Head and neck space infections 22 8-2016,dr.bini mohanophthalmgmcri
This document discusses various types of neck abscesses including parotid, submandibular, retropharyngeal, and parapharyngeal abscesses. It describes the anatomy of the neck spaces involved, common causes of infection, symptoms, examinations findings, and treatment approaches which typically involve intravenous antibiotics along with surgical drainage if an abscess has formed. Complications can include airway obstruction, sepsis, or spread of infection to dangerous spaces like the mediastinum.
This document provides information about acute and chronic pharyngitis. It discusses the anatomy of the pharynx and causes of acute pharyngitis such as viral and bacterial infections. Clinical features of acute pharyngitis are described along with investigations and treatment options. Complications are outlined. Acute tonsillitis is also discussed including types, symptoms, signs, and treatment. Chronic pharyngitis and conditions such as peritonsillar abscess, diphtheria, and retropharyngeal abscess are summarized as well.
Complications of sinusitis can be local, such as orbital cellulitis, or distant, like brain abscesses. Orbital complications are most common, with progression from preseptal cellulitis to orbital cellulitis, subperiosteal abscess, and orbital abscess. Intracranial complications include meningitis, epidural abscesses, subdural abscesses, and cerebral or venous sinus abscesses. Treatment involves antibiotics, surgical drainage of abscesses, and in severe cases like cavernous sinus thrombosis, anticoagulation. Prognosis is good with prompt treatment but risks include vision loss, diplopia, and neurological deficits.
1. A 2-year-old child presented with stridor and was diagnosed with laryngomalacia based on age of onset and examination findings.
2. Bacterial tracheitis causes upper airway obstruction in children aged 6 months to 14 years and is characterized by high fever, toxic appearance, and barking cough. It requires antibiotics and airway management.
3. Epiglottitis is a medical emergency that causes sudden upper airway obstruction in young children. It presents with fever, drooling, dysphagia, and a toxic appearance, and requires securing the airway with intubation.
This document discusses nasal septum abnormalities including deformities like anterior dislocation, C-shaped, and S-shaped deformities as well as spurs and thickening. Clinical features include nasal obstruction, headaches, sinusitis, and epistaxis. Treatments include submucous resection and septoplasty. Septoplasty involves elevating mucosal flaps on both sides of the septum to remove deviated parts and reposition the septum, while submucous resection removes only the most deviated parts and corrects the septum through plastic means, elevating flaps on just one side. Septoplasty has almost replaced submucous resection.
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
Head and neck space infections 22 8-2016,dr.bini mohanophthalmgmcri
This document discusses various types of neck abscesses including parotid, submandibular, retropharyngeal, and parapharyngeal abscesses. It describes the anatomy of the neck spaces involved, common causes of infection, symptoms, examinations findings, and treatment approaches which typically involve intravenous antibiotics along with surgical drainage if an abscess has formed. Complications can include airway obstruction, sepsis, or spread of infection to dangerous spaces like the mediastinum.
This document provides information about acute and chronic pharyngitis. It discusses the anatomy of the pharynx and causes of acute pharyngitis such as viral and bacterial infections. Clinical features of acute pharyngitis are described along with investigations and treatment options. Complications are outlined. Acute tonsillitis is also discussed including types, symptoms, signs, and treatment. Chronic pharyngitis and conditions such as peritonsillar abscess, diphtheria, and retropharyngeal abscess are summarized as well.
Complications of sinusitis can be local, such as orbital cellulitis, or distant, like brain abscesses. Orbital complications are most common, with progression from preseptal cellulitis to orbital cellulitis, subperiosteal abscess, and orbital abscess. Intracranial complications include meningitis, epidural abscesses, subdural abscesses, and cerebral or venous sinus abscesses. Treatment involves antibiotics, surgical drainage of abscesses, and in severe cases like cavernous sinus thrombosis, anticoagulation. Prognosis is good with prompt treatment but risks include vision loss, diplopia, and neurological deficits.
