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EAR NOSE AND THROAT DESORDER PowerPoint Presentation

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Description : On completion of this tutorial, you will be able to manage: Inflammatory Disorders of Ear, Nose and Throat (ENT) Foreign Bodies in the Ear, Nose and Throat Epistaxis

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Published on : Dec 15, 2020 | Views : 2442 | Downloads : 15

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EAR, NOSE AND THROAT DISORDERS LELE MUTOMBO Fabrice Md, MCS COSECSA Candidate 2021 18/12/2020 1
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Objectives On completion of this tutorial, you will be able to manage: Inflammatory Disorders of Ear, Nose and Throat (ENT) Foreign Bodies in the Ear, Nose and Throat Epistaxis 18/12/2020 2
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OUTLINE Introduction Topic 1 — Inflammatory Disorders of Ear, Nose and Throat (ENT) Topic 2 — Foreign Bodies in the Ear, Nose and Throat Topic 3 — Epistaxis Summary 18/12/2020 3
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ENT disorders are common number of causes will focus on three particular areas of interest : Inflammatory disorders Foreign bodies Epistaxis 18/12/2020 4
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Inflammatory disorders in the head and neck are a frequent cause of doctor visits. These can involve specific structures such as the pharynx and larynx, or may be manifestations of a general condition. Symptoms may develop fairly quickly, as with infections, or may develop over a period of time. symptoms depend on the site and severity of the disease, and in many instances they arise from the effects of the disease on the upper respiratory and/or alimentary tract. 18/12/2020 5
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Otitis Externa This is inflammation of the skin of the cartilaginous ear canal. It may be part of a systemic disorder such as psoriasis or eczema. Symptoms : otalgia, scanty otorrhoea, aural fullness, hearing loss. Itching without smelly discharge → generalised condition common pathogens : Pseudomonas, Staphylococci, Proteus and fungi. Treatment: cleaning and antibiotic/steroid ear drops, systemic broad spectrum antibiotics and in severe cases, meatoplasty. 18/12/2020 6
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Otitis Externa There are two rare variants of otitis externa.:. Necrotising external otitis : germ :Pseudomonas aeruginosa ; population: elderly diabetics or ID patients. Clini man: Purulent otorrhoea, involvement (VII, X, XI), osteomyelitis. Therapy: local debridement, penicillin or cephalosporin + aminoglycoside. Herpes zoster of the ear : Clini man: otalgia, vesicular eruption on the external canal and TM, deafness, vertigo and facial paralysis ; germ : zoster virus in the geniculate ganglion 18/12/2020 7
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Acute Otitis Media (AOM) symptoms : otalgia, decreased hearing, fever, unsteadiness and otorrhoea Germ: bacteria (85%) : streptococci and Haemophilus influenza. viruses (15%) rhinovirus and adenovirus. Examination : immobile TM: dull and opaque, injected (that is, with prominent blood vessels), bulging. If TM has perforated= meatus discharge. Treatment : is pain relief, antibiotics, decongestants and, if necessary, myringotomy. Complications acute mastoiditis, labyrinthitis (vomiting, vertigo), TM perforations, intracranial spread of infection. 18/12/2020 8
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Otitis Media with Effusion (OME, Serous Otitis Media) generally due to Eustachian tube dysfunction. may be asymptomatic, Symptomes: deafness and speech delay in children. ↗↗↗ television volume, school progress deteriorated. Treatment : Watchful waiting (50% natural resolution), Ventilation tubes (˃3 months), Adenoidectomy. 18/12/2020 9
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Chronic Suppurative Otitis Media (CSOM) result of poorly treated acute infections due to a failure of the normal mechanism by which squamous epithelial cells are shed from the external aspect of the TM can lead to TM perforations, and local inflammatory changes may cause granulations, aural polyps and cholesteatoma. Cholesteatoma is an especially harmful epithelial ingrowth into the middle ear cleft which can erode the skull bones, causing: ossicular destruction, damage to the labyrinth, damage to the facial nerve, inflammation of the dura. Treatment is surgical removal of the cholesteatoma 18/12/2020 10
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Referred Pain Earache is often caused by disease elsewhere: Cervical spine disease. Disease of the tongue, oral cavity and lower teeth Disease of the pharynx and larynx 18/12/2020 11
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Rhinitis — Inflammation of the Nasal Cavity The causes are numerous: allergic, infection, hormonal, environmental, foreign bodies. The symptom, to put it simply, is a runny nose If the nasal secretions are clear, the cause is likely to be allergic. If they are purulent (yellow, green), the cause is likely to be infective. If there are significant amounts of blood (more than a few spots or streaks), consider cancer. 18/12/2020 12
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Sinusitis — Frontal, Ethmoid, Maxillary Def: Acute sinusitis ≤ 12 weeks. Chronic sinusitis ˃ 12 weeks. ≥ 4 isolated episodes/ year = recurrent acute sinusitis. Symptoms include: facial pain/pressure, nasal obstruction, purulent rhinorrhea, postnasal drip. Germ : streptococcus pneumoniae, haemophilus influenzae and moraxella catarrhalis Investigations : fluid level on x-ray. 18/12/2020 13
