Ekek

1. Epistaxis

2. Definition :
 It is bleeding per nose
 Epistaxis, or a nosebleed, is when you
lose blood from the tissue that lines the
inside of your nose

3.  Anatomy :
 The main blood vessils that contributes in
epistaxis are :
 1. Anterior ethmoidal artery – from the
internal carotid artery
 2. Greater palatine artery
 3. Sphenopalatine artery
 4. Superior labial artery

4. Causes.:
A. Local :
1.Idiopathic < 90%
2. Nasal picking specialy in children
3. Trauma
4. Foreign body nose
5. After nasal surgery
6. Inflamatory e.g chronic sinusitis
7. fever

5. 8. dry weather
9. hot weather
10. cold weather
11. benign and malignant tumours of the
nose , paranasal sinuses and nasopharynx

6. B. General :
1. Hypertension
2.Raised venous pressure in cardiac or
pulmonary diseases e. g miteral stenosis
3. Renal failure
4. Chronic liver diseases e g liver cirrhosis
or liver failure

7. 5. Diseases of blood and blood vessels :
- Leukaemia
- Haemophelia
- Christmas disease (lack of Vit K )
- Purpura(Purpura occurs when small blood vessels leak blood under the skin. )
- Sickle cell anaemia
- Vit C diffeciency

8. Sites Of Bleeding :
1. nasal septum : Little’s area (Kiesseibach’s
plexus ) 75%-90% of all cases of epistaxis
arises from the septum .
2. inferior turbinates and nasal floor
3 . above the middle turbinate : arises from
anterior ethmoidal artery and usually occurs
in hypertensive patients

10. Little’s Area anatomy

11.  4. Wood rough’s area : it is a venous
plexus in the posterior end of the inferior
turbinate and it is the commonest site of
bleeding in hypertensive patients

12. Treatment :
A. Immediate :
1. Pressure on the nostril compresses the vessels
in Little’s area
2. packing of the nose :
- anterior nasal packing with gauze impregnated in
vaselin or tetracycline ointment
- posterior nasal packing by gauze or Foley’s
catheter

13. B. Curative and preventive :
Done when immediate treatment fails or
repeated bleeding occurs :
1. cauterization of the bleeding point either
with galvanocautery or silver niterate
(chemical cautery )
2. examination under general anesthesia to
identify the site of bleeding

14. 3 . arterial ligation done on rare occasions
when packing and cautery fails
- external carotid artery
- ligation or clipping of the maxillary artery
-- ethmoidal artery

15. Foley’s catheter(nasal packing)

16. Anterior nasal pack

17. Laryngitis
 Laryngitis is an inflammation of your
voice box (larynx) from overuse,
irritation or infection.
 Inside the larynx are your vocal cords
— two folds of mucous membrane
covering muscle and cartilage.
Normally, your vocal cords open and
close smoothly, forming sounds
through their movement and
vibration.

19. Symptoms
In most cases laryngitis symptoms last less than a
couple of weeks and are caused by something minor,
such as a virus. Less often, laryngitis symptoms are
caused by something more serious or long lasting.
Laryngitis signs and symptoms can include:
 Hoarseness
 Weak voice or voice loss
 Tickling sensation and rawness in your throat
 Sore throat
 Dry throat
 Dry cough

20. Causes
Acute laryngitis
 Most cases of laryngitis are temporary and improve
after the underlying cause gets better. Causes of
acute laryngitis include:
 Viral infections similar to those that cause a cold
 Vocal strain, caused by yelling or overusing your
voice
 Bacterial infections, although these are less
common

21. Continue
Chronic laryngitis can be caused by:
 Inhaled irritants, such as chemical fumes, allergens or
smoke
 Acid reflux, also called gastroesophageal reflux disease
(GERD)
 Chronic sinusitis
 Excessive alcohol use
 Habitual overuse of your voice (such as in singers or
cheerleaders)
 Smoking
Less common causes of chronic laryngitis include:
 Bacterial or fungal infections
 Infections with certain parasites

22. Risk factors
Risk factors for laryngitis include:
 Having a respiratory infection,such as a
cold, bronchitis or sinusitis
 Exposure to irritating substances, such
as cigarette smoke, excessive alcohol
intake, stomach acid or workplace
chemicals
 Overusing your voice, by speaking too
much, speaking too loudly, shouting or
singing

23. Prevention
 Avoid smoking and stay away from
secondhand smoke.Smoke dries your
throat. It can also cause your vocal cords
to become irritated.
 Limit alcohol and caffeine.These cause
you to lose total body water.
 Drink plenty of water. Fluids help keep
the mucus in your throat thin and easy to
clear.

