the inner ear pressure during an acute Ménière attack.

◦ If given systemically, aminoglycosides affect both ears.◦ Although these drugs can be used to treat extremely

severe bilateral Ménière disease, they leave thepatient with little or no balance function. The resultingDandy syndrome, a complete loss of inner ear

function, can be debilitating.



During the quiescent phase, medical treatment of Ménière disease is tailored to each patient.

Lifestyle and dietary changes are usually the first

step. Avoiding trigger substances (eg, caffeine)

alone may be sufficient. Smoking cessation also isrecommended.



Surgical Care:◦ Surgical therapy for Ménière disease is reserved for

medical treatment failures and is otherwise controversial.

◦ Surgical procedures are divided into 2 major

classifications as follows:

Destructive surgical procedures

Nondestructive surgical procedures



Destructive surgical procedures◦ Rationale to control vertigo: Endolymphatic hydrops

causes fluid pressure accumulation within the inner ear, which causes temporary malfunction and misfiringof the vestibular nerve. These abnormal signals cause

vertigo. Destruction of the inner ear and/or thevestibular nerve prevents these abnormal signals. Aslong as the opposite inner ear and vestibular apparatus function normally, the brain eventually willcompensate for the loss of one labyrinth.



Problems with destructive procedures:◦ Destruction of one inner ear depends on the adequate

function of the opposite ear. Unfortunately, Ménière

disease can be bilateral (7-50%), in which case this

method is contraindicated. Since balance and hearing

are closely intertwined within the labyrinth, destruction

of the balance portion carries a high risk of hearing

loss. Note that destructive procedures are irreversible

and reserved for severe cases.



Nondestructive surgical procedures:◦ These are directed toward improving the

state of the inner ear. They are less invasivethan destructive procedures :

1. endolymphatic sac decompression or shunt

2. vestibular nerve section

3. Labyrinthectomy

4. transtympanic medication perfusion.



Vestibular nerve section◦ For patients with useful hearing in the affected ear,sectioning the diseased vestibular nerve can be theultimate solution.

◦ Although the hearing and balance functions are housed

in one common chamber within the inner ear, their neural connections to the brain separate into distinctnerve bundles as they course through the internalauditory canal.

◦ This anatomical separation allows balance function to

be isolated and ablated without affecting hearingfunction.



Labyrinthectomy◦ This management option for Ménière disease has the

advantage of a high cure rate (>95%) and is useful in thepatient whose hearing on the diseased side has beendestroyed already by Ménière disease.

◦

Labyrinthectomy involves ablation of the diseased inner ear organs.

◦ This procedure is less complex than vestibular nervesection because labyrinthectomy does not require entryinto the cranial cavity.

◦ Labyrinthectomy is less invasive than vestibular nerve

section.



This procedure carries less danger of cerebrospinalfluid leak and meningitis since craniotomy is notrequired.

Like those who undergo vestibular nerve section,patients require a few days of inpatient care.

Accommodation to the surgical loss of onevestibular apparatus usually takes weeks or months.

Vestibular rehabilitation during this time period isalso helpful.



Transtympanic perfusion of medication◦ Medications for Ménière disease are applied through a

myringotomy within the middle ear cavity, where they

presumably are absorbed through the round window

membrane into the inner ear.

◦ Transtympanic perfusion is a relatively low-risk, simple

procedure that applies a high concentration of

medicine with minimal systemic effects.



Diet:◦ Dietary management is appropriate in patients notseverely affected; patients avoid substances that maytrigger or exacerbate fluid pressure buildup in the inner ear.

◦ Similar to managing systemic hypertension, the goalfor Ménière disease is to reduce the total body fluidvolume. This, in turn, may reduce the inner ear fluidvolume.

◦ Since sodium seems to play a major role in fluid

retention within the inner ear, avoiding salt (eg, pizza,preserved foods, smoked fish) is paramount.



Consult with a nutritionist to establish a rigidsalt-restricted diet (1.5 g sodium per day). Avoiding other trigger substances (eg, caffeine,

nicotine, alcohol, high-carbohydrate substances,

high-cholesterol/triglyceride foods) also canhelp.

Note that many preserved and smoked foods

contain sodium nitrite, which can contribute to

high sodium content.



Activity:◦ Endolymphatic hydrops does not preclude regular

activity. Exercise is recommended in moderation.

◦ Because of the unpredictable nature of the disease,

balance-intensive, dangerous tasks (eg, especially

climbing ladders) should be avoided..



