EENT Flashcards
(212 cards)
1
Q
What is the Weber Test used for and what do the results indicate?
A
- Test to determine hearing loss.
- Sound goes to crummy ear for conductive hearing loss and sound goes to good ear for sensorineural hearing loss.
2
Q
What is the Rinne test used for and what do the results indicate?
A
- Test to determine hearing loss.
- BC>AC in conductive hearing loss.
- AC>BC (normal) in sensorineural hearing loss.
3
Q
What is the etiology of cerumen impaction?
A
Self induced by using Q tips.
4
Q
What are the clinical presesentations of cerumen impaction?
A
- Hearing loss
- Earache or fullness
- Itchiness
- Reflex cough
- Dizziness
- Tinnitus
5
Q
What are the treatments for cerumen impaction?
A
- Detergent ear drops
- Mechanical removal
- Irrigation using body temperature water only when TM is intact
6
Q
What are the clinical presentations of foreign body in the ear?
A
- Often asymptomatic
- Decreased hearing
- Pain
- Drainage
- Chronic cough/hiccups
7
Q
How do you treat foreign body in the ear?
A
- Firm object: Remove with loop, hook, or irrigation
- Organic: Do not irrigate for it will cause swelling
- If there are living insects immobilize with lidocaine prior to removal
8
Q
What is otitis externa (swimmer’s ear)?
A
Inflammation of external auditory canal
9
Q
What are the etiologies of otitis externa
A
- Allergy
- Dermatologic
- Bacterial infection with gram negative rods (Pseudomonas, S. epidermidis, S. aureus)
- Fungal infection (Aspergillus, Candida)
10
Q
What is the most common bacteria that causes otitis externa? What are the other bacterial species that cause otitis externa?
A
- Pseudomonas (most common)
- S. epidermidis
- S. aureus
11
Q
What are risk factors for otitis externa?
A
Warmer climates with high humidity
- Increased water exposure like swimming
- Debris from bermatologic conditions like psoriasis
- Trauma
- Occlusive devices
12
Q
What are the clinical presentations of otitis externa?
A
- Otalgia
- Pruritis
- Purulent discharge
- Hearing loss
- Fullness
- History of recent water exposure
- History of mechanical trauma
13
Q
What are the physical exam findings for otitis externa?
A
- Erythema and edema of ear canal skin
- Purulent exudate
- Tenderness with tragal pressure
- Tenderness with manipulation of auricle
- Erythematous TM
- Mobile TM with pneumatic otoscopy
- Possible obstructed vision of TM due to significant canal edema
14
Q
What are possible differential diagnoses for otitis externa?
A
- Middle ear disease
- Contact dermatitis
- Psoriasis
- Chronic suppurative otitis media
- Squamous cell carcinoma of external canal
- Herpes simplex virus
- Radiation therapy
15
Q
What are diagnostic tests used to detect otitis externa?
A
-None needed.
16
Q
What is the most common neoplasm of the ear canal
A
Squamous cell carcinoma of external canal
17
Q
What is Ramsay Hunt Syndrome?
A
- Rare vesicles on outer ear canal caused by herpes simplex virus.
- Causes facial paralysis on side of affected ear.
18
Q
How is otitis externa treated?
A
- Treat for 7-10 days with topical aminoglycoside or fluroquinolone antibiotic with or without corticosteroids
- Remove debris
- Place wick if there is significant swelling
- Recalcitrant cases or severe otitis media with cellulitis of periauricular tissue need oral antibiotics
- Keep canal dry using drying agent
19
Q
What are ways to prevent otitis externa?
A
- Keep ear dry
- Stop removing cerumen with Q tip
- Avoid trauma to ear canal
- Treat dermatologic conditions
20
Q
What are complications of otitis externa?
A
- Periauricular cellulitis
- Contact dermatitis
- Malignant otitis externa
21
Q
What is malignant otitis externa (aka necrotizing otitis externa)?
A
-Osteomyelitis of temporal bone/skull base
22
Q
What are the clinical presentations of malignant otitis externa?
A
- Foul smelling discharge
- Granulations in ear canal
- Deep otalgia
- Cranial nerve palsies
- Headache
23
Q
What diagnostic test is used to assess malignant otitis externa?
A
-CT scan which reveals osseous erosion
24
Q
What population of patients are at risk for malignant otitis externa?
