EAR , NOSE AND THROAT DISORDERS - PowerPoint Presentation

1. EAR, NOSE AND THROAT DISORDERSLELE MUTOMBO FabriceMd, MCS COSECSA Candidate 202115/12/20201

2. ObjectivesOn completion of this tutorial, you will be able to manage:Inflammatory Disorders of Ear, Nose and Throat (ENT)Foreign Bodies in the Ear, Nose and ThroatEpistaxis15/12/20202

3. OUTLINEIntroductionTopic 1 — Inflammatory Disorders of Ear, Nose and Throat (ENT)Topic 2 — Foreign Bodies in the Ear, Nose and ThroatTopic 3 — EpistaxisSummary15/12/20203

4. ENT disorders are commonnumber of causes will focus on three particular areas of interest :Inflammatory disordersForeign bodiesEpistaxis15/12/20204IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummary

5. IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammatory disorders in the head and neck are a frequent cause of doctor visits. These can involve specific structures such as the pharynx and larynx, or may be manifestations of a general condition. Symptoms may develop fairly quickly, as with infections, or may develop over a period of time. symptoms depend on the site and severity of the disease, and in many instances they arise from the effects of the disease on the upper respiratory and/or alimentary tract.15/12/20205

6. IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the EarOtitis ExternaThis is inflammation of the skin of the cartilaginous ear canal. It may be part of a systemic disorder such as psoriasis or eczema.Symptoms : otalgia, scanty otorrhoea, aural fullness, hearing loss.Itching without smelly discharge → generalised condition common pathogens : Pseudomonas, Staphylococci, Proteus and fungi.Treatment: cleaning and antibiotic/steroid ear drops, systemic broad spectrum antibiotics and in severe cases, meatoplasty.15/12/20206

7. Otitis ExternaThere are two rare variants of otitis externa.:.Necrotising external otitis : germ :Pseudomonas aeruginosa ; population: elderly diabetics or ID patients. Clini man: Purulent otorrhoea, involvement (VII, X, XI), osteomyelitis. Therapy: local debridement, penicillin or cephalosporin + aminoglycoside.Herpes zoster of the ear : Clini man: otalgia, vesicular eruption on the external canal and TM, deafness, vertigo and facial paralysis ; germ : zoster virus in the geniculate ganglion15/12/20207IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Ear

8. Acute Otitis Media (AOM)symptoms : otalgia, decreased hearing, fever, unsteadiness and otorrhoeaGerm: bacteria (85%) : streptococci and Haemophilus influenza. viruses (15%) rhinovirus and adenovirus.Examination : immobile TM: dull and opaque, injected (that is, with prominent blood vessels), bulging. If TM has perforated= meatus discharge.Treatment : is pain relief, antibiotics, decongestants and, if necessary, myringotomy. Complications acute mastoiditis, labyrinthitis (vomiting, vertigo), TM perforations, intracranial spread of infection. 15/12/20208IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Ear

9. Otitis Media with Effusion (OME, Serous Otitis Media)generally due to Eustachian tube dysfunction. may be asymptomatic, Symptomes: deafness and speech delay in children. ↗↗↗ television volume, school progress deteriorated.Treatment : Watchful waiting (50% natural resolution), Ventilation tubes (˃3 months), Adenoidectomy.15/12/20209IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Ear

10. Chronic Suppurative Otitis Media (CSOM)result of poorly treated acute infectionsdue to a failure of the normal mechanism by which squamous epithelial cells are shed from the external aspect of the TMcan lead to TM perforations, and local inflammatory changes may cause granulations, aural polyps and cholesteatoma. Cholesteatoma is an especially harmful epithelial ingrowth into the middle ear cleft which can erode the skull bones, causing: ossicular destruction, damage to the labyrinth, damage to the facial nerve, inflammation of the dura.Treatment is surgical removal of the cholesteatoma15/12/202010IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Ear

11. Referred PainEarache is often caused by disease elsewhere:Cervical spine disease.Disease of the tongue, oral cavity and lower teeth Disease of the pharynx and larynx15/12/202011IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Ear

12. Rhinitis — Inflammation of the Nasal CavityThe causes are numerous: allergic, infection, hormonal, environmental, foreign bodies. The symptom, to put it simply, is a runny noseIf the nasal secretions are clear, the cause is likely to be allergic.If they are purulent (yellow, green), the cause is likely to be infective.If there are significant amounts of blood (more than a few spots or streaks), consider cancer.15/12/202012IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Nose and Sinuses

13. Sinusitis — Frontal, Ethmoid, MaxillaryDef: Acute sinusitis ≤ 12 weeks. Chronic sinusitis ˃ 12 weeks. ≥ 4 isolated episodes/ year = recurrent acute sinusitis. Symptoms include: facial pain/pressure, nasal obstruction, purulent rhinorrhea, postnasal drip.Germ : streptococcus pneumoniae, haemophilus influenzae and moraxella catarrhalisInvestigations : fluid level on x-ray. 15/12/202013IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Nose and Sinuses

