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ENT > ENT infections > Flashcards

ENT infections Flashcards

1
Q

Otitis Media : Definition

A

Infection of the middle ear

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2
Q

Otitis Media : Pathophysiology

A
  1. Middle ear : Place between the tympanic membrane and the inner ear } where cochlea is
  2. Via the Eustachian tube : Bacteria travel from the throat and enter the middle ear
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3
Q

Otitis Media : Causative organism

A

Streptococcus Pneumonia

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4
Q

ACUTE Otitis Media : Presentation

A
  1. Preceding URTI
  2. Ear pain - reduced hearing
  3. Discharge : if tympanic membrane has perforated
  4. Fever and coryzal sx
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5
Q

Otitis Media : Examination

A

Otoscope : bulging, red, inflamed looking membrane.
* Discharge present if Tympanic membrane has perforated

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6
Q

ACUTE Otitis Media : Criteria for diagnosis

A

1 . Acute onset of symptoms
* otalgia or ear tugging

2 . Presence of a middle ear effusion
* bulging of the tympanic membrane, or
* otorrhoea

3 . Inflammation of the tympanic membrane
* i.e. erythema

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7
Q

ACUTE Otitis Media : Management

A

Step 1 : Conservative management and analgesia for -> 3 days
If not symptoms not resolved in 3 days

Step 2 : Antibiotics
* Amoxicillin for 5-7 days
* Allergy : Eryth/Clarithromycin

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8
Q

ACUTE Otitis Media : Indication for immediate Abx

A
  1. Young or Immunocompromised
    * <2 years old with bilateral otitis oedema
    * Immuncompromise or high risk of complication due to comorbidity
  2. Symptoms not resolves for > 4 days
  3. Systemically unwell - high fever etc
  4. Otitis media with peroration or discharge in the canal
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9
Q

Acute otitis media : Complications

A
  1. Glue ear
  2. Mastoiditis
  3. Choleaosteatoma
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10
Q

Glue ear : Definition

A

AKa Otitis media with effusion
* Presence of thick, sticky fluid (effusion) in the middle ear without the signs of acute infection

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11
Q

Glue ear : Cause

A
  1. Associtated with previous ear infections
  2. Most common due to : Eustachian tube dysfunction
    * Tube that connects the middle ear to the back of the throat doesn’t function properly
    * Fluid build up occurs
  3. Not acute infection - just fluid build up in middle ear
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12
Q

Glue ear : Clinical presentation

A

peaks at 2 years of age
1. Hearing loss - may cause speech and language delay or issues with balance

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13
Q

Glue ear : Management

A
  1. Observation for 3 months
  2. Grommet insertion - allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube
  3. Referral to secondary care if;
    * Down’s syndrome/Cleft palate
    * Sig affecting education or developmental milestone
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14
Q

Mastoiditis : Definition

A

Infection spread from middle ear to mastoid air spaces of temoral bone

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15
Q

Mastoiditis : Clinical features

A

1 . Otalgia: severe, classically behind the ear
-there may be a history of recurrent otitis media
2 . Fever
- typically very unwell

3 . Swelling, erythema and tenderness over the mastoid process

  • the external ear may protrude forwards
  • ear discharge may be present if the eardrum has perforated
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16
Q

Mastoiditis : Mx and complications

A

Management
* IV antibiotics

Complications
* facial nerve palsy
* hearing loss
* meningitis

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17
Q

Perforated tympanic membrane : Clinical presentation

A
  • Commonly : 2nd to infection
  • Trauma
  1. Coryzal sx
  2. Effusion of the middle ear
  3. Hearing loss - depending on the size
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18
Q

Perforated tympanic membrane : Mx

A
  • 2nd to acute ottitis media : Immediate Abx prescribed
  • No acute symptoms : Conservative mx, heal after 6-8 weeks, avoid water entering ear
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19
Q

Otitis externa : Definition

A
  • Inflammation of the skin in the external ear canal
  • Infection may be localised or diffuse - spreads to external ear
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20
Q