A
-Patients with diabetes or immunocompromised
25
What is hematoma of the external ear?
-It is a traumatic auricular hematoma that must be recognized promptly.
26
How do you treat hematoma of the external ear?
By draining.
27
What is a complication of hematoma of the external ear?
-Cauliflower ear: No blood supply to cartilage causes necrosis and distorted development of new cartilage. This will affect hearing and how the ears conduct sound .
28
What causes acute otitis media?
- Bacterial infection of middle ear in most cases (Strep pneumoniae, H. influenza)
- URI where eustachian tube becomes obstructed and fluid and mucous accumulated and is secondarily infected
- Poor drainage of eustachian tubes because of age, inflammation/edema, congenital malformation
- Recurrent cases associated with allergies and second hand smoke exposure
29
What are the most common organisms that cause acute otitis media?
- Streptococcus pneumoniae
| - Haemophilus influenza
30
What are the risk factors for acute otitis media?
- Family history
- Day care
- Lack of breastfeeding
- Tobacco smoke/air pollution
- Pacifier use
31
Which group of people are most commonly affected by acute otitis media?
-Children 4-24 months
32
What are the clinical presentations of acute otitis media?
- Otalgia
- Pressure buildup
- Hearing loss
- Fever
- URI symptoms
33
What are the physical exam findings for acute otitis media?
- Immobile TM
- Erythema and bulging of TM
- Can also have retracted TM
- Can also have bullae associated with mycoplasma infection
- TM may be ruptured
34
What are the differential diagnoses for acute otitis media?
- Otitis media with effusion
- Otitis externa
- Eustachian tube dysfunction
- Herpes zoster
- Head and neck infection
35
How is acute otitis media treated?
- 1st line: high dose amoxicillin (80-90 mg/kg/day divided twice daily)
- For patients allergic to penicillin use cephalosporin, doxycycline, and macrolide
- 2nd line: High dose amoxicillin-clavulanate or 2nd or 3rd generation cephalosporin
- Topical antibiotic with low ototoxicity (ofloxacin) if there is perforated TM
- Analgesics
36
How can acute otitis media be prevented?
-Pneumo vax vaccination
37
What dose of amoxicillin should be given as a first line treatment for acute otitis media?
-80-90 mg/kg/day divided twice daily
38
What are complications of acute otitis media?
- Labrynthitis
- Hearing loss
- Mastoiditis
- No response to medication because of resistant organism
- Recurrent infection
39
True or False: Tympanic membrane perforations cannot be healed.
False. Small ruptures close on their own while larger ones (rupture >25%) may require tympanoplasty.
40
What is the pathophysiology of otic barotrauma?
- Inability to equalize the pressure exerted on the middle ear during air travel, rapid altitude change, underwater diving.
- Poor eustachian tube function is a precursor and can be due to mucosal edema or congenital narrowing
41
What are the clinical presentations of otic barotrauma?
- Otalgia
| - Happens more during airplane descent than ascent
42
What is the treatment for otic barotrauma?
- Take systemic decongestants a few hours before travel
| - Use topical nasal decongestants one hour before descent
43
What are the complications of otic barotrauma?
- TM rupture followed possibly by middle ear infection
| - Persistent pressure after landing
44
What are ways to prevent otic barotrauma?
- Swallow, yawn, or autoinflate during airplane descent
- During diving equilibriate pressure in middle ears in stages to prevent hemotympanum or perilymphatic fistula complications
45
What are the treatments for eustachian tube dysfunction?
- Topical (intranasal) or systemic (oral) decongestants
- Autoinflation
- Desensitization therapy
- Intranasal corticosteriods
- Surgery
46
What are complications of eustachian tube dysfunction?
-Increased risk for serous otitis media, cholesteatoma
47
What are the physical examination findings for eustachian tube dysfunction?
- Retraction of TM
| - Decreased mobility of TM on pneumatic otoscopy
48
What are ways to manage eustachian tube dysfunction?
- Avoid air travel
- Avoid altitude change
- Avoid underwater diving
49
What is the etiology of eustachian tube dysfunction?
- Edema of tubal lining. Air trapped in middle ear causing negative pressure
- Viral URI
- Allergies
50
What are the clinical presentations of eustachian tube dysfunction?
- Fullness
- Fluctuating hearing
- Pain with pressure change
- Popping or crackling sensation
51
What are the treatments for cholesteatoma?
