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Eye Ear Nose and Throat Infections PowerPoint Presentation

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Description : Check out this medical presentation on Dental Abrasion, which is titled "Eye, Ear, Nose, and Throat Infections", to know about the Eye infections (Conjuctivitis, Keratitis, and Endophtalmitis), Throat infections (Pharyngitis and Epiglottitis), Ear infections (Otitis externa, Otitis media, and Mastoiditis), and Sinus infections (Sinusitis).

Tags : Dental Abrasion, Eye, Ear, Nose, Throat, Infections, Conjuctivitis, Keratitis, Endophtalmitis, Pharyngitis, Epiglottitis, Otitis externa, Otitis media, Mastoiditis, Sinus infections, Sinusitis

Published on : Jul 01, 2021 | Views : 1872 | Downloads : 6

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Slide 1-

Eye, Ear, Nose, and Throat Infections Nenad Pandak
Slide 2-

Why ? Ophthalmologist ENT specialist ID specialist & GP Familiar with these infections Preliminary empiric therapy
Slide 3-

Task Eye infections Conjuctivitis Keratitis Endophtalmitis Throat infections Pharyngitis Epiglottitis
Slide 4-

Task Ear infections Otitis externa Otitis media Mastoiditis Sinus infections Sinusitis
Slide 5-

Eye anatomy
Slide 6-

Conjuctivitis Inflammation of conjuctiva Doesn’t threaten the vision Rapid respond to therapy
Slide 7-

Conjuctivitis Direct contact with the environment Tears Antibacterial agents Lysozyme, IgA, IgG Decresed tear production Recurrent infections
Slide 8-

Clinical presentation Vessel dilatation “red eye” Pus formation Eyelid swelling Itching, pain Glued eyelid shut (dried purulent exudate)
Slide 9-

Causes Bacteria Staph. aureus Str. pneumoniae H. influenzae M. catarrhalis N. gonorrhoeae N. meningitidis P. aeruginosa C. trachomatis Viruses Adenoviruses Enteroviruses HSV VZV Measles
Slide 10-

Causes Fungi Candida Blastomyces Sporothrix schenckii Parasites Trichinella spiralis Taenia solium Schistosoma haematobium Lola loa Onchocerca volvulus
Slide 11-

Causes Viral The most common Highly contagious Spread to the 2nd eye in 24-48 hrs Bacterial Highly contagious Profuse pus formation
Slide 12-

Causes Allergic and toxic Pollens Symmetrical Itching Systemic diseases Reiter syndrome Vasculitis SLE
Slide 13-

Diagnosis History & examination Severe cases Swab or scraping: Gram stain & culture Viral: mononuclear cell exudate Allergic: eosinophils Bacterial: PMNs
Slide 14-

Treatment Topical antibiotics? To do or not to do? Are your eyelids glued in the morning?(+5) Does your eye itch? (-1) Do you have recurrent conjuctivitis?(-2) Score: 5 – bacterial 77% 2 – bacterial 2%
Slide 15-

Treatment Prefered therapy Moxifloxacin 0.5% sol TID 7 days Alternate therapy Gentamycin Tobramycin Polymyxin B / bacitracin Neomycin / polymixin
Slide 16-

Eye anatomy
Slide 17-

Keratitis Inflammation of cornea Prompt treatment Corneal perforation – blindness
Slide 18-

Predisposing conditions Minimal injury of cornea Trauma Contact lens abrasion Eye surgery Impaired tear production Diabetes mellitus Immunosupression Comatose patient
Slide 19-

Causes Bacteria – 65-90% Some produce toxins and enzymes Penetration without epithelial disruption Hypopyon is the rule Perforation
Slide 20-

Causes Staph. aureus P. aeruginosa (contact lenses) N. gonorrhoeae N. meningitidis H. influenzae
Slide 21-

Causes Viruses HSV recurrent keratitis Unilateral Dendritic lesion Erythema, pain, foreign body sensation
Slide 22-

