Ears Nose Throat
Terms
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- what are characteristics of inner ear disease?
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1. tinnitus (ringing in ears)
2. vertigo (feeling as though surroundings are spinning when eyes are open) - what are some causes of tinnitus?
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1. foreign body in ext canal
2. pulsating vascular tumors
3. meds (aspirin)
4. hearing loss - what are characteristics of benign positional vertigo?
- 1. sudden, episodic vertigo c/ head movement lasting for seconds
- what is tx of benign positional vertigo?
- 1. epley maneuver
- what are characteristics of meniere/s disease?
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1. dilation of membranous labyrinth resulting from excess endolymph
2. classic triad=hearing loss, tinnitus, and episodic vertigo lasting several hours - what is tx for meniere/s disease?
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1. medical: thiazide, anticholinergics, antihistamines
2. surgical: labyrinthectomy - what are characteristics of viral labyrinthitis?
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1. preceded by viral respiratory illness
2. vertigo lasting days to weeks - what is tx for viral labyrinthitis?
- 1. meclizine
- what are characteristics of acoustic neuroma?
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1. CN VIII schwannoma, commonly affects vestibular portion but can also affect cochlea
2. si/sx: vertigo, sudden deafness, tinnitus
3. dx=MRI of cerebellopointine angle - what is tx for acoustic neuroma?
- 1. local radiation or surgical excision
- where do 90% of epistaxis bleeds occur?
- at Kiesselbach's plexus (anterior nasal septum)
- what is the #1 cause of epistaxis in children?
- trauma!! often induced by exploring digits!
- what is epistaxis also precipitated by?
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1. rhinitis
2. nasal nucosa dryness
3. septal deviation
4. bone spurs
5. alcohol
5. antiplatelet meds
6. bleeding diathesis - how do you tx epistaxis?
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1. direct pressure
2. topical nawal vasoconstrictors (neosynephrine)
3. anterior nasal packing if unable to stop - 5% of epistaxis occur where?
- in posterior nasal cavity, requiring packing to occlude choana (the opening between the nasal cavity and the nasopharynx)
- What are the m/c sinues involved in sinusitis?
- maxillary sinuses
- what is dx for sinusitis?
- CT scan showing inflammatory changes or bone destruction
- whats are potentail complications of sinusitis?
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1. meningitis
2. abscess formation
3. orbital infection
4. osteomyelitis - what organisms are m/c c/ acute bacterial sinusitis (<4 wks)?
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1. streptococcus pneumoniae
2. haemphilus influenzae
3. moraxella catarrhalis - what are si/sx of acute bacterial sinusitis (<4 wks)?
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1. purulent rhinorrhea
2. HA
3. pain on sinus palpation
4. fever
5. halitosis
6. anosmia
7. tooth pain - what is tx for acute bacterial sinusitis (<4 wks)?
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1. bactrium (tMP/SMX)
2. amoxicillin
3. decongestants - what organisms are m/c c/ chronic bacterial sinusitis (>3 mons)?
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1. bacteroides
2. S. aureus
3. Pseudomonas
4. Streptococcus spp. - what are si/sx of chronic bacterial sinusitis (>3 mons)?
- same as for acute, but lasts longer, also otitis media in children
- what is tx for chronic bacterial sinusitis (>3 mons)?
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1. surgical correction of obstruction
2. nasal steroids
3. abx - what organisms are m/c c/ fungal sinusitis?
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aspergillus, but
diabetics get MUCORmycosis!!!
*usually seen in immunocompromised pts
*tx with curgery and amphotericin!!! - what are si/sx of group A strep throat pharyngitis?
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1. high fever
2. sever throat pain s/ cough
3. edematous tonsils c/ white or yellow exudate
4. cervical adenopathy - what the dx for group A strep throat pharyngitis?
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1. H and P 50% accurage
2. antigen agglutinationkit for screening
3. throat swab culture is gold standard - what the tx for group A strep throat pharyngitis?
- penicillin to prevent acute rheumatic fever!!!
- what are si/sx of membranous (diphtheria) pharyngitis?
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1. high fever
2. dysphagia
3. drooling
4. can cause respiratory failure (airway occlusion!) - what is dx for membranous (diphtheria) pharyngitis?
- pathognomonic gray membrane on tonsils extending into throat
- what is tx for membranous (diphtheria) pharyngitis?
- STAT ANTITOXIN!!!!!!
- what are si/sx for fungal pharyngitis (candida)?
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1. dysphagia, sore throat c/ white, cheesy patches in oropharynx (oral thrush)
2. seen in AIDS and small children - what is dx for fungal pharyngitis (candida)?
- clinical or endoscopy
- what is tx for fungal pharyngitis (candida)?
- 1. nystatin liquid--swish and swallow
- what are si/sx for adenovirus pharyngitis?
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pharyngoconjunctival fever:
1. fever
2. red eye
3. sore throat
*clinical dx
*supportive tx - what are si/sx for mononucleosis (ebstein-barr virus) pharyngitis?
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1. generalized lymphadenopathy
2. exudative tonsillitis
3. palatal petechiae
4. splenomegaly - what is dx for mononucleosis (ebstein-barr virus) pharyngitis?
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1. positive heterophile anitbody
2. skin rash in pts given ampicillin
3. supportive tx - what are si/sx for herpangina (coxsackie A) pharyngitis?
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1. fever
2. pharyngitis
3. body ache
4. tender vesicles along tonsils, uvual, and soft palate
5. clincial dx
6. supportive tx