Transcript Eye, Ear, Nose & Throat Disorders

Eyes, Ears, Nose and Throat
A Review for the OHN
Steven Marks, MSN, RN, APN-C, COHN-S, FAAOHN
Conjunctivitis
• Bacterial
• Viral
• Allergic
Bacterial Conjunctivitis
• Staph, Strep, H. Flu,
• Gonocococcal,
chalamydial
• Thick yellow
discharge
– Crusting of lashes
• Injected eye
• Handwashing
Viral Conjunctivitis
• Following viral illness
– Cold or flu
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Injected eye
Clear discharge
Puritis
No crusting
Self limiting disease
Handwashing
Allergic Conjunctivitis
• Cobblestoning
• Sclera relatively clear
• Whitish ropey
discharge
• Identify cause
• Treat to minimize
allergic rhinitis
• Patanol, Pataday etc
– Visene AC, Naphcon
OTC’s
Glaucoma
• Acute angle closure
– Painful Hard Red Eye
• Red Flag Sign
– Risks – African or
Spanish Ancestry
– True ocular
emergency
Glaucoma
• Chronic open angle
– Most common
– Blurred vision, headache, eye pain, rainbow halos around lights,
nausea and vomiting
• Testing
– Tonometry
– Peripheral vision screening
• Treatment
– Miotics
– Beta blockers
• Exacerbations – Dark rooms>>Pupil dilation and
angle closure
Hordeolum
• Stye
– Localized infection
of Zeis or
meibomian glans
• Self limiting
• Warm compresses
• Lash care
– Discard eyeliner
• Abx ointment if
not resolving
Chlazion
• Meibomian gland
– Chronic granulomatous
• Warm compress
• May be surgically
removed
Chalazion vs Stye
Ocular Foreign Body
• Common finding
• Foreign body sensation
• R/o globe
puncture/rupture
• Superficial metallic
bodies leave rust rings
• Start with visual acuity
Corneal Abrasion
• Examine for retained
foreign body
• Evert lids
• Irrigate
• Fluorescein exam
– Cobalt blue lamp
Corneal Abrasion
• Fuorescein exam
with cobalt blue
light
– Woods lamp
• Often treated
with combination
of abx and steroid
gtts
– r/o viral causes
and ulceration 1st
Subconjunctival Hematoma
• Common Causes
– Coughing
– Vomiting
– Blunt force trauma
• Bleeding between
conjunctiva and
sclera
• Self limiting
• Asymptomatic
Ptrygium
• Forms over perilimbal
conjunctiva
• UV light exposure
• Itching, FB sensation
• Lubrication gtts
• Surgical excision if
visual impairment
Blepharitis
• Bacterial infection
of eyelid
• Warm compresses
• Lid care
• Abx ointment
Diabeitc Retinopathy
• Present in 40% of diabetics
• Leading cause of new
blindness in adults age 20-65
• Hemorrhage, cotton wool
patches, and
neovascularization
• Treatment
– Good DM control
– Laser
Uvitis/Iritis
• Inflammation of iris and
ciliary muscle
– Dilated corneal edge
– Irreg. pupil
• May be auto immune
• Meds
– Steroids
– Cycloplegic drugs (paralyze
ciliary muscle)
– Immune supressive agents
Presbyopia
• Normal age related
change
– Stiffening of lens
– Focal point behind
retina
– Reading glasses
Dry Eye
• Disturbance in
tear film
• S/S
– Burning, pain, fb
sensation
• Schirmer test
Cataract
• Decreased clarity of lens
• Complaints of poor
night vision
• Surgical correction can
correcton for other
vision issues
– Nearsightedness,
presbyopia
Macular Degeneration
• Loss of central vision
– Breakdown of retinal
pigment epithelium in
the macula
• Wet and Dry forms
– Dry – Retinal thinning
• No treatment
– Wet – Leaking choroidal
vessels
• Treat w/ laser
• Peripheral vision spared
Ectropion
• Outward
turning of lid
• Excessive
tearing and
dryness
• Surgical
correction
Entropion
• In-turning of lid due to degenaration of lid
fascia
• Foreign Body sensation
• Botulinum
• Surgical correction
Floaters
• Floating Spots
– Cellular debris
• Flashes/Floaters =
Retinal Detachment
Temporal Arteritis
