Brief Summary of Otitis externa

Also known as external otitis and swimmer’s ear, otitis externa is an inflammation of the skin of the external ear canal and auricle. It may be acute or chronic, and it’s most common in the summer. With treatment, acute otitis externa usually subsides within 7 days (although it may become chronic) and tends to recur.

Causes
Otitis externa usually results from bacterial infection with an organism, such as Pseudomonas, Proteus vulgaris, streptococci, or Staphylococcus aureus; sometimes it stems from a fungus, such as Aspergillus niger or Candida albicans (fungal otitis externa is most common in the tropics). Occasionally, chronic otitis externa results from dermatologic conditions, such as seborrhea or psoriasis. 

Predisposing factors include:

• swimming in contaminated water (cerumen creates a culture medium for the waterborne organism)
• cleaning the ear canal with a cotton swab, bobby pin, finger, or other foreign objects (irritates the ear canal and may introduce the infecting microorganism)
• exposure to dust, hair care products, or other irritants (causes the patient to scratch his ear, excoriating the auricle and canal)
• regular use of earphones, earplugs, or earmuffs (traps moisture in the ear canal, creating a culture medium for infection)
• chronic drainage from a perforated tympanic membrane.

Signs and symptoms
Acute otitis externa characteristically produces moderate to severe pain that’s exacerbated by manipulation of the auricle or tragus, clenching of the teeth, opening of the mouth, or chewing. Other signs and symptoms include fever, foul-smelling aural discharge, regional cellulitis, and partial hearing loss.

Fungal otitis externa may be asymptomatic, although A. niger produces a black or gray blotting paper–like growth in the ear canal. 

With chronic otitis externa, pruritus replaces pain, which may lead to scaling and skin thickening with a resultant narrowing of the lumen. An aural discharge may also occur. Asteatosis (lack of cerumen) is common.

Special Considerations in Patients with Laryngeal cancer

Special considerations

• Psychological support and good preoperative and postoperative care can minimize complications and speed recovery.
• Before partial or total laryngectomy:
• Instruct the patient to maintain good oral hygiene. If appropriate, instruct a male patient to shave off his beard.
• Encourage the patient to express his concerns before surgery. Help him choose a temporary nonspeaking method of communication (such as writing).
• If appropriate, arrange for a laryngectomee to visit him. Explain postoperative procedures (suctioning, nasogastric [NG] tube feeding, and care of laryngectomy tube) and their results (the need to breathe through the neck, altered speech). Also, prepare him for other functional losses: He won’t be able to smell, blow his nose, whistle, gargle, sip, or suck on a straw.

After partial laryngectomy:

• Give I.V. fluids and, usually, tube feedings for the first 2 days postoperatively; then give the patient oral fluids. Keep the tracheostomy tube (inserted during surgery) in place until edema subsides.
• Keep the patient from using his voice until he has medical permission (usually 2 to 3 days postoperatively). Then caution him to whisper until healing is complete.

After total laryngectomy:

• As soon as the patient returns to his bed, place him on his side and elevate his head 30 to 45 degrees. When you move him, remember to support his neck.
• The patient will probably have a laryngectomy tube in place until his stoma heals (7 to 10 days). This tube is shorter and thicker than a tracheostomy tube, but requires the same care.
• Watch for crusting and secretions around the stoma, which can cause skin breakdown. To prevent crust formation, provide adequate room humidification. Remove crusting with petroleum jelly, antimicrobial ointment, and moist gauze.
• Teach the patient stoma care.

Introduction to Epistaxis

Nosebleed, or epistaxis, may either be a primary disorder or occur secondary to another condition. Such bleeding in children generally originates in the anterior nasal septum and tends to be mild. In adults, such bleeding is most likely to originate in the posterior septum and can be severe. Epistaxis is twice as common in children as in adults.

Causes
Epistaxis usually follows trauma from external or internal causes: a blow to the nose, nose picking, or insertion of a foreign body. Less commonly, it follows polyps; acute or chronic infections, such as sinusitis or rhinitis, that cause congestion and eventual bleeding from capillary blood vessels; or inhalation of chemicals that irritate the nasal mucosa. It may also follow sudden mechanical decompression (caisson disease) and violent exercise.

