This document discusses various otolaryngological manifestations of systemic diseases such as HIV, tuberculosis, and sarcoidosis. It provides detailed information on common oral, ear, nose, throat, and neck conditions seen in patients with these diseases, including oral candidiasis, Kaposi's sarcoma, cervical lymphadenopathy, tuberculosis of the larynx, and sarcoidosis of the parotid gland and facial nerve. The document also outlines treatments for many of these conditions.
Clinical features and diagnosis of rhinosinusitiskrishnakoirala4
Plain C.T. scan and M.R.I. are useful imaging modalities for evaluating sinusitis and its complications. C.T. scan is most reliable for delineating the extent of disease and defining anatomical variants. M.R.I. helps assess intracranial extension and orbital complications.
This document discusses conditions of the nasal septum, including deviated nasal septum, septal hematoma, septal abscess, and septal perforation. It describes the causes, symptoms, and treatment options for each condition. Deviated nasal septum is often caused by trauma or developmental factors and can be corrected through septoplasty or submucosal resection of the septum. Septal hematoma and abscess develop due to bleeding or infection under the septal cartilage and require drainage and antibiotics. Septal perforation has various etiologies and may be treated with flaps or an obturator.
Rhinosinusitis is commonly referred to as sinusitis. Here, we walk you through its classification, predisposing factors, pathophysiology, signs, symptoms, diagnosis, treatment, complications, and prognosis.
Rhinosinusitis: clinical features and diagnosis kkkrishnakoirala4
Rhinosinusitis is inflammation of the nose and paranasal sinuses. It can be acute (<4 weeks), subacute (4-12 weeks), or chronic (>12 weeks). Types include unilateral/bilateral, maxillary/frontal/ethmoidal/sphenoidal sinus involvement. Common causes are rhinitis, dental issues, and trauma. Clinical features include nasal discharge, obstruction, headache, and facial pain. Diagnosis involves endoscopy, imaging like CT scan, and culture/sensitivity of secretions. CT scan is most reliable for delineating sinus anatomy and disease extent.
Sinusitis is inflammation of the paranasal sinuses that can be acute or chronic. Acute sinusitis lasts less than 4 weeks and is usually caused by a viral infection leading to secondary bacterial infection when the sinus defenses are breached. It can be caused by infections, swimming/bathing, trauma, or general diseases. The osteomeatal complex is an important drainage site that when blocked can cause bacterial sinusitis. Treatment involves antibiotics, nasal decongestants, antihistamines, and anti-inflammatories while surgery is rarely needed and complications are common.
Clincal presentation and investigations of rhinosinusitisEunice Abdulai
This document provides an overview of rhinosinusitis, including its definition, types, clinical presentation, investigations, differential diagnosis, and potential complications. Rhinosinusitis is inflammation of the nose and paranasal sinuses that can be acute (<12 weeks) or chronic (>12 weeks, with or without polyps). Common symptoms include nasal congestion, discharge, facial pain or pressure. Investigations may include imaging like CT scans, as well as blood tests and microbiological cultures. Potential complications involve nearby structures like the eyes, brain and bones.
This document discusses sinusitis, defined as an infection of the para nasal sinuses. It describes the different types of sinusitis, risk factors, stages of pathology, clinical manifestations, diagnostic tests, potential complications, management with medications and surgery, and surgical procedures for treating sinusitis.
Clinical features and diagnosis of rhinosinusitiskrishnakoirala4
Plain C.T. scan and M.R.I. are useful imaging modalities for evaluating sinusitis and its complications. C.T. scan is most reliable for delineating the extent of disease and defining anatomical variants. M.R.I. helps assess intracranial extension and orbital complications.
This document discusses conditions of the nasal septum, including deviated nasal septum, septal hematoma, septal abscess, and septal perforation. It describes the causes, symptoms, and treatment options for each condition. Deviated nasal septum is often caused by trauma or developmental factors and can be corrected through septoplasty or submucosal resection of the septum. Septal hematoma and abscess develop due to bleeding or infection under the septal cartilage and require drainage and antibiotics. Septal perforation has various etiologies and may be treated with flaps or an obturator.
Rhinosinusitis is commonly referred to as sinusitis. Here, we walk you through its classification, predisposing factors, pathophysiology, signs, symptoms, diagnosis, treatment, complications, and prognosis.
Rhinosinusitis: clinical features and diagnosis kkkrishnakoirala4
Rhinosinusitis is inflammation of the nose and paranasal sinuses. It can be acute (<4 weeks), subacute (4-12 weeks), or chronic (>12 weeks). Types include unilateral/bilateral, maxillary/frontal/ethmoidal/sphenoidal sinus involvement. Common causes are rhinitis, dental issues, and trauma. Clinical features include nasal discharge, obstruction, headache, and facial pain. Diagnosis involves endoscopy, imaging like CT scan, and culture/sensitivity of secretions. CT scan is most reliable for delineating sinus anatomy and disease extent.
Sinusitis is inflammation of the paranasal sinuses that can be acute or chronic. Acute sinusitis lasts less than 4 weeks and is usually caused by a viral infection leading to secondary bacterial infection when the sinus defenses are breached. It can be caused by infections, swimming/bathing, trauma, or general diseases. The osteomeatal complex is an important drainage site that when blocked can cause bacterial sinusitis. Treatment involves antibiotics, nasal decongestants, antihistamines, and anti-inflammatories while surgery is rarely needed and complications are common.
Clincal presentation and investigations of rhinosinusitisEunice Abdulai
This document provides an overview of rhinosinusitis, including its definition, types, clinical presentation, investigations, differential diagnosis, and potential complications. Rhinosinusitis is inflammation of the nose and paranasal sinuses that can be acute (<12 weeks) or chronic (>12 weeks, with or without polyps). Common symptoms include nasal congestion, discharge, facial pain or pressure. Investigations may include imaging like CT scans, as well as blood tests and microbiological cultures. Potential complications involve nearby structures like the eyes, brain and bones.