1. A 2-year-old child presented with stridor and was diagnosed with laryngomalacia based on age of onset and examination findings.
2. Bacterial tracheitis causes upper airway obstruction in children aged 6 months to 14 years and is characterized by high fever, toxic appearance, and barking cough. It requires antibiotics and airway management.
3. Epiglottitis is a medical emergency that causes sudden upper airway obstruction in young children. It presents with fever, drooling, dysphagia, and a toxic appearance, and requires securing the airway with intubation.
This document discusses nasal septum abnormalities including deformities like anterior dislocation, C-shaped, and S-shaped deformities as well as spurs and thickening. Clinical features include nasal obstruction, headaches, sinusitis, and epistaxis. Treatments include submucous resection and septoplasty. Septoplasty involves elevating mucosal flaps on both sides of the septum to remove deviated parts and reposition the septum, while submucous resection removes only the most deviated parts and corrects the septum through plastic means, elevating flaps on just one side. Septoplasty has almost replaced submucous resection.
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
This document discusses several deep neck space infections including Ludwig's angina, retropharyngeal abscess, and parapharyngeal abscess. Ludwig's angina is a rapidly progressing cellulitis of the submandibular space that can compromise the airway. Retropharyngeal abscess is a collection of pus in the retropharyngeal space, often caused by upper respiratory infections in children, and treated with antibiotics and incision and drainage. Parapharyngeal abscess has multiple potential causes and requires systemic antibiotics as well as intraoral or external incision and drainage.
Acute suppurative otitis media is an infection of the middle ear cavity that occurs more commonly in children and infants, especially during winter/spring and after upper respiratory infections. The infection is usually caused by bacteria like Streptococcus pneumoniae and Haemophilus influenzae. It begins with occlusion of the Eustachian tube and progresses through stages of pre-suppuration, suppuration, and sometimes resolution or complications. Symptoms include earache, fever, hearing loss, and a bulging eardrum. Treatment involves antibiotics, analgesics, myringotomy if needed, and treating any predisposing conditions.
Rhinosinusitis can lead to serious orbital, intracranial, and bony complications if not properly treated. The document describes the various classifications of orbital complications including preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. It also details intracranial complications such as meningitis, epidural/subdural empyema, brain abscess, and cavernous sinus thrombosis. Treatment involves antibiotics, surgical drainage if needed, and management of the underlying sinusitis. Failure to improve or clinical deterioration despite treatment indicates the need for more aggressive management.
Malignant otitis externa is an aggressive infection of the soft tissues of the external ear that spreads to involve the skull base. It is usually caused by Pseudomonas aeruginosa and predominantly affects diabetics. Key features include otalgia, otorrhea, and cranial nerve palsies. Diagnosis involves biopsy showing microabscesses, positive cultures, and imaging showing bone involvement. Treatment requires prolonged high-dose intravenous and then oral antibiotics, with surgery reserved for complications.
Here are the key steps the emergency department would take after obtaining history and performing an examination:
1. Stabilize the patient. Given the high fever and altered mental status, immediate focus would be on stabilizing vital signs through IV fluids and antipyretics. Oxygen supplementation may also be needed.
2. Obtain imaging. A non-contrast head CT would be done urgently to evaluate for complications like abscess, thrombosis or meningitis. Contrast may be added based on findings.
3. Start empiric antibiotics. Broad spectrum IV antibiotics like vancomycin and piperacillin-tazobactam would be started immediately based on suspicion of orbital or intracranial infection.
