Head, Eyes, Ears, Nose

1
Head, Eyes, Ears, Nose Throat Diagnosis

• Class Notes

2
Head, Eyes, Ears, Nose Throat Diagnosis

• Nose, Sinuses, Oral Cavity Chapter 11

3
Nose, Sinuses, Oral Cavity

• Review of Anatomy
• Nose External
• Bridge
• Tip
• Ala Nasi
• Columella
• Anterior Naris
• Vestibule
• Roof
• Floor

4
Nose, Sinuses, Oral Cavity

• Review of Anatomy
• Nose Internal
• Septum
• Anterior Cavities
• Cribriform Plates
• Turbinates
• Superior
• Middle
• Inferior
• Meatus

5
Nose, Sinuses, Oral Cavity

• Review of Anatomy
• Sinuses
• Maxillary
• Frontal
• Ethmoid
• Sphenoid

6
Nose, Sinuses, Oral Cavity

• Review of Anatomy
• Oral Cavity
• Divided into the Vestibule Mouth
• Vestibule
• Mouth
• Roof
• Floor
• Stensons Ducts
• Whartons Ducts

7
Nose, Sinuses, Oral Cavity

• Case History
• The case history will determine if examination of
  the nose, sinuses, or oral cavity is clinically
  necessary

8
Nose, Sinuses, Oral Cavity

• Case History
• Possible Complaints Necessitating Examination
• Nasal Discharge rhinorrhea
• Tenderness over the sinuses
• Snoring change in pattern or if excessive
• Recurrent Nosebleeds
• Mouth Lesions
• Sore throat
• Difficulty swallowing
• Trauma

9
Nose, Sinuses, Oral Cavity

• Examination
• Equipment Needed
• Nasal Speculum
• Tongue Blades
• Gauze
• Gloves
• Penlight
• Vials of different fragrances tastes

10
Nose, Sinuses, Oral Cavity

• Examination
• Nose External
• Inspection
• Deviations, Size, Shape, Color
• Discharge
• Flaring or Narrowing of the nostril
• Nasal Depression
• Palpation
• Nasal Patency

11
Nose, Sinuses, Oral Cavity

• Examination
• Nose Internal
• Use nasal speculum
• Procedure
• Inspection
• Mucosa
• Concha/Turbinates
• Septum
• Clinical Conditions
• Nasal Polyp
• Septal Perforation

12
Nose, Sinuses, Oral Cavity

• Examination
• Sinus Procedure
• Only the Frontal Maxillary sinuses are
  accessible for examination
• Inspection
• Palpation
• Percuss
• Trans-illumination
• Clinical Conditions

13
Nose, Sinuses, Oral Cavity

• Examination
• Oral Cavity
• Lips
• Inspection
• Color Pallor, Circumoral Pallor, Cyanosis,
  Cherry Red, Peutz-Jeghers Syndrome
• Clinical Conditions
• Cheilitis
• Cheilosis
• Swelling
• Lesions/Plaques/Ulcerations

14
Nose, Sinuses, Oral Cavity

• Examination
• Oral Cavity
• Buccal Mucosa, Teeth, Gums
• Inspection Clinical Conditions
• Teeth Occlusion, Color
• Mucous Membrane
• Gingiva
• Palpation
• Use gloves
• Gums should be free of any masses, lesions,
  thickening or pain

15
Nose, Sinuses, Oral Cavity

• Examination
• Oral Cavity
• Tongue, Floor, Roof of Mouth
• Inspection
• CN IX, X, XII
• Clinical Conditions

16
Nose, Sinuses, Oral Cavity

• Examination
• Oral Cavity
• Oropharynx
• Inspection
• Gag Reflex
• Clinical Conditions

17
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• Leukoplakia
• Oral Cancer
• Trench Mouth

18
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS
• Epidemiology
• Effects 36.7-45.3 million people worldwide
• Caused 3.1 million deaths in 2005
• 5 million newly infected in 2005
• WHO estimates 2.2-2.3 million children infected
  worldwide
• 930,000 cases of AIDS in US ½ causing mortality

19
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS
• Epidemiology
• CDC reports the distribution of AIDS based on
  lifestyles
• Males 57 male-to-male contact
• Females 71 heterosexual contact
• Misc IV Drug use, Blood Transfusions, etc
• Found in every state in the US
• Washington DC highest incidence
• North Dakota lowest incidence
• Missouri 1 (10,265)

20
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS
• Microbiology of the HIV virus
• Def obligate intracellular parasite
• Belongs to the Retroviridae family with further
  classification of Lentivirinae subfamily (slow
  virus)

21
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• General Viral Life-Cycles
• Typical viruses have a well defined life-cycle
• Life-cycle begins with the virus binding to a
  receptor
• Absorptive phase
• Entrance into the cell
• Penetration Uncoating phase
• Blood viral load low
• Production of viral genetic and structural
  proteins
• Expression Phase
• Assembly of viral material and release of newly
  formed viruses into the blood stream
• Final Stage
• Blood viral load increases dramatically

22
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Initial infection (Acute Retroviral Syndrome)
• Begins 2-4 wks after infection lasts up to 6
  months
• Two Types of Responses
• Mononucleosis-like Illness
• Brain Infection

23
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Clinical Latency Period
• Viral load low in blood and lymphocytes
• No correlation between length of latency period
  survival time

24
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Early Immune Failure
• Viral load increases
• Lymphadenopathy
• One of first symptoms
• Def increase in the size of the lymph nodes for
  at least 3 months in at least 2 extrainguinal
  sites
• Sites Head, Face, Neck

25
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Early Immune Failure
• Wasting Syndrome
• Def loss of 10 of the body mass associated with
  30 days of diarrhea
• Affects 20 of AIDS patients
• Decrease in muscle mass
• Night Sweats
• Occur CD4 cells lt 100/uL
• Associated fever

26
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Early Immune Failure
• Shingles
• Herpes Zoster
• Dermatomal pattern
• Tingling Pain
• Rash
• Lasts 4-5 wks

27
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Early Immune Failure
• Thrush
• Candida Albacans
• Occur CD4 lt 500/uL
• Affects 20 of AIDS patients
• Burning
• White patches in mouth, throat, and esophagus

28
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Early Immune Failure
• Hairy Leukoplakia
• Epstein-Barr virus
• Affects 4 w/ tx, 11 w/o tx
• White plagues on the lateral tongue

29
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Frank AIDS
• Characterized by opportunistic infections
• Pneumocystis carinii pneumonia (PCP)
• Affects 60 of AIDS patients
• Round or cup-like cyst parasite
• Clinical S/S

30
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Frank AIDS
• Kaposis Sarcoma
• Affects 3.5-25 of AIDS patients w/ male
  predilection (8x)
• Tumor below the skin surface or in mucous
  membranes of the mouth, nose, or anus
• Apperance raised blotch or nodule
  purple/brown/red greenish halo
• Cause Kaposis sarcoma associated virus (KSHV)
  or human herpes 8 (HHV-8)

31
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• Frank AIDS
• Kaposis Sarcoma
• 4 Types Classic, African (Endemic),
  Transplant-related (Acquired), AIDS-related
  (Epidemic)

32
Nose, Sinuses, Oral Cavity

• Clinical Conditions
• AIDS Clinical Picture
• The Nervous System
• 30 will show some nervous system involvement
• Damage to myelin sheath and loss of nerve cells
  18-30
• Basal ganglia white matter of the brain most
  severely affected
• Progressive Multifocal Leukoencephalopathy - a
  progressive and fatal demyelinating disease of
  the central nervous system
• Manifestations of Brain involvement