Otolaryngologic Clinical manifestations on Hiv

patients
HIV
 blood-borne and sexually transmitted

 infection that leads to acquired immunodeficiency syndrome (AIDS)

 HIV belongs to the Lentivirus genus of the retroviridae family

 An enveloped, single-stranded RNA virus that primarily infects CD4+ T lymphocytes

HIV
 blood-borne and sexually transmitted

 infection that leads to acquired immunodeficiency syndrome (AIDS)

 HIV belongs to the Lentivirus genus of the retroviridae family

 An enveloped, single-stranded RNA virus that primarily infects CD4+ T lymphocytes

Clinical presentation
 HIV can spread via blood, semen, vaginal fluid, or breast milk.

 Primary HIV infection can be asymptomatic or present as a viral prodrome occurring

 2 to 4 weeks a er exposure.

 Symptoms include fever, reactive cervical lymphadenopathy, pharyngitis, maculopapular

 rash, orogenital ulcers, and meningoencephalitis.

 Leukopenia and decreased CD4 count can also occur with associated opportunistic

 infections.
Management
 HAART

 Initiated when CD4 count drops below 350 cells/mm3 or there is presence of an AIDS
defining illness.
Common Manifestations of
Immunodeficiency in the Head
and Neck
 INFECTIOUS MANIFESTATIONS  NONINFECTIOUS
MANIFESTATIONS
Oral Cavity  Salivary gland disease

 Candidiasis  Hearing loss

 Aphthous ulcers Malignancy

 Oral hairy leukoplakia • Kaposi sarcoma

PARANASAL SINUSES • Non-Hodgkin lymphoma

 Acute sinusitis • Hodgkin lymphoma

 Chronic sinusitis • Nonmelanoma skin cancer

 Invasive sinusitis

EAR AND TEMPORAL BONE

 Otitis media
Salivary Gland
Benign Lymphoepithelial Cyst
• most common parotid gland lesions seen in HIV-
positive patients
• viral inflammation
• compression of the parotid ducts from the cysts
can cause pain and sialadenitis
• Cervical lymphadenopathy
• Treatment: HAART, Serial aspiration,
Sclerotherapy with doxycycline injections,
Parotidectomy
Diffuse Infiltrative Lymphocytosis
• similar to Sjogren syndrome seen in HIV-positive
patients
• Diffuse parotid enlargement and sicca symptoms
• Treatment: Primarily symptom control with
salivary substitutes and sialogogues.
Xerostomia may cause dental caries
complication and referral to dentistry is warranted.
Oral Cavity
Oral Hairy Leukoplakia Gingival and Periodontal
Disease
• white, corrugated, • Linear gingival erythema:
hyperkeratotic lesion Fiery red band of marginal
• Almost pathognomonic of gingiva
HIV progression to AIDS • Necrotizing ulcerative
• Asymptomatic gingivitis/periodontitis/stom
• Treatment: acyclovir, atitis- bleeding, tissue
sulpha drugs, zidovudine sloughing, pain, malodor,
or topical retinoic acid and loss of the interdental
papillae
• Treatment: chlorhexidine
and nystatin mouthwash
Oral Histoplasmosis
• Histoplasmosis is a fungal
infection and is an AIDS
defining illness
• Painful, erythematous
mucosa to granulomatous
lesions with or without
pseudomembrane formation,
CLADs
• Treatment : systemic
antifungals, such as
amphotericin B or
itraconazole
Oral Candidiasis
Pseudomembranous (aka Atrophic (aka
oral thrush) erythematous
Angular chelitis Hyperplastic Candidiasis
most common oral cavity lesion seen in HIV/AIDS
candidiasis)
• Most common • Mucosa is • Involvement of the • Rarest
presents erythematous, with oral commissure, • Involves the buccal
• White curd-like loss of tongue with cracking, mucosa, presents as
plaques that can be papillations ulceration, and thick
scraped off with a pseudomembranous white plaque that cannot
tongue depressor formation be scraped off
underlying mucosa is
erythematous and
occasionally raw
• Treatment :
Antifungals (topical
and systemic)
Adenoid Hypertrophy
• Lymphoid hyperplasia and
generalised lymphadenopathy and
enlarged tonsils are frequently
part of the clinical picture.
• Presents as persistent nasal
obstruction
• May cause OME d/t obstruction
of the Eustachian tubes by the
lymphoid mass in the postnasal
space

Treatment:lymphoid hyperplasia-
adenoidectomy
 Paranasal sinuses
Acute Sinusitis
• Fever
• Facial pain or pressure
• Nasal congestion
• Mucopurulent nasal discharge
• Postnasal drainage
 Diagnosis: H& N examination, nasal endoscopy, endoscopic guided cultures, CT scan, MRI,
Biopsy
Chronic Sinusitis Invasive Sinusitis
• Congestion • Facial paresthesias
• Nasal discharge • Swelling
• Pain
• Rhinorrhea with or without
fever
• absolute neutrophil count
below 600 cells/µL or a
• CD4 count below 50 cells/µL
OTOLOGIC AND
NEUROLOGIC
MANIFESTATIONS OF
IMMUNODEFICIENCY
Malignant Otitis Externa
• severe, painful inflammation
• purulent otorrhea
• fleshy granulation tissue along
the inferior aspect of EAC at the
bony-cartilaginous junction.
• Treatment: 6-week high-dose
intravenous antipseudomonal
antibiotic regimen.
(Ciprofloxacin + a third or
fourth-generation cephalosporin)
Serous otitis media and recurrent
acute otitis media
• Most common otologic problems
reported in HIV-infected patients
• Ear discomfort
• Fullness
• Conductive hearing loss
• Tinnitus
• Treatment: Antimicrobial
therapy with or without steroids
for 10-14 days, Myringotomy
and ventilation tube insertion if
persistent x 3 mos
Sensorineural Hearing loss
• delayed wave latencies on
auditory brainstem-evoked
response (ABR) testing
• Central demyelination consistent
with viral infection
• Treatment: auditory
rehabilitation
with hearing aids, cochlear
implantation
Malignancies
Kaposi Sarcoma
• angioproliferative tumor
• commonly presents in the oral
cavity, most frequent
subsites(hard palate, gingiva,
and tongue)
• maculopapular violaceous
lesion that does not blanche
• Treatment: treat underlying
cause, palliative
Lymphoma Nonmelanotic Skin Cancer
• fever, night sweats, • more often invasive and
unexplained weight loss aggressive
enlarging lymph nodes with higher rates of metastasis and
• Treatment: Consist primarily of recurrence
chemotherapy with concurrent • Treatment: wide local excision,
HAART removal of the draining
lymph node basins, and adjuvant
therapy based on the presenting
tumor and stage