Complications of rhinosinusitis(Dr ravindra daggupati)Ravindra Daggupati
orbital complications of rhino sinusitis,intra cranial complications of rhino sinusitis,classification of complications,diagnosis and treatment of complications
This document summarizes the history, indications, techniques, and adjuvant therapies for tonsillectomy. It discusses the evolution of tonsillectomy from ancient techniques using fingers and knives to modern methods utilizing instruments like the tonsillotome. Key indications for tonsillectomy outlined include recurrent infection, sleep disorders, and airway obstruction. Innovative techniques described are intracapsular tonsillectomy using microdebriders or lasers, as well as coblation and harmonic scalpel methods. Studies show these new techniques reduce postoperative pain and recovery time compared to electrocautery. Adjuvant therapies explored are local anesthetics like bupivacaine and perioperative steroids like dexamethas
This document discusses nasal polyposis, including its definition, epidemiology, etiology, pathogenesis, pathology, symptoms, signs, diagnosis and treatment. Some key points include:
- Nasal polyps are soft, non-cancerous growths that develop in the nasal cavity or sinuses. The two main types are ethmoidal polyps and antrochoanal polyps.
- Ethmoidal polyps are more common in adults and often associated with chronic rhinosinusitis, asthma or allergies. Antrochoanal polyps usually present in adolescents and originate in the maxillary sinus.
- Symptoms include nasal obstruction, loss of smell, discharge and headaches. Diagnosis involves
This document provides an overview of epistaxis (nosebleeds), including causes, locations, clinical approach, and management. It notes that epistaxis affects 5-10% of the population annually and can originate from the nose, nasopharynx, paranasal sinuses, or anterior cranial fossa. Local causes include trauma, inflammation, and tumors, while systemic causes involve conditions like hypertension, coagulopathies, and liver/kidney disease. Anterior nosebleeds are more common and originate from Little's area, while posterior bleeds originate from the sphenopalatine artery. Clinical assessment involves history, exam, and identifying the bleeding site. Management includes vasoconstrictors, caut
Diana Harbuz provides a summary of common ENT issues including:
1. Mastoiditis, otitis externa, perichondritis, and haematoma in the ears section.
2. Epistaxis and sinusitis/meningitis/CSF rhinorrhoea in the nose section.
3. Peritonsillar abscess, epiglottitis, retropharyngeal abscesses, Ludwigs angina, laryngomalacia, and angiooedema in the throat section.
4. Emergency management of laryngectomy/tracheostomy patients, parotitis, and facial cellulitis referral guidelines in the head and neck
otosclerosis....
stapedectomy vs stapedotomy
complication of otosclerotic surgery
management of otosclerotic surgery complications
techniques
latest trends
1) Otosclerosis is a disease of the bony labyrinth where normal bone is replaced by spongy vascular bone. It most commonly causes conductive hearing loss.
2) Stapedial otosclerosis is the most common type and results in a lesion in front of the oval window causing progressive conductive hearing loss.
3) Treatment options include hearing aids for mild cases and stapes surgery to replace the stapes footplate for more severe conductive hearing loss. Complications of stapes surgery include sensorineural hearing loss or perilymph fistula.
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
The document discusses infectious rhinosinusitis and provides details on:
1. Rhinosinusitis is inflammation of the nose and paranasal sinuses characterized by nasal obstruction, discharge, facial pain and loss of smell. Acute rhinosinusitis is usually caused by viral infection but can become bacterial.
2. Chronic rhinosinusitis lasts over 12 weeks and is characterized by persistent inflammation not resolved by treatment. The role of bacteria is unclear but biofilms and osteitis may perpetuate inflammation.
3. Imaging like CT is used to confirm acute rhinosinusitis especially in severe cases, while most cases are diagnosed clinically. Treatment involves analgesics, decongestants and antibiotics if bacterial infection
Vocal nodules are benign, bilateral growths on the vocal cords caused by overuse or misuse of the voice. They are usually treated with voice therapy and rest, and may require surgery if not improved after 3-6 months. Vocal polyps are also benign growths but are usually unilateral and caused by vocal trauma or irritants like smoking. They are typically treated with excision during microlaryngoscopy. Reinke's edema is a bilateral swelling of the vocal cords caused by irritants like smoking, and is treated by removing the fluid or tissue via stripping under microlaryngoscopy along with voice therapy.
