Transcript Ear Nose and Throat - Lectures

Disorders of the Ear, Nose, Throat
& Mouth
Chapter 11
Pathology
EARS
 Otitis Externa- a painful inflammation of the
membranous lining of the auditory canal and/or
contiguous structures.
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Refers to acute and chronic inflammatory process
It may be diffuse or localized
Is largely benign and self-limiting
Invasive otitis externa is a potentially life threatneing
situation
EARS
 OE continued
 Epidemiology
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10-20% more common in the summer months
 Patho- inflammation is most commonly
caused by microbial infection. Colonization
of the external ear is prevented immune and
anatomic mechanisms
EARS
 Management and Treatments
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Pain meds
Heat or ice
Keep dry- no swimming for 7 days
Treatment for basic OE
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Irrigation if indicated
Pain drops
Antibiotic drops
 Ciprodex, Floxin Cortisporin
 May need a wick if very swollen
EARS
 Otitis Media- OM- inflammation of the
structures in the middle ear.
 Otitis media with effusion –OME involves
the transudation of plasma from middle ear
blood vessels leading to chronic fluid; this
can be chronic
 Acute Otitis Media-AOM is infection in the
middle ear
EARS
 OM
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Epidemiology
Accounts for 2-3% of all family practice office visits.
Number of visits increases in the winter. More
common in colder weather and in children.
 Contributing factors include; allergies, rhinitis,
pharyngitis due to swelling of upper airway
membranes. Most common factor is upper airway
infections (colds), caused by many different viruses.
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 Influenza, RSV, pneumovirus, adenovirus
EARS
 OME symptoms
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Stuffiness, fullness, decreased hearing, pain is
rare, may have popping. Rarely vertigo
Usually a history of recent URI, allergies
Rhinitis
 Rhinitis or coryza –inflammation of the nasal
mucosa with congestion, rhinorrhea, sneezing,
pruritus, post nasal drip
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Allergic
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Seasonal or perennial
Nonallergic
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Infectious, irritant related, vasomotor, hormone-related,
associated with medication, or atrophic
 May be chronic or acute
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Most common types
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Viral
Perennial (hay fever)
Rhinitis
 Epidemiology/Causes
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Actual prevalence is undocumented, but is very common
Occurs at least as much as the common cold
Estimated 40-50 million American adults suffer
Seasonal allergic rhinitis parallels pollen production
fall/spring
Allergy occurs in all age groups
 Most common in adults 30-40 years
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Non allergic rhinitis may be acute or chronic
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Chronic maybe associated with bacterial sinusitis
Rhinitis
 Rhinitis – symptoms
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Viral-malaise, HA, substernal tightness, rare
fever, sneezing and coughing
Allergic-itching of all upper air way mucosa,
watery eyes, sore throat, sneezing, coughing
Vasomotor-watery nasal discharge, nasal speech,
mouth breathing, nasal obstruction that switches
sides
Rhinitis
 Treatments
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Allergic rhinitis
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Avoid the triggers
Antihistamines
 Allegra, Claritin, Clarinex, Zyrtec, Astelin
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Nasal steroids
 Flonase, Nasonex, Nasacort
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Leukotriene receptor antagonists
 Singular
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Desensitizing immunotherapy
Atrophic- bacitracin to nares, saline, irrigation
Sinusitis
 Sinusitis is an inflammation of the mucous
membranes of one or more of the paranasal sinuses;
frontal, sphenoid, posterior ethmoid, anterior
ethmoid, and maxillary
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Acute-abrupt onset of infection and post-therapeutic
resolution lasting no more than four weeks
Subacute with a purulent nasal discharge persist despite
therapy, lasting 4-12 weeks
Chronic, with episodes of prolonged inflammation with
repeated or inadequately treated acute infection lasting
greater than 12 consecutive weeks
Sinusitis
 Clinical presentation
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Gradual onset of symptoms
Pain over the affected sinus, with increasing pain
 Pain is worse with coughing
 Area of pain corresponds the sinus affected
 Develop over at least 2 weeks of URI symptoms
 Nasal congestion, runny nose, pressure, cough, sore
throat, eye pain, malaise, and fatigue, headache,
cough, fever
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Sinusitis
 Sinusitis Management
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Usually viral
Supportive care is most helpful
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Sinus rinse
Few meds are helpful
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Sudafed, nasal spray, expectorants,
 Rarely use steroids or antihistamines
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Localized sinus infections are self limited
Sinusitis
 Sinusitis patient education
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Should focus on the worsening of symptoms
Avoid all contributing factors
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Smoke, allergens, antihistamine
Increase fluids
Pharyngitis
 Pharyngitis and tonsillitis are generalized
inflammatory process of both infectious and
non infectious etiology
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Most cases are viral and self-limiting
Most cases of pharyngitis are contagious
All cases of tonsillitis are contagious
Pharyngitis
 Testing
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Viral throat swab cultures are used to detect herpes virus
as well other viral infections…
Tzanck smear of a exudate is used to detect HSV, and
herpes zoster
Blood test may be used for viruses
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HSV, EBV, CMV
Candida – KOH potassium hydroxide- looking for
hyphal yeast
Mono spot for mono
CBC for infectious pharyngitis
X-ray may be needed to assess for abscess
Pharyngitis
 Management depends on the cause
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Home care with symptom management
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Antibiotics for bacterial causes
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Diflucan, nystatin
Be sure and assess immune status if no known cause is found
Viral illnesses
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See therapeutics handout
Antifungal for candida
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Voice rest, humidification, saline, viscous Xylocaine, gargles,
cool mist, lozenges, sprays, Acetaminophen, codeine, warm
compresses for lymph nodes
May use antivirals in some cases- IE; Flu- use Tamiflu
Abscess- hospital IV antibiotics and maybe surgery
Temporomandibular Joint
(TMJ) Disease
 TMJ is a collective term that refers to disorders
affecting the masticatory musculature and
associated structures. Sometimes know as
temporomandibular disorder. TMD is a cluster or
related disorder that have many features in
common.