- Antibiotic drops
| - Surgical removal
52
What are complications of cholesteatoma?
-Erosion into inner ear, facial nerve, brain abscess
53
What are the clinical presentations of cholesteatoma?
- Asymptomatic
- Hearing loss
- Ear drainage in chronic infection
54
What are the physical examination findings for cholesteatoma?
- TM pocket
| - TM perforation exuding debris
55
What is the pathophysiology of cholesteatoma?
-It is a type of chronic otitis media
56
What is the etiology of cholesteatoma?
- Prolonged eustachian tube dysfunction- most common cause
- Chronic negative middle ear pressure retracts part of TM
- Creates sac lined with squamous epithelium that produces keratin
- Secondary infection with Pseudomonas or Proteus
57
What is the clinical presentation of serous otitis media?
- No acute signs of illness or inflammation
- Conductive hearing loss
- Fullness
58
What are the physical examination findings for serous otitis media?
- TM is dull and hypomobile
- Visible bubbles
- Conductive hearing loss
59
What are treatments for serious otitis media?
- Nasal steroids if there is underlying allergy
- In resistant cases use ventilating tubes
- Possibly decongestants
- Possibly antihistamines
60
What is the pathopysiology of serous otitis media?
- Eustachian tube is blocked for long time
| - Negative pressure causes transudation of fluid into middle ear
61
In what group of patients is serous otitis media most common?
-Children because eustachian tubes are narrower and more horizontal than in adults
62
What condition occurs in adults after URI, barotrauma, or with chronic allergies?
-Serous otitis media
63
What is the etiology of chronic otitis media?
Recurrent acute otitis media
64
What are the physical examination findings in chronic otitis media?
- Perforated TM
| - Conductive hearing loss
65
What are the treatments for chronic otitis media?
- Removal of infected debris
- Earplug use
- Topical or oral antibiotics
- Surgery for TM repair
66
What are the symptoms for mastoiditis?
- Spiking fevers
- Postauricular pain
- Erythema
67
What are the treatments for mastoiditis?
- IV antibiotics
| - Mastoidectomy
68
Under what conditions are children with acute otitis media put in observation?
- 6 months-2 years old with unilateral acute otitis media and mild symptoms
- Greater than or equal to 2 years of age, unilateral or bilateral if not severe
69
Under what conditions are children with acute otitis media put on immediate antibiotics?
- Children < 6 months
- Children < 24 months if they are experiencing moderate or severe pain, pain for more than 48 hours, bilateral acute otitis media, and a body temperature of 102.2 F
70
What is the pathophysiology of conductive hearing loss?
-Dysfunction of external or middle ear.
71
What is the etiology of conductive hearing loss?
Most common in adults:
- cerumen impaction
- eustachian tube dysfunction
Other causes:
- otitis media
- otitis externa
- TM perforation
- trauma
- otosclerosis
72
What is the pathophysiology of sensorineural hearing loss?
- Sensory loss: dysfunction of cochlea from loss of hair cells
- Neural loss: dysfunction of CN VIII or central auditory pathway
73
What is the etiology of sensorineural hearing loss?
- Most common: presbycusis
- Loud noise exposure
- Meniere's disease
- Head trauma
- Systemic disease (infection, inflammation)
- Acoustic neuroma
- MS
- Auditory neuropathy
74
What are some ways to evaluate hearing loss?
- Evaluate function of cranial nerves especially facial and trigeminal
- Examine nose, nasopharynx, upper respiratory tract
- Examine ear, ear canal, TM (penumatic otoscopy)
- Check gross hearing with whispered voice test
- Weber test
- Rinne test
75
What are ways to treat or manage hearing loss?
- Surgical correction to correct conductive hearing loss
- Hearing aids for sensorineural hearing loss
- Cochlear implants
- Use hearing protectors
- Avoid exposure to loud noise
76
What is the pathology of tinnitus?
- Occurs from somatic sounds near cochlea
- Loss of cochlear input to neurons in central auditory pathways causing abnormal neural activity in auditory cortex
- Auditory seizures
- Neurotransmitter abnormalities
- Development of alternative neural synapses that lack normal inhibitory pathways
77
What are some treatments for tinnitus?