Battered baby syndrome, also known as Caffey's syndrome, refers to a combination of physical injuries in an infant or young child caused by non-accidental violence from a parent or guardian. Common signs include inconsistent stories about the injuries, multiple bruises of different ages, delays in seeking medical care, repeated injuries over time, and injuries more common in unwanted, youngest or only children from low-income families with relationship issues. Physical manifestations can include skull fractures, broken ribs, bleeding between the brain and skull, retinal hemorrhages, bruises, burns and torn lip frenulums. Shaken baby syndrome is a type of head injury that can occur from just 5 seconds of violent shaking and may lead to seizures or
This document summarizes various diseases of the external ear, including congenital conditions, infections, and other abnormalities. It describes conditions such as Darwin's tubercle, Wildermuth's ear, Mozart's ear, microtia, macrotia, bat ears, lop ear, cup ear, accessory auricles, preauricular sinus, hematoma auris, perichondritis, furunculosis, otitis externa, otitis media, granular myringitis, bullous myringitis, necrotizing otitis externa, and malignant otitis externa. For each condition, it provides details on causes, signs, symptoms, pathology,
This document discusses several deep neck space infections including Ludwig's angina, retropharyngeal abscess, and parapharyngeal abscess. Ludwig's angina is a rapidly progressing cellulitis of the submandibular space that can compromise the airway. Retropharyngeal abscess is a collection of pus in the retropharyngeal space, often caused by upper respiratory infections in children, and treated with antibiotics and incision and drainage. Parapharyngeal abscess has multiple potential causes and requires systemic antibiotics as well as intraoral or external incision and drainage.
Acute suppurative otitis media is an infection of the middle ear cavity that occurs more commonly in children and infants, especially during winter/spring and after upper respiratory infections. The infection is usually caused by bacteria like Streptococcus pneumoniae and Haemophilus influenzae. It begins with occlusion of the Eustachian tube and progresses through stages of pre-suppuration, suppuration, and sometimes resolution or complications. Symptoms include earache, fever, hearing loss, and a bulging eardrum. Treatment involves antibiotics, analgesics, myringotomy if needed, and treating any predisposing conditions.
Rhinosinusitis can lead to serious orbital, intracranial, and bony complications if not properly treated. The document describes the various classifications of orbital complications including preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. It also details intracranial complications such as meningitis, epidural/subdural empyema, brain abscess, and cavernous sinus thrombosis. Treatment involves antibiotics, surgical drainage if needed, and management of the underlying sinusitis. Failure to improve or clinical deterioration despite treatment indicates the need for more aggressive management.
Malignant otitis externa is an aggressive infection of the soft tissues of the external ear that spreads to involve the skull base. It is usually caused by Pseudomonas aeruginosa and predominantly affects diabetics. Key features include otalgia, otorrhea, and cranial nerve palsies. Diagnosis involves biopsy showing microabscesses, positive cultures, and imaging showing bone involvement. Treatment requires prolonged high-dose intravenous and then oral antibiotics, with surgery reserved for complications.
Here are the key steps the emergency department would take after obtaining history and performing an examination:
1. Stabilize the patient. Given the high fever and altered mental status, immediate focus would be on stabilizing vital signs through IV fluids and antipyretics. Oxygen supplementation may also be needed.
2. Obtain imaging. A non-contrast head CT would be done urgently to evaluate for complications like abscess, thrombosis or meningitis. Contrast may be added based on findings.
3. Start empiric antibiotics. Broad spectrum IV antibiotics like vancomycin and piperacillin-tazobactam would be started immediately based on suspicion of orbital or intracranial infection.