This document discusses sinusitis, defined as an infection of the para nasal sinuses. It describes the different types of sinusitis, risk factors, stages of pathology, clinical manifestations, diagnostic tests, potential complications, management with medications and surgery, and surgical procedures for treating sinusitis.
Rhinosinusitis is inflammation of the nasal passages and sinuses. The paranasal sinuses are air spaces surrounding the nasal cavity. Common causes include viral or bacterial infection leading to blocked sinus drainage and inflammation. Symptoms include facial pain, pressure, congestion, and mucus discharge. Treatment involves antibiotics, nasal steroids, surgery to improve drainage if symptoms persist long-term. Chronic rhinosinusitis lasts over 12 weeks and may require repeated treatments.
This document discusses the embryology, anatomy, and clinical presentation of acute sinusitis. It begins by describing the development of the paranasal sinuses from pouches in the nasal cavity between 3-5 months of gestation. It then covers the specific anatomy and development of the maxillary, frontal, ethmoid, and sphenoid sinuses. The document discusses the causes, symptoms, diagnoses, and potential complications of acute sinusitis involving each sinus. Common symptoms include headache, facial pain, and nasal discharge. Diagnosis involves transillumination, x-rays such as Waters' view, and CT scans. Complications can include orbital or brain infections if the condition worsens or goes untreated.
The document discusses sinusitis, including:
- The four pairs of paranasal sinuses located in the frontal, maxillary, ethmoid, and sphenoid bones.
- Sinusitis is characterized by inflammation of the paranasal sinus linings, often caused by viral rhinitis leading to bacterial infection.
- Acute sinusitis lasts less than a month while chronic sinusitis persists over 3 months, with risk factors including allergies and structural issues.
This document discusses acute sinusitis, providing details on the types and causes. It begins by explaining that the maxillary sinus is most commonly infected, followed by the ethmoid, frontal and sphenoid sinuses. Acute sinusitis is usually caused by viral infections that are later invaded by bacteria like streptococcus pneumoniae. Each type of acute sinusitis is then described in more detail, outlining signs and symptoms, treatments, and potential complications for maxillary, frontal, ethmoid and sphenoid infections.
The document outlines terms of use for an educational slide set on acute sinusitis. It specifies that the slides remain the copyrighted property of the American College of Physicians and may only be used for nonprofit educational activities. Users can incorporate slides into their own presentations but may not alter the content or remove the copyright notice. Print copies can be made for handouts but broader reproduction or distribution requires permission. Unauthorized use constitutes copyright infringement.
Clinical features and diagnosis of rhinosinusitiskrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses complications that can arise from sinusitis, including orbital and intracranial complications. It classifies orbital complications into 5 stages based on severity, from preseptal cellulitis to cavernous sinus thrombosis. Risk factors include age, immunocompromise, and anatomical variations. Common pathogens include Staphylococcus aureus and Streptococcus pneumoniae. Management involves thorough examination, imaging, and targeted antibiotic therapy.
This document discusses various complications that can arise from sinusitis, including orbital complications, intracranial complications, and long-term sequelae. Orbital complications range from preseptal cellulitis to orbital abscesses and cavernous sinus thrombosis. Intracranial complications include abscesses, meningitis, and thrombosis. Long-term issues include vision loss, osteomyelitis, and mucoceles. The document provides details on the pathogenesis, clinical presentation, imaging findings, and management of these various sinusitis complications.
Rhinitis is inflammation of the nasal mucosa that can be acute or chronic. It is classified based on etiology into infectious and non-infectious types. Common infectious causes are viral infections like the common cold, while non-infectious causes include allergies. Clinical features vary depending on type but may include nasal obstruction, rhinorrhea, sneezing, and loss of smell. Treatment involves managing symptoms, treating underlying causes, and antibiotics for secondary bacterial infections. Complications can include sinusitis if left untreated.
This document summarizes information about acute sinusitis. It describes the symptoms of acute sinusitis such as blocked nose, facial pain, and cough. Signs include purulent nasal secretions and tenderness over the sinuses. Investigations include x-ray, CT scan, and diagnostic nasal endoscopy. Cultures are not routinely obtained but may be in certain cases. Treatment involves drainage of the sinus with medications or surgery along with a 14 day course of antibiotics such as amoxicillin or azithromycin. Symptomatic therapies like warm compresses and hydration can provide additional relief.
Sinusitis refers to inflammation of the paranasal sinuses caused by viruses, bacteria, fungi or irritants. Common causes include rhinoviruses, Streptococcus pneumoniae and cigarette smoke. Symptoms include facial pain, nasal discharge, cough and headaches. Diagnosis involves examination, imaging and nasal endoscopy. Treatment involves antibiotics, analgesics, decongestants and nasal irrigation. Surgery may be required for chronic cases that do not respond to medical management. Complications can include meningitis, brain abscess and orbital cellulitis if left untreated.
This document outlines various potential complications of chronic rhinosinusitis that can affect the orbit, intracranial cavity, and bones. It describes orbital complications such as preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Intracranial complications discussed include meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis, and sagittal sinus thrombosis. Bone complications include osteomyelitis (Pott's puffy tumor). Chronic complications include mucocoeles.
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Describe nursing assessment of the ear, sinuses ,nose, throat.
Identify nursing responsibilities for patient undergo diagnostic test or procedure for ear, sinuses, nose, throat.
Describe the common therapeutic measures for ear, sinuses ,nose, throat.
Explain the pathophysiology, etiology, clinical manifestation and treatment for ENT disorders.
Assist in developing nursing care plans for patient with ENT disorders.
1) The document discusses diseases of the paranasal sinuses, focusing on sinusitis which is the inflammation of the mucous membrane lining the sinuses.
2) Sinusitis can be acute or chronic and involves inflammation of the maxillary, ethmoidal, frontal, or sphenoid sinuses.
3) Sinusitis is usually caused by infection spreading from the nasal cavity or upper teeth, but may also be due to immunodeficiency, anatomical abnormalities blocking sinus drainage, or changes in sinus secret quality.