• Giant cell arteritis
• Age >50 mostly women
– White, Scandanavian
• S/S polymalgia rheumatica
– Aching, stiffness in neck shoulders and hips
• Risk – Blindness due to optic nerve ischemia
• Labs
– Elevated sed rate and CRP
• Temporal artery biopsy
• Treat with steroids
Vertigo
• The sensation of the environment spinning
• Leads to nausea, vomiting, headaches
• May be brought on by sudden movements or
position changes
– Benign Paryoxysmal Positional Vertigo
– Peripheral vestibular disorder
• Movement of canoliths in semicircular canals
Vertigo
• Meniere Syndrome
– Sudden onset of vertigo with low frequency
hearing loss and tinnitus
– Due to either an overproduction of endolymph or
drainage issue
• Possibly due to food allergy in some cases
– Treat with low sodium diet and diruetics
– Anti emetics and cortico-steroids
– ENT referral
Dix Hall Pike Maneuver
Otitis Media
• Chronic
• Acute
Otitis Media
Otitis Media
• Pain/fullness in ear
• Red injected and bulging
TM
• May note serous build up
behind tm or air fluid levels
• May lead to spontaneous
perforation
• Respiratory virus or strep
pneumonae, then H flu and
moraxalla catarrhalis
Otitis Externa
• Swimmers ear
• Pseudomonas most
common
– Staph, then strep
• Treat with Vosol HC
(acetic acid) or
ofloxacin otic
• Ear wick
Cholesteatoma
• Pouching of TM
– Middle ear debris
• Epidermal cells
– Lead to bony
destruction
Tinnitus
• Mostly a
subjective finding
• Examine for
cerumen
impaction or
effusion
• Avoid caffiene &
sodium
• Hearing aid to
mask sounds
Otosclerosis
• Fusion of the
ear bone joints
with age
• Tinnitus
• Progressive
hearing loss
• Genetically
inhertited in
10%
Cerumen Impaction
• Common cause of
hearing loss
• Debrox to soften
• Removal with
instrument, suction or
irrigation
• Hearing may be
hyperacute after
• Don’t’ irrigate if TM
rupture is suspected
Foreign Body of the Ear
• Q tip
• Insect
• Just about anything
in kids
Allergic Rhinitis
• Acute inflammatory
/immune response
• Identify cause
• Don’t forget eyes
– Histamine leaking into
nose
• Nasal steroids
– Multiple mediators
• Antihistamines
– 1 mediator
Presbycusis
• Age related hearing loss
Sinusitis
• Allergic, Acute, Chronic
CT Scan showing sinusitis in the left
maxillary sinus and ethmoid sinus
Acute Bacterial Rhino-Sinusitis
ABRS
• H flu and Strep
• Red Flag
– Supraorbital
cellulitis
• Abx with DRSP
coverage
Nasal Polyps
• Pearly white/grey
• Nasal/sinus obstruction
Epistaxis
• Anterior or Posterior
Angular Chelitis
• Candida or staph
• Immune
suppressed
Oral Cancer
• Tobacco and Alcohol use
account for 75% of oral
cancers
• Look under tongue
• Often painless lesion
• Mostly squamous cell
• 15% will have another
cancer near by
– Lungs, larynx, esophagus
Dental issues
• Dental pain is common
• Insurance issues
• Fear
Caries
Gingivitis
Peridontitis
Epiglotitis
• Life threatening
• Drooling is a RED FLAG
• Do not use a tongue
blade for exam
– May lose airway
• “Thumb Sign” on soft
tissue lateral neck xray
• Cause
– H. Flu
– Decreased incidence
due to HIB vaccine
Parotitis
• Viral infections
– Mumps>>MMR
• Poor oral hygiene
– Salivary stones
• Debilitated
• ABX if bacterial
• Possible I&D
URI
• Common office
visit
– Rhino Virus
• Nasal congestion,
headache, sore
throat, ear
pain/fullness, body
aches
• Symptomatic
therapy with OTC’s
Pharyngitis
• Sore throat
Viral
– Treat the cause
– Educate on
bacterial resistance
Group A beta-hemolytic strep
Tonsillitis
• Sore throat,
difficulty
swallowing,
referred ear
pain, hoarseness
• R/O Mono
– Posterior
cervical lymph
adenopathy
Bacterial Tonsillitis
Mono
Thank you