ENT Chart
| DISEASE | CAUSES | SIGNS & SYMPTOMS | DIFFERENTIAL DIAGNOSIS | DIAGNOSIS | TREATMENTS |
|---|---|---|---|---|---|
| Allergic Rhinitis | Inflammation of the mucous membrane of the nose, edema of mucosa, nasal discharge | Pale ,boggy ,nasal mucosa Clear thin nasal secretions +/- nasal congestion Sneezing, postnasal drip Red, itchy, watery eye Enlarged nasal turbinates Allergic shiners, allergic salute | Rhinitis Medicamentosa Epistaxis | Saline nasal spray Nasal steroids- First line (Nasonex, Flonase) Antihistamine (Allegra, Claritin, Zyrtec) Decongestant-oral or topical |
|
| Candidiasis | Caused by Candida albicans | White plaques on erythematous base to tongue, inner lips, and buccal mucosa | Leukoplakia Apthous stomatitis | Nystatin oral suspension for 10-14 days Sterilize all bottles, pacifiers, toys |
|
| Cataract | Leading cause of blindness in US | Opacification of the lens of the eyes Cloudy, Foggy, Blurred vision Decreased visual acuity | Glaucoma Herpes keratitis | ||
| Chalazion | Focal, Chronic inflammation of Meibomian gland May result from chronic stye | Discrete mass on conjunctival side of lid | Blepharitis Orbital cellulitis | IF small, and asymptomatic or IF large, secondary infection-ointment, & warm compress Refer if it continues to grow or when vision is affected |
|
| Conjunctivitis Bacterial Viral Allergic Chlamydial Irritant-chemical | Chlamydia- caused by contamination of eye after sexual contact Neonatal-during delivery via infected birth canal Chlamydia conjunctivitis- associated in Seborrhea/ Rosacea | Bacterial conjunctivitis-mucopurulent drainage Eyes matted on awakening Itching of the affected eye Injection (redness) of conjunctival vessels Unilateral involvement-bilateral Viral conjunctivitis-watery discharge, eyes matted upon wakening , presence of URI Allergic conjunctivitis-mild-moderate conjunctival inflammation, severe itching-burning Watery Drainage, Seasonal presentation Chlamydia Conjunctivitis-Inflammation of eyelid margins Resulting in redness, scaling, crusting Minimal itching PROFUSE purulent drainage | Allergic rhinitis Corneal abrasion | H&P Chlamydia: culture- Giemsa-stained conjunctival scraping | Bacterial conjunctivitis-Antibiotic ophthalmic preparation (Erythromycin, Gentamycin ointment or drops) Viral Conjunctivitis- Topical/oral antihistamine Throw away eyeliner Change contact lens Allergic conjunctivitis-topical vasoconstriction and antihistamine (Benadryl) Topical steroids may be required Chlamydia: Doxycycline BID x 3-5 weeks Refer to Ophthalmologist |
| Corneal Abrasion | Complete or partial tear of the epithelium of the cornea Caused by foreign bodies, fingernails, or contact lenses | Complaint of “gritty” feeling Pain often in proportion in degree of tear Photophobia Red eye | Conjunctivitis Acute angle-closure glaucoma | Flourescein staining Search for any remaining foreign bodies using the slit lamp and everting the eyelids | Refer to ophthalmologist |
| Blepharitis (Chronic condition) | Associated with Seborrhea/ Rosacea | Inflammation of Eyelid margins Resulting in redness, scaling, crusting Acute flare-ups | Staphyloccal vs. Seborrheic | H&P Slit lamp exam | Remove the crust and clean lids with baby shampoo BID Bacitracin or Erythromycin ointment to the lids BID |
| Glaucoma | Disorder characterized by elevated intraocular pressure | Decreased visual acuity, orbital pain, headache, middilated fixed pupil, clouded cornea Acute-closed angle most severe | Cataracts Corneal abrasion | This is an ocular emergency requiring immediate diagnosis and treatment Refer |
|
| Hordeolum (Stye) | Bacterial infection of hair follicle on the eyelid, painful Caused by staph | Tender “focal mounding” of one eyelid that develops over days, often with pustule formation Itchy eyelid and acute onset | Chalazion Blepharitis | H&P | Warm compress BID to TID-until pustule drains Antibiotic drops Sulfa gtts Erythromycin gtts Ointment |
