Common ENT diseases Prepared by dr: Latifa Mari’e

•Many common ENT disorders presenting to the hospital emergency department could be managed in primary care.

•Acute otitis externa is a common condition involving inflammation of the ear canal. The acute form is caused primarily by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus the most common pathogens

•Fungal pathogens, primarily those of the Aspergillus and Candida species, occur more often in tropical or subtropical environments and in patients previously treated with antibiotics.Inflammatory skin disorders and allergic reactions may cause noninfectious otitis externa, which can be chronic.

•Acute otitis externa presents with the rapid onset of ear canal inflammation, resulting in otalgia, itching, canal edema, canal erythema, and otorrhea, and often occurs following swimming or minor trauma from inappropriate cleaning.

•Tenderness with movement of the tragus or pinna is a classic finding

• Tenderness of tragus/pinna or ear canal edema/erythema With or without otorrhea, tympanic membrane erythema, cellulitis of the pinna, or local lymphadenitis

•Topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones are the treatment of choice in uncomplicated cases. These agents come in preparations with or without topical corticosteroids; the addition of corticosteroids may help resolve symptoms more quickly.

• Malignant otitis externa(necrotizing) may be suspected in older patients with diabetes mellitus or immunocompromise who have refractory purulent otorrhea and severe otalgia that may worsen at night. Clinical findings include granulation tissue in the external auditory canal, especially at the bone-cartilage junction. Extension of the infection beyond the auditory canal can cause lymphadenopathy, trismus, and facial nerve and other cranial nerve palsies

• It is a medical emergency

•Otitis media is a group of inflammatory diseases of the middle ear. The two main types are acute otitis media(AOM) and otitis media with effusion (OME).

•AOM is an infection of rapid onset that usually presents with ear pain.In young children this may result in pulling at the ear, increased crying, and poor sleep.Decreased eating and a fever may also be present

•Discharge from the ear can be caused by acute otitis media with perforation of the ear drum

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The cause of AOM is related to childhood anatomy and immune function.Either bacteria or viruses may be involved •The most common bacteria isolated from the middle ear in AOM are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus.

Treatment • Oral and topical pain killers are effective to treat the pain caused by

otitis media

• amoxicillin is the first line

• Decongestants and antihistamines, either nasal or oral, are not recommended

• otitis media with effusion (OME), also known as serous otitis media (SOM) or secretory otitis media (SOM), and colloquially referred to as 'glue ear,is fluid accumulation that can occur in the middle ear and mastoid air cells due to negative pressure produced by dysfunction of the Eustachian tube. This can be associated with a viral URI or bacterial infection such as otitis media.

• An effusion can cause conductive hearing loss

Risk factors

• Early-onset OME is associated with feeding of infants while lying down, early entry into group child care, parental smoking, lack, or too short a period of breastfeeding and greater amounts of time spent in group child care, particularly those with a large number of children.

• The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including audiometry, tympanogram, temporal bone CTand MRI.

• Decongestants,glucocorticoids, and topical antibiotics are generally not effective as treatment for non-infectious, or serous, causes of mastoid effusion.

• Moreover, it is recommended against using antihistamines and decongestants in children with OME.

• In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as autoinflation.In more severe cases, tympanostomy tubes can be inserted,possibly with adjuvant adenoidectomy as it shows a significant benefit as far as the resolution of middle ear effusion in children with OME is concerned.

vertigo

• A person with vertigo will have a sense that their head, or their surrounding environment, is moving or spinning.

• Occurs at any age but mostly >65 yrs old

Causes of vertigo

Causes • Labyrinthitis: This is an inflammation of the inner ear labyrinth, and

the nerve within that is responsible for encoding the body's head motion and position as well as sound, known as the vestibulocochlear nerve. It is usually caused by a viral infection.

• Vestibular neuronitis: This is also thought to occur as a result of inflammation of the vestibular nerve, usually due to a viral infection

• Cholesteatoma: This is a skin growth that occurs in the middle ear, usually as a result of repeated infection. If the growth becomes larger, it can damage the ear, leading to hearing loss and dizziness.

