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one of the commonest ent disease

one of the commonest ent disease

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    Ent Ent Presentation Transcript

    • بسم الله الرحمن الرحيم NASAL INFLAMMATIONS Presented by :- Ass.professor Mohammad shaddad ENT consultant
    • Furunclosis of the vestibule (boil)
      • Acute infection of the hair follicles by staphylococcus,
      • Etiology:
      • Nose picking (mechanical trauma).
      • Lowered immunity (esp. Diabetics).
      • Clinical picture:
      • Pain & swelling of the nasal tip.
      • The boil is seen inside the vestibule as tender, red nodule which may be fluctuant later & may open & drain.
      • Complications:
      • Cavernous sinus thrombosis (the boil lies in the dangerous area of the face) mostly after squeezing of the boil.
      • Treatment:
      • Systemic antibiotic.
      • Local antibiotic cream.
      • Analgesics.
      • Incision with pus accumulation.
      • (N.B) in recurrent cases, a blood sugar should be tested.
    • Acute Non Specific rhinitis Acute coryza (common cold)
      • It is viral infection caused by rhinoviruses of more than 100 type 2ry bacterial infection may occurs.
      • Route of infection:
        • Droplet infection
        • Incubation period 1-3 days .
      • Predisposing Fs:
      • General: low body resistance.
      • Local:
        • Nasal disease causing n. obstruction.
        • Nasal irritation by smoking & dusty occupation.
      • Clinical picture: Passes into the following stages:
      • ischemic stage: (vasoconstriction)
      • Burning sensation & dryness in the nose with sneezing.
      • Generalized body aches.
      • Hyperaemic stage: (vasodilatation & secretion)
      • Nasal obstruction, watery discharge.
      • Fever & malaise.
      • stage of 2ry infection: (suppurative rhinitis)
      • Nasal obstruction & Nasal discharge & Mucoid mucopurulent, purulent.
      • Constitutional symptoms with high
      • Stage of resolution: (recovery)
    • Complications:
      • Sinusitis.
      • Otitis media.
      • Descending infection: laryngitis, bronchitis pneumonia.
      • Permanent anosmia.
      • Treatment:
      • Rest, plenty of warm fluids.
      • Analgesics, antipyretics & Vit.C.
      • Antibiotics to avoid 2ry bacterial. Infection.
      • Oral decongestants, antihistaminic.
      • Local nasal drops.
      • Steam inhalation.
      • Prophylaxis - Avoid predisposing factors.
      • - Avoid exposure to persons with common old.
      • Influenzal rhinitis
      • Similar to common cold, but more sever.
      • Caused by influenza viruses, types A,B,&C.
      • Clinical picture: Similar to common cold with the following differences:
      • - Sever headach, fever & malaise.
      • - Mild rhinorrhoea & sneezing.
      • - 2ry bacterial infection more common.
      • - Complication may occur & more sever.
      • Treatment: : - As common cold.
      • - Vaccination of high risk groups.
    • CHRONIC INFLAMMATION A. Chronic non-specific rhinitis 1.Chronic hypertrophic rhinitis
      • Hypertrophy of the mucous membrane of the nose especially the turbinates.
      • Etiology: - Repeated acute rhinitis irreversible changes.
      • - Allergic rhinitis.
      • - Vasomotor rhinitis.
      • Symptoms: nasal obstruction & nasal & postnasal discharge.
      • Signs : enlarged inferior turbinate which dose not Shrink with the application of vasoconstrictor (irreversible changes).
    • Treatment: Control of predisposing. Reduction of size of inferior turbinate: * Sub mucous diathermy (Electro coagulation ) * Partial inferior turbinectomy. * Laser turbinectomy
      • Atrophic rhinitis
      • Definition:
      • Chronic nonspecific rhinitis with progressive atrophy of the nasal mucosa(with its vessels & glands) & bony turbinates.
      • Etiology:
      • Primary
      • (idiopathic or ozaena): unknown cause,
      • Endocrinal imbalance, as it more common in females (estrogen lack).
      • Infection, purulent sinusitis and rhinitisin young age . Organism may be klebsilla ozaenae.
      • Deficiency of iron & vit A.
      • Autoimmune disease.
      • Autonomic imbalance sympathetic over activity.