Complications of sinusitis 23.05.16- dr.sithanadhakumarophthalmgmcri
This document discusses complications that can arise from rhinosinusitis. The main categories are orbital, intracranial, and bony complications. Orbital complications are most commonly caused by ethmoid sinus infections, while intracranial complications usually follow chronic frontal sinusitis. Specific complications covered include orbital cellulitis, subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, meningitis, epidural abscess, subdural abscess, and intracerebral abscess. Treatment involves intravenous antibiotics, draining abscesses surgically, and opening involved sinuses. A multidisciplinary approach between otolaryngology, ophthalmology, neurosurgery, and infectious disease
This document discusses ENT manifestations of AIDS. It begins by providing background on HIV, noting that it attacks CD4 cells. When CD4 counts fall below 200, opportunistic infections and malignancies can develop. ENT issues are then reviewed, including candidiasis, Kaposi's sarcoma, herpes zoster, Bell's palsy, sinusitis, oral thrush, hairy leukoplakia, and recurrent tonsillitis. Neck lymphadenopathy can indicate bacterial or mycobacterial infections, P. carinii, toxoplasmosis or fungal infections. Overall, the document outlines the varied ENT presentations associated with HIV/AIDS and emphasizes the need for a high index of suspicion to properly
This document discusses various skin lesions and oral manifestations that can occur due to viral, bacterial, fungal infections and autoimmune diseases.
It provides details on Herpes Zoster (Shingles), Hand Foot and Mouth disease caused by viruses. Bacterial infections like Tuberculosis and Syphilis are explained. Candidiasis is discussed as the common fungal infection causing thrush in the oral cavity. Skin conditions and oral lesions associated with HIV/AIDS are summarized. Treatment options for many of these conditions are also mentioned.
Rhinosinusitis is inflammation of the nasal passages and sinuses. The paranasal sinuses are air spaces surrounding the nasal cavity. Common causes include viral or bacterial infection leading to blocked sinus drainage and inflammation. Symptoms include facial pain, pressure, congestion, and mucus discharge. Treatment involves antibiotics, nasal steroids, surgery to improve drainage if symptoms persist long-term. Chronic rhinosinusitis lasts over 12 weeks and may require repeated treatments.
This document discusses the embryology, anatomy, and clinical presentation of acute sinusitis. It begins by describing the development of the paranasal sinuses from pouches in the nasal cavity between 3-5 months of gestation. It then covers the specific anatomy and development of the maxillary, frontal, ethmoid, and sphenoid sinuses. The document discusses the causes, symptoms, diagnoses, and potential complications of acute sinusitis involving each sinus. Common symptoms include headache, facial pain, and nasal discharge. Diagnosis involves transillumination, x-rays such as Waters' view, and CT scans. Complications can include orbital or brain infections if the condition worsens or goes untreated.
The document discusses sinusitis, including:
- The four pairs of paranasal sinuses located in the frontal, maxillary, ethmoid, and sphenoid bones.
- Sinusitis is characterized by inflammation of the paranasal sinus linings, often caused by viral rhinitis leading to bacterial infection.
- Acute sinusitis lasts less than a month while chronic sinusitis persists over 3 months, with risk factors including allergies and structural issues.
This document discusses acute sinusitis, providing details on the types and causes. It begins by explaining that the maxillary sinus is most commonly infected, followed by the ethmoid, frontal and sphenoid sinuses. Acute sinusitis is usually caused by viral infections that are later invaded by bacteria like streptococcus pneumoniae. Each type of acute sinusitis is then described in more detail, outlining signs and symptoms, treatments, and potential complications for maxillary, frontal, ethmoid and sphenoid infections.
The document outlines terms of use for an educational slide set on acute sinusitis. It specifies that the slides remain the copyrighted property of the American College of Physicians and may only be used for nonprofit educational activities. Users can incorporate slides into their own presentations but may not alter the content or remove the copyright notice. Print copies can be made for handouts but broader reproduction or distribution requires permission. Unauthorized use constitutes copyright infringement.
Clinical features and diagnosis of rhinosinusitiskrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses complications that can arise from sinusitis, including orbital and intracranial complications. It classifies orbital complications into 5 stages based on severity, from preseptal cellulitis to cavernous sinus thrombosis. Risk factors include age, immunocompromise, and anatomical variations. Common pathogens include Staphylococcus aureus and Streptococcus pneumoniae. Management involves thorough examination, imaging, and targeted antibiotic therapy.
This document discusses various complications that can arise from sinusitis, including orbital complications, intracranial complications, and long-term sequelae. Orbital complications range from preseptal cellulitis to orbital abscesses and cavernous sinus thrombosis. Intracranial complications include abscesses, meningitis, and thrombosis. Long-term issues include vision loss, osteomyelitis, and mucoceles. The document provides details on the pathogenesis, clinical presentation, imaging findings, and management of these various sinusitis complications.
Rhinitis is inflammation of the nasal mucosa that can be acute or chronic. It is classified based on etiology into infectious and non-infectious types. Common infectious causes are viral infections like the common cold, while non-infectious causes include allergies. Clinical features vary depending on type but may include nasal obstruction, rhinorrhea, sneezing, and loss of smell. Treatment involves managing symptoms, treating underlying causes, and antibiotics for secondary bacterial infections. Complications can include sinusitis if left untreated.
This document summarizes information about acute sinusitis. It describes the symptoms of acute sinusitis such as blocked nose, facial pain, and cough. Signs include purulent nasal secretions and tenderness over the sinuses. Investigations include x-ray, CT scan, and diagnostic nasal endoscopy. Cultures are not routinely obtained but may be in certain cases. Treatment involves drainage of the sinus with medications or surgery along with a 14 day course of antibiotics such as amoxicillin or azithromycin. Symptomatic therapies like warm compresses and hydration can provide additional relief.