Complications of rhinosinusitis(Dr ravindra daggupati)Ravindra Daggupati
orbital complications of rhino sinusitis,intra cranial complications of rhino sinusitis,classification of complications,diagnosis and treatment of complications
This document summarizes the history, indications, techniques, and adjuvant therapies for tonsillectomy. It discusses the evolution of tonsillectomy from ancient techniques using fingers and knives to modern methods utilizing instruments like the tonsillotome. Key indications for tonsillectomy outlined include recurrent infection, sleep disorders, and airway obstruction. Innovative techniques described are intracapsular tonsillectomy using microdebriders or lasers, as well as coblation and harmonic scalpel methods. Studies show these new techniques reduce postoperative pain and recovery time compared to electrocautery. Adjuvant therapies explored are local anesthetics like bupivacaine and perioperative steroids like dexamethas
This document discusses nasal polyposis, including its definition, epidemiology, etiology, pathogenesis, pathology, symptoms, signs, diagnosis and treatment. Some key points include:
- Nasal polyps are soft, non-cancerous growths that develop in the nasal cavity or sinuses. The two main types are ethmoidal polyps and antrochoanal polyps.
- Ethmoidal polyps are more common in adults and often associated with chronic rhinosinusitis, asthma or allergies. Antrochoanal polyps usually present in adolescents and originate in the maxillary sinus.
- Symptoms include nasal obstruction, loss of smell, discharge and headaches. Diagnosis involves
This document provides an overview of epistaxis (nosebleeds), including causes, locations, clinical approach, and management. It notes that epistaxis affects 5-10% of the population annually and can originate from the nose, nasopharynx, paranasal sinuses, or anterior cranial fossa. Local causes include trauma, inflammation, and tumors, while systemic causes involve conditions like hypertension, coagulopathies, and liver/kidney disease. Anterior nosebleeds are more common and originate from Little's area, while posterior bleeds originate from the sphenopalatine artery. Clinical assessment involves history, exam, and identifying the bleeding site. Management includes vasoconstrictors, caut
Diana Harbuz provides a summary of common ENT issues including:
1. Mastoiditis, otitis externa, perichondritis, and haematoma in the ears section.
2. Epistaxis and sinusitis/meningitis/CSF rhinorrhoea in the nose section.
3. Peritonsillar abscess, epiglottitis, retropharyngeal abscesses, Ludwigs angina, laryngomalacia, and angiooedema in the throat section.
4. Emergency management of laryngectomy/tracheostomy patients, parotitis, and facial cellulitis referral guidelines in the head and neck
otosclerosis....
stapedectomy vs stapedotomy
complication of otosclerotic surgery
management of otosclerotic surgery complications
techniques
latest trends
1) Otosclerosis is a disease of the bony labyrinth where normal bone is replaced by spongy vascular bone. It most commonly causes conductive hearing loss.
2) Stapedial otosclerosis is the most common type and results in a lesion in front of the oval window causing progressive conductive hearing loss.
3) Treatment options include hearing aids for mild cases and stapes surgery to replace the stapes footplate for more severe conductive hearing loss. Complications of stapes surgery include sensorineural hearing loss or perilymph fistula.
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
The document discusses infectious rhinosinusitis and provides details on:
1. Rhinosinusitis is inflammation of the nose and paranasal sinuses characterized by nasal obstruction, discharge, facial pain and loss of smell. Acute rhinosinusitis is usually caused by viral infection but can become bacterial.
2. Chronic rhinosinusitis lasts over 12 weeks and is characterized by persistent inflammation not resolved by treatment. The role of bacteria is unclear but biofilms and osteitis may perpetuate inflammation.
3. Imaging like CT is used to confirm acute rhinosinusitis especially in severe cases, while most cases are diagnosed clinically. Treatment involves analgesics, decongestants and antibiotics if bacterial infection
Vocal nodules are benign, bilateral growths on the vocal cords caused by overuse or misuse of the voice. They are usually treated with voice therapy and rest, and may require surgery if not improved after 3-6 months. Vocal polyps are also benign growths but are usually unilateral and caused by vocal trauma or irritants like smoking. They are typically treated with excision during microlaryngoscopy. Reinke's edema is a bilateral swelling of the vocal cords caused by irritants like smoking, and is treated by removing the fluid or tissue via stripping under microlaryngoscopy along with voice therapy.
