Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Presented by Subhangi Shukla on topic diseases of nasal passage .
5 Diseases are here discussed and effect of covid on nasal passage with introduction of black fungus.
Pleases Follow, like and comment if you like PPT
Nasal discharge, also known as rhinorrhea, is a common symptom that can be caused by a variety of conditions related to the ear, nose, and throat (ENT). It is the result of excess mucus production in the nasal cavity, which can be caused by inflammation or infection of the nasal passages.
Common causes of nasal discharge include allergies, colds, sinus infections, and nasal polyps. Allergies can cause the nasal passages to become inflamed and produce excess mucus, leading to a runny nose. Colds and sinus infections can also cause inflammation and infection, leading to nasal discharge.
Nasal polyps are growths in the nasal cavity that can obstruct airflow and cause chronic inflammation and excess mucus production. Other less common causes of nasal discharge include foreign bodies in the nasal cavity, tumors, and hormonal changes during pregnancy.
Treatment for nasal discharge depends on the underlying cause. For allergies, antihistamines and nasal corticosteroids may be recommended. For colds and sinus infections, decongestants, saline nasal sprays, and antibiotics may be used. Nasal polyps may require surgical removal.
In addition to nasal discharge, other symptoms that may be present with ENT-related conditions include nasal congestion, headache, facial pain or pressure, cough, and sore throat. If nasal discharge is persistent, accompanied by other symptoms, or affects quality of life, it is important to seek medical evaluation by an ENT specialist.
Similar to Inflamatory diseases of the nose (1) 30.05.16 dr.davis (20)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
3. Definition
• Atrophic rhinitis is defined as a chronic nasal disease
characterised by progressive atrophy of the nasal mucosa
along with the underlying bones of turbinates.
• There is also associated presence of viscid secretion which
rapidly dries up forming foul smelling crusts.
• This fetid odour is also known as ozaena.
• The nasal cavity is also abnormally patent.
• The patient is fortunately unaware of the stench emitting
from the nose as this disorder is associated with merciful
anosmia.
4. Aetiology
The etiology of this problem still remains obscure.
Numerous pathogens have been associated with this condition,
the most important of them are
• 1. Coccobacillus,
• 2. Bacillus mucosus,
• 3. Coccobacillus foetidus ozaenae,
• 4. Diptheroid bacilli and
• 5. Klebsiella ozaenae.
These organisms despite being isolated from the nose of
diseased patients have not categorically been proved as the
cause for the same.
7. COMMONEST CAUSE OF UNILATERAL
ATROPHIC RHINITIS
GROSSLY DEVIATED SEPTUM
MECHANICAL THEORY OF ZAUFAL – It
states that skeletal defects due to gross septal
deviation to one side leads to unilateral atrophic
rhinitis on the roomy side.
8. Pathology:
1. Metaplasia of ciliated columnar nasal epithelium into
squamous epithelium.
2. There is a decrease in the number and size of compound
alveolar glands
3. Loss of cilia
4. Atrophy of nerves
5. Fibrosis of lamina propria
9. Type I
is characterised by the presence of endarteritis and
periarteritis of the terminal arterioles.
This could be caused by chronic infections.
These patients benefit from the vasodilator effects of
oestrogen therapy.
10. Type II
is characterised by vasodilatation of the capillaries,
these patients may worsen with estrogen therapy.
They also showed a positive reaction for alkaline
phosphatase suggesting the presence of active bone
resorption.
12. Clinical features:
Nasal obstruction - crust formation
atrophic nerve endings
Thick crusts
Epistaxis
Anosmia
Offensive smell perceived by others
Headache
Impairment of hearing
Associated changes in pharynx & larynx
13. Clinical examination
Clinical examination of these patients show that their
nasal cavities filled with foul smelling greenish, yellow or
black crusts,
the nasal cavity appear to be enormously roomy.
When these crusts are removed bleeding starts to occur
Septal perforations &external deformity
14. Why nasal obstruction even in
the presence of roomy nasal
cavity?
• The nasal cavity is filled with sensory nerve endings close
to the nasal valve area.
• These receptors sense the flow of air through this area
thus giving a sense of freeness in the nasal cavity.
• These nerve endings are destroyed in patients with
atrophic rhinitis thus depriving the patient of this
sensation.