• Ménière's disease: A buildup of fluid in the inner ear can lead to attacks of vertigo with ringing in the ears and hearing loss. It tends to affect people between the ages of 40 and 60 years

• BPPV: This is thought to stem from a disturbance in the otolith particles. These are the crystals of calcium carbonate within inner ear fluid that touch the sensory hair cells inside the semicircular canals during movement. They stimulate the vestibular nerve to send information to the brain about a person's position.

• In people with BPPV, movement of the endolymph fluid continues after head movement has stopped because of the presence of otolith crystals in the semicircular canals.

• BPPV normally affects older adults, and the cause is usually unknown. It has been linked to dementia and is twice as common in women as in men.

Benign positional vertigo (BPV) is the most common cause of vertigo • Symptoms include:

• Loss of balance and falling

• Nausea or vomiting

• Nystagmus (involuntary eye movements)

•Labyrinthitis and vestibular neuritis share same symptoms except

Labyrinthitis is associated with hearing loss and tinnitus

treatment

• Epley’s maneuver

• Some doctors consider the Epley maneuver the most effective treatment for BPV. It’s a simple exercise you can try at home that doesn’t require any equipment. It involves tilting your head in order to move the piece of calcium carbonate to a different part of your inner ear.

• sedative-hypnotics

• anticholinergics

• antihistamines

sinusitis

• Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the mucous membrane that lines the sinusesresulting in symptoms. Common symptoms include thick nasal mucus, a plugged nose, and facial pain.Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, and a cough. The cough is often worse at night.

classification

• Acute sinusitis – A new infection that may last up to four weeks and can be subdivided symptomatically into severe and non-severe.

• Recurrent acute sinusitis – Four or more full episodes of acute sinusitis that occur within one year

• Subacute sinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection

• Chronic sinusitis – When the signs and symptoms last for more than 12 weeks.

• Acute exacerbation of chronic sinusitis – When the signs and symptoms of chronic sinusitis exacerbate, but return to baseline after treatment

symptoms

• Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. This pain is usually localized to the involved sinus and may worsen when the affected person bends over or when lying down. Pain often starts on one side of the head and progresses to both sides.Acute sinusitis may be accompanied by thick nasal discharge that is usually green in color and may contain pus or blood. Often a localized headache or toothache is present, and it is these symptoms that distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches. Another way to distinguish between toothache and sinusitis is that the pain in sinusitis is usually worsened by tilting the head forwards and with valsalva maneuvers

• Mxillary – can cause pain or pressure in the maxillary (cheek) area (e.g., toothache,or headache)

• Frontal – can cause pain or pressure in the frontal sinus cavity (located above the eyes), headache, particularly in the forehead

• Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches

• Sphenoidal – can cause pain or pressure behind the eyes, but is often felt in the top of the head, over the mastoid processes, or the back of the head.

Mostly viral infection

• Rhinoviruses

• coronaviruses

• and influenza viruses

Bacterial causes

• Streptococcus pneumoniae

• Haemophilus influenza

• and Moraxella catarrhalis.

treatment

• amoxicillin is a reasonable antibiotic for first treatment, with amoxicillin/clavulanate being indicated if symptoms do not improve after 7 days on amoxicillin alone

• Usually symptomatic treatment we use antibiotics if symptoms didn’t improve after 10 days

Epistaxis

•Epistaxis, or nosebleed, is bleeding from the nasal cavity and/or nasopharynx and may be

•classified as anterior or posterior

•A common condition with a bimodal age distribution, occurring more frequently in the young and the old.

•90% arise at Little's area of the anterior septum, the location of the Kiesselbach plexus

•Precipitating factors include dry weather and other causes of nasal mucosal inflammation or hyperemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, dust, or chemicals. Although rare, neoplasm may also cause nosebleed. •Bleeding may be refractory in the presence of coagulopathy. •Nose picking is the most common cause !!!

treatment

•Topical anesthesia and vasoconstriction are essential for initial treatment of active bleeding. If initial measures fail, almost all episodes may be controlled with anterior or anterior-posterior packing techniques.

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