Otitis Media - Definition
Infection of the middle ear
Otitis Media - Causes
- Viral: Most common
- Bacterial: Strep. pneumoniae, h. influenzae, strep. pyogenes
Otitis Media - Clinical features
- Pain
- Fever
- Discharge (only if +perforation)
Otitis Media - Examination findings
- Red, bulging, tympanic membrane
Otitis Media - Investigations
Clinical diagnosis
Otitis Media - When are antibiotics given
- Systemically Unwell
- Evidence of ear drum perforation (discharge)
- Vulnerable patients (e.g. immunocompromised)
Otitis Media - Complications
- Intratemporal: glue ear, drum perforation, mastoiditis, facial nerve involvemnt
- Intracranial: Meningitis, brain abscess
- Systemic: sepsis, IE, septic arthritis
Epistaxis - Anterior v Posterior bleeds
Anterior - 90%
- from littles area
Posterior - 10%
- from deep nose structures
- more common in older people
- risk of airway compromise
Epistaxis - Little’s area
- Aka Kiesselbach’s plexus
- Anastomosis of 5 arteries
Epistaxis - Elements of history to look at
- Trauma (common)
- Foreign bodies (common)
- Finger picking (v common in children)
- Neoplasm
- Cocaine
- PMH: HTN + diabetes
Epistaxis - Management (anterior)
- ABCDE approach
- Simple measures: pinch nose, ice pack to neck, suck ice
- Chemical cautery (if necessary)
Epistaxis - Management (posterior)
- ABCDE approach
- Folle catheter through nose
- String of swabs soaked in lidocaine/adrenalin
- Definitive: nasal endoscopy
Nasal fracture - presentation
History of trauma
Nasal fracture - important complication
Septal Haematoma
- can cause avascular necrosis of cartilage
- leads to saddle-shaped nose
- management: incision + drainage
Nasal fracture - Management
- Manipulation under anaesthetic
- 1 week after injury
What to do about foreign body in Nose
Always take it out
- risk of aspiration
What are the components of the CENTOR criteria
- Pyrexia
- Tonsillar exudate
- No cough
- Tender lymphadenopathy
> 2 suggest need for antibiotics
Tonsilitis - Cause
- Viral (most common)
- Bacterial: s. pyogenes + s. aureus
Tonsilitis - Clinical features
- Pain on swallowing
- Pyrexia + malaise
- Halitosis
- Trismus (locked jaw)
Tonsilitis - Management
- Analgesia
- Antibiotics (based on CENTOR)
- If they can’t eat/drink: admit
- If EBV: no contact sport, amoxicillin will cause rash
What are the indications for tonsilectomy
- Frequency of tonsilitis
- 7 times in a year for 1 year
- 5 times a year for 2 years
- 3 times a year for 3 years - Suspected malignancy
- Peritonsillar abscess
- Sleep apnoea
What is a quinsey
A peritonsillar abscess
Quinsey - Clinical features
- Sore throat
- Halitosis, trismus + pyrexia (much worse than tonsilitis_
- On examination: uvula pushed down + away from abscess
Quinsey - Management
- IV antibiotics
- Definitive: incision + drainage
