Pharyngitis & labyrinthitis

EYE EAR NOSE THROAT DISEASES

1. PHARYNGITIS & LABYRINTHITIS SUDESHNA BANERJEE DUTTA LECTURER S.R.S.V.M B.SC NURSING COLLEGE

2. DEFINITION Inflammation of the pharynx

3. ETIOLOGY: Environmental exposure to viral agents - adenovirus, influenza virus, Epstein-Barr virus, herpes simplex virus & measles Bacterial infection – 10% of adults with pharyngitis have group A beta-hemolytic streptococcus (GABHS) infection Other bacterias - Mycoplasma pneumoniae , Neisseria gonorrhoeae , H. influenzae type B Poorly ventilated rooms

4. CLINICAL FEATURES Malaise Dysphagia Dry cough, sneezing, runny nose Fever & headache Loss of appetite Redness and swelling in the tonsillar pillars, uvula, and soft palate. A creamy exudate may be present in the tonsillar pillars Lymph node enlargement

5. DIAGNOSIS History collection Physical examination Blood investigation Throat swab culture

6. Treatment Antibiotics – Doxycycline 100 mg twice daily , 5-7 days Once-daily Azithromycin may be given for only 3 days A 5-days or 10-days course of Cephalosporin may be prescribed. 5-days administration of Cefuroxime has also been successful in producing bacteriologic cures. Anti inflammatory - Ibuprofen Pottasium permanganate gargles

7. Nutritional Therapy Soft, bland and warm diet Warm liquids, and flavored frozen desserts such as Popsicles are often soothing. Occasionally, the throat is so sore that liquids cannot be taken in adequate amounts by mouth. In severe situations, intravenous (IV) fluids may be needed. Otherwise, the patient is encouraged to drink as much fluid as possible (at least 2 to 3 L per day).

8. LABYRINTHITIS

9. DEFINITION Inflammation of the labyrinth of the inner ear

10. Etiology Viral or bacterial infections Cholesteatoma ( an abnormal, noncancerous skin growth that can develop in the middle section of ear, behind the eardrum. It may be a birth defect, but it's most commonly caused by repeated middle ear infections ) Drug toxicity Head injury Tumor

11. Clinical manifestations Vestibular manifestations (vertigo) Cochlear manifestations (hearing loss) Nausea and vomiting

12. Bacterial Infections Two types of labyrinthitis associated with bacterial infections: Toxic Labyrinthitis Suppurative Labyrinthitis

13. Toxic Labyrinthitis Results from an inflammation of the inner ear following an acute or chronic otitis media or early bacteria meningitis. Toxins penetrate the cochlear aqueduct and cause an inflammatory reaction in the perilymph space. Toxic Labyrinthitis produces mild high frequency hearing loss or mild vestibular dysfunction Treatment: Antibiotics for precipitating otitis , possible myringotomy .

14. Suppurative Labyrinthitis Suppurative Labyrinthitis : direct invasion of the inner ear by bacteria. From otitis or meningitis

15. Diagnosis History: – severe vertigo from any movement of the head. – Nausea and vomiting – U/L or B/L hearing loss – Recent URTI – Loss of balance and falling in the direction of the affected ear

16. Physical findings: – Spontaneous nystagmus ( a vision condition in which the eyes make repetitive, uncontrolled movements) – Jerking movements of eyes toward unaffected ear – Purulent discharge Lab: – Culture and sensitivity test Audiometry Electronystagmography ( a diagnostic test to record involuntary movements of the eye )

17. Management Meclizine to relieve vertigo Antiemetics Antibiotics Oral fluids IV fluids for severe dehydratio n

18. Surgery Surgical excision of cholesteatoma Incision and drainage Labyrinthectomy

19. Complications Meningitis Permanent balance disability Permanent hearing loss