Causes Fungi After organic material injury (tree branch) Prolonged corticoid eye drop therapy Aspergillus Protoza Unsterilized tap water for contact lens cleaning Acanthamoeba
Slide 23-

Clinical presentation Eye pain Foreign body sensation Corneal edema – impaired vision Photophobia Reflex tearing
Slide 24-

Diagnosis Medical history & exam Swab or scraping Gram stain, Giemsa stain, methenamine silver stain, culture Therapy Emergently Experienced ophthalmologist
Slide 25-

Endophthalmitis Serious infection Ocular chamber & adjacent structures Involving all tissue layers: panophthalmitis Often leads to blindness
Slide 26-

Predisposing conditions Posttraumatic Staph. aureus and epidermidis Str. spp Bacillus cereus Fungi Organic matter penetrating injuries
Slide 27-

Predisposing conditions Hematogenous Any source of bacteremia 2/3 – right eye Candida albicans G + and G – bacteria Bacillus cereus – IDU
Slide 28-

Predisposing conditions Contiguous spread Uncontrolled keratitis Delays in antibiotic therapy
Slide 29-

Predisposing conditions Ocular surgical procedures Staph. aureus and epidermidis Str. spp Early 1 – 5 days after the surgery Delayed Weeks to months after the surgery Opportunistic pathogens
Slide 30-

Clinical presentation Eye pain Eye redness Photophobia Reduced vision Fever, algic syndrome
Slide 31-

Diagnosis and therapy Cultures and smears Systemic broad spectrum antibiotics Intravitreal antibiotic injection 1/10 patients – enucleation Experienced ophthalmologist
Slide 32-

ENT infectios
Slide 33-

Pharyngitis Common infectious disease Usually self-limiting Antibiotics malpractice
Slide 34-

Causes Viruses Rhino, corona, adeno, HSV, EBV, CMV, influenza, parainfluenza, coxsackie A, HIV Bacteria Group A streptococci (GAS) Children 50% of all cases Adults 10%
Slide 35-

GAS pharygitis
Slide 36-

Diagnosis Centor clinical criteria Tonsillar exudates Tender anterior cervical adenopathy Fever Abscence of cough
Slide 37-

Diagnosis 3-4 criteria Positive predictive value 40-60% 3-4 criteria absent Negative predictive value 80% Adding age 3 – 14 y/o: +1 >45 y/o: -1
Slide 38-

Therapy Penicillin the drug of choice Oral Penicillin VK 10 days Benzathine penicillin 1.2-2.4 MU im once Penicillin-allergic patients Clarithromycin, clindamycin, cephalosporins 10 days, azithromycin 3 days
Slide 39-

Peritonsillar abscess Symptoms worsening despite antibiotics Medial displacement of uvula Soft palate bulging Surgical intervention Recurrent abscess – tonsillectomy
Slide 40-

Epiglottitis High fever Difficulty swallowing Drooling Difficulty breathing Indirect laryngoscopy Swollen, cherry-red epiglottis
Slide 41-

Epiglottitis High risk of airway obstruction Children Mortality 80% Adult Closely monitored Endotracheal intubation
Slide 42-

Epiglottitis Causes H. influenzae Str. pneumoniae Staph. aureus Therapy 3rd generation cephalosporins iv 7-10 days
Slide 43-

Ear infections
Slide 44-

Otitis externa Immunocompetent Mild disease Immunocompromised Possible life – threatening
Slide 45-

Otitis extrena Local itching and pain Redness and swelling of the external canal skin Tenderness of the auricula
Slide 46-

Causes Gram-negative bacteria P. aeruginosa the most prevalent Staph. epidermidis or aureus Candida or Aspergillus
Slide 47-

Therapy Polymyxin neomicin sol. + Hydrocortison sol. Clotrimazol or miconazol
Slide 48-