Battered baby syndrome, also known as Caffey's syndrome, refers to a combination of physical injuries in an infant or young child caused by non-accidental violence from a parent or guardian. Common signs include inconsistent stories about the injuries, multiple bruises of different ages, delays in seeking medical care, repeated injuries over time, and injuries more common in unwanted, youngest or only children from low-income families with relationship issues. Physical manifestations can include skull fractures, broken ribs, bleeding between the brain and skull, retinal hemorrhages, bruises, burns and torn lip frenulums. Shaken baby syndrome is a type of head injury that can occur from just 5 seconds of violent shaking and may lead to seizures or
This document summarizes various diseases of the external ear, including congenital conditions, infections, and other abnormalities. It describes conditions such as Darwin's tubercle, Wildermuth's ear, Mozart's ear, microtia, macrotia, bat ears, lop ear, cup ear, accessory auricles, preauricular sinus, hematoma auris, perichondritis, furunculosis, otitis externa, otitis media, granular myringitis, bullous myringitis, necrotizing otitis externa, and malignant otitis externa. For each condition, it provides details on causes, signs, symptoms, pathology,
Презентация предназначена для краткого ознакомления с заболеванием острый тонзиллит. В данной презентации изложены: определение, этиология, клиническая картина и формы заболевания.
2. Аденоиды – это лимфатические железы, расположенные в задней части горла, там,
где соединяются носовой и ротовой проходы.
Все лимфатические железы, в том числе аденоиды, производят лимфоциты - белые
кровяные клетки, которые борются с инфекциями. Аденоиды расположены так, что они
фильтруют и, обычно, уничтожают любой вирус, который попадает к ним через нос.
4. Этиология:
У детей раннего возраста гипертрофию аденоидной ткани до определенного
возраста можно отнести к физиологическому явлению, отражающему
формирование защитной системы на пути проникновения микроорганизмов со
струей воздуха в верхние дыхательные пути.
5. Этиология:
Предрасполагающими к гипертрофии аденоидной ткани факторами могут быть:
1. возрастная несовершенность иммунологических процессов;
2. воспалительные заболевания глотки;
3. различные детские инфекционные заболевания и повышенная аллергизация детского
организма в связи с частыми острыми респираторно-вирусными заболеваниями
(гемолитические стрептококки, стафилококки, гемофильная палочка, моракселла,
пневмококки);
4. эндокринные нарушения;
5. гиповитаминозы;
6. аномалии конституции (диатез);
7. грибковая инвазия (заражение);
8. неблагоприятные социальные и бытовые условия;
9. радиационное и другие виды воздействия, снижающие реактивность организма.
6. Патогенез:
В патогенезе этого заболевания играет роль как возрастная незрелость евстахиевых
труб, так и их закупорка гиперплазированной тканью глоточной миндалины, а также
горизонтальное распространение инфекции, персистирующей в ткани аденоидов.
Лимфоцитарно-лимфобластная гиперплазия – следствие повторного усиления
функциональной активности глоточной миндалины под влиянием часто повторяющихся
местных воспалительных изменений при различных инфекционных заболеваниях,
особенно протекающих на фоне аллергии и при несовершенстве иммунологических
процессов у детей младшего возраста.
7. Степени развития:
1 степень. Разрастание глоточной миндалины приводит к закрытию ею только
высоты носовых ходов либо верхней части сошника;
2 степень. За счет увеличения глоточной миндалины закрывается порядка 2/3 от
высоты носовых ходов либо 2/3 сошника;
3 степень. Увеличение глоточной миндалины приводит к закрытию практически
всего сошника.
10. Острый аденоидит. Глоточная миндалина отечна, гиперемирована, на поверхности
прослеживается гнойное отделяемое. Интоксикация умеренная, выражено затруднение
носового дыхания.
