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6 - Otitis Externa
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 37-38
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Summary
INTRODUCTION – AGENTS
Otitis externa (OE) or “swimmer's ear” is a relatively common infection of the pinna and/or external auditory canal. Most episodes of OE are caused by Pseudomonas aeruginosa. Other bacterial etiologies include Staphylococcus aureus, other Staphylococcus spp., Streptococcus, Proteus, and Klebsiella.
OE can occasionally be caused by fungi, most often Aspergillus species such as Aspergillus niger, flavus, and fumigatus. Candida albicans can also cause OE.
Less commonly, a herpetic viral etiology can cause OE, or an eruption of herpetic vesicles can become secondarily infected by bacteria.
EPIDEMIOLOGY
Otitis externa occurs in both children and adults, and is often seen in months when swimming is a popular activity. This association may result from injury to the ear canal skin in the process of drying ears after swimming, which facilitates bacterial infection. Patients with chronic moisture in their ears are more susceptible to OE, and increased incidence is seen in warm, humid environments and seasons. Hearing aid wearers or frequent ear-plug users may also be at increased risk.
A history of trauma, laceration, or a recent intra-aural foreign body may be an inciting event. Overaggressive Q-tip users are frequent OE patients because of abrasion and subsequent infection of the ear canal. A careful history must be elicited in refractory cases, because although patients may have claimed that they have ceased using Q-tips, other objects such as pins, paper clips, and the ends of eyeglasses are often substituted.
10 - Deep Neck Space Infections
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 47-50
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Summary
INTRODUCTION – AGENTS
The head and neck contain a variety of fascial planes forming potential spaces for the spread of infection. If these spaces are seeded, infection may travel to vital structures such as the carotid artery, jugular vein, or mediastinum. Deep neck spaces include the submandibular, peritonsillar, parapharyngeal, retropharyngeal, and prevertebral spaces.
The majority of deep neck space infections are caused by the organisms that frequently infect or colonize the upper aerodigestive tract. These include Streptococcus and Staphylococcus species, as well as bacteria commonly found in the oral cavity such as Bacteroides species, Klebsiella, Escherichia coli, Enterobacter, Actinomyces, and Eikenella corrodens. Often these infections involve mixed flora.
EPIDEMIOLOGY
Both adults and young children can develop deep neck space infections. Teenagers and young adults present with peritonsillar space abscesses more commonly than other age groups. A recent dental infection or procedure may be a predisposing factor for a submental or submandibular space infection (see Chapter 3, Dental and Odontogenic Infections). Intravenous or subcutaneous injection of illicit substances into neck veins or tissue also predisposes to neck infections.
CLINICAL FEATURES
The clinical features of a particular deep neck space infection will reflect the anatomic characteristics of the deep neck space involved (Table 10.1). A submandibular space infection may reveal a concomitant infection of the submandibular duct. Odontogenic infections can progress to submental or sublingual infections, and therefore a through dental examination is always indicated.
7 - Sinusitis
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 39-42
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Summary
INTRODUCTION – AGENTS
Causative agents of acute bacterial sinusitis are similar to those seen in other infections of the head and neck and include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Anaerobes are less frequently encountered in acute sinusitis but play a role in chronic sinusitis. Viruses can also cause acute rhinosinusitis.
EPIDEMIOLOGY
Sinusitis is a common chronic condition for which patients seek physician attention in the United States. There are more than 25 million patient visits per year pertaining to sinus problems, including allergic rhinitis, viral upper respiratory infections, vasomotor rhinitis, bacterial rhinosinusitis, and nasal polyposis. Sinusitis occurs in patients of all ages but is more common in adults. Children with cystic fibrosis, however, are a unique population at much higher risk for sinus disease caused by atypical organisms, especially Pseudomonas.
CLINICAL FEATURES
The spectrum of acute to chronic sinusitis is mostly dependent on the duration of signs and symptoms. Acute sinusitis is defined as an infection that generally clears within 4 weeks. Chronic sinusitis is an infection that has been present for about 12 weeks despite treatment. Subacute sinusitis lasts longer than 4 weeks but less than 12 weeks. Recurrent acute sinusitis may be referred to as chronic (recurrent) sinusitis if a patient is afflicted with more than four infections in a year, each clearing completely (Tables 7.1 and 7.2).
11 - Mumps
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 51-52
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Summary
INTRODUCTION
Once considered a common childhood illness, mumps has dramatically declined in incidence with the widespread usage of the mumps vaccine, though there have been significant sporadic outbreaks in the United States recently. Mumps is still a common disease in countries without widespread vaccination programs.