Sinusitis refers to inflammation of the paranasal sinuses caused by viruses, bacteria, fungi or irritants. Common causes include rhinoviruses, Streptococcus pneumoniae and cigarette smoke. Symptoms include facial pain, nasal discharge, cough and headaches. Diagnosis involves examination, imaging and nasal endoscopy. Treatment involves antibiotics, analgesics, decongestants and nasal irrigation. Surgery may be required for chronic cases that do not respond to medical management. Complications can include meningitis, brain abscess and orbital cellulitis if left untreated.
This document outlines various potential complications of chronic rhinosinusitis that can affect the orbit, intracranial cavity, and bones. It describes orbital complications such as preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Intracranial complications discussed include meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis, and sagittal sinus thrombosis. Bone complications include osteomyelitis (Pott's puffy tumor). Chronic complications include mucocoeles.
Rare presentation of left maxillary sinusitis: A Case Reportiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Describe nursing assessment of the ear, sinuses ,nose, throat.
Identify nursing responsibilities for patient undergo diagnostic test or procedure for ear, sinuses, nose, throat.
Describe the common therapeutic measures for ear, sinuses ,nose, throat.
Explain the pathophysiology, etiology, clinical manifestation and treatment for ENT disorders.
Assist in developing nursing care plans for patient with ENT disorders.
1) The document discusses diseases of the paranasal sinuses, focusing on sinusitis which is the inflammation of the mucous membrane lining the sinuses.
2) Sinusitis can be acute or chronic and involves inflammation of the maxillary, ethmoidal, frontal, or sphenoid sinuses.
3) Sinusitis is usually caused by infection spreading from the nasal cavity or upper teeth, but may also be due to immunodeficiency, anatomical abnormalities blocking sinus drainage, or changes in sinus secret quality.
Complications of sinusitis 23.05.16- dr.sithanadhakumarophthalmgmcri
This document discusses complications that can arise from rhinosinusitis. The main categories are orbital, intracranial, and bony complications. Orbital complications are most commonly caused by ethmoid sinus infections, while intracranial complications usually follow chronic frontal sinusitis. Specific complications covered include orbital cellulitis, subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, meningitis, epidural abscess, subdural abscess, and intracerebral abscess. Treatment involves intravenous antibiotics, draining abscesses surgically, and opening involved sinuses. A multidisciplinary approach between otolaryngology, ophthalmology, neurosurgery, and infectious disease
This document discusses ENT manifestations of AIDS. It begins by providing background on HIV, noting that it attacks CD4 cells. When CD4 counts fall below 200, opportunistic infections and malignancies can develop. ENT issues are then reviewed, including candidiasis, Kaposi's sarcoma, herpes zoster, Bell's palsy, sinusitis, oral thrush, hairy leukoplakia, and recurrent tonsillitis. Neck lymphadenopathy can indicate bacterial or mycobacterial infections, P. carinii, toxoplasmosis or fungal infections. Overall, the document outlines the varied ENT presentations associated with HIV/AIDS and emphasizes the need for a high index of suspicion to properly
This document discusses various skin lesions and oral manifestations that can occur due to viral, bacterial, fungal infections and autoimmune diseases.
It provides details on Herpes Zoster (Shingles), Hand Foot and Mouth disease caused by viruses. Bacterial infections like Tuberculosis and Syphilis are explained. Candidiasis is discussed as the common fungal infection causing thrush in the oral cavity. Skin conditions and oral lesions associated with HIV/AIDS are summarized. Treatment options for many of these conditions are also mentioned.
1. Oral manifestations are among the earliest signs of HIV infection. Conditions like oral candidiasis, oral hairy leukoplakia, and Kaposi's sarcoma are strongly associated with HIV.
2. Other less common conditions include necrotizing gingivitis/periodontitis, infections by Mycobacterium tuberculosis or M. avium-intracellulare, and salivary gland diseases.
3. The progression of oral lesions correlates with declining CD4 counts and worsening immune suppression in patients with HIV/AIDS.
This document provides an overview of ulcerative and infective vesicullobular lesions, including their classification, etiology, clinical manifestations, and management. It discusses viral lesions caused by herpes simplex virus, varicella zoster virus, and cytomegalovirus. Fungal infections from histoplasmosis, blastomycosis, and mucormycosis are also reviewed. Bacterial infections from tuberculosis are mentioned. For each condition, the document outlines etiology, pathogenesis, clinical features, investigations, and management. Differential diagnoses are provided for comparison of conditions.
This document discusses otolaryngologic manifestations of HIV/AIDS. It begins by explaining how HIV works and disease progression as CD4 counts decline. AIDS is diagnosed when CD4 counts fall below 200 or AIDS-defining conditions occur. Common conditions include Kaposi's sarcoma, non-Hodgkin's lymphoma, herpes zoster outbreaks, recurrent ear/sinus infections, facial palsy, and sensorineural hearing loss. Fungal and atypical bacterial infections increase with immunosuppression. Evaluation with imaging/biopsy is important to identify treatable underlying causes of symptoms like lymphadenopathy. Management involves antiviral/antibiotic therapy and occasionally surgery.
General_HIVandENT.pptx GENERAL HIV AND ENTcs4rsrtnks
HIV patients can be grouped into stages based on their CD4 count. ENT manifestations are common, occurring in 70-90% of patients. Common manifestations include oral candidiasis, rhinosinusitis, neck lymphadenopathy, and otological issues like otitis media. Specific conditions like oral hairy leukoplakia and Kaposi's sarcoma indicate more severe HIV infection and progression to AIDS. Proper diagnosis and treatment requires consideration of both typical and opportunistic pathogens according to the patient's CD4 count and immune status.
Opportunistic infections are infections that occur more frequently and are more severe in people with weakened immune systems such as those with HIV/AIDS. These infections include fungal, bacterial, viral, and parasitic infections that typically do not seriously affect those with healthy immune systems. Common opportunistic infections in HIV/AIDS patients include Pneumocystis pneumonia, tuberculosis, candidiasis, toxoplasmosis, cryptococcus, and cytomegalovirus. Antiretroviral therapy has significantly reduced the rates of opportunistic infections by suppressing HIV and allowing immune recovery. HIV/AIDS remains a major global public health challenge.