Подострый аденоидит. Развитие подострой формы происходит, преимущественно, на
фоне острой формы с характерной субфебрильной температурой (в некоторых случаях
возможен ее более высокий подъем). Также отмечается гнойный насморк затяжного
характера, шейный лимфаденит, в некоторых случаях рецидивирующий и
консервативному лечению не поддающийся, кашель и острый средний отит.
11. Хронический аденоидит. Хроническая форма аденоидита становится следствием
ранее перенесенной острой формы заболевания, при этом она нередко сочетается с
увеличением, образующимся в глоточной миндалине.
Как правило, хронический аденоидит выражается в следующих проявлениях:
• Затрудненность носового дыхания;
• Насморк (постоянный катаральный, реже – насморк постоянный гнойный);
• Частые обострения заболевания, проявляющиеся в подъемах температуры в среднем
до 38 градусов, а также в усилениях насморка и заложенности носа;
Достаточно часто параллельными заболеваниями возникают средний гнойный отит и
синусит, а также воспаления в области нижних дыхательных путей либо обострения
хронического типа заболеваний, связанных с ЛОР-органами.
12. Диагностика
Во врачебной практике используется перечень инструментальных исследований и
диагностических приемов, которые необходимо делать для подтверждения диагноза. А
именно:
Пальцевое исследование носоглотки – методика с наименьшей
информативностью визуализации, позволяет получить информацию
об аденоидах на ощупь.
Рентгенографическое исследование – методика дает больше
информации, но детям делать нельзя из-за лучевой нагрузки.
13. Компьютерная томография – методика с
максимальной информативностью, но не всем
доступна из-за своей дороговизны.
Эндоскопический метод – основная методика для распознавания аденоидов, имеет
два варианта: «эндоскопическая риноскопия», выполняемая через нос; «эндоскопическая
эпифарингоскопия» производится через полость рта.
14. Задняя риноскопия – частый метод, применяемый в отоларингологии –
осмотр через рот в специальные зеркала.
17. Аденоид Ангиофиброма
Ангиофиброма, в основном у мальчиков, отличается рецидивирующими
кровотечениями в анамнезе, плотной консистенцией и выраженным сосудистым
рисунком при задней риноскопии.
18. Аденоид Антрохоанальный полип
Антрохоанальный полип исходит из верхнечелюстной или клиновидной
пазух, имеет ножку, гладкую поверхность и бледно-розовый цвет, может
баллотировать при форсированном дыхании или пальпации.
19. Аденоид Мозговая грыжа
Мозговая грыжа исходит из свода носоглотки, имеет гладкую овальную
поверхность, серовато-голубой цвет.
21. Лечение зависит не только от степени гипертрофии миндалины, но и от
клинических проявлений.
Гипертрофия аденоидов второй, третьей степени является показанием к
операции - аденотомии; при разрастаниях I степени показана консервативная
терапия.
В некоторых случаях, даже при незначительном увеличении аденоидов, когда
нет выраженного нарушения носового дыхания, но имеется нарушение
проходимости слуховой трубы, частые отиты, понижение слуха, ребенку показано
оперативное вмешательство - аденотомия.
22. Консервативные методы включают антигистаминную терапию,
гомеопатические средства местно: препараты, содержащие раствор серебра
(колларгол, протаргол в нос), эуфорбиум - спрей в нос, лимфомиозот - по схеме,
поливитамины, физиопроцедуры.
23. Хирургическое лечение - аденотомия, часто проводится как в стационаре,
так и в амбулаторных условиях, с предварительным обследованием, включающим
клинический анализ крови, время кровотечения и время свертываемости, анализ
мочи, при показаниях - и другие анализы, осмотр педиатра (терапевта), санация
полости рта.
24. Операция производится кольцевидным ножом - аденотомом Бекмана под
аппликационной анестезией, а в некоторых случаях и под кратковременным
наркозом.