ENT infections Flashcards
(56 cards)
1
Q
Otitis Media : Definition
A
Infection of the middle ear
2
Q
Otitis Media : Pathophysiology
A
- Middle ear : Place between the tympanic membrane and the inner ear } where cochlea is
- Via the Eustachian tube : Bacteria travel from the throat and enter the middle ear
3
Q
Otitis Media : Causative organism
A
Streptococcus Pneumonia
4
Q
ACUTE Otitis Media : Presentation
A
- Preceding URTI
- Ear pain - reduced hearing
- Discharge : if tympanic membrane has perforated
- Fever and coryzal sx
5
Q
Otitis Media : Examination
A
Otoscope : bulging, red, inflamed looking membrane.
* Discharge present if Tympanic membrane has perforated
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
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
8
Q
ACUTE Otitis Media : Indication for immediate Abx
A
- Young or Immunocompromised
* <2 years old with bilateral otitis oedema
* Immuncompromise or high risk of complication due to comorbidity - Symptoms not resolves for > 4 days
- Systemically unwell - high fever etc
- Otitis media with peroration or discharge in the canal
9
Q
Acute otitis media : Complications
A
- Glue ear
- Mastoiditis
- Choleaosteatoma
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
11
Q
Glue ear : Cause
A
- Associtated with previous ear infections
- 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 - Not acute infection - just fluid build up in middle ear
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
13
Q
Glue ear : Management
A
- Observation for 3 months
- Grommet insertion - allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube
- Referral to secondary care if;
* Down’s syndrome/Cleft palate
* Sig affecting education or developmental milestone
14
Q
Mastoiditis : Definition
A
Infection spread from middle ear to mastoid air spaces of temoral bone
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
16
Q
Mastoiditis : Mx and complications
A
Management
* IV antibiotics
Complications
* facial nerve palsy
* hearing loss
* meningitis
17
Q
Perforated tympanic membrane : Clinical presentation
A
- Commonly : 2nd to infection
- Trauma
- Coryzal sx
- Effusion of the middle ear
- Hearing loss - depending on the size
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
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
20
Q
Otitis externa : Risk factors
A
- Swimmer’s ear : exposure to water when swimming can cause inflammation
- Trauma : external ear canal via cotton buds
21
Q
Otitis externa : Causes of inflammation
A
- Infection
* Bacterial infection (Most common cause)
* Fungal infection } Candida infection 2nd to antibiotic use - Dermatitis;
* Eczema
* Seborrhoeic dermatitis
* Contact dermatitis
22
Q
Otitis externa : Most common cause
A
- Bacterial infection
2.Causative organsims;
* Pseudomonas Aeruginosa
* Staphylococcus Aureus
23
Q
Otitis externa : Clinical features
A
- Ear pain, itchiness
- Discharge
- 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
Otitis externa : Clinical signs
1 . Ear canal : Erythema, swelling, discharge of pus from
2 . Palpation :
* Tenderness
* Lymphadenopathy : around neck or ear
3 . Otoscopy : red, swollen, eczematous canal
26
Otitis externa : Diagnosis
1. Otoscopy } Clinical diagnosis
2. Ear swab : can be used to identify causative mechanism
27
Otitis externa : Management
**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
Malignant Otitis Externa : Definition
A very severe and life-treating form of otitis externa
29
Malignant Otitis Externa : Pathophysiology
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
Malignant Otitis Externa : Risk factors
Malignant otitis externa is usually related to underlying risk factors for severe infection
* *Diabetes*
* *Immunosuppressant medications* (e.g., chemotherapy)
* *HIV*
31
Malignant Otitis Externa : Clinical features
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
Malignant Otitis Externa : Investigation
CT scan
33
Malignant Otitis Externa : IMx
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
Malignant Otitis Externa : Complication
1. Facial nerve damage + Palsy
2. Meningitis
35
Sinusitis : definition
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
Sinusitis : Pathophysiology
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
Sinusitis : Risk factors
* Nasal obstruction e.g. septal deviation or nasal polyps
* Recent local infection e.g. rhinitis or dental extraction
* Swimming/diving
38
Chronic rhinosinusitis : Definition
Inflammation of paranasal sinuses and linings of the nasal passages that lasts > 12 weeks.
39
Chronic rhinosinusitis : Predisposing factors
* 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
Chronic rhinosinusitis : Clinical features
* **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
Post-nasal drip (PND) : Definition
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
Chronic/Recurrent rhinosinusitis Mx
* avoid allergen
* intranasal corticosteroids
* nasal irrigation with saline solution
43
Chronic sinusitis : Red flags symptoms
* unilateral symptoms
* persistent symptoms despite compliance with 3 months of treatment
* epistaxis
44
Sinusitis : Clinical features
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
Chronic sinusitis : Definition
* Sinusitis > 12 weeks
* Assoc : Nasal polyps
* Unilateral sx (sinuses only affected on one side of face) : Indicates underlying polyps, infection, tumor
46
Sinusitis : Management
1. >10 days of sx : Intranasal corticosteroids
1. Systemic unwell : PO Abx
1. Nasal irrigation with saline solution
47
Tonsillitis : Definition
* Inflammation of the tonsils secondary to an infection
* Most common cause of tonsillitis : Viral infection
48
Tonsillitis : Bacterial causes
1. Streptococcus Pyogenes (Group AStrep) } Most common
2. Streptococcus Pneumoniae
49
Tonsillitis : Clinical presentation
* Sore throat
* Fever (above 38°C)
* Pain on swallowing
50
Tonsillitis : Clinical signs
1. Throat examination : Enlarged, red, inflamed tonsil - with or without exudate
1. Lymphadenopathy :
* Anterior cervical : anterior triangle of the neck
* Tonsillar : behind the angle of the mandible
51
Tonsillitis : Diagnosis
**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
Tonsillitis : Management
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
Tonsillitis : Complications
* *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
Peritonsillar abscess : Cause
1. Complication of untreated/partially related tonsillitis : bacterial infection of the tonsils traps pus } abscess formation
2. Can also arise sporadically
55
Peritonsillar abscess : Clinical features
1. Tonsillitis symptoms
**AND**
1. Unable to open mouth
2. Change in voice
3. Swelling and erythema beside the tonsils
56
Peritonsillar abscess : Management
ENT referral : Needle aspiration /Incision and drainage
