Foreign Bodies Air-ways

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ENT

• Otolaryngology/ Otorhinolaryngology
• ENT Head Neck Surgery
• Gateways of body
• Special senses. Taste, hearing, Smell, Balance
• Narrow cavities. Special equipment
• Complex anatomy

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EARACHE OR OTALGIA
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Sensory Supply Of the Ear

• 5th CN - Auriculotemporal branch
• 1st and 2nd cervical nerves.
• 9th CN - Jacobson branch
• 10th CN- Arnold branch
• 7th CN - Ramsey hunt branch

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EAR ACHE / OTALGIA

• Types
• Primary otalgia
• Referred otalgia.

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EVALUATION OF OTALGIA

• History
• Ear symptoms
• Nasal symptoms
• swallowing disorders
• recent trauma
• General Symptoms
• Examination
• Genral physical examination
• Complete ENT examination
• Rhinoscopy, nasopharyngoscopy, and indirect
  laryngoscopy.
• Palpation of the neck is important to look for
  thyroid disease and 1lymphadenopathy

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PRIMARY OTALGIA

• PINNA
• Trauma
• Haematoma
• Infected Eczema
• Frost Bite
• Sunburn
• Chondrodermatitis nodularis chronica helicis
• Infected Basal Cell/Squamaous cell Ca

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PRIMARY OTALGIA

• Meatus
• Impacted Wax
• Keratosis Obturans
• Boil
• Otitis Externa
• Malignant Otitis externa
• Herpes Zoster Oticus
• Trauma

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PRIMARY OTALGIA

• Middle Ear
• Acute Otitis Media
• Otitic Barotrauma
• Bullous Myringitis
• Haemotympanum
• Carcinoma
• Complicated CSOM
• Acute Mastoiditis
• Inner Ear
• Noise
• Tinnitus described as throbbing pain

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REEFERRED EAR ACHE

• Tonsillitis
• Nasal Polyps
• Mumps
• Thyroid diseases
• Laryngitis
• Long Styloid Process
• Dental Abnormalities
• Oral Ulceration
• TMJ Disordres

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IMPACTED WAX

• Normal secretion of ceruminous glands
• Cause of impaction
• Pain, deafness, tinnitus,
• Removal
• Prevention

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EAR WAX
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FURUNCLOSIS EAR (Boil)

• Staphylococal Infection hair follicle of Ext
  Meatus
• Clinical Features
• Pain full swelling in outer 1/3rd of ext auditory
  canal
• Discomfort aggravated on movement of jaw
• Deafness
• Treatment
• Aural dressing
• Antibiotic Steroid Cream or icthamol
• Antibiotics
• Cloxacillin,Flucloxacillin,Cephradine
• Analgesics
• Most drain spontaneously
• Blood Sugar Levels

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FURUNCLE
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FURUNCLE
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FURUNCLE
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Diffuse Otitis Externa

• Diffuse inflammation of meatal skin
• Aetiology
• Hot humid climate
• Swimmers
• Trauma
• Unskilled instrumentation
• Scratching ear canal with hair pin
• Excessive cleaning of ear canal after swimming
• Existing CSOM
• Causative Organisms
• Pseudomonas aeruginosa
• Staph.aureus
• B.proteus

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Diffuse Otitis Externa

• Clinical features
• Hot burning sensation
• Pain
• Serous or purulent discharge
• Meatal skin is red warm and tender
• Cheesy debris in the deep meatus
• Treatment
• Aural toilet
• Aural dressing
• Topical antibiotics with steroids

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MALIGNANT OTITIS EXTERNA

• Progressive infection of meatus, surrounding soft
  tissue and skull base
• Causative Organism
• Pseudomonas aeroginosa
• Predisposing Factors
• Elderly diabetics
• Immunocompromised

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MALIGNANT OTITIS EXTERNA

• Clinical Features
• Excruciating Pain
• Granulations in the Ext ear canal
• IX, X, XI CN palsies
• Intracranial complications
• Treatment
• I/V Antibiotics high doses 6-8 weeks
• Glycemic control
• Debridement of devitalized tissue bone

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HERPES ZOSTER OTICUS
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HERPES ZOSTER OTICUS

• Viral Infection affecting genicualte ganglion of
  facial nerve
• Clinical Features
• Severe otalgia
• Vesicular rash on the concha or pinna
• VII Nerve Palsy (Ramsay Hunt Synd.)
• Treatment
• Oral acyclovir
• Pain continues months after the rash as post
  herpetic neuralgia requiring
• Tricyclic antidepressants

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OTOMYCOSIS
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OTOMYCOSIS

• Fungal Infection of ear canal
• Aspergilis niger, Aspergilis fumigatis, Candida
  albicans
• Predisposing Factors
• Hot Humid climate
• Topical antibiotics drops for CSOM or otitis
  externa

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OTOMYCOSIS

• Clinical Features
• Itching
• pain in ear
• Discharge with musty color
• Fungal mass looks like Wet piece of filter paper
• Treatment
• Aural Toilet
• Antifungal Agents
• Clotrimazole
• 2 salicylic acid in alcohal

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REACTIVE OTITIS EXTERNA
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ACUTE OTITIS MEDIA
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ACUTE OTITIS MEDIA

• Acute Infection of middle ear by pyogenic
  organisms.
• Common in infants and children
• Bacteriology
• Strep.Pneumonae,H INF, Moraxella Catarrhalis
• Clinical Features
• Otalgia,Fever,Ear discharge
• Red Congested buldging TM
• Small Perforation with ear discharge

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ACUTE OTITIS MEDIA

• Managememnt
• Antibiotics
• Antipyretics
• Decongestants
• Systemic,Topical
• Ear Toilet
• Myringotomy
• Pain Not responding to above treatmenty
• Development of complications
• Facial paralysis etc

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OTITIC BAROTRAUMA

• Non suppurative condition due to failure of
  eustacchian tube to maintain middle ear pressure
  at ambient atmospheric level
• Mechanism
• When atmospheric pressure is higher than middle
  ear pressure by a critical of 90 mm of hg
  eustachian tube gets locked.-? -ve pressure in
  middle ear -? retraction of tympanic
  membrane-?hyperaemia,transudation and haemorrhage
  in the middle ear.

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OTITIC BAROTRAUMA
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OTITIC BAROTRAUMA

• Treatment
• Nasal decongestants
• Antihistamines
• Myringotomy
• Prevention
• Swallow during descent
• Donot sleep during descent?decreases swallows
  ?Effects opening of eustachians tube
• Autoinflation of tube by valsalva during descent.
  

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ACUTE MASTOIDITIS
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Acute Mastoiditis

• Inflammation of mucosal lining of antrum and
  mastoid air cell system.
• Clinical Features
• Pain behind the ear
• Fever
• Ear Discharge
• Mastoid tenderness
• Ear discharge
• Sagging of posterosuperior meatal wall
• Swelling over the mastoid
• Deafness

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Acute Mastoiditis

• Antibiotics
• Myringotomy
• Pus under tension not resolving with medical
  therapy
• Cortical Mastoidectomy
• Subpreiosteal abscess
• Positive reservoir sign
• No change in symptoms after 48 hrs of medical
  management
• Complications
• Facial palsy, labrynthitis,intracranial
  complications.

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ACUTE TONSILLITIS- referred otalgia
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PERITONSILLAR ABSCESS- Referred otalgia
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LARYNGITIS- Referred otalgia
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THYROID DISEASE- referred otalgia
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APHTHUS ULCER -Referred otalgia
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LONG STYLOID PROCESS-Referred otalgia
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