Common ENT Diseases PDF

COMMON ENT DISEASES Common ENT diseases include Epistaxis Otitis externa Adenoids Tonsillitis Allergic rhinitis Foreign body in the ear, nose and throat Otitis media, Head and neck tumours Hearing impairment EPISTAXIS Epistaxis Defined as bleeding from inside the nose Commo...

COMMON ENT DISEASES Common ENT diseases include Epistaxis Otitis externa Adenoids Tonsillitis Allergic rhinitis Foreign body in the ear, nose and throat Otitis media, Head and neck tumours Hearing impairment EPISTAXIS Epistaxis Defined as bleeding from inside the nose Common sites include the Little’a area, above and below the middle turbinates, posterior nasal wall, nasopharynx. Causes : Local, General, Idiopathic Local causes = trauma, infections (eg viral rhinitis), acute sinusitis,TB Generalized causes =disorders of blood and blood vessels (leukemia, haemophilia, thrombocytopaenia), liver disease (hepatic cirrhosis), drug (salicylates, anticoagulant therapy), acute general infections (measles, influenza), menstruation. Management Mode of onset Duration and frequency of bleeding Site of bleeding (anterior, posterior) History of bleeding tendencies in patient/patient’s family History of medical ailments eg leukaemia, cirrhosis, cardiomyopathies. History of drug intake eg analgesics, anticoagulants. Procedures: Cauterization Anterior nasal packing Posterior nasal packing Otitis externa(swimmer’s ear) The inflammation of the external ear Classified based on aetiology into Infective & Reactive groups Infective group: Bacterial = Localised, Diffused & Malignant Otitis Externa Viral = Herpers zoster oticus Otitis externa haemorrhagia Fungal = Otomycosis Reactive group : Eczematous OE Seborrhoeic OE Neurodermatitis Localized OE(Furunculosis) Staphylococcal infection of the hair follicle Symptoms include ear pain, meateal swelling, serous discharge and itching (in diffuse otitis externa) Treatment include ear toileting, medicated wicks, localized steroid drops, antibiotics and analgesics. Otomycosis Fungal infection of the ear canal. Presents are filamentous growths in the canal. Aspergillus niger (black ), Aspergillus fumigatus(pale blue/green), Candida albican(whitish/creamy growth. Clinical features include : intense itching, ear pain/discomfort, watery discharge, ear blockage. Treatment : 1. ear toileting 2. antifungal agent(ketoconazole cream) 3. antibiotics (in co-existing bacterial infection) 4. steroid preparation(to reduce inflammation & edema). Adenoids (Nasopharyngeal tonsils) Lymphoid tissues located at the junction of the roof and posterior wall of the nasopharynx. Present at birth, shows physiological enlargement up to the age of 6years, tend to atrophy at puberty and disappear at early adulthood. Aetiology - Lymphoid hyperplasia - Allergy of upper respiratory tract - Recurrent upper respiratory tract infection Clinical features Nasal symptoms - nasal obstruction, nasal discharge, sinusitis, voice changes, snoring, mouth breathing Aural symptoms - ET obstruction, recurrent OE, OME, CSOM General symptoms – Adenoid facies, pulmonary HTN, Diagnosis 1.Detailed history (including history of snoring, mouth breathing) 2.Post nasal space(PNS) x ray showing enlarged adenoids and the extent of the nasopharyngeal air space occupied. Treatment Nasal decongestants, antihistamine(for co-existing nasal allergy), breathing exercises. Definitive treatment is Adenoidectomy Tonsillitis The palatine tonsils are two ovoid tissues, each located in the lateral wall of the oropharynx. Functions primarily for - local immunity & - surveillance mechanism Types of tonsillitis: Acute tonsillitis & Chronic tonsillitis Acute tonsillitis - Acute Catarrhal/Superficial tonsillitis - Acute follicular tonsillitis - Acute parenchymal tonsillitis - Acute membranous tonsillitis Aetiology Haemolytic streptococcus is the most common organism, others include staphylococci, pneumococci, H. influenza Symptoms include : sore throat, difficulty in swallowing, fever, headache, malaise, ear ache. Signs include : - inflamed tonsils, -foetid breath, -hyperaemia of pillars, soft palate and uvula, -yellowish spots of purulence at the opening of crypts(Acute follicular tonsillitis). Treatment -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 may be a predisposing factor Occurs mostly in children and young adults. Types - chronic follicular tonsillitis - chronic parenchymal tonsillitis - chronic fibroid tonsillitis Clinical features : recurrent sore throat, halitosis, chronic throat irritation with cough, obstructive sleep apnea, dysphagia. Examination Tonsillar enlargement Yellowish beads of pus in the medial surface( chronic follicular tonsillitis) Flushing of anterior pillars. Definitive treatment Tonsillectomy Complications : peritonsillar abscess, parapharyngeal abscess, intratonsillar abscess, tonsilloliths, tonsillar cysts. Allergic rhinitis An IgE mediated immunological response of the nasal mucosa to airborne allergens characterized by watery discharge, nasal obstruction, sneezing and itching in the nose. Symptoms can be seasonal or perennial. Aetiology : - Allergens, - Genetic predisposition Clinical features 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). Clinical features contd Otologic : retracted tympanic membrane, serous otitis media (secondary to Eustachian tube blockage). Pharyngeal : pharyngitis from hyperplasia of submucosal lymphoid tissues. Laryngeal : hoarseness, oedema of the vocal cord. Diagnosis : a. based on duration of symptoms (ie intermittent < 4days a week or < 4 weeks, persistent > 4days a week or > 4 weeks) b. based on severity of symptoms ie mild, moderate or severe c. detailed history and physical examination Investigations FBC (eosinophilia) Nasal smear (shows aggregation of eosinophils) Skin prick test Specific IgE measurement Nasal provocation test Treatment : 1. Avoidance of allergen 2. Drug therapy eg antihistamine, leukotriene receptor antagonist(montelucast), corticosteroids, anticholinergics. 3. Immunotherapy Complications Recurrent sinusitis Nasal polyps Serous otitis media Bronchial asthma  Foreign body / Trauma  Ear Non-vegetative materials: cotton bud, beads, eraser, biro tips, sticks, colour pencils e.t.c Vegetative materials: beans, maize Live insects especially cockroaches, moths Rx Removal: Either with instruments (Jobson-Horne probe, crocodile forceps) or ear irrigation Removal can be done under G.A especially impacted F.Bs and in an uncooperative child Foreign bodies can be pushed into the middle ear in untrained hands. Otitis media Inflammation of middle ear cleft Predisposing factors – Malnutrition, overcrowding, Poor ventilation, cleft palate Pathology – Tubal occlusion, inflammation, exudation Head and Neck Tumors Nasopharyngeal carcinoma Laryngeal Cancer Oropharyngeal cancer Hypo pharyngeal carcinoma Head and neck lymphoma