Ear and Nose Conditions Overview

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Questions and Answers

Which of the following is NOT a local cause of epistaxis?

Leukemia (correct)

Trauma

Acute sinusitis

Viral rhinitis

What is epistaxis primarily defined as?

Bleeding from the mouth

Bleeding from the ears

Bleeding from inside the nose (correct)

Bleeding from the throat

Which type of otitis externa is caused by a fungal infection?

Eczematous Otitis Externa

Malignant Otitis Externa

Otomycosis (correct)

Localized Otitis Externa

What is a common symptom of localized otitis externa, also known as furunculosis?

Ear pain and meatal swelling Signup and view all the answers

What is one of the treatments used for otomycosis?

Antifungal agent Signup and view all the answers

Which of the following options describes a common presentation of otomycosis?

Filamentous growths and intense itching Signup and view all the answers

Which of the following can be considered a generalized cause of epistaxis?

Hepatic cirrhosis Signup and view all the answers

Which of the following is NOT a symptom of chronic tonsillitis?

Eustachian tube obstruction Signup and view all the answers

What is the primary management intervention for anterior nasal bleeding?

Anterior nasal packing Signup and view all the answers

What is the main physiological change observed in adenoids from birth to early adulthood?

They show physiological enlargement, then atrophy. Signup and view all the answers

What is considered a definitive treatment for adenoid hyperplasia?

Adenoidectomy Signup and view all the answers

Which organism is the most common cause of acute tonsillitis?

Streptococcus Signup and view all the answers

Which of the following types of tonsillitis is characterized by yellowish spots of purulence?

Acute follicular tonsillitis Signup and view all the answers

Among the following, which is a symptom associated with adenoid hypertrophy?

Nasal obstruction Signup and view all the answers

Chronic tonsillitis often arises as a complication of which condition?

Acute tonsillitis Signup and view all the answers

What is one of the general symptoms associated with adenoid enlargement?

Pulmonary hypertension Signup and view all the answers

What is the definitive treatment for chronic follicular tonsillitis?

Tonsillectomy Signup and view all the answers

Which of the following symptoms is NOT commonly associated with allergic rhinitis?

Persistent cough Signup and view all the answers

What do skin prick tests help diagnose in patients with suspected allergic rhinitis?

Airborne allergens Signup and view all the answers

Which of the following is a common otologic complication of allergic rhinitis?

Serous otitis media Signup and view all the answers

In the management of allergic rhinitis, which of the following substances is NOT typically used in drug therapy?

Antibiotics Signup and view all the answers

Which of the following foreign bodies is considered vegetative?

Beans Signup and view all the answers

What is a possible complication of untreated allergic rhinitis?

Bronchial asthma Signup and view all the answers

Which method is recommended for the removal of impacted foreign bodies in the ear of an uncooperative child?

General anesthesia Signup and view all the answers

Study Notes

Epistaxis (Nosebleed)

Bleeding from inside the nose.
Common sites: Little's area, above and below the middle turbinates, posterior nasal wall, nasopharynx.
Causes: Local (trauma, infections, sinusitis, TB), Generalized (blood disorders, liver disease, drugs, infections), Idiopathic.
Management:
- Assess mode of onset, duration and frequency of bleeding, site of bleeding, history of bleeding tendencies, medical ailments, drug intake.
- Procedures: Cauterization, anterior nasal packing, posterior nasal packing

Otitis Externa (Swimmer's Ear)

Inflammation of the external ear.
Classified by aetiology:
- Infective: Bacterial (Localized, Diffused, Malignant Otitis Externa), Viral (Herpes zoster oticus, Otitis externa haemorrhagia), Fungal (Otomycosis)
- Reactive: Eczematous OE, Seborrhoeic OE, Neurodermatitis

Localized OE (Furunculosis)

Staphylococcal infection of the hair follicle.
Symptoms: Ear pain, meateal swelling, serous discharge, itching (in diffuse otitis externa).
Treatment: Ear toileting, medicated wicks, localized steroid drops, antibiotics, analgesics.

Otomycosis

Fungal infection of the ear canal.
Presents as filamentous growths in the canal.
Common organisms: Aspergillus niger, Aspergillus fumigatus, Candida albicans.
Clinical features: Intense itching, ear pain/discomfort, watery discharge, ear blockage.
Treatment: Ear toileting, antifungal agent (ketoconazole cream), antibiotics (if bacterial infection), steroid preparation (to reduce inflammation and edema).

Adenoids (Nasopharyngeal Tonsils)

Lymphoid tissues located at the junction of the roof and posterior wall of the nasopharynx.
Present at birth, enlarge physiologically up to age 6, tend to atrophy at puberty and disappear in early adulthood.
Aetiology: Lymphoid hyperplasia, Upper respiratory tract allergy, Recurrent upper respiratory tract infection.