- Treat underlying conditions
- Stop ototoxic medications
- Avoid exposure to loud sounds
- Behavioral therapy
- Vagus nerve stimulation
Experimental therapies:
- Brain surface implants
- Deep brain stimulation
- Transcranial direct current stimulation
- Transcranial magnetic stimulation of central auditory system
78
What is tinnitus in general?
- Perception of continuous or intermittent sounds in ear or head
- Mild high pitched sounds- buzzing, ringing, hissing
- Often associated with sensory hearing loss
79
What are other forms of tinnitus?
Pulsatile and staccato
80
What is pulsatile tinnitus?
- Described as hearing one's own heartbeat
| - Usually indicates a vascular abnormality
81
What is staccato tinnitus?
- Rapid series of pops or clicks with sensation of ear fluttering
- Occurs from middle ear muscle spasm
82
What are some diagnostic tests to assess tinnitus?
- MRI if it is unilateral without obvious etiology
| - Consider MRA, MRV, temporal bone CT for pulsatile tinnitus
83
What are the differential diagnoses of dizziness?
- Vertigo
- Disequilibrium
- Presuncope
- Nonspecific dizziness including fibromyalgia, psychiatric disorders, hyperventilation, medication side effect, etc.
84
What is vertigo?
- Sense of motion when there is no motion
- Spinning sensation
- Sense of tumbling
- Falling forward or backward
85
What is the primary symptom of vestibular disease?
-Vertigo
86
What are the two causes of vertigo?
- Peripheral
- Central
* Can also have mixed central and peripheral causes
87
What are the clinical presentations of vestibular schwannoma?
- Unilateral hearing loss
- Continuous dysequilibrium
- Tinnitus
88
What diagnostic tests are used to detect vestibular schwannoma?
- Audiometry
| - MRI with contrast
89
How is vestibular schwannoma treated?
- Observation
- Surgical excision
- Radiotherapy
90
What is the pathophysiology of vestibular schwannoma?
- Benign tumor of CN VIII
- Begins in internal auditory canal
- Gradually grows to compress pons and cause hydrocephalus
- Usually unilateral
91
What is one of the most common intracranial tumors?
-Vestibular schwannoma
92
What is the treatment for Meniere Disease?
- Course is unpredictable so difficult to treat. Aimed at decreasing endolymph fluid pressure in inner ear
- Diuretics like acetalzolamide
- Low salt diet
In refractory cases:
- Intratympanic corticosteroid injections
- Endolymphatic sac decompression
- Vestibular ablation
93
How is Meniere Disease diagnosed?
- Refere to ENT and audiology
| - Caloric testing
94
What is the clinical presentation of Meniere Disease?
- Episodic vertigo with discrete spells lasting 20 min to several hours
- Fluctuating sensorineural hearing loss for low frequency sounds
- Tinnitus that has a low tone, blowing/roaring quality
- Sensation of unilateral ear pressure (aural fullness)
95
What is Meniere Disease?
- aka Endolymphatic hydrops
| - Vertigo syndrome due to a peripheral lesion
96
What is the pathophhysiology of Meniere Disease?
- Distention of endolymphatic compartment of inner ear
- Symptoms wax and wane as pressure riseases and falls
- Can permanently damage inner ear structures
97
How is BPPV treated?
- Epley maneuver
- PT/OT referral
- Vestibular suppressants
- Bed rest if severe
98
What is the etiology of Labryinthitis?
- Inflammatory disorder of vestibular portion of CN VIII
| - Occurs post-viral infection
99
What are the clinical presentations of Labryinthitis?
- Acute onset of continuous, severe vertigo
- Commonly with hearing loss and tinnitus
- Nausea and vomiting
- Gait impairment
100
What are diagnostic tests used to detect Labryinthitis?
-Neuroimaging with MRI/MRA
101
What are treatments for Labryinthitis?
- Antibiotics if patient is febrile or with symptoms of bacterial infection
- Vestibular suppressants (anticholinergics, antihistamines, benzodiazepines)
- Anti-emetics (ondansetron/Zofran)
- Corticosteroids
102
What are diagnostic tests used to detect vertigo?
-Dix-Hallpike maneuver
-Audiometry
ENG/VNG
-Caloric stimulation
-VEMP
MRI
103
If the Dix-Hallpike maneuver is positive it indicates what?
-Delayed onset fatigable nystagmus which means it is a peripheral cause
104
If nystagmus in Dix-Hallpike maneuver is non-fatigable it indicates what?