Definition◦Otosclerosis is an abnormalbone growth in the middle ear

that causes hearing loss.



Symptoms◦ Hearing loss

◦ Slow hearing loss that continues to

get worse◦ Hearing may be better in noisyenvironments than quiet areas.

◦

Ringing in the ears (tinnitus)



Signs and tests◦A hearing test (audiometry/audiology) may determine the

extent of hearing loss.◦ Temporal-bone CT may be usedto distinguish otosclerosis from

other causes of hearing loss.



Treatment◦A hearing aid may be used totreat the hearing loss.

◦Surgery: Stapedectomy -replacement of the stapes witha prosthesis



To reduce the risk of complications after surgery:

◦ Do not blow your nose for 1 week after surgery.

◦ Avoid people with respiratory or other infections.

◦ Avoid bending, lifting, or straining, which may causedizziness.

◦Avoid loud noises or sudden pressure changes such asscuba diving, flying, or driving in the mountains untilhealed.

◦ If surgery is unsuccessful, total hearing loss may occur. Treatment then involves developing skills to cope with

deafness, including use of hearing aids and visual cues.



Surgery Complications◦Complete deafness

◦ Infection, dizziness, pain, or

blood clot in the ear aftersurgery



Definition

◦ Tonsillitis is inflammation of the tonsils.



Causes:◦ Infection of tonsils, pharynx,and surrounding regions

Commonly by: Group A beta-hemolytic Streptococci



Symptoms◦ Difficulty swallowing

◦ Ear pain

◦ Fever, chills

◦ Headache◦ Sore throat - lasts longer than 48 hours andmay be severe

◦ Tenderness of the jaw and throat

◦ Voice changes, loss of voice



Signs and tests◦ Inspection of tonsils by use of tongue depressor

Tests that may be doneinclude:◦Rapid strep test

◦ Throat swab culture



Treatment◦Antibiotic therapy Per oremMust be taken throughout the entire

regimen

Intramuscular injection

Usually given in 1 shot

◦Surgery: tonsillectomy



Complications◦ Blocked airway from swollen tonsils

◦ Dehydration from difficulty swallowing fluids

◦ Kidney failure

◦ Peritonsillar abscess or abscess in otherparts of the throat

◦ Post-streptococcal glomerulonephritis

◦ Rheumatic fever and related cardiovascular

disorders



Surgical removal of tonsils The tonsillectomy has been practiced for 2000

years, with varying popularity over thecenturies. The procedure is first mentioned in

"Hindu medicine" about 1000 BC; roughly amillennium later the Roman aristocrat Celcus(25 AD – 50 AD) described a procedurewhereby using the finger (or a blunt hook if necessary), the tonsil was separated from theneighboring tissue prior to being cut out.



Pre operative phaseEnsure a signed informed consent, &CP clearance

NPO 8-12 hrs prior to procedureGive pre meds as orderedMonitor for untoward signs andsymptoms

Refer to the medical teamAccomplish pre-op checklist



Ensure safety- keep side rails up Ensure patent airway, oxygen therapy, DBE Orient to time, person, and place Assess LOC periodically

Close monitoring of vital signs – v/s q15mins Positioning – supine with head turned to the side Give due medications and IV’s as prescribed Watch out for dyspnea, hemmorrhage (common

sign is frequent swallowing)



Provide a safe environment◦ Sharp objects must kept away

◦ Heating devices must be secured

◦ Non slip surfaces and ramps must be provided

◦ Furniture must not be moved often

◦ Identify yourself when approaching them

◦ Ask for permission when touching them



Speak in a normal tone Refer to special education for specific needs

such as:◦ Walking canes

◦

Guide dogs◦ The use of braile



The hearing impaired are persons with nosense of hearing

In the absence of hearing other senses maycompensate for its loss (especially sight).

Involve the family and significant other inthe care and treatment of the patient

Alternative communication methods mustbe explored

Refer to proper resources for education of the patient and family. E.g. sign language



Speak to them normally, there is no need toshout

If the patient still has a functioning ear,speak in to it as much as possible

Accentuate speech with hand gestures Articulate speech well and not too fast for

them to read lips



Do not cover your mouth when speaking tothem

Do not chew gum or speak with anything inour mouth when communicating with them

Always face the patient when talking tothem

Sounds of household items like thetelephone or doorbell maybe fitted with

lights for them to have a visual cue.

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