EENT , Lecture

EYES 1. ConjunctivitisMost common eye diseaseMay be acute or chronicMost cases caused : 1- bacterial (gonococcal and chlamydial ) 2-viral infectionOther causes : allergy and chemical irritants 2. Bacterial ConjunctivitisGonococcal ConjunctivitisAcquired through contact with infected genital secretions.Manifested by a copious purulent dischargeInvolvement of corneal leads to perforationDx confirmed by stained smear and culture of the discharge. TreatmentTopical antibiotic :erythromycin or bacitracinSingle IM dose of ceftriaxone ,1g ,is effectiveWhen the cornea is involved , a 5-day of parenteral ceftriaxone ,1-2g daily ,is required.

3. Viral ConjunctivitisAdenovirus is the most common causeAssociated with :pharyngitis, fever, malaise and preauricular adenopathy.Characterized by :red palpebral conjunctiva and copious watery dischargeTreatment : local sulfonamide therapy , hot compresses Allergic ConjunctivitisNo pain , vision changesMarked pruritusBilateral watery eyesTreatment :antihistamine or steroid drops Herpes Zoster OphthalmicusFrequently 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

Ocular manifestations:ConjunctivitisKeratitisEpiscleritisAnterior uveitisElevated intraocular pressureTreatment :high dose oral acyclovir UveitisInflammation of the iris , ciliary body and /or choroidCharacterized by : pain , miosis, photophobiaDiagnosis made by slit lamp examinationFlare & cells seen in aqueous humorSeen in IBD, sarcoidosisTreatment underlying disease GlaucomaA group of diseases that can damage the eyes optic nerve and result in vision loss and blindness2 types :Angle closure glaucomaOpen-angle glaucoma

Angle closure glaucomaSevere painDecreased peripheral vision Presence of halos around lightsFixed mid-dilated pupilTonometry reveals elevated intraocular pressureTreatment : IV mannitol , acetazolamide, laser iridotomy for cureCataract Lens opacityBlurred vision ,progressive over months or yearsNo pain or rednessTreatment :surgery

Most common cause of cataract is agingChief complaint of any patient with cataract is blurred vision

13 Macular degenerationAge-related Painless loss of visual acuityDx by altered pigmentation in maculaNo Tx , but patient often retains adequate peripheral vision

Retinal detachmentBlurred vision in one eye becoming w0rse ( a curtain came down over my eyes)No pain or rednessDetachment seen by ophthalmoscopyTx = urgent surgical reattachment

OTITIS EXTERNAPresents with otalgiaPruritusPurulent dischargeh/o recent water exposure or mechanical traumaExamination reveals : erythema and edema of the ear canal and pulling on pinna or pushing on tragus cause painPseudomonas is usual causeTreatment: 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 hydrocortisoneMalignant External otitisPersistent external otitis in the diabeticCaused by pseudomonas aeruginosaMay evolve into osteomyelitis of the skull basePresents with persistent foul aural discharg, granulations in the ear canal ,deep otalgia, progressive cranial nerves palsies CT confirmed the dx by demonstrating of osseous erosionTreatment Medical : antipseudominal antibiotic often for several monthsSurgical debridementAcute Otitis MediaBacterial 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 childrenMost common pathogens : streptococcus pneumonia, haemophilus influenzae and streptococcus pyogenesPatient 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 Vertigo SyndromesBenign positional vertigo Sudden,episodic vertigo with head movement lasting for seconds.Treatment : hallpike maneuver B. Viral labyrinthitisPrececed by viral respiratory illnessVertigo lasting days to weeksTreatment : meclizine Menieres diseaseDilation of membrane labyrinth due to excess endolymphCharacterized by classic triad :hearing loss, tinnitus and episodic vertigo lasting several hours.Treatment : thiazide, anticholinergic or surgery Acoustic neuromaCN VIII schwannoma commonly affects vestibular portion but can also affect cochlea.Patient presents with : vertigo, sudden deafness and tinnitus.Dx = MRI of cerebellopontine angleTx = local radiation or surgical erectionEPISTAXISBleeding from Kiesselbachs 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.Treatment = direct pressure, topical nasal constriction (phenylephrine 0.125-1% solution), consider anterior nasal packing if unable to stop. SINUSITISResult 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.

A . Acute sinusitisPatient presents with : purulent rhinorrhea, headache, pain on sinus palpation,fever, halitosis.Most common pathogens : S. pneumoniae, H. influenzae, Moraxella catarrhalis.Tx : Bactrim , amoxicillin, decongestants B. Chronic sinusitisSame clinical presentation as for acute.Lasts longer > 3 monthsCommon pathogens : Bacteroides, Staph. Aureus, Pseudomonas , Streptococcus spp.Dx = CT scan showing inflammatory changes or bone destruction.Tx = surgical correction of obstruction , nasal steroidsComplication : meningitis, abscess formation,orbital infection,osteomyelitis PHARYNGITISGroup A Strep throatHigh feverSevere throat pain w/o coughEdematous tonsils with white or yellow exudateUnilateral cervical adenopathy

DiagnosisH&P 50 % accurateRapid antigen testThroat swab culture is gold standardTx: penicillin to prevent acute rheumatic feverMembranous ( diphtherial )High fever DysphagiaDrooling can cause respiratory failureDx : pathognomonic gray membrane on tonsils extending into throatTx : AntitoxinFungal (candida)Dysphagia Sore throat with white ,cheesy patches in oropharynx (oral thrush)seen in AIDS and small childrenDx : clinical or endoscopyTx : nystatin ,clotrimazole

AdenovirusFeverRed eyeSore throatDx : clinicalTx : supportiveHerpangina ( coxsackie A)FeverPharyngitisBody acheTender vesicles along tonsils, uvula and soft palateDx : clinicalTx : supportive