-Vertigo is due to central cause
105
What are the characteristics of vertigo due to a central cause?
- Gradual onset
- Progressive increase in severity
- Gait and posture impaired
- No auditory symptoms
- Non-fatigable nystagmus in any direction
106
What are the characteristics of vertigo due to a peripheral cause?
- Sudden onset
- Acutely severe symptoms
- Nausea and vomiting
- Tinnitus
- Hearing loss
- Horizontal nystagmus with rotatory component
- Eye motion in response to head turning
107
Patient education in Labryinthitis includes?
- Ressurance condition is benign and self-limited
- Recovery is gradual
- Improvement occurs over several weeks
- Need for vestibular rehabilitation referral is possible
- Risk of falls
108
What type of nystagmus is present in peripheral vs. central cause of vertigo?
- Peripheral: Horizontal with torsional component.
| - Central: Can be in any direction
109
What are some peripheral causes of vertigo?
- Labryinthitis
- Meniere disease
- Alcohol intoxication
- Inner ear barotrauma
- Semicircular canal dehiscence
- Benign positional vertigo
110
What are the central causes of vertigo?
- Seizure
- MS
- Wernicke encephalopathy
- Chiari malformation
- Cerebellar ataxia syndromes
111
What are some mixed central and peripheral causes of vertigo?
- Migraine
- Stroke and vascular insufficiency
- Vestibular schwannoma
- Meningioma
- Lyme disease
- Syphilis
- Vascular compression
- Hyperviscosity syndromes
- Endocrinopathies like hypothyroidism
112
What vestibular disorders are associated with vertigo?
- BPPV
- Labryinthitis
- Meniere disease
113
What causes Benign Paroxysmal Positional Vertigo?
- Sediment in semicircular canals (otoliths)
- Provoked by changes in head position
- Episodes are brief in duration but recurrent
- Happens in clusters lasting several days
114
What are some treatments for allergic conjunctivitis?
- Cold compresses
- Antihistamine drops (ketotifen, olopatadine)
- Oral antihistamines (loratidine, diphenhydramine)
115
What are some etiologies for red eye?
- Blepharitis
- Chalazion/hordeolum
- Cellulitis
- Conjunctivitis
- Dacryoadenitis
- Corneal ulcer (keratitis)
- Uveitis
- Subconjunctival hemorrhage
- Foreign body
- Hyphema
- Glaucoma
- Tumor
116
What are some associated symptoms for red eye?
- Vision
- Discharge
- Pain
117
What is blepharitis?
-Chronic condition with inflammation of eyelids with intermittent exacerbations
118
The two types of blepharitis are?
- Anterior: due to seborrheic component or S. aureus
| - Posterior: due to meibomian gland dysfunction
119
What are the clinical presentations of blepharitis?
- Red eyes
- Gritty or foreign body sensation
- Burning sensation
- Excessive tearing
- Crustiness in lashes
- Light sensitivity
- +/- blurry vision
120
What are some physical examination findings?
- Diffuse conjunctival injection
- Eyelid margins often inflamed and red
- Crusting or matting of eyelashes
- Plugged glands with magnification
- Collarettes
121
What is the treatment for Blepharitis?
- Warm compresses
- Lid massage
- Lid hygiene
- Topical antibiotics (erythromycin)
- Oral antibiotics in severe cases
- Omega-3 supplements for prevention
122
What are the clinical presentations of orbital cellulitis?
- Eye pain
- Eyelid swelling and erythema
- Vision changes (possibly diplopia)
- Fever
- Pain with eye movements
123
What are the physical examination findings of orbital cellulitis?
- Proptosis
- Ophthalmoplegia
- Conjunctivitis
- +/- discharge
124
What is periorbital cellulitis?
- An infection of soft tissues around eye that does not extend into the orbit
- Not an infection that involves the globe
- A more common infection
- Common in children than adults
125
What is orbital cellulitis?
- An infection of fat and muscle tissue surrounding the globe
- Not an infection that involves the globe
- Common in children than adults
126
What is the etiology of periorbital cellulitis?
- Blepharitis
- Insect bites
- Foreign object
- Sometimes sinusitis
127
What is the etiology of orbital cellulitis?
-Extension of infection from paranasal sinuses (ethmoid sinuses)
128
What are the clinical presentations of periorbital cellulitis?