14. Sinusitis — Frontal, Ethmoid, MaxillaryClinical examination : mucosal hyperaemia, purulent nasal discharge and nasal polyps. Ethmoidal and frontal can spread to the orbit.treatment is medical : topical and/or oral decongestions, broad spectrum antibiotics, analgesics and antihistamines. Surgical measures may be necessary. Endoscopic sinus surgery (ethmoidectomy) is the commonest surgical procedure today for the treatment of chronic rhinosinusitis.15/12/202014IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Nose and Sinuses

15. Sinusitis — Frontal, Ethmoid, MaxillaryMaxillary sinusitis : Maxillary sinus lavage (washout) is indicated only if the sinus contains pus. Treatment is often ineffective. Conservative measures against the most common pathogens (ampicillin, amoxycillin, cefaclor, TMP-SMX) Surgical measures maxillary sinus irrigation, intranasal antrostomy or ethmoidectomy.15/12/202015IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Nose and Sinuses

16. discomfort, pain and voice changes, earache can accompany throat infections. Pharynx : infectious mononucleosis (glandular fever), tonsillitis, peritonsillar abscess (quinsy)Larynx : epiglottitis (supraglottitis), laryngeal polyps, laryngotracheobronchitis (croup)15/12/202016IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Throat

17. Inflammations of the PharynxInfectious Mononucleosis (Glandular Fever) : Epstein-Barr virus, The Paul Bunnell or monospot test is positive, TTT : analgesia with steroids for airway obstruction and antibiotics for secondary infectionTonsillitis germ: bacterial, viral. Sym: sore throat, fever and often enlarged lymph node behind the throat.TTT: Acute tonsillitis = treated symptomatically. Chronic tonsillitis = tonsillectomyPeritonsillar Abscess (Quinsy) : collection of pus in the area above the tonsils, Symptoms include unilateral throat pain, dysphagia, drooling, muffled voice and fever15/12/202017IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Throat

18. Inflammations of the PharynxEpiglottitis (Supraglottitis) : occurs most frequently in children. Supraglottic structures become inflamed and oedematous leading to respiratory obstruction. The causative organism is usually Haemophilus influenzae type B.Symptoms : sudden fever and sore throat, a rapid onset of respiratory distress, three Ds — drooling, dysphagia, distressExamination: fever, anxiety, stridor along with a muffled cough, and the red tip of the epiglottis.Treatment : immediate intubation in OR. (crico or even tracheo). ATB.15/12/202018IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Throat

19. Inflammations of the PharynxLaryngeal Polyps caused by: chemical, physical, idiopathic, malignant.Benign polyps are usually caused by overuse or abuse of the voice. Treatment is removal.Laryngotracheobronchitis (Croup) : viral infection of the upper respiratory tract , ± airway obstruction.Symptoms : stridor and fever. Treatment is humidified oxygen, adrenaline nebulizer, steroids.15/12/202019IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Throat

20. Neck InflammationSymptoms include: pain, fever, neck swelling, dysphagia, trismus, airway obstructionantibiotics may mask the symptoms.blood cultures) and imaging investigationsantibiotics and surgical drainage, if necessary.15/12/202020IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammations of the Throat

21. More common in the parotid gland than in the other salivary gland. usually caused by Staphylococcus aureus, although Streptococcus pneumoniae, Escherichia coli, or Haemophilus influenzae may be involved.painful diffuse swelling , purulent discharge from the duct.stimulation of saliva by sialogogues (such as lemon), rehydration, improved oral hygiene, analgesics, and antibiotics.Stone = chronic = removal15/12/202021IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryInflammation of the Salivary Glands

22. Granulomatous conditions can cause inflammations in the head and neck : fungal infections — histoplasmosis, Aspergillus fumigatus, tuberculosis and other mycobacterial infections, actinomycosis, syphilis, eosinophilic granuloma, Wegener's granulomatosis, sarcoidosisIf you suspect these, call for help from a head and neck specialist and/or a physician.15/12/202022IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryGranulomatous inflammation in the head and neck

23. can be completely asymptomatic or cause some: discomfort (live insects), secondary otitis externa, (vegetative material), hearing loss Foreign Bodies in the Noseunilateral rhinorrhea, nasal obstruction, severe burns, orbital or intracranial infection may develop if undetected. Direct inspection is necessary. Foreign Bodies in the ThroatOropharynx and HypopharynxOesophagusLarynx, Trachea and Bronchi15/12/202023IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryForeign Bodies in the Ear

24. The nasal mucosa has a rich blood supply from branches of both the external carotid (mainly maxillary) and internal carotid (ethmoidal) arteries. Vessels anastomose freely. Most bleeds come from the Kiesselbach's plexus at the anterior portion of the septum15/12/202024IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummaryNasal Blood Supply

25. Assess the general condition of the patient: blood pressure, pulse rate, signs of shock,…Estimate the approximate amount of blood loss and rule out medications such as NSAIDs or anticoagulants.Perform a quick physical examination to rule out bleeding or clotting disorders.Order a full blood count and, depending on history and clinical findings, coagulation screen, liver function tests and renal function tests.15/12/202025IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummary

26. More advanced options include:postnasal packendoscopic sphenopalatine artery ligation. embolisation laser surgeryarterial ligation used as last resort15/12/202026IntroductionInflammatory Disorders of ENTForeign Bodies in the ENTEpistaxisSummary

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