1. Eyes, Ears, Nose and Throat A Review for the OHN Steven Marks, MSN, RN, APN-C, COHN-S, FAAOHN

2. Conjunctivitis Bacterial Viral Allergic

3. Bacterial Conjunctivitis Staph, Strep, H. Flu, Gonocococcal, chalamydial Thick yellow discharge – Crusting of lashes Injected eye Handwashing

4. Viral Conjunctivitis Following viral illness – Cold or flu Injected eye Clear discharge Puritis No crusting Self limiting disease Handwashing

5. Allergic Conjunctivitis Cobblestoning Sclera relatively clear Whitish ropey discharge Identify cause Treat to minimize allergic rhinitis Patanol, Pataday etc – Visene AC, Naphcon OTC’s

6. Glaucoma Acute angle closure – Painful Hard Red Eye Red Flag Sign – Risks – African or Spanish Ancestry – True ocular emergency

7. Glaucoma Chronic open angle – Most common – Blurred vision, headache, eye pain, rainbow halos around lights, nausea and vomiting Testing – Tonometry – Peripheral vision screening Treatment – Miotics – Beta blockers Exacerbations – Dark rooms>>Pupil dilation and angle closure

8. Hordeolum Stye – Localized infection of Zeis or meibomian glans Self limiting Warm compresses Lash care – Discard eyeliner Abx ointment if not resolving

9. Chlazion Meibomian gland – Chronic granulomatous Warm compress May be surgically removed

10. Chalazion vs Stye

11. Ocular Foreign Body Common finding Foreign body sensation R/o globe puncture/rupture Superficial metallic bodies leave rust rings Start with visual acuity

12. Corneal Abrasion Examine for retained foreign body Evert lids Irrigate Fluorescein exam – Cobalt blue lamp

13. Corneal Abrasion Fuorescein exam with cobalt blue light – Woods lamp Often treated with combination of abx and steroid gtts – r/o viral causes and ulceration 1st

14. Subconjunctival Hematoma Common Causes – Coughing – Vomiting – Blunt force trauma Bleeding between conjunctiva and sclera Self limiting Asymptomatic

15. Ptrygium Forms over perilimbal conjunctiva UV light exposure Itching, FB sensation Lubrication gtts Surgical excision if visual impairment

16. Blepharitis Bacterial infection of eyelid Warm compresses Lid care Abx ointment

17. Diabeitc Retinopathy Present in 40% of diabetics Leading cause of new blindness in adults age 20-65 Hemorrhage, cotton wool patches, and neovascularization Treatment – Good DM control – Laser

18. Uvitis/Iritis Inflammation of iris and ciliary muscle – Dilated corneal edge – Irreg. pupil May be auto immune Meds – Steroids – Cycloplegic drugs (paralyze ciliary muscle) – Immune supressive agents

19. Presbyopia Normal age related change – Stiffening of lens – Focal point behind retina – Reading glasses

20. Dry Eye Disturbance in tear film S/S – Burning, pain, fb sensation Schirmer test

21. Cataract Decreased clarity of lens Complaints of poor night vision Surgical correction can correcton for other vision issues – Nearsightedness, presbyopia

22. Macular Degeneration Loss of central vision – Breakdown of retinal pigment epithelium in the macula Wet and Dry forms – Dry – Retinal thinning No treatment – Wet – Leaking choroidal vessels Treat w/ laser Peripheral vision spared

23. Ectropion Outward turning of lid Excessive tearing and dryness Surgical correction

24. Entropion In-turning of lid due to degenaration of lid fascia Foreign Body sensation Botulinum Surgical correction

25. Floaters Floating Spots – Cellular debris Flashes/Floaters = Retinal Detachment

26. Temporal Arteritis Giant cell arteritis Age >50 mostly women – White, Scandanavian S/S polymalgia rheumatica – Aching, stiffness in neck shoulders and hips Risk – Blindness due to optic nerve ischemia Labs – Elevated sed rate and CRP Temporal artery biopsy Treat with steroids

27. Vertigo The sensation of the environment spinning Leads to nausea, vomiting, headaches May be brought on by sudden movements or position changes – Benign Paryoxysmal Positional Vertigo – Peripheral vestibular disorder Movement of canoliths in semicircular canals

28. Vertigo Meniere Syndrome – Sudden onset of vertigo with low frequency hearing loss and tinnitus – Due to either an overproduction of endolymph or drainage issue Possibly due to food allergy in some cases – Treat with low sodium diet and diruetics – Anti emetics and cortico-steroids – ENT referral

29. Dix Hall Pike Maneuver

30. Otitis Media Chronic Acute

31. Otitis Media

32. Pain/fullness in ear Red injected and bulging TM May note serous build up behind tm or air fluid levels May lead to spontaneous perforation Respiratory virus or strep pneumonae, then H flu and moraxalla catarrhalis

33. Otitis Externa Swimmers ear Pseudomonas most common – Staph, then strep Treat with Vosol HC (acetic acid) or ofloxacin otic Ear wick

34. Cholesteatoma Pouching of TM – Middle ear debris Epidermal cells – Lead to bony destruction

35. Tinnitus Mostly a subjective finding Examine for cerumen impaction or effusion Avoid caffiene & sodium Hearing aid to mask sounds

36. Otosclerosis Fusion of the ear bone joints with age Tinnitus Progressive hearing loss Genetically inhertited in 10%

37. Cerumen Impaction Common cause of hearing loss Debrox to soften Removal with instrument, suction or irrigation Hearing may be hyperacute after Don’t’ irrigate if TM rupture is suspected

38. Foreign Body of the Ear Q tip Insect Just about anything in kids

39. Allergic Rhinitis Acute inflammatory /immune response Identify cause Don’t forget eyes – Histamine leaking into nose Nasal steroids – Multiple mediators Antihistamines – 1 mediator

40. Presbycusis Age related hearing loss

41. Sinusitis Allergic, Acute, Chronic CT Scan showing sinusitis in the left maxillary sinus and ethmoid sinus

42. Acute Bacterial Rhino-Sinusitis ABRS H flu and Strep Red Flag – Supraorbital cellulitis Abx with DRSP coverage

43. Nasal Polyps Pearly white/grey Nasal/sinus obstruction

44. Epistaxis Anterior or Posterior

45. Angular Chelitis Candida or staph Immune suppressed

46. Oral Cancer Tobacco and Alcohol use account for 75% of oral cancers Look under tongue Often painless lesion Mostly squamous cell 15% will have another cancer near by – Lungs, larynx, esophagus

47. Dental issues Dental pain is common Insurance issues Fear Gingivitis Peridontitis Caries

48. Epiglotitis Life threatening Drooling is a RED FLAG Do not use a tongue blade for exam – May lose airway “Thumb Sign” on soft tissue lateral neck xray Cause – H. Flu – Decreased incidence due to HIB vaccine

49. Parotitis Viral infections – Mumps>>MMR Poor oral hygiene – Salivary stones Debilitated ABX if bacterial Possible I&D

50. URI Common office visit – Rhino Virus Nasal congestion, headache, sore throat, ear pain/fullness, body aches Symptomatic therapy with OTC’s

51. Pharyngitis Sore throat – Treat the cause – Educate on bacterial resistance Viral Group A beta-hemolytic strep

52. Tonsillitis Sore throat, difficulty swallowing, referred ear pain, hoarseness R/O Mono – Posterior cervical lymph adenopathy Mono Bacterial Tonsillitis

53. Thank you