Clinical Features of Adenoids

Nasal: Nasal obstruction, nasal discharge, sinusitis, voice changes, snoring, mouth breathing.
Aural: Eustachian tube obstruction, recurrent OE, otitis media with effusion (OME), chronic suppurative otitis media (CSOM).
General: Adenoid facies, pulmonary hypertension.

Diagnosis of Adenoids

Detailed history (including snoring and mouth breathing).
Post-nasal space (PNS) x-ray showing enlarged adenoids and the extent of nasopharyngeal air space occupied.

Treatment of Adenoids

Nasal decongestants, antihistamines (for co-existing nasal allergy), breathing exercises.
Definitive treatment: Adenoidectomy

Tonsillitis

Palatine tonsils are two ovoid tissues located on the lateral wall of the oropharynx.
Functions: Local immunity, surveillance mechanism.
Types: Acute tonsillitis, Chronic tonsillitis

Acute Tonsillitis

Types: Acute Catarrhal/Superficial tonsillitis, Acute follicular tonsillitis, Acute parenchymal tonsillitis, Acute membranous tonsillitis.

Aetiology of Acute Tonsillitis

Haemolytic Streptococcus is the most common organism. Others include staphylococci, pneumococci, H. influenza.

Symptoms of Acute Tonsillitis

Sore throat, difficulty swallowing, fever, headache, malaise, earache.

Signs of Acute Tonsillitis

Inflamed tonsils, foetid breath, hyperaemia of pillars, soft palate and uvula, yellowish spots of purulence at the opening of crypts (Acute follicular tonsillitis).

Treatment of Acute Tonsillitis

Liberal oral fluid intake, analgesics, antimicrobial therapy.

Chronic Tonsillitis

Aetiology: Complication of acute tonsillitis, subclinical infection of tonsils without an acute attack, chronic infection in sinuses/teeth.
Occurs mostly in children and young adults.
Types: Chronic follicular tonsillitis, Chronic parenchymal tonsillitis, Chronic fibroid tonsillitis.

Clinical Features of Chronic Tonsillitis

Recurrent sore throat, halitosis, chronic throat irritation with cough, obstructive sleep apnea, dysphagia.

Examination of Chronic Tonsillitis

Tonsillar enlargement, yellowish beads of pus on the medial surface (chronic follicular tonsillitis), flushing of anterior pillars.

Definitive Treatment of Chronic Tonsillitis

Tonsillectomy

Complications of Tonsillitis

Peritonsillar abscess, parapharyngeal abscess, intratonsillar abscess, tonsilloliths, tonsillar cysts.

Allergic Rhinitis

IgE-mediated immunological response of the nasal mucosa to airborne allergens.
Characterized by watery discharge, nasal obstruction, sneezing, itching in the nose.
Symptoms can be seasonal or perennial.

Aetiology of Allergic Rhinitis

Allergens, genetic predisposition.

Clinical Features of Allergic Rhinitis

Nasal: Sneezing, nasal obstruction, watery nasal discharge, nasal itching, loss of sense of smell, post nasal drip, allergic salute, enlarged turbinates.
Occular: Edema of the eyelids, cobble-stone appearance of the conjunctiva, dark circles under the eye (allergic salute).
Otologic: Retracted tympanic membrane, serous otitis media (secondary to Eustachian tube blockage).
Pharyngeal: Pharyngitis from hyperplasia of submucosal lymphoid tissues.
Laryngeal: Hoarseness, edema of the vocal cord.

Diagnosis of Allergic Rhinitis

Based on duration of symptoms (intermittent < 4 days/week or < 4 weeks, persistent > 4 days/week or > 4 weeks), severity of symptoms (mild, moderate, severe), detailed history and physical examination.

Investigations for Allergic Rhinitis

FBC (eosinophilia), nasal smear (shows aggregation of eosinophils), skin prick test, specific IgE measurement, nasal provocation test.

Treatment of Allergic Rhinitis

Avoidance of allergen, drug therapy (antihistamine, leukotriene receptor antagonist (montelucast), corticosteroids, anticholinergics), immunotherapy.

Complications of Allergic Rhinitis

Recurrent sinusitis, nasal polyps, serous otitis media, bronchial asthma.

Foreign Body/Trauma in the Ear

Non-vegetative materials: Cotton buds, beads, eraser, biro tips, sticks, colour pencils, etc.
Vegetative materials: Beans, maize.
Live insects: Cockroaches, moths.
Treatment: Removal with instruments (Jobson-Horne probe, crocodile forceps) or ear irrigation. Removal under general anesthesia may be necessary for impacted foreign bodies and uncooperative children. Foreign bodies can be pushed into the middle ear by untrained hands.

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Description

This quiz focuses on common ear and nose conditions, including epistaxis and otitis externa. Learn about their causes, symptoms, management techniques, and various classifications. Ideal for students in healthcare or those interested in ENT (Ear, Nose, and Throat) specialties.