24.  Keep spicy foods out of your diet. Spicy
foods can cause stomach acid to go into
the throat or esophagus. This can lead to
heartburn or gastroesophageal reflux
disease (GERD).
 Include a variety of healthy foods in
your diet. Eat fruits, vegetables and whole
grains. These have several vitamins, such
as vitamins A, E and C, that are important
for overall health. These foods can also
help keep the mucous membranes in the
throat healthy.

25.  Avoid clearing your throat. This does
more harm than good, because it causes
an abnormal vibration of your vocal cords
and can increase swelling. Clearing your
throat also causes your throat to secrete
more mucus and feel more irritated,
making you want to clear your throat
again.
 Avoid upper respiratory
infections. Wash your hands often, and
avoid contact with people who have upper
respiratory infections such as colds.

26. Diagnosis
 The most common sign of laryngitis is hoarseness
 Laryngoscopy. In a procedure called laryngoscopy,
your doctor can visually examine your vocal cords by
using a light and a tiny mirror to look into the back of
your throat. Or your doctor may use fiber-optic
laryngoscopy. This involves inserting a thin, flexible
tube (endoscope) with a tiny camera and light through
your nose or mouth and into the back of your throat.
Then your doctor can watch the motion of your vocal
cords as you speak.
 Biopsy. If your doctor sees a suspicious area, he or
she may do a biopsy — taking a sample of tissue for
examination under a microscope.

27. Treatment
 Acute laryngitis often gets better on its
own within a week or so. Self-care
measures, such as voice rest, drinking
fluids and humidifying your air, also can
help improve symptoms.
 Chronic laryngitis treatments are aimed at
treating the underlying causes, such as
heartburn, smoking or excessive use of
alcohol

28. Medications used in some cases include:
 Antibiotics. In almost all cases of laryngitis, an
antibiotic won't do any good because the cause is
usually viral. But if you have a bacterial infection, your
doctor may recommend an antibiotic.
 Corticosteroids. Sometimes, corticosteroids can help
reduce vocal cord inflammation. However, this
treatment is used only when there's an urgent need to
treat laryngitis — such as in some cases when a
toddler has laryngitis associated with croup.

29. Deviated nasal septum
 A deviated septum is a
condition where the nasal
septum is crooked. Most
people have a slight
deviation, only severe
deviations need treatment.

32. Causes
 A deviated septum can be caused by:
 A condition present at birth. In some
cases, a deviated septum occurs when the
fetus develops in the womb and is
apparent at birth.
 Injury to the nose. A deviated septum can
also be the result of an injury that causes
the nasal septum to be moved out of
position.

33. Complications
A severely deviated septum causing nasal
blockage can lead to:
 Dry mouth, due to chronic mouth
breathing
 A feeling of pressure or congestion in
your nasal passages
 Disturbed sleep, due to the
unpleasantness of not being able to
breathe comfortably through your nose at
night

34. Risk factors
For some people, a deviated septum is present
at birth — occurring during fetal development or
due to injury during childbirth. After birth, a
deviated septum is most commonly caused by an
injury that moves your nasal septum out of place.
Risk factors include:
 Playing contact sports
 Not wearing your seat belt while riding in a
motorized vehicle

35. Diagnosis
 To examine the inside of your nose, the
doctor will use a bright light and
sometimes an instrument designed to
spread open your nostrils. Sometimes the
doctor will check farther back in your nose
with a long tube-shaped scope with a
bright light at the tip. The doctor may also
look at your nasal tissues before and after
applying a decongestant spray.

36. Treatment
 Mild septal deviation may cause occasional
symptoms. You can treat these symptoms with
over-the-counter (OTC) medications, including:
 Nasal decongestants. (You shouldn’t use nasal
decongestant sprays for more than three days in
a row. It could cause rebound congestion.)
 Nasal steroid sprays.
 Antihistamines.

