Epiglottitis

Define epiglottis?
Is a cartilaginous structure positioned at the anterior aspect of the opening of the
trachea.
What is the function?
To protect the airway from the aspiration of secretions and food during
swallowing.
Define Epiglottitis?
is an inflammation and swelling of the epiglottis.
What can cause acute epiglottitis? And what the result can lead it?
It can be a rapidly progressive infection of this structure and of adjacent soft
tissues in the upper airway, which can result in airway obstruction and respiratory
failure, a life-threatening emergency.
Who is the primary effect of epiglottitis?
Historically, it was primarily a disease of children aged 2 to 7 years.
What is the Causative Agents of epiglottis?
Most common is for Haemophilus influenza type B (Hib).
What are the other pathogens can cause epiglottis?
group A streptococcus (GAS),
S.pneumoniae,
staphylococci,
Haemophilus parainfluenzae, and
Klebsiella spp
Briefly talk Pathogenesis of epiglottitis?
The organisms colonize the epiglottitis and enter the tissues of the epiglottitis
through minor breaks in the mucosal surface and then grow in the tissues and
cause an inflammatory response that results in erythema and oedema.
Causative agent may spread to surrounding structures.
What are Clinical Manifestations of epiglottitis?
High-grade fever,
Dysphagia,
Sore throat and
Drooling.
bacteremia of epigolottitis what woud be result?
meningitis,
septic arthritis,
otitis media,
pneumonia or osteomyelitis.
in which position Children with severe respiratory distress and a narrowed
airway often sit?
in a tripod position, leaning forward with arms on the legs, The head and neck are
extended with the jaw thrust forward to help keep the airway open(seen in a
child with an acute asthma flare).
Diagnosis of epigolottitis?
direct visualization of the epiglottis or
Lab test(Blood cultures and swab cultures)
Treatment?
IV antibiotics (3rd GEN cephalosporin’s, ampicillin-sulbactam)
IV corticosteroids (reduce inflammation&swelling airway)
Circle the best answer
1 .Before widespread vaccination, most pediatric cases OF Epigolotitis and a
smaller percentage of adult disease was responsible for:-
a.Haemophilus influenzae type B (Hib)
b.group A streptococcus (GAS)
c.S.pneumoniae, staphylococci,
d. Klebsiella spp
2. Today, there are still documented cases of Hib causing epiglottitis, even in
vaccinated individuals, but most cases are caused by other pathogens (GAS).
a. True b. false
3. In childhood cases, the hallmark of epiglottitis in the absence of signs of
inflammation in the oropharynx on physical examination is:-
a. Presence of severe sore throat
b. Pain on swallowing (odynophagia)
c. high-grade fever
d. a and b
4. The onset of symptoms of epiglottitis in children which is sudden and
unexpected is:-
a. high-grade fever and
b. toxic appearance are common.
c. Pain
d. a and b
5. The morbidity and mortality of epiglottitis can be very high:-
a. true
b. false
Define Otitis externa or swimmer’s ear?
is an infection of the external auditory canal.
What are the most causes occur to the cases of otitis extrna?
Because water is trapped in the external auditory canal, causing swimmer’s ear.
Patient’s Diabetes mellitus or is immunocompromised in other ways, malignant
otitis externa can occur.
What are the most common causes of otitis externa 0r malignant otitis extrna?
Gram-negative bacilli (Pseudomonas aeruginosa)
What are Manifestations of otitis externa?
Ear pain,
Itching, and
Discharge.
The pinna is usually tender, and
Pain by movement of the ear
Who/ what is the most common in swimmers and divers?
Who frequently get water trapped in the external canal.
Combination of high humidity and perspiration
Predisposing factors
a. high environmental temperatures,
b. mechanical removal of earwax,
c. trauma following insertion of foreign objects (e.g., cotton )
d. And chronic dermatologic disease

What are things protect ear from foreign particles?

Hair and Cerumen (earwax produced in the ear canal
What are the factors that cause a person to be susceptible to development of
otitis externa?
Excessive moisture in the ear canal(ph become high)
Remove cerumen
Briefly talk about pathogenesis of otitis externa?
Once the protective cerumen is removed, keratin debris from sloughed off
keratinized epithelial cells in the ear canal absorbs the water, creating a desirable
medium for bacterial growth.
Bacterial growth can cause inflammation, causing the infection to spread and
damage the underlying cartilage or bone.
Diagnosis of otitis extern?
Based on clinical presentation with an otoscope.
Therapy of otitis extern?
Should be cleansed and debris removed
Topical application of antimicrobial agents (neomycin with polymyxin)
Drops of gentamicin
Malignant otitis externa give Systemic antibiotic
 Acute otitis media (AOM

Define Acute otitis media (AOM)?

Is an infection of the middle ear, is an inflammatory disease of the mucosa of the
inner ear with exudate production
Who is the most Peak incidence of AOM?
Children between the ages of 3 and 24 months
What are the most common causes of otitis media?
Streptococcus pneumonia,
Haemophilus influenza, and
Moraxella catarrhalis
What are the other agents cause AOM?
S.Aureus and streptococcus pyogenes
Fungi: Aspergillus

Manifestations OF AOM?
Hearing loss
Child pulling ear
Ear fullness
pain

Complications OF AOM?
• Tympanic membrane perforation.
• Hearing loss
• Severe suppurative complications of AOM are rare.
diagnosis of AOM?
based on signs, symptoms EXM with the tympanic membrane
Treatment and prevention of AOM?
otitis media resolve without antibiotic treatment.
Prevention of AOM?
Pneumovax is used to vaccinate children older than 2 years of age
Prevnar is used to vaccinate children younger than 2 years of age.

Acute otitis media (AOM

In children younger than 6 weeks of age,) common cause otitis media are
a.Gram-negative bacilli (e.g., Escherichia coli, klebsiella, pseudomonas)
b. Gram positive
fever and irritability may be the only signs of illness
a. T
b. F
Circle the best anwer
Staphylococcus aurous is as common a cause as gram-negative bacilli, it does
cause otitis externa
a. true
b. false
In malignant otitis externa, a necrotizing infection can spread to :-
a. the cartilage, blood vessels, and bone
b. mouth,
c. nose
Malignant otitis externa infection involve the base of the skull, the meninges, or
the brain, and can result in death.
a. T
b. F
Malignant otitis externa is more common
a. Diabetic patients.
b. Immunocompromised patients
c. blood pressure
d. a & b
The external auditory canal is warm and dark and traps moisture readily, and is
an excellent environment for the growth of bacteria and fungi.
a. T
b. F
Cerumen (earwax produced in the ear canal) creates an acidic coat containing
lysozymes and other substances that inhibit bacterial and fungal growth.
a. T
b. F
The cerumen is also rich in lipids, which allow water from penetrating to the
skin and causing maceration.
a. T
b. F
Patients with malignant otitis externa frequently have a discharge (otorrhea)
that contains foul-smelling yellow to yellow-green pus
a. T
b. F
If the disease is an acute bacterial infection, the discharge may be thick white
mucus.
a. T
b. F
If the disease is a chronic bacterial infection, a bloody discharge containing
granulation tissue is more common
a. T
b. F