- Eye pain
- Eyelid swelling and erythema
- No vision change
- No fever
- No pain with eye movements
129
What are the physical examination findings of periorbital cellulitis?
- No proptosis
| - No ophthalmoplegia
130
What diagnostic tests are done to detect periorbital and orbital cellulitis?
- CBC
- Blood cultures
- Culture of any discharge
- CT scan of orbits and sinuses
131
How is periorbital cellulitis treated?
- Can managed as an outpatient (>1 years old)
- Empiric antibiotic therapy for S. aureus, S. pneumoniae, MRSA
- If MRSA: Oral trimethoprim-sulfamethoxazole (Bactrim), oral clindamycin plus one of the following: amoxicillin, amoxicillin-clavulanic acid, cefdinir, cefpodoxime
- If not MRSA: amoxicillin-clavulanic acid
132
What is the etiology for viral conjunctivitis?
-Adenovirus
133
What are the associated symptoms for viral conjunctivitis?
- Pharyngitis
- Fever
- Malaise
- Watery discharge
- Preauricular adenopathy
134
What are the symptoms for acute pharyngitis?
- Sore throat
- Fever
- Headache
- Malaise
- "Swollen glands”
- URI symptoms
135
What are the physical examination findings?
- Pharyngeal erythema
- Tonsillar hypertrophy
- Purulent exudate
- Tender and/or enlarged anterior cervical lymph nodes
- Palatal petechiae
136
What are treatments for acute pharyngitis?
-If not strep then supportive treatment (fluids, rest, tylenol). Should improve in 5-7 days
137
What is the clinical presentatio of strep?
- Sudden onset
- Tonsillar exudate
- Tender cervical adenitis
- Fever
138
What are diagnostic tests for acute strep?
- Rapid antigen detection testing
| - If rapid strep test is negative then want to do a throat culture
139
What are treatments for strep?
-Penicillin V 500 mg PO BID – TID x 10 days
-Amoxicillin 500 mg BID x 10 days
-Penicillin G benzathine (Bicillin L-A) 1.2 million units IM single dose
-Cephalexin 500 mg PO BID x 10 days
-Penicillin allergic:
Macrolides (erythromycin, clarithromycin, azithromycin)
140
What are complications from strep?
- Acute rheumatic fever
- Acute glomerulonephritis
- Scarlet fever
- Peritonsillar abscess
- Otitis media
- Mastoiditis
- Sinusitis
- Bacteremia
- Pneumonia
-
141
What are the guidelines/criteria for a tonsillectomy?
- At least 7 episodes in the last year
- At least 5 episodes in each of the past 2 years
- At least 3 episodes in each of the past 3 years
- Episode = ST plus fever >100.9 OR tonsillar exudate OR anterior cervical adenopathy OR culture confirmed GABHS
- Appropriate antibiotic treatment for strept episodes
- Recommend 12 month observation period
142
What is peritonsillar abscess?
- Common deep neck infection in children and adolescents
- Occurs most frequently in adolescents and young adults
- Annual incidence is 30 per 100,000 persons aged 5-59
143
What is the etiology of peritonsillar abscess?
-Polymicrobial, -Predominant species being Streptococcus pyogenes (GABHS)
144
What are the symptoms of peritonsilalr abscess?
```
-Severe sore throat
Fever
-"Hot potato” or muffled voice
-Drooling
-Trismus
-Neck swelling/pain
-Ipsilateral ear pain
-Fatigue, irritability, decreased PO intake
```
145
What are the physical examination findings?
- Swollen, fluctuant tonsil with deviation of uvula to the opposite side
- Fullness or bulging of posterior soft palate
- Cervical LAD
146
What are some differential diagnoses for peritonsillar abscess?
- Infectious mono
- Lymphoma
- Peritonsillar cellulitis
- Retropharyngeal abscess
- Retromolar abscess
- Ludwig’s angina
147
What are treatments for peritonsillar abscess?
-Monitor for airway obstruction
-Drainage: Needle aspiration, incision and drainage, or tonsillectomy
-Antimicrobial therapy: Parenteral: ampicillin-sulbactam or clindamycin. Consider vancomycin if high rates of CA-MRSA,
Oral: amoxicillin-clavulanate or clindamycin X 14 days
-Supportive care
- +/- Hospitalization
148
What are the causes for laryngitis?