Otitis externa : Risk factors

A
  1. Swimmer’s ear : exposure to water when swimming can cause inflammation
  2. Trauma : external ear canal via cotton buds
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21
Q

Otitis externa : Causes of inflammation

A
  1. Infection
    * Bacterial infection (Most common cause)
    * Fungal infection } Candida infection 2nd to antibiotic use
  2. Dermatitis;
    * Eczema
    * Seborrhoeic dermatitis
    * Contact dermatitis
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22
Q

Otitis externa : Most common cause

A
  1. Bacterial infection

2.Causative organsims;
* Pseudomonas Aeruginosa
* Staphylococcus Aureus

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23
Q

Otitis externa : Clinical features

A
  1. Ear pain, itchiness
  2. Discharge
  3. Conductive hearing loss
24
Q

Severe Otitis externa : Clinical features

A
  • Red, oedematous ear canal which is narrowed and obscured by debris
  • Conductive hearing loss
  • Discharge
  • Regional lymphadenopathy
  • Cellulitis spreading beyond the ear
  • Fever
25
Q

Otitis externa : Clinical signs

A

1 . Ear canal : Erythema, swelling, discharge of pus from

2 . Palpation :
* Tenderness
* Lymphadenopathy : around neck or ear

3 . Otoscopy : red, swollen, eczematous canal

26
Q

Otitis externa : Diagnosis

A
  1. Otoscopy } Clinical diagnosis
  2. Ear swab : can be used to identify causative mechanism
27
Q

Otitis externa : Management

A

First line :
Mild OE : Topical acetic acid 2% spray
Severe OE : Topical antibiotic (Acetic acid) + Topical steroid aka ‘Otomize spray’

  • Consider removal of any canal debris OR Insert ear wick to apply antibiotic if too swollen
  • Contact Dermatitis : Neomycin

Second line :
* Systemic sx - Oral flucloxacillin

Third line : if no response to topical abx
* Consider fungal cause - Clotrimazole ear drops
* Refer to ENT

28
Q

Malignant Otitis Externa : Definition

A

A very severe and life-treating form of otitis externa

29
Q

Malignant Otitis Externa : Pathophysiology

A
  1. Otitis externa : infection of external auditory canal
  2. Spread to bone : osteomyelitis of the temporal bone of the skull

Caused by Pseudomonas aurinogasa in diabetic or immunocompromised patients.

30
Q

Malignant Otitis Externa : Risk factors

A

Malignant otitis externa is usually related to underlying risk factors for severe infection
* Diabetes
* Immunosuppressant medications (e.g., chemotherapy)
* HIV

31
Q

Malignant Otitis Externa : Clinical features

A
  1. Severe ear pain
  2. Temporal headache
  3. Purulent otorrhea
  4. Hx DM or HIV
  • Key finding ;
    3. Granulation tissue : found between bone + cartilage in the ear canal is a key finding in malignant otitis externa
32
Q

Malignant Otitis Externa : Investigation

A

CT scan

33
Q

Malignant Otitis Externa : IMx

A

All non-resolving otitis externa with worsening pain should be referred urgently to ENT

  1. Intravenous antibiotics that cover pseudomonal infections e.g. Ciprofloxacin
34
Q

Malignant Otitis Externa : Complication

A
  1. Facial nerve damage + Palsy
  2. Meningitis
35
Q

Sinusitis : definition

A

Sinusitis refers to inflammation of the paranasal sinuses in the face.
Sinusitis can be:
* Acute (less than 12 weeks)
* Chronic (more than 12 weeks)

36
Q

Sinusitis : Pathophysiology

A
  1. Paranasal sinuses : hollow spaces within bones of the nose which produce mucus and drain into nasal cavities
  2. Blockages of drains - results in infection
37
Q

Sinusitis : Risk factors

A
  • Nasal obstruction e.g. septal deviation or nasal polyps
  • Recent local infection e.g. rhinitis or dental extraction
  • Swimming/diving
38
Q

Chronic rhinosinusitis : Definition

A

Inflammation of paranasal sinuses and linings of the nasal passages that lasts > 12 weeks.

