Overview of Eye, Ear, Nose, and Throat Infections by Nenad Pandak

In this comprehensive guide by Nenad Pandak, various aspects of eye, ear, nose, and throat infections are discussed. The content covers infections such as conjunctivitis, keratitis, pharyngitis, otitis media, and sinusitis. It also delves into causes, clinical presentations, and diagnosis of these infections, making it a valuable resource for ophthalmologists, ENT specialists, infectious disease specialists, and general practitioners.

• Eye infections
• ENT specialist
• Nenad Pandak
• Infections
• Ophthalmologist

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1. Eye, Ear, Nose, and Throat Infections Nenad Pandak

2. Why ? Ophthalmologist ENT specialist ID specialist & GP Familiar with these infections Preliminary empiric therapy

3. Task Eye infections Conjuctivitis Keratitis Endophtalmitis Throat infections Pharyngitis Epiglottitis

4. Task Ear infections Otitis externa Otitis media Mastoiditis Sinus infections Sinusitis

5. Eye anatomy

6. Conjuctivitis Inflammation of conjuctiva Doesn t threaten the vision Rapid respond to therapy

7. Conjuctivitis Direct contact with the environment Tears Antibacterial agents Lysozyme, IgA, IgG Decresed tear production Recurrent infections

8. Clinical presentation Vessel dilatation red eye Pus formation Eyelid swelling Itching, pain Glued eyelid shut (dried purulent exudate)

9. Causes Bacteria Viruses Staph. aureus Str. pneumoniae H. influenzae M. catarrhalis N. gonorrhoeae N. meningitidis P. aeruginosa C. trachomatis Adenoviruses Enteroviruses HSV VZV Measles

10. Causes Fungi Parasites Candida Blastomyces Sporothrix schenckii Trichinella spiralis Taenia solium Schistosoma haematobium Lola loa Onchocerca volvulus

11. Causes Viral The most common Highly contagious Spread to the 2ndeye in 24-48 hrs Bacterial Highly contagious Profuse pus formation

12. Causes Allergic and toxic Pollens Symmetrical Itching Systemic diseases Reiter syndrome Vasculitis SLE

13. Diagnosis History & examination Severe cases Swab or scraping: Gram stain & culture Viral: mononuclear cell exudate Allergic: eosinophils Bacterial: PMNs

14. Treatment ANd9GcQplxbp_eigv6CRGbCiYCAZ9SIwG1F_ZVQKQzYWJwnrQ_Afo_wSPQ_dZ8SWgQ Topical antibiotics? To do or not to do? Are your eyelids glued in the morning?(+5) Does your eye itch? (-1) Do you have recurrent conjuctivitis?(-2) Score: 5 bacterial 77% 2 bacterial 2%

15. Treatment Prefered therapy Moxifloxacin 0.5% sol TID 7 days Alternate therapy Gentamycin Tobramycin Polymyxin B / bacitracin Neomycin / polymixin

16. Eye anatomy

17. Keratitis Inflammation of cornea Prompt treatment Corneal perforation blindness

18. Predisposing conditions Minimal injury of cornea Trauma Contact lens abrasion Eye surgery Impaired tear production Diabetes mellitus Immunosupression Comatose patient

19. Causes Bacteria 65-90% Some produce toxins and enzymes Penetration without epithelial disruption Hypopyon is the rule Perforation

20. Causes Staph. aureus P. aeruginosa (contact lenses) N. gonorrhoeae N. meningitidis H. influenzae

21. Causes Viruses HSV recurrent keratitis Unilateral Dendritic lesion Erythema, pain, foreign body sensation HSV-fluor

22. Causes Fungi After organic material injury (tree branch) Prolonged corticoid eye drop therapy Aspergillus Protoza Unsterilized tap water for contact lens cleaning Acanthamoeba

23. Clinical presentation Eye pain Foreign body sensation Corneal edema impaired vision Photophobia Reflex tearing

24. Diagnosis Medical history & exam Swab or scraping Gram stain, Giemsa stain, methenamine silver stain, culture Therapy Emergently Experienced ophthalmologist

25. Endophthalmitis Serious infection Ocular chamber & adjacent structures Involving all tissue layers: panophthalmitis Often leads to blindness

26. Predisposing conditions Posttraumatic Staph. aureus and epidermidis Str. spp Bacillus cereus Fungi Organic matter penetrating injuries

27. Predisposing conditions Hematogenous Any source of bacteremia 2/3 right eye Candida albicans G + and G bacteria Bacillus cereus IDU

28. Predisposing conditions Contiguous spread Uncontrolled keratitis Delays in antibiotic therapy

29. Predisposing conditions Ocular surgical procedures Staph. aureus and epidermidis Str. spp Early 1 5 days after the surgery Delayed Weeks to months after the surgery Opportunistic pathogens

30. Clinical presentation Eye pain Eye redness Photophobia Reduced vision Fever, algic syndrome

31. Diagnosis and therapy Cultures and smears Systemic broad spectrum antibiotics Intravitreal antibiotic injection 1/10 patients enucleation Experienced ophthalmologist

32. ENT infectios

33. Pharyngitis Common infectious disease Usually self-limiting Antibiotics malpractice

34. Causes Viruses Rhino, corona, adeno, HSV, EBV, CMV, influenza, parainfluenza, coxsackie A, HIV Bacteria Group A streptococci (GAS) Children 50% of all cases Adults 10%

35. GAS pharygitis

36. Diagnosis Centor clinical criteria Tonsillar exudates Tender anterior cervical adenopathy Fever Abscence of cough

37. Diagnosis 3-4 criteria Positive predictive value 40-60% 3-4 criteria absent Negative predictive value 80% Adding age 3 14 y/o: +1 >45 y/o: -1

38. Therapy Penicillin the drug of choice Oral Penicillin VK 10 days Benzathine penicillin 1.2-2.4 MU im once Penicillin-allergic patients Clarithromycin, clindamycin, cephalosporins 10 days, azithromycin 3 days

39. Peritonsillar abscess Symptoms worsening despite antibiotics Medial displacement of uvula Soft palate bulging Surgical intervention Recurrent abscess tonsillectomy

40. Epiglottitis High fever Difficulty swallowing Drooling Difficulty breathing Indirect laryngoscopy Swollen, cherry-red epiglottis

41. Epiglottitis High risk of airway obstruction Children Mortality 80% Adult Closely monitored Endotracheal intubation

42. Epiglottitis Causes H. influenzae Str. pneumoniae Staph. aureus Therapy 3rd generation cephalosporins iv 7-10 days

43. Ear infections

44. Otitis externa Immunocompetent Mild disease Immunocompromised Possible life threatening

45. Otitis extrena Local itching and pain Redness and swelling of the external canal skin Tenderness of the auricula

46. Causes Gram-negative bacteria P. aeruginosa the most prevalent Staph. epidermidis or aureus Candida or Aspergillus

47. Therapy Polymyxin neomicin sol. + Hydrocortison sol. Clotrimazol or miconazol

48. Malignant otitis externa Immunocompromised Severe pain Spreading of necrotizing infection Skull, meninges, brain CT scan, MRI Gallium scan P. aeruginosa almost always! Systemic therapy 6 weeks + surgical debridement

49. Otitis media Most commonly in childhood Up to 3 y/o 2/3 of children at least 1 episode Consequence of the Eustachian tube obstruction

50. Otitis media Viral upper respiratory infection Serous fluid accumulation Eustachian tube obstruction 5-10 days later fluid infected with mouth flora

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