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Eye Ear Nose and Throat Infections PowerPoint Presentation

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Description : Check out this medical presentation on Otolaryngology, which is titled "Eye, Ear, Nose, and Throat Infections", to know about the Eye, Ear, Nose, and Throat Infections.

Tags : Otolaryngology, Eye, Ear, Nose, Throat Infections

Published on : Jul 10, 2021 | Views : 1927 | Downloads : 8

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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
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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
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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
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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
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