Targets

Etiology

Oropharynx (OP)
Acute epiglottitis

Children 2 4 y/o
(more toxic)
Haemophilus
influenzae type B
- Gram ve coccobacilli
- X(hemin) & V(NAD)
factors
- a-f serotypes/
non-typeable
- Produce -lactamase

S&S

Dx

Other
Investigation

i) HIGH fever
(6 12 hr)
ii) Severe sore throat
iii) Dysphonia,
drooling, stridor

Laryngoscopy
- Cherry-red
epiglottis
(DONT wait for XR!)

Peritonsillar
abscess
Adolescents +
Young adults
1) Grp A strep
(Strep pyogenes)
- -hemolytic
- Sensitive to
bacitracin

2) Mixed OP flora
- Viridans strep
- Anaerobes
i) Low grade fever
ii) Severe sore throat
iii) Hot potato voice
iv) Dysphagia
Saliva dribbling
v) - PT area infm +
- Tonsil medially
vi) Bilateral
Aw obstruction
stridor
Contrast CT
Abscess lateral to
tonsils
Needle aspiration
firm pus

Oropharynx (deep fascia space infection)

Submandibular/
Lateral/para-
Sublingual space
pharyngeal space
=Ludwigs angina


Underlying cause
(50-90% w/
dental root
abscess)

mixed oral flora

Characteristic:
1) HIGH fever
(systemic toxicity)
2) Board-like
swelling of
bilateral spaces
3) Dysphagia
4) Mouth held
open

Dental assesement

Underlying cause
(spread from
adj infn)
e.g. - odontitis
- pharyngitis
- tonsillitis - otitis
- parotitis
- mastoiditis

Retropharyngeal
space

Underlying cause
e.g.
- odontitis
- peritonsillar absc
- cervical vertebral
osteomyelitis
1) mixed oral flora

Larynx
Laryngotracheobronchitis
(CROUP)
Children 3 moths 3 y/o
(well looking)
Viruses!!!!!!
- Parainfluenza V
- Influenza V
- RSV
- Adenovirus
- Rhinovirus
(rare: Mycoplasma)

2) SA(vertebral OM)

i) Fever ii) Sore throat

iii) Dysphagia iv) Neck stiffness
Complications
LIFE-THREATENING 1) Mediastinitis
1) Jugular vein
(if infection spread
thrombophlebitis along space)
(Lemierre syndr.)
2) Carotid artery
erosion
1) CT/MRI extent of involvement
any complications?
2) Blood + pus culture
3) Neck XR (for retropharyngeal)
Prevertebral soft tissue swelling
Gas formation

1) Fever
2) Hoarseness
3) Barking cough
4) Stridor
(MOST common cause
of stridor in child!!!!)
+
URI synptoms (2 3 days)

Neck XR
- Hourglass (steeple) sign
- Subglottic swelling
Nasopharyngeal aspirate
- For respiratory V antigen

i) Neck XR

- Thumb sign
ii) Blood culture
Management Airway protection, airway protection, airway protection!!!!!!!!!! Upper airway obstruction no oxygen death medical emergency!!!
1) Antibiotic
1) Antibiotic
1) Antibiotic
1) Antibiotic
1) Racemic adrenaline
w/ beta-lactam I
2) Abscess drainage 2) Surgical
2) Surgical drainage (if needed)
2) Steroid
(Amoxic. + clauvu)
antibiotics cant soft tissue
3) Treat primary infective focus
for edema of airway
2) Rifampicin
penetrate!!!
decompression
prophylaxis
3) Dental
assessment



Target
Types

Etiology

Pathogen

Sx

Dx

Complic

Allergic rhinitis

(Also infectious rhinitis
Etiology same as OtM)

Allergens
Dust, pollens, animal dander

Otitis media
Child (v. common!!)
Eustachian tube short and horizontal
Acute
Chronic suppurative
otitis media
otitis media
Viral URTI blocks Perforation of
Eustachian tube tympanic membrane
Effusion into after AOM for few wk
Middle ear
1) Active 2) Inactive
(discharge) (dry)

Tonsillitis

Bacterial

Sialoadenitis

Virus

1) Red swollen tonsil

2) Throat redness
Swollen uvula
White spots
Grey furry
tongue
VIRAL most common!!
- Rhinovirus
- AdenoVirus
- EBV

Bacterial
- Strep pyogenes
- Strep pneumonia
- SA
- HI

1) Odynophagia
2) Trismus
pterygoid MS infm
3) Ear pain (REFERRED)

Parotiditis MOST COMMON

(Red + swollen in front of ear)
Bilateral = mumps

Submandibular gland
R + S gland in front of parotid
gland at floor of mouth

Streptococcus pneumoniae
Viral: Mumps, coxsackievirus, HIV
Haemophilus influenza type B
Bacterial: SA, TB, syphilis
Moraxella catarrhalis
AI: Sjogrens syndrome
Inhaled allergens
Preceding URTI
Ascending duct infn
Type I HS (IgE)
Blockage of Eustachian tube
1) Gland hyposecretion
Mast cell degran.
Swelling of nasopharynx
- Dehydration
(histamine, PGs)
Air-trapped inside middle ear slowly
2) Ductal obstruction
vasodilation
absorbed into BVs
- Mucocele / stone
Late phase
Mild vacuum
Cell infiltrate
Surrounding fluid sucked from NP
chronic nasal obstruction
into middle ear predispose to infn
1) Eyelid, conjunctival swelling 1) Ear pain
1) Unilateral pain, swelling
2) Sneezing, nasal congestion, 2) Discharge
2) Firm, tender, red gland
rhinorrhea, post-nasal drip 3) Fever
w/ pus leakage
3) Rash
4) Conductive hearing loss

Late Phase
Perforated tympanic membrane,
(Fever, chill)
Swollen & tender
Fluid accumulation in middle ear

nasal concha

Risk factor
- Xerostomia

Tympanic membrane:

- Radiation to H&N
Bulging, red, cloudiness congested bv
(NO cone of light)

1) Rupture of tympanic membrane

Tenderness + swelling + erythema behind ear
2) Tympanosclerosis

Spread i) CN 7 (matoid close to stylomastoid foramen)
3) Mastoiditis (mastoid antrum)

ii) CN 6 pasy iii)Abscess in p osterior cranial fossa