      • B)Secondary: Distraction of nasal mucosa with subsequent atrophic changes:
      • Chronic specific rhinitis (granulomas).
      • Postoperative: excessive removal of nasal mucosa as after turbinectomy.
      • Poste irraditon.
      • Symptoms: bilateral & female at age of puberty.
      • Nasal discharge: greenish crusty with foetor (2ry anaerobic infection & putrefaction under crusts).
      • The patient can not smell his bad odour.
      • Nasal obstruction : (although the nose is roomy) caused by crusts & dullness of sensation of air over the atrophic mucous membrane.
      • Anosmia, due to atrophy of never endings.
      • Epistaxis with separation of crusts.
      • Signs:
      • Roomy nose with pale atrophic mucosa & turbinates.
      • Greenish or black crusts with marked foetor.
      • Treatment:
      • 1.ttt of the cause in 2ry rhinitis
      • 2. Medical :
      • Alkaline nasal wash to dissolves & helps their separation.
      • 2.5% glucose in glycerin nasal drops
      • potassium iodide to stimulate secretion by glands.
      • Iron & Vit. A supplementation.
      • 3. Surgical :
        • TO narrow the wide cavity sub mucosal implantation of grafts e.g. fat or bone.
        • Temporary occlusion of one nostril, 6months-2years (young’s operation).
      • B. Chronic specific rhinitis
      • 1-Rhinoscleroma
      Definition Chronic specific granuloma of the upper respiratory tract ,affect nose ,larynx &pharynx.
      • Organism:
      • -Klebsiella rhinoscleromatis (gram-ve Frish bacillus)
      • -Infection requires long &intiamate contact.
      • Pathology:
      • 1. Atrophic stage : as atrophic rhinitis.
      • 2. Nodular active stage: sub mucosa show rich vascularity &cellular infiltration
      • . (Mickulicz cells, Russel bodies .lymphocyte & plasma cell).
      • 3. Fibrotic stage : there are increase in fibroblasts& collagen fibers with decrease in cellularity & vascularity.
      • Clinical picture :
      • Middle ages (15 -35years) females. Passes in to stages may be more than one stage at a time:
      • 1 . Atrophic stage similar to atrophic rhinitis
      • 2 . nodular stage
      • a. Bilateral sub mucosal hard
      • nodules starting at the mucocutaneous junction.
      • b. they coalesce to form a large mass filing
      • the nasal & cavity & expanding the nose.
      • c. May extend to : -Tip of nose & upper lip
      • -Lacrimal passages(dacryoscleroma)
      • 3- Fibrotic stage stenosis of nasal cavity & deformity.
      • Investigation:
      • Biopsy :Characteristic histopathological picture
      • A) Mikulicz cells :
      • -Macrophages undergo hydropic degeneration.
      • -Large vacuolated foam cells containing the bacilli within in the vaccules
      • B) Russel bodies ::bright red degenerated plasma cells
      • C) In fibrotic (in active )stage , these cell s are replaced by fibroblasts& dense fibrous tissues The vascularity decrease
      • 11) Electron microscopy : positive in some case –ve with light microscopy
      • 111)Culture :short capsulated gram -ve diplo-bacilli.
      • TREATMENT:
      • Medial:
      • 1.Rifampicin (rimactan):600mq/dialy before meals oraly for 8-10 weeks for 3 month
      • Side effects :Hepatotoxic & Reddish coloration of urine .
      • 2.Striptomycin :1gm/dialyIM for 40 days.
      • Side effects: Ototoxic, vestibulotoxic & nephrotoxic.
      • 3.Others: ampicilin ,cephalosporin.
      • 4.Local :as atrophic rhinitis
      • SURGICA L
      • 1 Removal of localized masses.
      • 2.Fibrotic narrowing can be removed by Co2 laser.
      • Plastic reconstruction e limited success.
      • Syphilis of the nose
      • Organism :Treponema palladum
      • (spirochatetes).
      • Pathology :
      • Either a - Acquired :1ry,2ry or 3ry
      • b- Congenital :early &late (Transplacental infection)
      • Like 2ry acquired.
      • Like 3ry acquired +hutchinson teeth, keratitis & SNHL
        • Like2ry acquired
        • Like3ry acquired
      • b)Congenital
      • Early(1 st 3ms)
      • Late
      • Nasal discharge(mucoid b1.stained)
      • Headache.