This document discusses HIV and its effects on the ENT system. It begins by explaining what HIV is and how it attacks the immune system. It then discusses the epidemiology of HIV and current global statistics. Various opportunistic infections that can affect the ENT system are described, including fungal infections of the ear, sinusitis, neoplasms like Kaposi's sarcoma, and lymphomas of the nose and oral cavity. Manifestations in different areas like the ear, nose, oral cavity and airways are summarized. Risk groups, disease progression, and treatment approaches are also briefly covered.
HIV is a retrovirus that infects CD4 cells of the immune system and ultimately causes AIDS if left untreated. It is defined as AIDS when the CD4 count drops below 200 cells/mm3 or if opportunistic infections develop. Common oral manifestations of HIV infection include candidiasis, oral hairy leukoplakia, non-Hodgkin's lymphoma, Kaposi's sarcoma, periodontal disease, and infections caused by the herpes viruses or histoplasmosis. Accurate diagnosis requires considering the patient's medical history and ruling out other conditions through clinical examination and potential biopsy.
The document summarizes ENT manifestations of HIV infection. It describes how HIV attacks CD4 cells leading to opportunistic infections and malignancies. Common ENT issues seen include oral thrush, recurrent sinusitis, sensorineural hearing loss, and Kaposi sarcoma of the oral cavity, nose and larynx. Diagnosis involves CD4 counts and virus detection tests. Universal precautions are essential to prevent transmission among health workers.
This document discusses the clinical manifestations of acute and early HIV infection. It begins by outlining the CDC stages of HIV disease progression. It then describes the symptoms of acute retroviral syndrome, which occurs in 50-70% of individuals within 3-6 weeks of initial HIV infection, including fever, lymphadenopathy, sore throat, rash, and constitutional symptoms. It also notes that opportunistic infections rarely occur during acute HIV infection but may include oral candidiasis or CMV. The document provides details on various oral manifestations of HIV infection and their diagnosis and treatment.
This document discusses various infections, vesiculobullous diseases, and ulcerations that can affect the oral cavity. It begins by covering viral infections such as herpetic stomatitis caused by HSV-1 and -2, chickenpox and shingles caused by varicella zoster virus, and infectious mononucleosis caused by EBV. It then discusses bacterial infections including necrotizing ulcerative gingivitis and actinomycosis. Finally, it covers fungal infections such as oral candidiasis caused by Candida albicans, and vesiculobullous diseases like pemphigus vulgaris which is an intraepithelial acantholytic lesion caused by autoant
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and can affect the lungs (pulmonary TB) or other organs (extrapulmonary TB). It spreads through the air when people with active TB cough, sneeze or speak. While most exposed people develop latent TB infection, 10% will develop active disease. Diagnosis involves chest x-rays, sputum smear and culture tests, and treatment requires a multi-drug regimen to prevent drug resistance. HIV co-infection increases the risks of developing active TB and facing treatment challenges.
Rhinosinusitis is inflammation of the nose and paranasal sinuses that is classified as acute or chronic based on duration of symptoms. Acute rhinosinusitis lasts less than 12 weeks and is usually viral in origin, while chronic rhinosinusitis lasts over 12 weeks with ongoing symptoms. Chronic rhinosinusitis can be further classified based on the presence of nasal polyps and type of inflammation present. Type 2 inflammation involving cytokines IL-4, IL-5 and IL-13 is associated with treatment failure, asthma, and higher rates of polyp formation. The sinus mucosa acts as an immune barrier, and type 2 inflammation can cause barrier weakness and failure, predisposing to recurrence of rhinosinusitis
This document summarizes various oral manifestations of systemic diseases. It describes acute pharyngitis caused by viruses like rhinovirus or bacteria like streptococcus. It then discusses diphtheritic pharyngitis caused by Corynebacterium diphtheriae. Finally, it provides a detailed overview of oral manifestations of various infectious diseases including herpes, tuberculosis, syphilis, and fungal infections; connective tissue disorders like Sjogren's syndrome and lupus; and other conditions such as oral cancer. The document serves as a comprehensive reference for oral signs of systemic illness.
This document discusses several common viral skin infections. It begins by introducing cutaneous manifestations of viral infections and how they are clinically diagnosed. It then covers the common DNA and RNA viruses that cause skin infections, including human papillomavirus, molluscum contagiosum, herpes simplex virus, varicella zoster virus, and coxsackie virus. For each virus, it describes the clinical features, pathogenesis, complications, investigations, and treatment approaches. It also provides details on viral exanthems including measles and rubella. Throughout it emphasizes the characteristic morphology, distribution, inclusion bodies, and clinical course of different viral skin infections.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The document provides information on various bacterial, viral, and fungal infections that can affect humans. It discusses specific infections such as actinomycosis, syphilis, tuberculosis, candidiasis, herpes simplex virus, and more. For each infection, it describes the causative agent, transmission, clinical features, histological features, and in some cases treatment. The document is an informative reference for various microbial infections.
This document discusses AIDS and its ocular manifestations. It begins with an introduction to AIDS, noting that eye involvement occurs in 90% of autopsy cases and ocular complications are present in 75% of patients with AIDS. It then covers the global prevalence of HIV/AIDS, modes of transmission, pathophysiology involving destruction of CD4+ cells, common signs and symptoms affecting multiple organ systems, diagnosis including CD4+ cell counts and WHO staging, and various ocular manifestations such as CMV retinitis, toxoplasmosis retinochoroiditis, HIV retinopathy, progressive outer retinal necrosis, herpes zoster ophthalmicus, and Kaposi's sarcoma.
This document provides information on sarcoidosis, including:
1) It is a chronic granulomatous disease characterized by noncaseating granuloma formation of unknown cause, often affecting the lungs and lymph nodes.
2) It has a higher prevalence in African Americans and Japanese populations. The disease often affects people aged 20-40 and has a female predominance.
