EYES, EARS, NOSE AND THROAT conjunctivitis Most common eye disease May be acute or chronic Most cases caused : 1- bacterial (gonococcal and chlamydial ) 2-viral infection Other causes : allergy and chemical irritants

Bacterial Conjunctivitis A. Gonococcal Conjunctivitis Acquired through contact with infected genital secretions. Manifested by a copious purulent discharge Involvement of corneal leads to perforation Dx confirmed by stained smear and culture of the discharge.

Treatment Topical antibiotic :erythromycin or bacitracin Single IM dose of ceftriaxone,1g,is effective When the cornea is involved, a 5-day of parenteral ceftriaxone,1-2g daily,is required.

viral Conjunctivitis Adenovirus is the most common cause Associated with :pharyngitis, fever, malaise and preauricular adenopathy. Characterized by :red palpebral conjunctiva and copious watery discharge Treatment : local sulfonamide therapy, hot compresses

Allergic Conjunctivitis No pain, vision changes Marked pruritus Bilateral watery eyes Treatment :antihistamine or steroid drops

Herpes Zoster Ophthalmicus Frequently 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 glaucoma 2. 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 Syndromes A. 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 % 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

PHARYNGITIS A. Group A Strep throat High fever Severe throat pain w/o cough Edematous tonsils with white or yellow exudate Unilateral cervical adenopathy

Diagnosis I. H&P 50 % accurate II. Rapid antigen test III. Throat swab culture is gold standard Tx: penicillin to prevent acute rheumatic fever

Membranous ( diphtherial ) I. High fever II. Dysphagia III. Drooling can cause respiratory failure  Dx : pathognomonic gray membrane on tonsils extending into throat  Tx : 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 endoscopy IV. Tx : nystatin,clotrimazole

Adenovirus I. Fever II. Red eye III. Sore throat IV. Dx : clinical V. Tx : supportive

Herpangina ( coxsackie A) I. Fever II. Pharyngitis III. Body ache IV. Tender vesicles along tonsils, uvula and soft palate V. Dx : clinical VI. Tx : supportive