EYES, EARS, NOSE AND THROAT conjunctivitisMost common eye diseaseMay be acute or chronicMost cases caused : 1- bacterial (gonococcal and chlamydial ) 2-viral infectionOther causes : allergy and chemical irritants

Bacterial ConjunctivitisA.Gonococcal ConjunctivitisAcquired through contact with infected

genital secretions.Manifested by a copious purulent dischargeInvolvement of corneal leads to perforationDx confirmed by stained smear and culture

of the discharge.

TreatmentTopical antibiotic :erythromycin or bacitracinSingle IM dose of ceftriaxone ,1g ,is effectiveWhen the cornea is involved , a 5-day of

parenteral ceftriaxone ,1-2g daily ,is required.

viral ConjunctivitisAdenovirus is the most common causeAssociated with :pharyngitis, fever, malaise

and preauricular adenopathy.Characterized by :red palpebral conjunctiva

and copious watery dischargeTreatment : local sulfonamide therapy , hot

compresses

Allergic ConjunctivitisNo pain , vision changesMarked pruritusBilateral watery eyesTreatment :antihistamine or steroid drops

Herpes Zoster OphthalmicusFrequently involves the ophthamic division

the trigeminal nerve.Eruptions preceded by :malaise, fever,

headache and burning and itching in the peri-orbital region.

Rash ccc v vesicular pustular crusting

Ocular manifestations: Conjunctivitis Keratitis Episcleritis Anterior uveitis Elevated intraocular pressure Treatment :high dose oral acyclovir

Uveitis• Inflammation of the iris , ciliary body and /or

choroid• Characterized by : pain , miosis, photophobia• Diagnosis made by slit lamp examination• Flare & cells seen in aqueous humor• Seen in IBD, sarcoidosis• Treatment underlying disease

Glaucoma• A group of diseases that can damage the

eye’s optic nerve and result in vision loss and blindness

• 2 types :1.Angle –closure glaucoma2.Open-angle glaucoma

Angle closure glaucoma• Severe pain• Decreased peripheral vision • Presence of halos around lights• Fixed mid-dilated pupil• Tonometry reveals elevated intraocular

pressure• Treatment : IV mannitol , acetazolamide,

laser iridotomy for cure

Cataract • Lens opacity• Blurred vision ,progressive over months or

years• No pain or redness• Treatment :surgery

Macular degeneration• Age-related • Painless loss of visual acuity• Dx by altered pigmentation in macula• No Tx , but patient often retains adequate

peripheral vision

Retinal detachment• Blurred vision in one eye becoming w0rse ( “

a curtain came down over my eyes”)• No pain or redness• Detachment seen by ophthalmoscopy• Tx = urgent surgical reattachment

OTITIS EXTERNA• Presents with otalgia• Pruritus• Purulent discharge• h/o recent water exposure or mechanical

trauma• Examination reveals : erythema and edema of

the ear canal and pulling on pinna or pushing on tragus cause pain

• Pseudomonas is usual cause• Treatment: I.Protection of the ear from additional

moisture II.Otic drops containing a mixture of

aminoglycoside antibiotic and anti-inflammatory corticosteroid( eg. Neomycin sulfate , polymyxin B , and hydrocortisone

Malignant External otitis• Persistent external otitis in the diabetic• Caused by pseudomonas aeruginosa• May evolve into osteomyelitis of the skull

base• Presents with persistent foul aural discharg,

granulations in the ear canal ,deep otalgia, progressive cranial nerves palsies

• CT confirmed the dx by demonstrating of osseous erosion

Treatment • Medical : antipseudominal antibiotic often

for several months• Surgical debridement

Acute Otitis Media• Bacterial infection of the mucosally lined air-

containing spaces of the temporal bone.• Precipitated by a viral upper respiratory tract

infection.• Most common in infant and children• Most common pathogens : streptococcus

pneumonia, haemophilus influenzae and streptococcus pyogenes

Patient presents with otalgia, aural pressure, decreased hearing and fever.

Typical findings : erythema and decreased mobility of the tympanic membrane.

Treatment:First –choice antibiotic either amoxicillin or

erythromycin.Amoxicillin-clavulanate useful alternative

Vertigo SyndromesA. Benign positional vertigo • Sudden,episodic vertigo with head

movement lasting for seconds.• Treatment : hallpike maneuver B. Viral labyrinthitis• Prececed by viral respiratory illness• Vertigo lasting days to weeks• Treatment : meclizine

Meniere’s disease• Dilation of membrane labyrinth due to excess

endolymph• Characterized by classic triad :hearing loss,

tinnitus and episodic vertigo lasting several hours.

• Treatment : thiazide, anticholinergic or surgery

Acoustic neuroma• CN VIII schwannoma commonly affects

vestibular portion but can also affect cochlea.

• Patient presents with : vertigo, sudden deafness and tinnitus.

• Dx = MRI of cerebellopontine angle• Tx = local radiation or surgical erection

EPISTAXIS• Bleeding from Kiesselbach’s plexus, a

vascular plexus on the anterior nasal septum.• Predisposing factors :a.Nasal trauma (nose picking, foreign bodies,

forceful nose blowing)b.Rhinitis, drying of the nasal

mucosa ,deviation of the nasal septum, alcohol , bone spurs, antiplatelet medication.

Treatment = direct pressure, topical nasal constriction (phenylephrine 0.125-1% solution), consider anterior nasal packing if unable to stop.

SINUSITIS• Result of impaired mucociliary clearance

and obstruction of the osteomeatal complex. Edematous mucosa causes obstruction of the sinus drainage tract, resulting in the accumulation of mucous secretion in the sinus cavity that becomes secondarily infected by bacteria.

A . Acute sinusitis• Patient presents with : purulent rhinorrhea,

headache, pain on sinus palpation,fever, halitosis.

• Most common pathogens : S. pneumoniae, H. influenzae, Moraxella catarrhalis.

• Tx : Bactrim , amoxicillin, decongestants

B. Chronic sinusitis• Same clinical presentation as for acute.• Lasts longer > 3 months• Common pathogens : Bacteroides, Staph.

Aureus, Pseudomonas , Streptococcus spp.• Dx = CT scan showing inflammatory changes

or bone destruction.• Tx = surgical correction of obstruction , nasal

steroids• Complication : meningitis, abscess

formation,orbital infection,osteomyelitis

PHARYNGITISA. Group A Strep throat• High fever• Severe throat pain w/o cough• Edematous tonsils with white or yellow

exudate• Unilateral cervical adenopathy

DiagnosisI.H&P 50 % accurateII.Rapid antigen testIII.Throat swab culture is gold standard• Tx: penicillin to prevent acute rheumatic

fever

Membranous ( diphtherial )I.High fever II.DysphagiaIII.Drooling can cause respiratory failureDx : pathognomonic gray membrane on

tonsils extending into throatTx : Antitoxin

• Fungal (candida)I.Dysphagia II.Sore throat with white ,cheesy patches in

oropharynx (oral thrush)seen in AIDS and small children

III.Dx : clinical or endoscopyIV.Tx : nystatin ,clotrimazole

AdenovirusI.FeverII.Red eyeIII.Sore throatIV.Dx : clinicalV.Tx : supportive

Herpangina ( coxsackie A)I.FeverII.PharyngitisIII.Body acheIV.Tender vesicles along tonsils, uvula and soft

palateV.Dx : clinicalVI.Tx : supportive