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Flashcards in ENT Deck (33):
1

Reasons to refer opthalimic disorders

  • Eye pain
  • Blurred vision i.e. change in visual activity
  • Sensitivity to light (photophobia)
  • Contacts
  • Blunt trauma to eye
  • Chemical, heat, sun exposure to eyes
  • Symptoms persist >72 hours

2

Dry Eye: Symptoms

  • may or maynot be mildly red
  • sandy, gritty, foreign body sensation
  • tearing

3

Dry Eye: Causes

  • poor tear quality
  • decreased tear production
    • menopause
    • defects
      • eyelid problems.
    • collagen vascular disease (RA)
    • Bell's palsy
    • drugs
      • anticholinergics, beta-blocker, diuretic
    • environment
      • wind, air, high altitude
    • LASIK

4

Dry Eye: Treatment

  • When using drops, only 1 drop because of limited eye volume
  • Artificial tears: starting point
    • 3-5 times a day, blink 
    • cellulose esthers: viscosity
    • PVA: spreading agent
    • povidone: preservative
  • Non-medicated ointment at bedtime
    • white petroleum
  • Environmental strategies
    • blink at computer
    • move fans
  • inserts/plugs
  • Cyclosporine
    • Restasis, immunosuppresent, anti-inflammation

5

Allergic Conjunctivitis: Symptoms and Causes

  • Sx:
    • Red, watery, itchy eyes
  • Causes:
    • Allergens
    • Pollen, dander, topical eye preps, etc. 

6

Allergic Conjuctivitis: Treatment

  • Articifical tears (always helpful) then...
  • Opthalmic antihistamine/descongestant
    • DO NOT use 
      • pregnant, HT, diabetes, CV diseases
    • Combo drug can be cheaper than singular antihistamine (ex: Napchon-A)
    • Naphazoline/tetrahydrozoline won't cause rebound and thus good combo
    • Naphazoline/pheniramine
    • Naphazoline/pheniramine
    • Naphcon-A, Visine-A
    • antihistamine/mast cell stabalizer
      • alleviate watery eyes, itchiness
      • use for long process
      • prevents further redness
      • Zaditor and Alaway: Ketotifen
    • decongestant: reduce redness/tearing
      • short term
      • can get eye rebound
      • quick/cheap
      • Visine: Tetrahydrozoline
      • Naphcon/Clear Eyes: Naphazoline
      • Phenylephrine
      • Oxymetazoline

7

Viral Conjuctivitis: Symptoms

  • Symptoms:
    • red, watery discharge, with viral URI
      • bacterial: not stringy/thick discharge, eyes stuck after nap. Need antibiotics
  • ​"Pink Eye"

8

Viral Conjunctivits: Treatment

  • Self-limiting in 1-3 weeks
  • Artificial tears and ocular decongestants
  • Strict hygiene

9

Foreign Bodies in Eye/Chemical burns

  • Referral if corneal abraisons
  • Irrigation
    • A liter of saline
    • Use isotonic solution
    • See a physician for burns

10

Preservatives in Optic Solutions

  • Surfactants
    • long half-life, stability, coverage
    • long-term: toxic
    • bactericidal
    • BAK, benzathonium Cl
    • Polyquad, chlorhexidine
  • Metals (Hg/I), Alcohols
    • allergic reactions
    • Thimerosal: contact blepharitisk conjunctivitis
    • Chlorbutanol: weak, disappears with time
    • Methylparaben: unstable, allergic rxns, common in tears
    • EDTA
    • Sodium Perborate: dissociates on contact

11

Blepharitis

  • Chronic, common inflammation of eyelid margins
  • Red, scaly, thickened eyelids, loss of eyelashes, itching and burning
  • Treatment:
    • Good hygiene
    • Hot compress
    • Lid scrubs
    • Wash hair with Selsun blue, Head and Shoulders

12

Hordeolum 

  • Stye
  • Infection of gland of eyelid
  • Swelling, palpable, tender
  • Treatment:
    • usually clear in 1 week
      • if not, refer
    • hot compress
    • external/oral antibiotic

13

Chalazions

  • Like stye, but not tender to touch
  • "Sterile granuloma"
  • may need to be drained, or else keep growing

14

Otic Disorder: Exclusions

  • Signs of infection
  • Pain w/ discharge
  • bleeding/signs of trauma
  • Ruptured tympanic membrane
  • Ear surgery within 6 months
  • Tympanostomy tubes
  • Clutz/unable to follow direction
  • hypersensitivity to recommended agents

Self-treatment should be restricted to external ear disorders (water-clogged/cerumen)

15

Cerumenosis: Etiology

  • Narrow or mishapen EAC
  • excessive hair growth
  • overactive glands
  • hearing aid use
  • earplug use
  • oldsters

16

Cerumenosis: Symptoms

  • Sense of fullness and/or ear pressure
  • Gradual hearing loss
  • Ocassional dull pain
  • Vertigo

