ENT INFECTIONS

By
Dr MOHD HAZMI BIN MOHAMED
Infections in ENT
• Invasion and growth of
pathogens in the tissue
• Pathogen can be bacteria, virus
or fungi
• Infection in different area tends
to produce different Sx
Abscess
• Accumulation of pus in an inclosed tissue
space
• Pus is an exudate, protein rich fluids and
leukocytes from the body’s immune
responds
Principal in Diagnosis
• Symptomatic and clinical diagnosis
• Biochemistry test; etc WBC, ESR, CRP
• Microbiological test
• Imaging
Principal in Management
• Identify complications
• Admission Vs Out-Patient treatment
• Antibiotic : local vs systemic; Oral VS IV antibiotic
• Symptomatic treatment including analgesia
• Abscess incision and drainage
Ear
Infection
• Acute Perincondritis
• Acute otitits Externa
• Acute otitis Media
• Acute labyrinthitis
• Acute mastoiditis
Acute Perichonditis
• Infection over pinna
• Maybe due to trauma or extension of otitis externa
• Pseudomonas Aeruginosa is the common organism
• Treatment is systemic antibiotic
• If abscess formation incision & drainage
Acute Otitis Externa
• Diffuse inflammation over meatus skin
• Common organisms are Staph aereus,
pseudomonas, Bacillus proteus and E coli
• Clinical features: hot burning sensation,
earache, ear discharge
• Treatment:
-ear toilet
-medicated wicks
-antibiotic
Otomycosis
• Fungal infection of ear canal
• Most common due to Aspergillus niger or Candida albicans
• Clinical features: intense itchiness, pain, ear blockage
• Treatment
-ear toilet
-anti fungal agents
-antibiotic if co exist with bacteria infection
Herpes Zoster
Oticus
• Viral infection over outer, middle and inner ear
• Clinical features: formation of vesicles over
tympanic membrane, meatal skin and post
airucular groove
• VII CN may be involved
• Treatment: anti-viral drugs
Acute Otitis Media
• Pyogenic infection over ME
• Common in infants and children
• Spread of infection via Eustachian tube, external ear or
blood-borne
• Common organisms Strep pneumonia, Haemophilus
Influenza and Morexella catarrhalis
• Clinical features: ear pain, reduced in hearing, ear discharge
• Treatment:
• Ear toileting
• Anti-bacterial antibiotic
• Myringotomy in severe pain and bulging TM
Complication of Suppurative OM
• Intratemporal:
1. Mastoiditis
2. Petrositis
3. Facial paralysis
4. Labyrinthitis

• Intracranial:
1. Extradural abscess
2. Subdural abscess
3. Meningitis
4. Brain abscess
5. Lateral sinus thrombophlebitis
6. Otitic hydrocephalus.
Acute Mastoiditis
• Inflammation of mucosa lining of antrum and mastoid air
cell
• Symptoms: pain behind the ear, fever, ear discharge
• Clinical signs: mastoid tenderness , mastoid swelling,
posterior wall EAC sagging, pulsatile ear discharge
• Investigations: biochemistry, ear swab culture, imaging
• Treatment: hospitalization, antibiotic, cortical
mastoidectomy
Acute labyrinthitis
• Inflammation over inner ear/labyrinthin
• Clinical features: vertigo, hearing loss
• Treatment:
-Rest in bed
-Antibacterial therapy
-Labyrinthine sedatives
-Myringotomy is done if labyrinthitis has
followed acute otitis media and the drum is
bulging
Osteomyelitis of lateral skull base
• Necrotizing otitis externa
• Aetiology usually pseudomonas
aeruginosa
• Beginss as external otitis before
progress into temporal bone OM
• Commonly manifest in elderly,
diabetic
Infection over the
nose
• Cellulitis
• Acute Sinusitis
Cellulitis over nose
• Nasal skin may be invade by
streptococcus or staphylococci
• Clinical features: red, tender, swollen
nose
• Treatment: systemic antibiotic
Acute Bacterial
Sinusitis
• Acute inflammation over paranasal
sinus
• Common organisms: Strep
Pneumonia, Haemophilus Influenza
• Clinical features: facial pain, nasal
blockage, nasal discharge
• Investigations: nasal endoscopy,
Imaging
• Treatment: adjuvant therapies,
antibiotic
Fungal Sinusitis
 • Orbital
Complication of sinusitis • intracranial
Infection oral
cavity
• Commonly of dental origin
• Primary Herpetic
Gingivostomatitis due to Human
herpes virus (HHV-1)
• Rx usually sx relieve of pain and
maintain oral hygiene
Oral
Candidiasis
• Caused by candida sp.
• Rx: topical anti-fungal oral
anti fungal
Infection over throat
• Acute pharyringitis
• Acute tonsillitis
 Viral infection of pharyngotonsillitis

• Infectious mononucleosis is cause

by EBV virus
• Sx: generalized myalgia, fever, sore
throat, cervical lymphadenopathy
• Ix: FBC-lymphocytosis, mono spot
test
• Rx: supportive rx, 1/3 may need
antibiotic for superimposed
bacterial infection
Acute Pharyngitis
• Also known as common cold
• Inflammation over throat region
• Due to virus or bacteria infection
• Symptoms: sore throat, pain, cough
• Treatment is symptomatic treatment for viral infection and antibiotic
if bacteria infection
Acute tonsillitis
• Clinical signs:
sore throat
odynophagia
dysphagia, fever
enlarged cervical lymph node
Diphteria
• Cause by corneybacterium diphteriae
• Can lead to fatility in 5-10% of cases
• Toxin can lead to tissue necrosis affecting myocardium and
peripheral nerve
Infections of salivary gland

• Mumps cause by paramyxovirus is the most

common viral infection in salivary gland,
usually involve parotid gland
• After an incubation period of 2–3 weeks, low-
grade fever, malaise, and anorexia occur. This is
then followed by parotitis
Neck Spaces Infections
• Peritonsillar space
• Retropharyngeal space
• Parapharyngeal space
• Prevetebral space
• Parotid space
• masticator
Peritonsillar Abscess

• Usually follow episodes of acute tonsillitis

• Clinical features: hot potato voice, unilateral tonsillar bulging,
limited mouth opening
Parapharyngeal Abscess

• Deep neck space infection

• Symptoms may include neck swelling, odynophagia
• Clinical examination may reveal medialization lateral
pharyngeal wall
• Investigation: blood ix, Imaging-CT Scan
• Treatment:antibiotic, I&D
 Infection
over Upper
Airway
X-ray
Findings