3) Granulomas form as a result of an abnormal cellular immune response potentially triggered by infectious agents. This leads to the formation of noncaseating granulomas containing giant cells.
4) The disease can have acute or chronic presentations and involve multiple organs, with lungs and lymph nodes most commonly affected. Corticost
Similar to Otolaryngological manifestations of systemic diseases (20)
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Acute suppurative otitis media and and cortical mastoidectomykrishnakoirala4
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Sinusitis can lead to serious complications if left untreated. Orbital complications are the most common and include pre-septal cellulitis, orbital cellulitis, and orbital abscesses which can further progress to involve the cavernous sinus. Intracranial complications involve spread of infection to the brain and include meningitis, brain abscesses, and cerebral venous sinus thrombosis. Other complications include osteomyelitis of the bones around the sinuses, dental infections, and distant infections like toxic shock syndrome. Treatment involves high dose antibiotics, surgical drainage of abscesses, and sinus surgery to address the underlying cause.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
This presentation gives a lucid idea about different neoplasms of nose like inverted papilloma, ca maxilla, ethmoid and so on.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Deviated nasal septum and other septal conditionskrishnakoirala4
This document discusses conditions of the nasal septum, including deviated nasal septum, septal hematoma, septal abscess, and septal perforation. It describes the causes, symptoms, and treatment options for each condition. Deviated nasal septum is often caused by trauma or developmental factors and can be corrected through septoplasty or submucosal resection of the septum. Septal hematoma and abscess develop due to bleeding or infection under the septal cartilage and require drainage and antibiotics. Septal perforation has various etiologies and may be treated with flaps or obturators.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides were prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
3. HIV/AIDS IN ENT
• Caused by retrovirus of lentivirus subfamily
• Up to 80% of HIV-infected patients eventually develop ENT manifestations
• Oral disease appears to be the most common
• Cause: immunodeficiency leading to
– Opportunistic infections by viruses, fungi, bacteria, protozoa etc.
– Activation of neoplastic process e.g, Kaposi's sarcoma, Non-Hodgkin
lymphoma
5/11/2020 at 11:00 AM 3
4. •Predisposing factors for HIV-related ENT conditions
–CD4+ cell count of less than 200/µL
–Plasma HIV-RNA levels greater than 3000 copies/mL
–Xerostomia
–Poor oral hygiene
–Smoking
5/11/2020 at 11:00 AM 4
5. • Oro-pharyngeal :
– Candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy
leucoplakia, Kaposi's sarcoma, non-Hodgkin's lymphoma.
• Neck :
– Cervical lymphadenopathy, parotid gland enlargement
• Nose and PNS: sinusitis (often due to atypical bacteria), allergic rhinitis
• Ear:
– Otitis externa, otitis media, inner ear involvement (sensorineural hearing loss,
disequilibrium), facial nerve palsy
5/11/2020 at 11:00 AM 5
6. Oral Cavity - Fungal infection
• Oral Candidiasis
− Most frequently opportunistic infection in HIV
− Approx. 90% of patients affected
• Clinical patterns
– Pseudomembranous : creamy, white, curd-like plaques on the buccal
mucosa, tongue, and other oral mucosal surfaces. Can be wiped out leaving a
bleeding base
– Erythematous : red, flat, subtle lesion on the dorsal surface of the tongue,
or on the hard or soft palate
– Angular cheilitis: Fissure & ulcer at oral commissure
5/11/2020 at 11:00 AM 6
7. • Diagnosis: Clinical
–Staining : KOH mount , Gimsa stain, Periodic Acid Schiff stain
–Biopsy : to r/o malignancy
• Treatment
–Amphotericin, nystatin, clotrimazole locally for mild cases
–Fluconazole, ketoconazole, voriconazole systemic for moderate to
severe cases
(Minimum of two weeks to reduce the colony forming units to the lowest level possible and prevent recurrence)
5/11/2020 at 11:00 AM 7
8. Oral cavity : Bacterial infections
• Periodontal diseases
– With CD4 count <100
• 2 types
− Linear gingival erythema
− Necrotizing gingivitis/ ulcerative periodontitis
• Treatment:
– Debridement, betadine/chlorhexidine gargle,
metronidazole
• Oral and oropharyngeal tuberculosis
5/11/2020 at 11:00 AM 8
9. Oral cavity : Viral infections
Herpes simplex (Occurs in up to 9% of adults)
• Intraoral :
– Small rounded ulcers with erythematous halo in hard
palate , gingiva and dorsum of tongue (often bigger, recur
more frequently, and tend to be more persistent in HIV infected patients)
• Extraoral - Herpes labialis
– Commonest manifestation, fever blister
– More numerous , lasts longer and reoccur faster
• Diagnosis : Tzank test – monoclonal anti HSV Ab
• Treatment : acyclovir
5/11/2020 at 11:00 AM 9
10. • Oral Hairy Leukoplakia
– Caused by EBV and is one of the first opportunistic
infections in HIV-positive patients
– White corrugated lesion on the lateral border of the
tongue that cannot be scraped (appear hairy due to
elongated filiform papillae)
– Treatment : Topical trichloroacetic/glycolic acid,
podophyllum, oral acyclovir, zidovudine and sulfa drugs
• Oral Human Papilloma Virus
• Warty or papillomatous lesions in the mucous membrane
of oral cavity and oropharynx