39
Q

Chronic rhinosinusitis : Predisposing factors

A
  • atopy: hay fever, asthma
  • nasal obstruction e.g. Septal deviation or nasal polyps
  • recent local infection e.g. Rhinitis or dental extraction
  • swimming/diving
  • smoking
40
Q

Chronic rhinosinusitis : Clinical features

A
  • facial pain: typically frontal pressure pain which is worse on bending forward
  • nasal discharge:
    -If due to allergy : clear
    -2nd infection : thicker, purulent discharge
  • nasal obstruction: e.g. ‘mouth breathing’
  • post-nasal drip: may produce chronic cough
41
Q

Post-nasal drip (PND) : Definition

A
  1. Occurs as a result of excessive mucus production by the nasal mucosa.
  2. Excess mucus accumulates in the throat or in the back of the nose
  3. Resulting in a chronic cough and bad breath.
42
Q

Chronic/Recurrent rhinosinusitis Mx

A
  • avoid allergen
  • intranasal corticosteroids
  • nasal irrigation with saline solution
43
Q

Chronic sinusitis : Red flags symptoms

A
  • unilateral symptoms
  • persistent symptoms despite compliance with 3 months of treatment
  • epistaxis
44
Q

Sinusitis : Clinical features

A

1 . Facial pain
* Typically frontal pressure pain which is worse on bending forward
* Tender around sinuses

2 . Nasal sx :
* Nasal discharge: usually thick and purulent
* Nasal obstruction

3 . Systemic sx : fever

45
Q

Chronic sinusitis : Definition

A
  • Sinusitis > 12 weeks
  • Assoc : Nasal polyps
  • Unilateral sx (sinuses only affected on one side of face) : Indicates underlying polyps, infection, tumor
46
Q

Sinusitis : Management

A
  1. > 10 days of sx : Intranasal corticosteroids
  2. Systemic unwell : PO Abx
  3. Nasal irrigation with saline solution
47
Q

Tonsillitis : Definition

A
  • Inflammation of the tonsils secondary to an infection
  • Most common cause of tonsillitis : Viral infection
48
Q

Tonsillitis : Bacterial causes

A
  1. Streptococcus Pyogenes (Group AStrep) } Most common
  2. Streptococcus Pneumoniae
49
Q

Tonsillitis : Clinical presentation

A
  • Sore throat
  • Fever (above 38°C)
  • Pain on swallowing
50
Q

Tonsillitis : Clinical signs

A
  1. Throat examination : Enlarged, red, inflamed tonsil - with or without exudate
  2. Lymphadenopathy :
    * Anterior cervical : anterior triangle of the neck
    * Tonsillar : behind the angle of the mandible
51
Q

Tonsillitis : Diagnosis

A

The Centor criteria
* Use : estimates the probability that tonsillitis is due to bacterial infection and will benefit from antibiotics.

Offer antibiotics if : score of 3 or more, 40 - 60% probably of bacterial cause
* Fever over 38ºC
* Tonsillar exudates
* Absence of cough
* Tender anterior cervical lymph nodes (lymphadenopathy)

52
Q

Tonsillitis : Management

A
  1. Viral tonsillitis : conservative mx - r/v in 3 days if pain not settled or >38 fever
  2. Bacterial tonsillitis :
    * Strep Pypgenes : Phenoxymethylpenicillin for 10 days

3 . Admission if
* Immunocompromised / systemically unwell
* Respiratory distress
* Peritonsillar abscess

53
Q

Tonsillitis : Complications

A
  • Peritonsillar abscess, also known as quinsy
  • Otitis media, if the infection spreads to the inner ear
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
54
Q

Peritonsillar abscess : Cause

A
  1. Complication of untreated/partially related tonsillitis : bacterial infection of the tonsils traps pus } abscess formation
  2. Can also arise sporadically
55
Q

Peritonsillar abscess : Clinical features

A
  1. Tonsillitis symptoms
    AND
  2. Unable to open mouth
  3. Change in voice
  4. Swelling and erythema beside the tonsils
56
Q

Peritonsillar abscess : Management

A

ENT referral : Needle aspiration /Incision and drainage

ENT (9 decks)

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