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Crohns disease can involve any component of the gastrointestinal tract from the mouth to the

anus, and characteristically has skip areas of involvement. Although nonspesicfic, aphthous

ulcers in the mouth can be seen in Crohns disease. Granulomas are identified pathologically in

up to 30% of patients with Crohns disease.

Serous otitis media is defined as the presence of middle ear effusion without signs of an active

infection. Examination commonly reveals a dull tympanic membrane that is hypomobile on

pneumatic otoscopy.

Serous Otitis Media = mc middle ear pathology in a pt w/ AIDS. It is d/t the auditory tube

dysfunction arising from HIV lymphadenopathy or obstructing lymphomas.

Characterized by: presense of middle ear effusion without evidence of an acute infection

MC SX = conductive hearing loss o/e = dull tympanic membrane that is hypomobile on

pneumatic otoscopy

A muffled voice should make one consider a dx other than uncomplicated pharyngitis ortonsillitis. A peritonsilar abscess is a potential complication of tonsillitis and requires both iv

antibiotics therapy and urgent drainage of the abscess. Deviation of the uvula and unilateral

lymphadenopathy can be helpful in distinguishing a peritonsillar abscess from epiglottitis.

Muffled or hot potato voice and deviation of the uvula suggest that a peritonsillar abscess

developed as acomplication of his tonislits.

P/E: prominent unilateral lymphadenopathy

Complication: fatal secondary to either airway obstruction or spread of the infection to the

parapharyngeal space, which may lead to involvement of the carotid sheath.

TX: aspiration of the peritonsillar abscess and initiation of IV abxSurgical intervention may be necessary if the purulent material cannot be removed with

aspiration alone.

Leukoplakia presents as hard to remove white patches in the oral mucosa and may lead to

squamous cell carcinoma

Leukoplakia is a whitish pathc or plaque that cannot be clinically or pathologically characterized

as any other disease, and is not associated with any physical or chemical causative agent, except

the use of tobacco. These are localized, plaqye like lesions that have a granular appearance and

are hard to remove. Leukoplakia is usually cuased bychronic irritation to the oral mucosa due to

smoking, alcohol, or ill-fitting dentures. These lesions have a risk of transformation intosquamous cell carcinoma.

Patients with streptococcal pharyngitis often have a fever, exudative pharyngitis, and tender

cervical lymphadenopathy in the absence of a rash or rhinorrhea. A rapid streptococcal antigen

test can confirm the diagnosis. Treatment with penicillin is recommended to hasten recovery,

reduce the risk of rheumatic fever, and prevent transmission to close contacts.

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MOE (Malignant Otitis Externa) is a potentially serious infection of the external ear that is

usually caused by Pseudomonas aeruginosa. It is typically seen in elderly patients with poorly

controlled diabetes and presents with ear pain, drainage, and granulation tissue within the ear

canal on otoscopic exam. Intravenous is the most effective treatment

Patients with retropharyngeal abscess often complain of sore throat, fever, difficulty swallowing

(dysphagia), pain with swallowing (odynophagia), and pain with certain neck movements,

particularly neck extension. Treatment must be initiated rapidly in order to prevent the spread

of infection into the mediastinum. Treatment consists of iv broad-spectrum antibiotics and

urgent drainage of the abscess in order to avoid the dreaded complication of spread into the

mediastinum.

Trismus = inability to open the mouth normally

Sensorineural hearing loss that occurs with aging is referred to as PRESBYCUSIS. It is usually

first noticed in the sixth decade of life, and presents with hig-frequency, bilateral hearing loss.

Patients with presbycusis often have difficulty hearing n noisy, crowded environments.

Patients with Menieres disease typically present with a combination of vertigo, ear fullness,

tinnitus and hearing loss. First line therapy consists of environmental and dietary

modifications, including maintenance of a low-salt diet.

Triggers that increase endolyphatic retention should be avoided, including alcohol, caffeine,

nicotine, and foods high in salt.

Acute otitis media should be considered in any patient with symptoms of ear drainage and

difficulty hearing. Ear pain is also common, but may be absent in young patients. Nonspecific

systemic symptoms including fever, irritability, and diarrhea can sometimes be present as well.

Diagnosis of acute otitis media should be confirmed with an otoscopic examination, which

typically reveals erythema, retraction, or decreased mobility of the tympanic membrane.

Cavernous sinus thrombosis (CST) typically occurs in patients with infections of the skin

adjacent to the eye or nose, but ethmoid and sphenoid sinusitis can cause this condition as well.

Patients usually present with headaches, low-grade fever, periorbital edema, and cranial nerve

palsies.

CST TX = iv broad-spectrum antibiotic treatment, but anticoagulation, glucocorticoid therapy,

or surgery may be used in some cases.

The most likely diagnosis in this patient is cavernous sinus thrombosis (CST). Most cases of CST

are secondary to an infection located in the medial aspect of the face around the eyes and nose,

but ethmoid or sphenoid sinus infections can be the culprit as well. Headache is the MC early

symptom seen in pt with CST. A low-grade fever and periorbital edema usually occur several

days ater secondary to impaired venous flow in the abducens nerve palsy (CNVI), and is

probably the cause of his double vision. Cranial nerves III, IV, VI, V2, and VI all pass through the

cavernous sinus and can be affected in patients with CST. The headache that occurs in these

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patients is partly due to neuropathic pain as a result of irritation of the V1 and V2 branches of

the trigeminal nerve, which explains why the pain is usually sharp and located in the upper face.

Diagnosis can be confirmed with either MRI or CT scan of the orbits with contrast. IV broad-

spectrum antibiotics tx is required, but anticoagulation, glucocorticoid therapy, or surgery may

be used in some cases.

Cholesteatomas in children can either be congenital or acquired secondary to chronic middle

ear disease. New-onset hearing loss or chronic ear drainage despite antibiotic therapy are

typical presenting symptoms of cholesteatomas, and granulation tissue and skin debris may be

seen within retraction pockets of the tympanic membrane on otoscopy.

Temporomandibular joint (TMJ) dysfunction can result in referred pain to the ear that is

worsened with chewing. Patients typically report a history of nocturnal teeth grinding.

The most common organism responsible for the development of epiglottitis, especially in the

adult population, are Haemophilus influenza and Streptococcus pyogenes. Epiglottitis is a

medical emergency, and rapid treatment must be initiated in order to prevent obstruction of the

airway.

The most feared complication of retropharyngeal abscess is spread of infection into the

mediastinum, which can lead to acute necrotizing mediastinitis

Differentiating preseptal cellulits and orbital cellulits is important in any patient who presents

with a swollen and painful eye accompanied by fever. Pain with eye movement is more

suggestive of orbital cellulits, and proptosis in addition to decreased visual acuity are most

always seen in patients with orbital cellulits. CT can be used to confirm the extent of infection

and to identify a potential abscess.