Infectious causes:
-Respiratory viruses
Rhinovirus, influenza, parainfluenza, adenovirus, coxsackievirus, coronavirus, RSV
-Bacterial respiratory infections Streptococcus sp., M. catarrhalis, H. influenza, S. aureus
Noninfectious causes:
- Vocal abuse
- Intubation / trauma
- Toxic exposure
- GERD
- Vocal cord nodules or laryngeal polyps
- Vocal cord paralysis
- Carcinoma of vocal cords
149
What are the clinical presentations of laryngitis?
- Hoarseness
| - URI symptoms (rhinorrhea, nasal congestion, cough, strep throat)
150
What are the differential diagnoses for laryngitis?
- Irritant exposure
- Croup
- Acute epiglottitis
- Chronic causes
- Head/neck cancer
- GERD
- Vocal nodule
- Tuberculosis
151
What are the treatments for laryngitis?
- Treat the underlying cause
- Humidification
- Voice rest
- Hydration
- Avoid smoking
152
What are the etiologies for epiglottis?
- Viral or bacterial
- Haemophilus influenzae type B (HiB)
- Streptococci
- S. aureus
153
What are risk factors for epiglottitis?
- Incomplete or non-vaccination
| - Immunodeficiency
154
What are the clinical presentations of epiglottitis?
- Fever (38.8 – 40.0 C / 101.8-104 F)
- Respiratory distress
- Anxiety
- “Tripod” or “sniffing” position
- Drooling
- Odynophagia
- Pain out of proportion
- Muffled speech
- Stridor
155
What are diagnostic testing for epiglottitis?
-Labs – not until airway secured
CBC, blood culture, epiglottal culture (if intubated)
-Imaging-Lateral plain radiograph – “thumb sign”
-Direct laryngoscopy
-Fiberoptic nasolaryngoscopy
156
What are treatments for epiglottitis?
- Medical emergency
- Airway protection
- Hospitalization
- IV antibiotics
- 3rd generation cephalosporin & antistaphylococcal (vancomycin)
- +/- Dexamethasone
157
What is the cause for HSV?
Herpes simplex virus type 1
158
What are the clinical presentations for HSV?
-Sudden onset of multiple painful vesicular lesions on inflamed, erythematous base
159
How do you diagnose HSV?
- Clinical
- Viral culture
- Serology
- Immunofluorescence microscopy for antigens
160
What are treatments for HSV?
- Antivirals
- Analgesics
- Fluid management
161
What is the cause of hand foot mouth disease?
Coxsackie A16
162
What are the clinical presentations of hand foot mouth disease/
- Prodrome: low-grade fever, malaise, abdominal pain, URI symptoms
- Painful oral lesions- PAPULES on erythematous base
- Lesions on hand, feet, mouth and buttocks
163
How is hand foot mouth disease diagnosed?
-Clinically. No diagnostic tests are needed.
164
How is hand foot mouth disease treated?
-Supportive care. Resolves in 2-3 days
165
What is the etiology of aphthous ulcers?
- Uncertain, but associated with HHV-6
| - Also seen with celiac disease, IBD, HIV
166
What are the clinical presentations of aphthous ulcers?
- -Found on gums, tongue, lips, palate, buccal mucosa
- Single or multiple (but usually single)
- Recurrent
- Painful small, shallow, round ulcers with gray base surrounded by red halo
167
How is aphthous ulcers treated?
- Topical corticosteroids in adhesive base
| - Topical analgesics
168
What is the etiology of Bechet's?
-Inflammatory disorder
169
What are the clinical presentations of Bechet's?
- Recurrent oral and genital aphthae [genital ulcers (ie. apthae) occur in ≈ 75%]
- Lesions may occur at multiple sites
170
How is Bechet's diagnosed?
Recurrent oral ulcers ≥ 3 x per year + 2 other clinical findings (eg. recurrent genital ulcers, eye lesions, or skin lesions)
171
How is Bechet's treated?
-Refer to rheumatologist
172
What is the etiology of oral candidiasis?
Candida albicans
173
Who is commonly affected by oral candidiasis?
- Infants
| - Older adults who use dentures
174
What are the risk factors associated with oral candidiasis?
- Denture use
- Poor oral hygiene
- Diabetes mellitus
- Anemia
- Chemotherapy or local radiation
- Corticosteroid use
- Antibiotic use
- HIV
175
What are the clinical presentations of oral candidiasis?