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Sinusitis — Frontal, Ethmoid, Maxillary Clinical examination : mucosal hyperaemia, purulent nasal discharge and nasal polyps. Ethmoidal and frontal can spread to the orbit. treatment is medical : topical and/or oral decongestions, broad spectrum antibiotics, analgesics and antihistamines. Surgical measures may be necessary. Endoscopic sinus surgery (ethmoidectomy) is the commonest surgical procedure today for the treatment of chronic rhinosinusitis. 18/12/2020 14
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Sinusitis — Frontal, Ethmoid, Maxillary Maxillary sinusitis : Maxillary sinus lavage (washout) is indicated only if the sinus contains pus. Treatment is often ineffective. Conservative measures against the most common pathogens (ampicillin, amoxycillin, cefaclor, TMP-SMX) Surgical measures maxillary sinus irrigation, intranasal antrostomy or ethmoidectomy. 18/12/2020 15
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discomfort, pain and voice changes, earache can accompany throat infections. Pharynx : infectious mononucleosis (glandular fever), tonsillitis, peritonsillar abscess (quinsy) Larynx : epiglottitis (supraglottitis), laryngeal polyps, laryngotracheobronchitis (croup) 18/12/2020 16
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Inflammations of the Pharynx Infectious Mononucleosis (Glandular Fever) : Epstein-Barr virus, The Paul Bunnell or monospot test is positive, TTT : analgesia with steroids for airway obstruction and antibiotics for secondary infection Tonsillitis germ: bacterial, viral. Sym: sore throat, fever and often enlarged lymph node behind the throat. TTT: Acute tonsillitis = treated symptomatically. Chronic tonsillitis = tonsillectomy Peritonsillar Abscess (Quinsy) : collection of pus in the area above the tonsils, Symptoms include unilateral throat pain, dysphagia, drooling, muffled voice and fever 18/12/2020 17
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Inflammations of the Pharynx Epiglottitis (Supraglottitis) : occurs most frequently in children. Supraglottic structures become inflamed and oedematous leading to respiratory obstruction. The causative organism is usually Haemophilus influenzae type B. Symptoms : sudden fever and sore throat, a rapid onset of respiratory distress, three Ds — drooling, dysphagia, distress Examination: fever, anxiety, stridor along with a muffled cough, and the red tip of the epiglottis. Treatment : immediate intubation in OR. (crico or even tracheo). ATB. 18/12/2020 18
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Inflammations of the Pharynx Laryngeal Polyps caused by: chemical, physical, idiopathic, malignant. Benign polyps are usually caused by overuse or abuse of the voice. Treatment is removal. Laryngotracheobronchitis (Croup) : viral infection of the upper respiratory tract , ± airway obstruction. Symptoms : stridor and fever. Treatment is humidified oxygen, adrenaline nebulizer, steroids. 18/12/2020 19
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Neck Inflammation Symptoms include: pain, fever, neck swelling, dysphagia, trismus, airway obstruction antibiotics may mask the symptoms. blood cultures) and imaging investigations antibiotics and surgical drainage, if necessary. 18/12/2020 20
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More common in the parotid gland than in the other salivary gland. usually caused by Staphylococcus aureus, although Streptococcus pneumoniae, Escherichia coli, or Haemophilus influenzae may be involved. painful diffuse swelling , purulent discharge from the duct. stimulation of saliva by sialogogues (such as lemon), rehydration, improved oral hygiene, analgesics, and antibiotics. Stone = chronic = removal 18/12/2020 21
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Granulomatous conditions can cause inflammations in the head and neck : fungal infections — histoplasmosis, Aspergillus fumigatus, tuberculosis and other mycobacterial infections, actinomycosis, syphilis, eosinophilic granuloma, Wegener's granulomatosis, sarcoidosis If you suspect these, call for help from a head and neck specialist and/or a physician. 18/12/2020 22
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can be completely asymptomatic or cause some: discomfort (live insects), secondary otitis externa, (vegetative material), hearing loss Foreign Bodies in the Nose unilateral rhinorrhea, nasal obstruction, severe burns, orbital or intracranial infection may develop if undetected. Direct inspection is necessary. Foreign Bodies in the Throat Oropharynx and Hypopharynx Oesophagus Larynx, Trachea and Bronchi 18/12/2020 23
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The nasal mucosa has a rich blood supply from branches of both the external carotid (mainly maxillary) and internal carotid (ethmoidal) arteries. Vessels anastomose freely. Most bleeds come from the Kiesselbach's plexus at the anterior portion of the septum 18/12/2020 24
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Assess the general condition of the patient: blood pressure, pulse rate, signs of shock,… Estimate the approximate amount of blood loss and rule out medications such as NSAIDs or anticoagulants. Perform a quick physical examination to rule out bleeding or clotting disorders. Order a full blood count and, depending on history and clinical findings, coagulation screen, liver function tests and renal function tests. 18/12/2020 25
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More advanced options include: postnasal pack endoscopic sphenopalatine artery ligation. embolisation laser surgery arterial ligation used as last resort 18/12/2020 26
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