      • Septal& perforation .
      • Saddle nose deformity
      • Red rubbery swelling ucler
      • Deep
      • Punched out edges
      • Indurated margin
      • Yellowish necrotic floor
      Tertiary
      • Persistent cata rrhal rhinitis.
      • Nasal Vestibulitis
      • Generalized 1ymphadenitis
      • (epitrochlear )
      White, slightly raised plaques painless ulcer ( snail track ulcer) Secondary Raised inducted pain less swelling or painless Ulcer (sharp edges)
      • Hard red papule ulcer
      • Enlarged, discrete, rubbery LNs
      • a)Acquired
      • Primary
      Clinical picture Pathology Stage
      • Investigations:
      • 1-Serologicl tests:
        • Waserman reaction (W,R) (VDRL)
        • Treponema pallidum immobilization test(TPI)
        • unreliable in 1ry syphlis.
      • 2.Direct smear :motile spirochates
      • 3.biopsy:endarteritis .
      • Complication
        • 2ry bacterial infection
        • 2ryatrophic rhinitis
        • Perforation bony septum or head palace
        • Sadle nose deformity
        • Fibrosis& stenosis of nasal cavity
      • Treatment :
      • Penicillin.
      • Alkaline nasal wash
      • Plastic sugary for septal perforation.
    • Lupus of the nose(lupus vulgaris)
      • Definition :
      • Chronic form of TB . infection that affects skin & mucous membrane .
      • Organism:
      • Attenuated TB bacilli
      • Clinical picture :
      • More common in female
      • 1. Nasal obstruction, discharge,& epistaxis
      • 2.Apple jelly nodules, buffer fly area of the face, ulcer undermined edges perforation of canfilginous septum.
      • Investigations;
      • 1. BIOPSY
      • 2. Bacteriological ex T.B BACILI.
      • Treatment:
      • 1.ant.TB treatment.
      • 2.Alkaline nasal wash
      • 3.Surgical repair of nasal deformity
      • Leprosy
      • Caused by mycobacterium leprae it has three types:
      • Tuberculoid leprosy: solitory lesions cause anasthetic cutaneous patches with involvement of one or more related sensory or motor nerves.
      • Lepromatous leprosy : diffuse infiltration of the skin , nerves and mucosal surfaces , nasal discharge in these pts contains infectious bacilli root of spread of infection .
      • Border line leprosy: skin lesion more numerous. conversion to the above tow types may occur .
      • Clinical picture ;
      • With lepromatous leprosy ; nodular thickening of the nasal mucosa.
      • Perforation of the cartilaginous portion of nasal septum perichondritis and periositis which lead to typical nasal deformity
      • Diagnosis ;
      • Of early and intermediate change in the nose , pathognomion of lepromatous leprosy .
      • Microscopy of nasal discharge for acid fast bacilli
      • Microscopy of scraping of nasal mucosa (anterior end of inferior turbinate)for acid fast bacilli
      • Radiology of anterior nasal spine erosion.
      • Treatment ;
        • Dapson
        • Rifampicin
        • Clofazimine (lamprene)
        • local treatment of the nose ; Betnovate in unguentum .
      • For years or for life.
    • Wagener's granulomatosis
      • May affect the upper air way , lung and
      • kidney with systemic vasculitis
      • Diagnosis ;
      • ESR & C- reactive protein
      • Anti neutrophil cytoplasmic anti
      • Body (ANCA )
      • Histological ; shows vasculitis necrosis
      • and granulomatous inflammation
      • Treatment
        • Steroids
        • Cyclophosphomide
    • Sarcoidosis
      • Chronic systemic disease of un known cause
      • Hypothese advanced .
      • Clinical picture ;
      • Nasal discharge , nasal obstruction ,epistaxis ,facial pain
    • Sarcoidosis
      • Diagnosis :
      • Biopsy
      • Kveim skin test
      • Radiology of the nasal bone ,chest ,
      • hand & feet.
      • Serum & urinary calcium hypercalcemia .
      • Serum level of angiotensin converting
      • enzyme
    • Sarcoidosis
      • Treatment :
      • Steroids local or systemic
      • Chlorqine Retenal damage .
      • Methotrexate.
      • Heerfordt,s syndrome transient bilateral facial palsy ,fever ,parotid enlargement and uveal tract disease
    • Thanks 4 U...