• In the absence of these sensation the nose feels blocked.
18. CT scan findings
1. Mucoperiosteal thickening of paranasal sinuses
2. Loss of definition of osteomeatal complex due to
resorption of ethmoidal bulla and uncinate process
3. Hypoplastic maxillary sinuses
4. Enlargement of nasal cavity with erosion of the lateral
nasal wall
5. Atrophy of inferior and middle turbinates
19.
20.
21. Conservative Treatment
1.Nasal douching - The patient must be asked to douche
the nose atleast twice a day with a solution prepared with:
Sodium bicarbonate - 28.4 g
Sodium biborate - 28.4 g
Sodium chloride - 56.7 g
mixed in 280 ml of luke warm water.
The crusts may be removed by forceps or suction.
2. 25% glucose in glycerin drops can be applied to the nose
thus inhibiting the growth of proteolytic organism.
22. Conservative
• In patients with histological type I atrophic rhinitis oestradiol
in arachis oil 10,000 units/ml can be used as nasal drops.
• Kemecetine antiozaena solution - is prepared with
chloramphenicol 90mg, oestradiol dipropionate 0.64mg,
vitamin D2 900 IU and propylene glycol in 1 ml of saline.
• Potassium iodide can be prescribed orally to the patient in an
attempt to increase the nasal secretion.
• Systemic streptomycin injection
• Systemic use of placental extracts have been attempted with
varying degrees of success.
23. Surgical treatment
Aims
- to narrow the widened nasal cavity
- diminish drying and crust formation
- rest the mucosa and allow regeneration
24. Surgical management
1. Submucous injections of paraffin, .
2. Recently teflon strips, and autogenous cartilages
have been inserted along the floor and lateral nasal
wall after elevation of flaps.
3. Wilson's operation - Submucosal injection of 50%
Teflon in glycerin paste.
4. Witmack’s operation – rerooting of parotid duct
5. Lautenslager’s operation – medialisation of lateral
wall
6. Repeated stellate ganglion blocks have also been
employed with some success
25. 7. Young's operation
• This surgery aims at closure of one or both nasal cavities
by plastic surgery.
• After a period of 6 to 9 months when these flaps are
opened up the mucosa of the nasal cavities have found to
be healed.
• This can be verified by postnasal examination before
revision surgery is performed.
8.Modifications of this procedure has been suggested
(modified Young's operation) where a 3mm hole is left
while closing the flaps in the nasal vestibule. This enables
the patient to breath through the nasal cavities
28. It is a chronic granulomatous fungal disease of the
nose caused by Rhinosporidium Seeberi/ Kinealyi.
Mode of Transmission:
1. Exact mode is not known.
2.Acquired by swimming in contaminated ponds.
3.Inhaling the dust of dried cowdung.
Malignant:- Deep seated and multiple, spreading
through systemic route. Generalised
Rhinosporidiosis.
29. Incidence:- 95% from India & Srilanka
Male: Female – 2:1
Tamil Nadu – Hyperendemic areas – madurai
& Ramnad, Thirumangalam, Rajapalayam,
Sivagangai (Large Ponds)
Affects –Nasal mucosa, Conjunctiva, Sclera,
Tonsils, Genitalia and Skin
30. Trauma – Predisposing factor – infective spores
enter through traumatised nasal mucosa and
multiply in the submucosa forming sporangia.
Spores are discharged into tissues and cause
reactive hyperplasia and lead to formation of
vascular mass.
31. CLASSIFICATION – Anatomical Sites
1. Nasal (78%)
a. Mucous membrane of septum
b. Spur in nasal floor
c. Lateral wall
2. Nasopharyngeal (16%)
a. Upper aspect of palate
3. Mixed
a. Naso – nasopharyngeal (6.3%)
b. Ethmoido – nasopharyngeal
c. Naso – lacrimal
4. Bizaree
a. Conjuntival
b. Tarsal
c. Cutaneous
d. Laryngeal
33. Staining Method
Spherule is made up of liproprotein coat with protein
matrix and feulgen positive centre
Bromophenol blue – spherules
Bismark brown – wall of spherules
Sudan black B – Lipoprotein coat.
39. Investigations
Routine Blood and Urine investigations.