| Impacted cerumen | Obstruction of ear canal by cerumen | Possibly pain, itching, sensation of fullness Conductive hearing loss | Impacted object in ear canal | Curette or irrigation Use caution |
|
| Otitis Externa | Bacterial vs. Fungal | Inflammation of external auditory canal Tragus and/or pinna pain External canal red, TM normal Fungal colonization- ulceration (if fungal) | Otitis Media Sinusitis | Clean debris from canal to facilitate instillation of gtts Polymixin B-neomycin otic suspension Cortisporin otic suspension (fungal) |
|
| Otitis Media | Predisposing factor: exposure to tobacco smoke, Caucasian or Native American Congenital disorders: cleft palate , Down’s Syndrome Allergies | Lack of landmarks Full or bulging TM Distorted Light Reflex Limited or Incomplete Mobility of TM with pneumatic insufflation Erythema alone is an inconsistent finding | Otitis Externa Sinusitis | Teach patients prevention methods First line: Amoxil, Bactrim Second line: Augmentin, Zitromax, Cephalosporins Third line: Cleocin, Rocephin Otitis Media-unresponsive to therapy in 2-3 days If client not toxic, switch antibiotics Consult/Refer to specialist if 2-3 courses of recommended treatments fail or if pain and fever persist for 4-5 days on 2nd med Recurrent Otitis Media –infections in which middle ear effusion clears between episodes 3 infection in 6 months, or 2 infections before 6 months of age Continue prophylaxis for 3-6 months If prophylaxis fails Refer to ENT for tubes |
|
| Periodontal disease | Destruction of gingival and bony structures that support teeth Systemic factors: Hormones, Nutritional, Drug therapy | Poor dental hygiene-plaque formation Bleeding and inflammation | Avulsed tooth | Refer to dentist Educate on plaque prevention, flossing and brushing Dental visit every 6 months |
|
| Peritonsillar abscess | Group A Beta-hemolytic strep | Intraoral abscess surrounding one/both tonsils extending across soft palate Pharyngitis progressing to severe throat pain, fever , dysphagia Usually unilateral | Airway obstruction Foreign body | Immediate ENT referral | |
| Pharyngitis | Inflammation of the pharynx/tonsils Viruses are most common pathogens Group a beta-hemolytic Strept -Bacterial | Sore throat Pain radiating to the ears Dysphagia Tonsillar exudate Fever Petechiae Cervical adenopathy, rash | Peritonsillar abscess Rheumatic Fever Scarlet Fever | Rapid Strep test Throat culture if rapid test negative CBC, monospot | Pen VK (if +strep) Amoxicillin- DOC Erythromycin (if PCN allergy Ibuprofen or Acetaminophen for pain Symptom treatment- salt water gargles, etc |
| Sinusitis Risk Factors: Allergies, URI, Anatomical abnormities, extension of dental abscess, foreign body | Inflammation of mucous membranes that line the paranasal sinuses Strep H. Influenza Staph | Nasal discharge, discolored lasting 4-6 days or longer Nasal congestion Facial headache-worst when the head is bending forward Facial fullness Sore throat due to postnasal drip Facial tenderness +/- Fever Failure of the sinuses to be trans illuminated (indicates fluid-filled sinus) | Decongestants-Afrin nose spray Nasal steroids-beclomethasone Antibiotic therapy-treat for 10-14 days First line: Amoxicillin Bactrim Second line: Augmentin Clarithromycin Avoid smoking or exposure to smoke Avoid environmental irritants Irrigation of sinuses |
||
| Stomatitis | Caused by allergies, stress, hormones, nutritional deficiencies, trauma, medication | Inflammation of oral mucosal tissue with ulcers | No diagnostic test | Minor: most common typically heal in 7-14 days Clusterform: crops of small ulcers (1-5 mm) Major: Large lesions (>5mm) take 6 wks or longer to heal. Pain, lymphadenopathy Liquid Antacids/Benadryl, Xylocaine---spontaneous resolution |