5/11/2020 at 11:00 AM 10
11. Oral Cavity - Neoplastic lesions
• Kaposi's sarcoma
– Multifocal neoplasm of vascular endothelial origin
(oral, skin and visceral involvement)
– Intraoral lesion may be the first symptom of late
stage HIV disease
– Can be macular, nodular, or raised and ulcerated
– Most common in hard palate followed by gingival and
buccal mucosa , soft palate, and dorsum of tongue
5/11/2020 at 11:00 AM 11
12. • O/ E : Flat, reddish areas that do not blanch, can enlarge,
ulcerate or get infected, pain and bleeding is common
• Diagnosis : biopsy
– HPE: interweaving bundles of spindle shaped cells with
vascular slits & RBC extravasations
• Treatment :
− Surgery: local excision or electrodesiccation and
curettage, cryosurgery
− Radiation therapy
− Chemotherapy : vincristine, liposomal doxorubicin
− Biologic therapy : interferon alfa
5/11/2020 at 11:00 AM 12
13. • Non - Hodgkin’s lymphoma
– AIDS defining criteria
– Second most common malignancy in HIV infected
individuals
– B cell in origin, occurs as focal, ulcerated soft tissue
mass on the palate or gingival tissues
– Occur in 10-30% of AIDS patients
– Localized nodal or extranodal disease
– Occurs after CD4 count < 200/ mm3
– Firm painless /painful swelling with or without ulcer
5/11/2020 at 11:00 AM 13
14. Neck manifestations in HIV/ AIDS
• Cervical lymphadenopathy
–Most common manifestation of HIV infection in the neck
– Causes : Reactive lymphadenitis, tuberculosis, lymphoma, Kaposi's
sarcoma
–Presence of diffuse lymphadenopathy in two or more sites of the
neck for longer than three months (HIV lymphadenopathy)
–Soft and symmetrical , mostly in the posterior triangle
5/11/2020 at 11:00 AM 14
15. • Salivary gland diseases
–Parotid swelling:
• Bilateral, occasionally cystic
–Causes:
• Reactive hyperplasia of an intraparotid lymph node
• Benign lymphoepithelial lesions with ductal metaplasia
• Benign lymphoepithelial cysts
5/11/2020 at 11:00 AM 15
16. HIV –EAR manifestations
• Seborrhic dermatitis: Usually preauricular
• Otitis externa, otomycosis, Pneumocystis carinii infected aural polyps
• Serous otitis media : Frequent URTI, lymphoid hyperplasia, adenoid
hypertrophy, nasopharyngeal tumor
• AOM, Kaposi's sarcoma of EAC
• Sudden SNHL: Unilateral/Bilateral CMV, ototoxic drugs, demyelination,
• Facial paralysis
• Activation of latent syphilis: otosyphilis
5/11/2020 at 11:00 AM 16
17. HIV manifestations in nose
• HSV infection
• Allergic rhinitis : increased Ig E level & eosinophils
• Chronic rhinosinusitis with nasal crusting & dryness
• Acute fungal sinusitis
• Nasal and nasopharyngeal tumours
5/11/2020 at 11:00 AM 17
19. HIV Manifestations in larynx and esophagus
• Epiglottitis, Kaposi's sarcoma, HSV, CMV, Candidiasis
• Histoplasmosis, Coccidiomycosis, aspergillosis, candidiasis
• Three categories of respiratory tract infection s/o immunodeficiency
– Acute overwhelming respiratory infection
– Acute episodes of infection with normal intervening period
(recurrent pneumonia , bronchial infection)
– Chronic purulent bronchial disease, purulent sinusitis
5/11/2020 at 11:00 AM 19
20. Tuberculosis – Ear manifestations
• In association or secondary to pulmonary tuberculosis
• Infection reaches to middle ear through Eustachian tube
• Painless watery otorrhea not responding to conventional
treatment , multiple perforations in TM and pale
granulations (chicken fat) are common findings
• Complications
– Mastoiditis, facial palsy, labyrinthitis, SNHL
• Treatment : Systemic antitubercular therapy
5/11/2020 at 11:00 AM 20
21. Nasal manifestations in tuberculosis
• Rare affection, can be primary or secondary to
pulmonary tuberculosis
• Lesions can be ulcerative, infiltrative, or
proliferative and mostly unilateral in the
cartilaginous nasal septum
• Presents as nasal stuffiness (nasal obstruction),
epistaxis, nasal discharge, crusting, recurrent
nasal polyps, and ulcers
5/11/2020 at 11:00 AM 21
22. Lupus Vulgaris
• Chronic indolent post primary infection of mycobacterium tuberculosis
• Common site - Membranous and cartilaginous junction of nasal septum, trauma?
• Clinical features
− Butterfly appearance of the facial skin
− Nasal obstruction, foul smell, crusting ,epistaxis
− Ulceration and fibrosis leading to distortion of nasal ala, tip, vestibule
− Cartilaginous septal perforation
− Diascopy makes the reddish-brown nodule more evident (Apple jelly Nodule)
5/11/2020 at 11:00 AM 22
23. Pharyngeal tuberculosis
• Multiple painful shallow ulcers in the pharynx and oral cavity
• Primary
–Adenoids/tonsils in children
–Infected by contaminated cow’s milk in the past ( bovine TB)
• Secondary
–Secondary to coughing up heavily infected sputum
–Blood born in cases of miliary tuberculosis
5/11/2020 at 11:00 AM 23
24. Laryngeal tuberculosis
• Almost always secondary to pulmonary TB
• Sputum positive rate : 90-95%
• Spread
–Bronchogenic following contact of sputum containing AFB
–Rarely hematogenous or lymphatic spread
5/11/2020 at 11:00 AM 24
25. Pathology of laryngeal tuberculosis
• Stages:
– Exudation + hyperaemia : subepithelial inflammation
– Infiltration : subepithelial space infiltration causing pseudo - edema
– Proliferation or granuloma formation : Tubercle formation (characteristic lesion),
Coagulation necrosis with central caseation
– Ulceration : tubercles break down to form superficial shallow ulcers with
undermined margins which might progress to cartilage : perichondritis (very painful
condition)
– Cicatrization : Healing of ulcer by fibrosis