Predisposing factors
Such factors include anticoagulant therapy, hypertension, chronic aspirin use, high altitudes and dry climates, sclerotic vessel disease, Hodgkin’s disease, neoplastic disorders, scurvy, vitamin K deficiency, rheumatic fever, blood dyscrasias (hemophilia, purpura, leukemia, and anemias), and hemorrhagic telangiectasia.

Signs and symptoms
Blood oozing from the nostrils usually originates in the anterior nose and is bright red. Blood from the back of the throat originates in the posterior area and may be dark or bright red (it’s commonly mistaken for hemoptysis because of expectoration).
Epistaxis is generally unilateral, except when caused by dyscrasia or severe trauma. In severe epistaxis, blood may seep behind the nasal septum; it may also appear in the middle ear and corners of the eyes.

Brief Summary of Laryngitis

Laryngitis is a common disorder that involves acute or chronic inflammation of the vocal cords. Acute laryngitis may occur as an isolated infection or as part of a generalized bacterial or viral upper respiratory tract infection. Repeated attacks of acute laryngitis cause inflammatory changes associated with chronic laryngitis.

Causes
Acute laryngitis usually results from infection (primarily viral) or excessive use of the voice, an occupational hazard in certain vocations (for example, teaching, public speaking, and singing). It may also result from leisure activities (such as cheering at a sports event), inhalation of smoke or fumes, or aspiration of caustic chemicals. 

Causes of chronic laryngitis include chronic upper respiratory tract disorders (sinusitis, bronchitis, nasal polyps, or an allergy), mouth breathing, smoking, constant exposure to dust or other irritants, and alcohol abuse. Reflux laryngitis is caused by regurgitation of gastric acid into the hypopharynx.

Signs and symptoms
Acute laryngitis typically begins with hoarseness, ranging from mild to complete loss of voice. Associated signs and symptoms include pain (especially when swallowing or speaking), dry cough, fever, laryngeal edema, and malaise. 

With chronic laryngitis, persistent hoarseness is usually the only sign. With reflux laryngitis, hoarseness and dysphagia are present, but heartburn isn’t

Ménière’s disease

Definition: 

Also known as endolymphatic hydrops, Ménière’s disease is a labyrinthine dysfunction that produces severe vertigo, sensorineural hearing loss, and tinnitus. 

Incidence: 

It usually affects adults, slightly more men than women, between ages 30 and 60. After multiple attacks over several years, this disorder leads to residual tinnitus and hearing loss.

Causes
Ménière’s disease may result from overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells.
This condition may stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. In some women, premenstrual edema may precipitate attacks of Ménière’s disease.

Signs and symptoms
Ménière’s disease produces three characteristic effects: 

1. severe vertigo, 
2. tinnitus, and 
3. sensorineural hearing loss. 

Fullness or blocked feeling in the ear is also quite common. Violent paroxysmal attacks last from 10 minutes to several hours. During an acute attack, other signs and symptoms include severe nausea, vomiting, sweating, giddiness, and nystagmus. Also, vertigo may cause loss of balance and falling to the affected side.

To lessen these signs and symptoms, the patient may assume a characteristic posture—lying on the unaffected ear and looking in the direction of the affected ear. Initially, the patient may be asymptomatic between attacks, except for residual tinnitus that worsens during an attack.

Approach To A Patient Presenting With Hoarseness

Definition Of Hoarseness
Hoarseness is a change in the pitch or quality of the voice caused by abnormalities of vocal cords.

Etiology

Local Causes:

• URTI ( most common cause )
• Laryngitis
• Trauma to the vocal cords: shouting, coughing, vomiting, instrumentation.
• Hypothyroidism
• Acromegaly
• Chronic acid reflux
• Allergies
• Heavy smoking or drinking or both
• Carcinoma

Neurological Causes:

• Laryngeal nerve palsy
• Motor neuron disease
• Myasthenia gravis
• Multiple sclerosis

Muscular Causes:

• Muscular dystrophy

Functional Cause.

• Sometimes no definitive organic cause can be identified and it might be due to psychological causes.