Otitis Externa:

What is it

Pathogens-most common

Inflammatory process of the external auditory canal

Pseudomonas aeruginosa-Bacterial

Aspergillus niger & Candida Albicans-Fungal

Otitis Externa Presentation:

Fungal

Immunocompromised

Viral

Fungal :  White/Blackish spores in canal

Immunocompromised:  Granulation tissue

Viral:  Painful vesicles

Debridement

Ototopical

IF Viral: Acyclovir, Valcyclovir

Severe: Systemic ABX

Otitis Media:

Common pathogens

Complications if untreated

Common pathogens:

 Strep Pnuemonie,  H influenza, M catarrhalis

Complications if untreated:

Eardrum perforation

Eardrum atrophy

Erosion of ossicles

Middle ear adhesions

Scerolitc plaques

Acquired cholesteatoma

Think Tom & Matt

Tympanocentesis

Ossicular reconstruction

Myringotomy

Mastoidectomy

Adenodectomy

Typanostomy tube

Tympanoplasty

OM procedures, what are they?

Tympanocentesis

Ossicular reconstruction

Myringotomy

Mastoidectomy

Adenodectomy

Typanostomy tube

Tympanoplasty

Tympanocentesis:  make opening to obtain sample

Ossicular reconstruction: restore ossicle chair for hearing

Myringotomy: incision, drain pus, insert tube

Mastoidectomy:  make opening to remove Cholesteatoma

Adenodectomy: removal of adenoids

Typanostomy tube: allows middle ear ventilation

Tympanoplasty: graft, repair defect in TM

Ear-Tubal dysfunction:

define

sx

H&P

Tx

define: Eustachian tube dysfuntion

air trapped in middle ear, becomes absorbed, negative pressure results

sx: Sense of fullness & hearing impairment

Pop/Crackle sound

H&P:  TM retrated & decreased mobility

Tx:  Operative-Myringotomy with tube

Cholesteatoma:

Define

Cause

Associated with

Define: Epidermal inclusion cyst of middle ear or mastoid filled with desquamated keratin debris

acquired or congenital

Cause: Negative middle ear pressure from eustachian tube dys. or direct growth epithelium thru TM performation

Associated with: Chronic middle ear infections

Cholesteatoma:

Hx

presentation

tx

Hx:  Chronic ear infx w/ chronic malodorous drainage

presentation:  Grayish white, shiny keratinous mass behind or involving TM

tx:  Surgery tympanoplasty/mastoidectomy

eradication of dz & reconstruct ossicle chain

Foreign Body of Ear:

Removal method

 Should you use aqueous irrigation

Living insects immobilized by

Removal method:  Loop / Hook

 Should you use aqueous irrigation: 

NO, causes insect to swell

Living insects immobilized by: Lidocaine

Sinusitis:

Pathogens

Dx

Operative

Pathogens: Strep pneumonaie, H influenza, M cararrhalis

Dx: CT scan for

 chronic-mucosal thickening, air fluid levels, possible cysts in sinuses

Operative: Endoscopic sinus surgery to reestablish patency

Tonsilitis:

Pathogen

Sx

surgery indications

GABHS, N gonerrhoea, Chlamydia, Mycoplasma

Sx: Fever >38, Pharyngeal/Tonsillar exudate, Ant cervical adenopathy, NO COUGH

surgery indications: Removal

Airway obstruction, sleep apnea, Cor pulmonale,Marked asymmetrical tonsils, recurrent strep, abscesses

Blunt nasal-sinus trauma:

Signs

Dx

Signs:

Pain

Epistaxis

Obvious deformity

Septal deviation

Crepitus

Palpable bony segment

Soft tissue hematomy-"Black eyes"

Edema

Dx: CT 2-3 mm cuts-Axial, Coronal, Sagittal

Facial x-ray, rhinoscope exam

Pneumothorax:

Define

Spontaneous

Acquired

Tension

Open

Define:  Air in pleura space, resulting in LUNG COLLAPSE

1.Spontaneous-not assoc w/ precipitating factors, d/t rupture of subpleural BLEB

2.Acquired-d/t TRAUMA(rib fx, CVL, barotrauma)

3.Tension-air enters but cannot leave

 Venous return impaired, Cardiovascular collapse

4.Open-Penetrating chest trauma & open communication of pleura w/ outside

Pneumothorax:

S&S

Sudden onset of SOB, Cough, Pleuritic chest pain

Diminished/Absent breath sounds

Hyperresonance to percussion

Diminshed tactile fremitus on affected side

Tension-Tachycardia, Diaphoresis, Hypotension, Pallor

Tracheal shift to uninvolved side

Small:  Observe

Mild/Moderate:  Needle aspiration or percutaneous catheter drainage

Large >30:  Tube thoracostomy

Dx-chest x-ray

Empyema:

Definition

Organisms

Arises from

Definition: Pus in pleural cavity

Organisms:  Gram + Staph aurues and Streptococci

Gram - E.Coli, Klebsiella, Pseudomonas

Arises from:

50% complication Pneumonia

25% Esophageal/Pulmonary/ Mediastinal surgery

10% extension subphrenic abscess

Empyema:

Stages

Tx

Stages:

1st exudative-Low LDH, nl glucose & pH

2nd fibropurulent-invasion of pleura by bacteria, increased fibrin deposits,WBC

3rd organizational-fibroblast grow into sheets, makes pleura functionless

Tx:  Thoracocentesis dx & tx of early stage

CXR PA view

CT

Lung Cancer:

H&P / S&S

1. Cough/change in cough

2. Increased sputum production

3. Dyspnea

4. New onset of wheezing

5. Hemoptysis

6. Hoarseness in voice

7. Chest wall pain

8. Obstructive pneumonia

9. Superior vena cava syndrome-swelling of face, neck, UE (d/t mass obstruction)

Lung Cancer:

DX

Referral

Dx:

CXR

CT chest & abdomen

PET imaging-small cell carcinoma

Mediastinoscopy-mediastinal lymph node

Tissue biospy guided by CT/bronchoscopy

Referral/Consult:  Thoracic surgeon, Oncologist, Pulmonologist

Thyomas:

Define

S&S

Define:  Neoplasm in ant mediastimum

Originating from Thymus

Benign

Encapsulated-thymic epithelial cells & abundant lymphocytes

S&S:

MG-weakness & fatigue of skeletal muscles

Chest pain

Dyspnea

Hemoptysis

Cough

Sup. Vena Cava Syndrome

Red cell aplasia

Pulmonary TB:

organism

s&s

Organisms:  Mycobacterium tuberculosis

S&S:

wt loss

anorexia

fatigue/malaise

fever

night sweats

cough- dry at first then productive

Ludwig's angina:

definition

S&S

Dx

Tx

definition: begins as tooth abscess/infx and follows down to sublingual, submandibular, submental spaces

Bacterial infx of floor of mouth=Airway obstruction tongue

S&S: Poor dental hygiene, dysphagia, trismus, edema

DX: CT scan

Tx: EMERGENCY   I&D and ABX