5/11/2020 at 11:00 AM 25
26. • Clinical features
–Women - more commonly affected
–Hoarseness, productive cough, evening rise of temperature with chills,
–Odynophagia (due to shallow ulcers with exposed nerve ending)
• O/E:
– Laryngoscopy - Redness & edema of the cord with normal appearing
opposite cord
– Stroboscopy shows decreased amplitude & edge movements &
possible phonatory arrest
5/11/2020 at 11:00 AM 26
29. • Sarcoidosis is defined as a rare systemic granulomatous disease of
unknown etiology with a non-caseating hard granulomatous
inflammation
• Usually involves : Lungs, parotid gland , facial nerve, nasal cavity ,larynx,
nervous system
• Etiology:
– Special form of TB
– Undifferentiated organism
5/11/2020 at 11:00 AM 29
30. • Hearing loss
– Sudden, fluctuating or progressive SNHL
– B/L asymmetrical
– Caloric test - no response
• Uveitis ~ 80%
• Parotid swelling ~20%
• Facial Nerve Palsy~43%
• Lymphadenopathy~55%
5/11/2020 at 11:00 AM 30
31. Signs in the nose
• Mucosal – commonest :
Yellow nodule surrounded by hyperemic boggy granular
mucosa in anterior septum and inferior turbinates leading
to adhesions and stenosis of anterior nares
• Skin
• Lupus Pernio: resemblance of perniosis or cold induced injury
(Mortimer’s malady) symmetrical, bulbous, bluish red, dusky,
glistening lesion d/t stretching epidermis & large pilosebaceous
follicle
• Small lesions affect- cheek, lips, finger, & ear (Turkey ear)
• Nasal bone: swollen nasal bridge5/11/2020 at 11:00 AM 31
33. Larynx
• 10% involvement
• Hoarseness, dysphagia, dyspnea
• Epiglottis and false cord are swollen, edematous and pale
• Rim of epiglottis full & rounded
• True cord and subglottis rarely affected
• Lesion progresses rapidly causing life threatening airway obstruction
5/11/2020 at 11:00 AM 33
34. Investigations
• Chest X-Ray:
– B/L hilar LN enlargement, parenchymal infiltrates, fibrosis
• Biopsy:
• Non caseating granuloma (hard)
• Underdeveloped surrounding rim of lymphoid cells (naked
tubercle)
• Calcium and protein inclusions inside the Langhans giant
cells (Schaumann bodies)
5/11/2020 at 11:00 AM 34
35. • Kveim- Siltzbach test
– Intradermal injection of filtered extract of spleen from a case
of sarcoidosis skin biopsy 6 wks later development of
nodule in all mucosal cases and 75 -90% of active
sarcoidosis
• Serum ACE ( Angiotensin Converting Enzyme) :
– Increased in 60% of active diseases (produced by
epithelioid cells derived from activated macrophage)
• Serum/urine calcium : to exclude hypercalcemia (uncontrolled
synthesis of 1,25-dihydroxyvitamin D3 by macrophages)
5/11/2020 at 11:00 AM 35
36. Non-specific treatment
• Steroids - Topical & Systemic
– Prednisolone - 1mg/kg/day X 4-6 wks - taper over 2-3 months
– Effective in mucosal disease but ? in systemic disease
• Chloroquine: 250 mg PO alternate days X 9 months
– Used in combination in patients not responding to steroid
• Methotrexate 5mg PO weekly X 3 mths (alternative)
5/11/2020 at 11:00 AM 36
37. Syphilis
• Late Syphilis
– Affects the temporal bone 10-
50 years after the onset of
primary infection
– Hearing loss is permanent with
fluctuation in hearing
– Female >male
• Early Syphilis
– Malaise, Pyrexia, Headache, Skin
eruptions
– Pharyngitis, Lymphadenopathy
– Sudden B/L hearing loss - High
frequency SNHL
– Decreased Stapedial reflex
– Decreased Caloric response
– Endolymphatic hydrops
5/11/2020 at 11:00 AM 37
38. • PTA : flattened or high frequency SNHL
• Stapedial reflex : Alteration to retrocochlear pattern
• Decreased speech discrimination
• Progressive severe peripheral vestibular damage: increased
imbalance + ataxia
• Positive fistula test without middle ear disease (Henebert’s sign)
• Tullio’s phenomenon : transient vertigo & nystagmus on exposure to
sudden high intensity sound
5/11/2020 at 11:00 AM 38
39. • Primary Syphilis
• Lesion: CHANCRE, appears in external nose or inside the vestibule
• Hard, non painful, ulcerated papule appears after 3-4 wks of contact
• Disappears spontaneously in 6-10 wks
• LN - Enlarged, rubbery ,non tender
• Secondary syphilis
• Most infectious stage
• Commonest presentation- Simple catarrhal rhinitis with crusting/fissuring of nasal
vestibule
• Mucous patches, roseolar papular rashes, pyrexia, shotty enlarged LN
Nasal Syphilis
5/11/2020 at 11:00 AM 39
40. Tertiary Syphilis
• Tenderness on the bridge of nose - characteristic sign
• Pain & headache (worsens at night)
• Lesion: GUMMA
• Bony septal perforation most common: leads to saddle nose
• Hyposmia/Anosmia, offensive discharge, crusting & bleeding are common
• Bare bone may be felt with the probe when crust is removed
• Severe scarring leads to secondary atrophic rhinitis
• Scarring & stenosis of nasal passage
5/11/2020 at 11:00 AM 40
41. Oral cavity and oropharynx
• Primary: Chancre of lips, buccal mucosa, tongue & tonsils in descending order
• Secondary:
– Snail track ulcer or mucous patches covered with greyish white membrane which
on scrapping has pink base but no bleeding
• Tertiary:
– Gumma of hard palate, tonsils , posterior pharyngeal wall leading to oronasal
and oroantral fistula
5/11/2020 at 11:00 AM 41
43. Larynx
• Affected in only secondary or tertiary stage
• Hoarseness, dysphagia or stridor
• Lesions have predilection on anterior part of larynx, epiglottis &
aryepiglottic fold in contrast to tuberculosis
• Secondary : Erythematous mucous patches, greyish lesion
• Tertiary : Ulcers, granulomas, fibrosis, Laryngeal stenosis
5/11/2020 at 11:00 AM 43