- Painful, creamy-white, curd-like patches over erythematous mucosa. Or may present as angular cheilitis
- Easily scraped off- "thrush will brush”
- “Cotton” mouth
- Loss of taste
- Pain with eating or swallowing
176
How is oral candidiasis diagnosed?
- Clinical
- KOH wet prep. Budding yeasts with or without pseudohyphae
- Culture
- Biopsy
Other labs
- HIV
- Glucose
177
How is oral candidiasis treated?
Antifungals:
- Clotrimazole troches
- Nystatin mouth rinses
- Fluconazole
- Ketoconazole
178
What type of condition is oral lichen planus?
Chronic, inflammatory autoimmune disease
179
What are the clinical presentations of oral lichen planus?
- Reticular white plaques
- Mucosal erythema
- Erosions/ulcerations
- Hyperkeratotic plaques
- Painless or painful
180
How is oral lichen planus diagnosed?
- Exfoliative cytology
| - Biopsy
181
How is oral lichen planus treated?
-Manage pain/discomfort-
| Corticosteroids, cyclosporines, retinoids, tacrolimus
182
What kind of condition is oral leukoplakia?
Hyperplasia of squamous epithelium
183
What is the cause of oral leukoplakia?
-Chronic irritaion (dentures, tobacco, lichen planus, etc.)
184
What is the clinical presentation of oral leukoplakia?
-White lesion that cannot be removed by scraping
185
How is oral leukoplakia diagnosed?
- Biopsy
| - Exfoliative cytology
186
What is the presentation of erythroplakia?
-Red velvety plaque
187
How is erythroplakia treated?
Refer to ENT
188
How is erythroplakia diagnosed?
- Clinically
| - Biopsy
189
How is erythroplakia treated?
-Refer to ENT
190
What causes hairy leukoplakia?
-Epstein-Barr virus
191
What group of people does hairy leukoplakia affect the most?
-HIV individuals
192
What are the clinical presentations of hairy leukoplakia?
-White painless plaque on lateral tongue that cannot be scraped off
193
What are mucoceles?
Fluid filled cavities with mucous glands lining the epithelium
194
What is the cause?
Typically seen after mild oral trauma, may be seen on the labia
195
How are mucoceles diagnosed?
Clinically
196
How are mucoceles treated?
- May rupture spontaneously
| - Remove with cryotherapy or excision of entire cyst
197
What is an amalgam tattoo?
- Benign
| - Seen adjacent amalgam filling
198
What is torus palatinus?
- Benign boney lesions
| - Normally located on hard palate
199
What causes dental caries?
- Strep mutans
- Metabolizes sugars into acid
- Acid demineralizes enamel and causes cavity development
200
What are the clinical presentations of dental caries?
- Heat/cold intolerance
| - Visually disturbing to patient
201
How are dental caries diagnosed?
Clinically
202
How are dental caries treated?
Refer to dentist
203
What are complications of dental caries?
- Intraoral abscess
- Cellulitis
- Brain abscess
204
What is Sialolithiasis/Sialadenitis?
Stone and/or inflammation within the salivary glands or ducts
205
What is the etiology of Sialolithiasis/Sialadenitis?
Uncertain, related to reduced salivary flow, inflammation, and localized injury
206
What are risk factors for Sialolithiasis/Sialadenitis?
Dehydration, diuretics, anticholinergics, trauma, gout, smoking, history of kidney stones, chronic periodontal disease
207
Where do stones in Sialolithiasis/Sialadenitis commonly occur?
Wharton's duct
208
What are the clinical presentations of Sialolithiasis/Sialadenitis?
- Pain and swelling of gland aggravated by eating or anticipation of eating
- Can be episodic or persistent
- Worsening pain, erythema, fever may indicate infection
209
How is Sialolithiasis/Sialadenitis diagnosed?
Clinically
210
How is Sialolithiasis/Sialadenitis treated?
-Hydrate, heat, massage, “milk” the duct
-Sialagogues
-Discontinue aggravating medications
-NSAIDS
-Monitor for infection
S. aureus
-Referral if necessary
-For sialadenitis: IV or oral antibiotics; increase salivation
211
What are complications of Sialolithiasis/Sialadenitis?
- Abscess
| - Duct obstruction
212
What is suppurative parotitis?
- Acute infection of parotid gland. Viral or bacterial
| - Salivary stasis allows retrograde flow with the oral flora