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The most common is pain in the muscles of mastication,
the preauricular and the TMJ
Is a sub classification of musculoskeletal disorder
Temporomandibular Joint
(TMJ) Disease
 Epidemiology
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75% of people have at least one sign of joint dysfunction
and 33% have at least one symptom, like face pain
Only about 5% are in need of treatment
Differentiate contributing factors
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Predisposing factors- increase the risk
Initiating factors- cause the onset
Perpetuating factors- interfere with healing
Temporomandibular Joint
(TMJ) Disease
 Symptoms
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Pain in the preauricular area/or TMJ
Pain, jaw noise, ear symptoms, rarely jaw dislocation
Chewing aggravates
Pain in face or head
Dull pain in temple are
Tinnitus
Sinus symptoms
FB sensation in ear canal
Decreased hearing
Neck or shoulder pain
Visual disturbance
Limited jaw opening
Jaw popping
Temporomandibular Joint
(TMJ) Disease
 Questionnaires for screening- Example questions
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Do your jaws make noise
Does using your jaw cause you pain
Have you had jaw joint problems before
Does you jaw ever get stuck
Is opening your mouth difficult or cause pain
With ringing in the ear does opening or closing you
mouth change the sound
Do you have frequent headaches, neck aches, or tooth
aches
Temporomandibular Joint
(TMJ) Disease
 Physical finding
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Complete exam to exclude other problems
Observation of gait, balance, unusual habits
Palpate the muscles of mastication using
bimanual technique
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Start with the mouth closed then open
Temporomandibular Joint
(TMJ) Disease
 Management
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Involves understanding and treating the whole patient
Goals for management- reduction of pain, restorations of acceptable
function
Initial TX designed to be palliative and promote healing, with selfhelp techniques and pharmacotherapy
Adjustment of diet
Education and alteration of oral habits (gum chewing)
ICE/ HEAT
Medications such as pain meds, anti-inflammatory meds, injection of
trigger points
Most care will be given by the specialist
TMJ
 Follow up and referral
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Refer to a specialist is best idea for real TMJ
disease
Gingivitis
 Inflammation of the gingiva
 It may be characterized by edema, erythema,
bleeding, and occasionally pain
 Gingivitis is usually reversible with
appropriate therapy
Periodontitis
 An inflammatory disease of the supporting
tissues of the teeth caused by specific
microorganisms or groups of specific
microorganisms, resulting in progressive
destruction of the periodontal ligament and
alveolar bone with pocket formation,
recession, or both.
Oral Trauma
 What happened
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Tooth/jaw/lip/tongue hurt
What hit you
How long ago
 Where are the teeth
Oral Trauma
 Teeth
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Avulsed (knocked out, loose)
Fractured
Chipped
Intrusion
 Jaw/face: feel for “crunchy” sensation
 Mucosal/tongue injury
Tooth Anatomy
Avulsed Teeth
Fractured Teeth
Intrusion
Tongue/Mucosal Trauma
Oral Trauma
 Teeth
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Avulsion
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Primary teeth
 Out, leave out
 Loose, straighten or is very loose remove
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Permanent teeth
 Out, leave out, wash gently, tooth kit
 Loose, leave alone
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Fracture, keep fragment, store as above
Oral Trauma
 Tongue
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Well approximated, nothing
Bleeding  direct pressure with gauze
Gaping need repair
 Mucosal
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Well approximated, nothing
Gaping and vermillion border need repair
Oral Trauma
 Dental injuries
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Dentist for most injuries
Baby teeth may need nothing
 Tongue/Mucosa
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Most need nothing
Doctor if gaping or severe bleeding
Nose Bleeds
Nose Bleeds
 How much blood, how long
 What has been done to stop bleeding
 Trauma
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Blunt
Picking
 Upper respiratory infection/Allergies
 History of Bleeding
Nose Bleeds
 Nose
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Fracture (usually at bridge)
Active bleeding
Which side? Always the same?
 Throat
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 Neurologic
 Vision
Nose Bleeds
 Pinch x 10-20 minutes
 Ice
 Nose plugs
 Don’t blow nose
 Afrin if available
 No picking