17

Cerumenosis: Treatment

  • Carbamide Peroxide
    • softens wax
    • 12 yo and older
    • twice daily up to 4 days
  • Glycerin, mineral oil, olive oil
    • softens wax
  • Docusate
    • not very effective
  • Dilute H2O2
  • After softening wax, irrigate using otic bulb syringe filled with warm water
    • use caution when recommending irrigation
    • show patient how to do it
  • Prevent with frequent removal/clearning or hearing aid
  • Improper or excessive removal of cerumen can damage EAC
  • Q-Tips/Fingernail: can push cerumen further in, abrade skin and allow pathogens in 

18

Water-Clogged Ears: Etiology

  • Shape of EAC, cerumen, climate, swimming, bathing
  • NOT the same as "swimmer's ear" (otitis external)
    • wiggle ear and hurts
    • need steroid and antibiotics

19

Water-Clogged Ears: Symptoms

  • Feeling of fullness/wetness in ear
  • Gradual hearing loss
  • Can lead to tissue maceration
    • itching, pain, inflammation, infection

20

Water-Clogged Ears: Treatment

  • Isopropyl alcohol
  • Acetic acid (vinegar)

21

Misc. Ear Problems

  • Contact dermatitis
    • earrings and eardrops
  • Seborrhea, psoriasis
    • skin cells plugging things up
    • need same meds used on skin in eardrop formula
  • Hearing loss
  • Dizzines
  • Tinnitus

22

Teething

  • No fever, V/D, nasal congestion, rash 
  • Symptoms:
    • sleep disturbance, irritability, drooling
  • Treatment:
    • frozen pacifiers/washclothes
    • Ibuprofen (baby Tylenol), APAP
  • NO lidocaine
  • NO benzocaine
    • can bind hemoglobin and cause blue lips
    • Methemoglobinemia
      • blue lips, SOB, fatigue, confusion, tachycardia
      • minutes to hours onset, 1st or several times after use
         

23

Apthous Stomatitis: Etiology

  • Canker Sore
  • unknown
  • Things to consider: smoking, stress, diet
  • Precipitating factors: stress, trauma
  • Smoking cessation
  • Allergies
  • Hormonal change
  • Genetics
  • Malnutrition
  • HIV/AIDS

24

Apthous Stomatitis: Symptoms

  • ulceration on nonkeratinized mucosa
  • lasts 5-14 days
  • heal spontaneously with no scarring
  • painful

25

Apthous Stomatitis: Treatment

  • No cure, only relief
  • Nonpharmacological
    • increase iron, folate, Vit B12, avoid spicy/acidic food, apply ice 
    • NO HEAT, can spread infection
  • Pharmacolgic
    • Oral debriding/wound cleaning agents
      • carbamide peroxide, H2O2, sodium bicarb, perborates
    • Topical anesthetics
      • not benzocaine
      • butacaine
    • Oral Protectants
      • Orabase (mix with steroid and put it on), Zilactin
    • Oral rinses
      • Listerine to hasten healing
      • Saline/baking soda to soothe
    • Analgesic

26

Aphtous Stomatitis: When to refer

  • Lesions with underlying pathology
  • Lesions there for more than 2 weeks
  • frequently reoccuring
  • systemic illness

27

Leukoplakia

  • white, flaky patches on tounge
  • tobacco users
  • referral, risk of oral cancer

28

Herpes Simplex Labialis/Virus: Trigger, Etiology

  • Etiology
    • lips/bordering mouth area
    • painful/reoccurant lesion
    • self-limiting, heals w/o scarring, 5-14 days 
  • Trigger
    • hides in trigeminal ganglion
    • reactivated by UV, stress, fatigue, cold, windburn 

29

HSV: Symptoms

  • Prodrome (warning sign)
    • tingly, burning, numbness
  • vesiculopapular eruption
  • Other symptoms:
    • fever, pain, bleeding, swollen lymph nodes, malaise

30

HSV: Treatment

  • Avoid triggers
  • Keep lesions clean
  • Topical to prevent infection and relieve dryness
    • DO NOT USE NEOSPORIN (for bacteria, not virus)
  • Docosanol (Abreva)
    • prevents viral replication
    • shortens course
  • Acyclovir
    • Don't use good drugs if don't need them
    • Can cause antibiotic resistance
  • Refer if >14 days, increased frequency, compromised immune, infection

31

Xerostomia: Etiology 

  • AKA: Dry mouth
  • Sjorgens, DM, depression, Chron's
  • Radiation
  • Medication

32

Xerostomia: Symptoms

  • From increased talking, swallowing,
  • stomatitis (inflammation of mouth)
  • burning tounge
  • halitosis
  • loss of apetitie
  • dental decay

33

Xerostomia: Treatment

  • Good dental care
  • Avoiding:
    • tobacco, alcohol, antihistamines, CNS stimulants, sugary/acidic food
    • xylitol is okay
  • Artifical saliva
  • Flouride
  • pilocarpine, cevimeline (prescription)