37. Septoplasty
 The most common deviated septum treatment
is septoplasty. If you have breathing problems,
frequent sinus infections or other bothersome
symptoms, a septoplasty may be an option for
you.
 During a septoplasty, a surgeon reshapes your
septum. This may involve adding or removing
bone and cartilage.
 Typically, septoplasty is an outpatient procedure. It
takes between 30 and 90 minutes to complete.

38. Tonsillitis
 Tonsillitis is
inflammation of the
tonsils, two oval-
shaped pads of tissue
at the back of the
throat — one tonsil on
each side

39. Symptoms
 Red, swollen tonsils
 White or yellow coating or patches on the tonsils
 Sore throat
 Difficult or painful swallowing
 Fever
 Enlarged, tender glands (lymph nodes) in the neck
 A scratchy, muffled or throaty voice
 Bad breath
 Stomachache
 Neck pain or stiff neck
 Headache

40. Causes
 Tonsillitis is most often caused by common
viruses, but bacterial infections also can
be the cause.
 The most common bacterium causing
tonsillitis is Streptococcus pyogenes
(group A streptococcus), the bacterium
that causes strep throat. Other strains of
strep and other bacteria also may cause
tonsillitis.

41. Risk factors
Risk factors for tonsillitis include:
 Young age. Tonsillitis most often affects
children, and tonsillitis caused by bacteria
is most common in children ages 5 to 15.
 Frequent exposure to germs.School-age
children are in close contact with their
peers and frequently exposed to viruses or
bacteria that can cause tonsillitis.

42. Complications
 Disrupted breathing during sleep
(obstructive sleep apnea)
 Infection that spreads deep into
surrounding tissue (tonsillar cellulitis)
 Infection that results in a collection of pus
behind a tonsil (peritonsillar abscess)

43. Diagnosis
 Using a lighted instrument to look at your child's throat
and likely his or her ears and nose, which also may be
sites of infection
 Checking for a rash known as scarlatina, which is
associated with some cases of strep throat
 Gently feeling (palpating) your child's neck to check for
swollen glands (lymph nodes)
 Listening to his or her breathing with a stethoscope
 Checking for enlargement of the spleen (for
consideration of mononucleosis, which also inflames the
tonsils)

44. Treatment
At-home care strategies to use during the recovery time
include the following:
 Encourage rest. Encourage your child to get plenty of
sleep.
 Provide adequate fluids. Give your child plenty of
water to keep his or her throat moist and prevent
dehydration.
 Provide comforting foods and beverage. Warm
liquids — broth, caffeine-free tea or warm water with
honey — and cold treats like ice pops can soothe a
sore throat.

45.  Offer lozenges. Children older than age 4 can suck
on lozenges to relieve a sore throat.
 Avoid irritants. Keep your home free from cigarette
smoke and cleaning products that can irritate the
throat.
 Treat pain and fever. Talk to your doctor about
using ibuprofen (Advil, Children's Motrin, others) or
acetaminophen (Tylenol, others) to minimize throat
pain and control a fever. Low fevers without pain do

46.  Prepare a saltwater gargle. If your child can
gargle, a saltwater gargle of 1/2 teaspoon (2.5
milliliters) of table salt to 8 ounces (237
milliliters) of warm water can help soothe a
sore throat. Have your child gargle the solution
and then spit it out.
 Humidify the air. Use a cool-air humidifier to
eliminate dry air that may further irritate a sore
throat, or sit with your child for several minutes
in a steamy bathroom.

47. 
Antibiotics
 If tonsillitis is caused by a bacterial
infection, your doctor will prescribe a
course of antibiotics. Penicillin taken by
mouth for 10 days is the most common
antibiotic treatment prescribed for tonsillitis
caused by group A streptococcus. If your
child is allergic to penicillin, your doctor will
prescribe an alternative antibiotic

48. Surgical management
 Surgery to remove tonsils (tonsillectomy) may
be used to treat frequently recurring tonsillitis,
chronic tonsillitis or bacterial tonsillitis that
doesn't respond to antibiotic treatment.
Frequent tonsillitis is generally defined as:
 At least seven episodes in the preceding year
 At least five episodes a year in the past two
years
 At least three episodes a year in the past three
years

49. Thank you
Sahar