Histamine level to be estimated – Histamine content
of Rhinosporidiosis is increased so proliferates quickly
and bleeds profusely.
X-Ray PNS.
Microscopic (KOH) examination of nasal discharge.
DNE.
HPE.
40. Treatment
Wide excision of the mass along with basal cautery.
Dapsone 100 mg daily to prevent recurrence (arrest
the maturation of spores).
Side effects – Methaemoglobinemia
Hepatotoxicity
Recurrence – 1) Incomplete removal
2) Submucosal presence of spores
3) Multiple sites.
42. It is a chronic granulomatous disease of the nose,
caused by Gram negative, non motile, encapsulated,
diplobacillus, Klebsiella Rhinoscleromatis (Frisch
Bacillus).
Site – Nose, nasopharynx, oropharynx, larynx, trachea
and bronchi.
Common in females.
Predisposing factors – Poor hygiene and low socio
economic status.
43. Pathogenesis:
Droplet infection
Clinical features:
1) Atrophic stage.
2) Granulomatous stage – Tapir Nose (Subdermal
infiltration of the nodules in lower part of nose &
upper lip giving a woody feel).
3) Cicatricial stage – Hebra Nose (Scarring, enlargement
& disfigurement of the nose).
44. Histology
Mikulicz cells – Presence of scattered large foam cells
with a central nucleus and vacuolated cytoplasm
containing the bacilli.
Russel bodies – Plasma cells with eosinophilic,
homogenous inclusion bodies .
45. Investigations
Biopsy & HPE
Culture of the organism in Mc-conkey agar medium
and staining by PAS and Giemsa stains.
X Ray skull lateral view – ‘V’ shaped soft palate
attachment – Palatal sign – Gothic arch deformity
47. Rhinitis Medicamentosa
The prolonged usage of Sympathomimetic nasal
decongesant drops and sprays leads to Tachyphylaxis
resulting in rebound vasodilatation & engorgement of
nasal mucosa leads to nasal obstruction.
48. Rhinitis Sicca :
It is a form of rhinitis characterised by dryness of
nose, limited to the anterior part of nasal cavity. It
occurs in people who work in hot and dry
surroundings.
Rhinitis Caseosa:
It is a chronic nasal disease characterized by the
presence of caseous cholesteatoma like material with
granulations in the nose. It is also called nasal
cholesteatoma.
49. Stewart’s Granuloma
It is also called peripheral sinonasal T-cell lymphoma.
It presents as an indurated swelling of the nose, nasal
vestibule and septum.
HPE – dense collection of cells especially
lymphocytes.
Treatment : Radiotherapy.
50. Wegener’s Granuloma
It is an autoimmune disease of unknown aetilogy
characterised by necrotising granuloma and vasculitis
of the upper and lower airways, systemic vasculitis
and focal necrotising glomerulonephritis.
Diagnosis by nasal biopsy.
Treatment : Saline nasal douching
Cyclophosphamide 1-2 mg/kg/day
High dose of steroids.
53. Pathogenesis
Neglected foreign body/ blood clot /
inspissated mucus -nidus
↓
Granulations formation
↓
Calcium, mg CO 3 or PO4 gets deposited
↓
Hard rhinolith
↓
Enlarges & nerosis of septum
54. CLINICAL FEATURES
Unilateral nasal discharge
Nasal obstruction
Occasional epistaxis
Sometimes asymptomatic
AR – irregular , grey or greyish black mass along the
floor
On probing – gritty sensation
55. Diagnosis
- History , examination
- X- ray PNS
Treatment
surgical excision – endoscopic
lateral rhinotomy
56. NASAL MYIASIS
SYNONYM – maggots in the nose
Suppurative conditions of nose / unhygenic living
condition
↓
attracts flies – chrysomiya , lay eggs
↓
hatch & grow into larvae
↓
Crawl into nasal cavity & surrounding regions
58. Clinical features
Irritation of nose
Watering of eyes
Swelling & puffiness of eyelids, lips
Thin blood stained nasal discharge to epistaxsis
Foul smell
Formication – Crawling sensation in the nose.
AR- multiple maggots with purulent, foul smelling
nasal discharge
60. Treatment
Handpicked with nasal dressing forceps
Instillation of 25% chloroform or turpentine oil
Douching with warm saline
Treat complications
Treat underlying cause