Malignant otitis externa Immunocompromised Severe pain Spreading of necrotizing infection Skull, meninges, brain CT scan, MRI Gallium scan P. aeruginosa almost always! Systemic therapy 6 weeks + surgical debridement
Slide 49-

Otitis media Most commonly in childhood Up to 3 y/o 2/3 of children at least 1 episode Consequence of the Eustachian tube obstruction
Slide 50-

Otitis media Viral upper respiratory infection Serous fluid accumulation Eustachian tube obstruction 5-10 days later – fluid infected with mouth flora
Slide 51-

Clinical presentation Ear pain Ear drainage Occasionally hearing loss Fever Vertigo, tinnitus, nystagmus Loose stools (children)
Slide 52-

Diagnostic criteria Abrupt onset of middle-ear inflamation Presence of middle-ear effusion (any) Bulging of the tympanic membrane Limited mobility of the tympanic membrane Air-fluid level behind the tympanic membrane Otorrhea Signs of middle-ear inflamation (any) Erythema of the tympanic membrane Otalgia that interferes with normal activity or sleep
Slide 53-

Causes Str. pneumoniae H. influenzae M. catarrhalis GAS Staph. aureus
Slide 54-

Therapy Amoxycillin after 72 hrs – revision Improvement – continuation Failure Amoxycillin – clavulante Cefuroxime 10 days
Slide 55-

Mastoiditis Rare otitis media complication Manifestation Swelling, redness, tenderness in the area of the mastoid bone Possible spreading – temporal bone – temporal lobe – brain abscess CT, MRI Prolonged antibiotic therapy
Slide 56-

Sinuses - anatomy
Slide 57-

Sinusitis Nasal and sinus mucosa inflammation Rhinosinusitis Viral upper respiratory infection preceding 0.5 – 1% progress to bacterial sinusitis
Slide 58-

Sinus physiology Respiratory epithelium Goblet cells – mucin Cilia lining – move mucin out Sinus drainage into nasal cavity Osteomeatal complex
Slide 59-

Pathogenesis OMC obstruction Sinus drainage impaired Accumulation of serous fluid Fluid infection with oral flora
Slide 60-

Predisposing conditions Septal deformities Nasal polyps Intranasal neoplasms Indwelling nasal tubes Nasogastric tubes Nasal allergies Dental abscess Cystic fibrosis (abnormally voscous mucous) Kartagener syndrome (impaired ciliary function)
Slide 61-

Clinical presentation Headache Facial pressure Nasal obstruction Nasal discharge Loss of smell Foul-smelling breath Fever
Slide 62-

Bacterial causes Str. pneumoniae H. influenzae M. catarrhalis S. aureus S. epidermidis GAS G-neg bacteria Anaerobs
Slide 63-

Diagnosis WBC often normal, CRP may be elevated Culture of nasal swabs poorly corelate with intrasinus cultures Direct sampling complicated and painful X-rays, CT, MRI not helpful for the etiology diagnosis Medical history & exam
Slide 64-

Bacterial sinusitis Peristent acute sinusitis symptoms >10 days Abrupt onset with high fever (39°C) and purulent nasal discharge, facial pressure lasting 3-4 consecutive days Sudden worsening of typical viral upper respiratory infection
Slide 65-

Therapy Amoxycillin – clavulanic acid 2x1.0 g Fluoroquinolones Levofloxacin 1x250 mg Moxifloxacin 1x400 mg Doxycyclin 2x100 mg Cefuroxim – axetil 2x250-500 mg Cefixim 1x400 mg
Slide 66-

Therapy Intravenous therapy Frontal, ethmoid, sphenoid sinusitis Prevent the infection spreading Vital organs beyond the thin sinus walls
Slide 67-

Therapy Nasal decongestants in viral infections Saline irrigation Intranasal corticosteroids in patients with nasal allergy Symptomatic treatment Bed resting, fluid replacement, analgesics, antipyretics
Slide 68-

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