Académique Documents
Professionnel Documents
Culture Documents
Etiology
Oropharynx
(OP)
Acute
epiglottitis
Children
2
4
y/o
(more
toxic)
Haemophilus
influenzae
type
B
-
Gram
ve
coccobacilli
-
X(hemin)
&
V(NAD)
factors
-
a-f
serotypes/
non-typeable
-
Produce
-lactamase
S&S
Dx
Other
Investigation
i)
HIGH
fever
(6
12
hr)
ii)
Severe
sore
throat
iii)
Dysphonia,
drooling,
stridor
Laryngoscopy
-
Cherry-red
epiglottis
(DONT
wait
for
XR!)
Peritonsillar
abscess
Adolescents
+
Young
adults
1)
Grp
A
strep
(Strep
pyogenes)
-
-hemolytic
-
Sensitive
to
bacitracin
2)
Mixed
OP
flora
-
Viridans
strep
-
Anaerobes
i)
Low
grade
fever
ii)
Severe
sore
throat
iii)
Hot
potato
voice
iv)
Dysphagia
Saliva
dribbling
v)
-
PT
area
infm
+
-
Tonsil
medially
vi)
Bilateral
Aw
obstruction
stridor
Contrast
CT
Abscess
lateral
to
tonsils
Needle
aspiration
firm pus
Characteristic:
1)
HIGH
fever
(systemic
toxicity)
2)
Board-like
swelling
of
bilateral
spaces
3)
Dysphagia
4)
Mouth
held
open
Dental
assesement
Underlying
cause
(spread
from
adj
infn)
e.g.
-
odontitis
-
pharyngitis
-
tonsillitis
-
otitis
-
parotitis
-
mastoiditis
Retropharyngeal
space
Underlying
cause
e.g.
-
odontitis
-
peritonsillar
absc
-
cervical
vertebral
osteomyelitis
1)
mixed
oral
flora
Larynx
Laryngotracheobronchitis
(CROUP)
Children
3
moths
3
y/o
(well
looking)
Viruses!!!!!!
-
Parainfluenza
V
-
Influenza
V
-
RSV
-
Adenovirus
-
Rhinovirus
(rare:
Mycoplasma)
2) SA(vertebral OM)
1)
Fever
2)
Hoarseness
3)
Barking
cough
4)
Stridor
(MOST
common
cause
of
stridor
in
child!!!!)
+
URI
synptoms
(2
3
days)
Neck
XR
-
Hourglass
(steeple)
sign
-
Subglottic
swelling
Nasopharyngeal
aspirate
-
For
respiratory
V
antigen
i)
Neck
XR
-
Thumb
sign
ii)
Blood
culture
Management
Airway
protection,
airway
protection,
airway
protection!!!!!!!!!!
Upper
airway
obstruction
no
oxygen
death
medical
emergency!!!
1)
Antibiotic
1)
Antibiotic
1)
Antibiotic
1)
Antibiotic
1)
Racemic
adrenaline
w/
beta-lactam
I
2)
Abscess
drainage
2)
Surgical
2)
Surgical
drainage
(if
needed)
2)
Steroid
(Amoxic.
+
clauvu)
antibiotics
cant
soft
tissue
3)
Treat
primary
infective
focus
for
edema
of
airway
2)
Rifampicin
penetrate!!!
decompression
prophylaxis
3)
Dental
assessment
Target
Types
Etiology
Pathogen
Sx
Dx
Complic
Allergic
rhinitis
(Also
infectious
rhinitis
Etiology
same
as
OtM)
Allergens
Dust,
pollens,
animal
dander
Otitis
media
Child
(v.
common!!)
Eustachian
tube
short
and
horizontal
Acute
Chronic
suppurative
otitis
media
otitis
media
Viral
URTI
blocks
Perforation
of
Eustachian
tube
tympanic
membrane
Effusion
into
after
AOM
for
few
wk
Middle
ear
1)
Active
2)
Inactive
(discharge)
(dry)
Tonsillitis
Bacterial
Sialoadenitis
Virus
Streptococcus
pneumoniae
Viral:
Mumps,
coxsackievirus,
HIV
Haemophilus
influenza
type
B
Bacterial:
SA,
TB,
syphilis
Moraxella
catarrhalis
AI:
Sjogrens
syndrome
Inhaled
allergens
Preceding
URTI
Ascending
duct
infn
Type
I
HS
(IgE)
Blockage
of
Eustachian
tube
1)
Gland
hyposecretion
Mast
cell
degran.
Swelling
of
nasopharynx
-
Dehydration
(histamine,
PGs)
Air-trapped
inside
middle
ear
slowly
2)
Ductal
obstruction
vasodilation
absorbed
into
BVs
-
Mucocele
/
stone
Late
phase
Mild
vacuum
Cell
infiltrate
Surrounding
fluid
sucked
from
NP
chronic
nasal
obstruction
into
middle
ear
predispose
to
infn
1)
Eyelid,
conjunctival
swelling
1)
Ear
pain
1)
Unilateral
pain,
swelling
2)
Sneezing,
nasal
congestion,
2)
Discharge
2)
Firm,
tender,
red
gland
rhinorrhea,
post-nasal
drip
3)
Fever
w/
pus
leakage
3)
Rash
4)
Conductive
hearing
loss
Late
Phase
Perforated
tympanic
membrane,
(Fever,
chill)
Swollen
&
tender
Fluid
accumulation
in
middle
ear
nasal
concha
Risk
factor
-
Xerostomia
Tympanic
membrane:
-
Radiation
to
H&N
Bulging,
red,
cloudiness
congested
bv
(NO
cone
of
light)
1)
Rupture
of
tympanic
membrane
Tenderness
+
swelling
+
erythema
behind
ear
2)
Tympanosclerosis
Spread
i)
CN
7
(matoid
close
to
stylomastoid
foramen)
3)
Mastoiditis
(mastoid
antrum)
ii)
CN
6
pasy
iii)Abscess
in
p
osterior
cranial
fossa