EPIDEMIOLOGY
Mumps is an enveloped negative-sense RNA virus belonging to the Paramyxovirus family. In the United States between 2001 and 2005, only 200–300 cases of mumps were diagnosed annually. Between January and May, 2006, however, there were more than 2,500 outbreaks in 11 states. Unvaccinated individuals are particularly at risk for infection, though the majority of outbreak cases have occurred among those who have been vaccinated and have not achieved immunity.
Current recommendations are that children receive a first dose of MMR vaccine at ages 12 to 15 months and a second dose at ages 4 to 6 years. Two doses of MMR vaccine are also recommended for students attending colleges and other post–high school institutions and who do not have proof of two prior doses or other evidence of immunity.
CLINICAL FEATURES
Patients with mumps commonly present with painful, bilateral parotid swelling (Figure 11.1). They may also have fevers, dry mucous membranes, dysphagia, and trismus (Table 11.1). On questioning, the patient may describe prodromal symptoms including malaise, fevers, and a sore throat. Milking of saliva along Stenson's duct should reveal clear saliva (purulent saliva suggests a bacterial etiology).
9 - Pharyngitis and Tonsillitis
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 45-46
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Summary
INTRODUCTION – AGENTS
Pharyngitis and tonsillitis both are most frequently caused by Streptococcus pyogenes (group A beta-hemolytic streptococcus). However, many other organisms have been cultured in pharyngitis and tonsillitis, including viridans group Streptococci, Staphylococcus aureus, and Haemophilus influenzae. Oral flora such as Actinomyces can also be a bacterial etiology. It is not uncommon for the infection to be caused by a mix of aerobic and anaerobic flora.
Viruses with a predilection for the upper respiratory tract can also be causative and are, in fact, more prevalent. These include rhinoviruses, influenza viruses, adenovirus, enteroviruses, reovirus, respiratory syncytial virus, parainfluenza viruses, and coronaviruses. Infection with the Epstein-Barr virus (EBV) is common and may be accompanied by extensive tonsillar exudates. Other etiologies include toxoplasmosis, candida, tularemia, and cytomegalovirus.
EPIDEMIOLOGY
Pharyngitis and tonsillitis are most commonly seen in children and teenagers (though rarely in children under 2), and are not unusual in adults. In general, it is more likely for children than for adults to have a bacterial etiology of a sore throat. There is a peak incidence in Streptococcus pharyngitis from November to May.
CLINICAL FEATURES
Pharyngitis and tonsillitis both present with dysphagia, odynophagia, and a low-grade fever (Table 9.1). There may be erythema of the pharynx. In a tonsillar infection in which the many crevices (or crypts) harbor bacterial infection, patients may complain of bad breath and foul-tasting whitish lumps on the tonsils.
8 - Supraglottitis
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 43-44
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- Chapter
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Summary
INTRODUCTION – AGENTS
Patients with supraglottitis may present to the acute care setting with complaints of a sore throat and difficulty breathing. These symptoms may reflect a self-limited upper respiratory infection (URI) or, infrequently, an impending airway emergency.
Supraglottitis describes inflammation of the supraglottic structures, which include the epiglottis, the false vocal cords and arytenoids, and the aryepiglottic folds. In the past these infections were all called epiglottitis, but supraglottitis is a more anatomically accurate description as the surrounding supraglottic structures are usually involved. The vallecula and tongue base, technically part of the oropharynx, may also be affected.
Haemophilus influenzae was previously the primary organism responsible for epiglottitis/supraglottitis. With the advent of the H. influenzae type B (HIB) vaccine and its widespread use, the overall incidence of supraglottitis and H. influenza as a causative organism has decreased significantly. Other causative etiologies include Streptococcus pneumoniae, Streptococcus pyogenes Staphylococcus species, and other Haemophilus species, such as Haemophilus parainfluenzae. Less commonly involved are bacteria such as Klebsiella or Pseudomonas, viruses, or Candida.
EPIDEMIOLOGY
In the past, young children made up the majority of cases of epiglottitis (see Chapter 49, Pediatric Respiratory Infections). With widespread HIB vaccination of the pediatric population, however, the disease is now more common in adults than children in the United States.
5 - Otitis Media
- from Part I - Systems
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- By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
-
- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 33-36
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- Chapter
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Summary
INTRODUCTION – AGENTS
The majority of otitis media (OM) infections are caused by organisms commonly found in the upper aerodigestive tract, including the ears, nose, sinuses, oral cavity, oropharynx, hypopharynx, and larynx. These agents include Streptococcus pneumoniae, Haemophilus influenzae, and less commonly, Moraxella catarrhalis, Streptococcus pyogenes, and Staphylococcus aureus. Anaerobic bacteria may play a role in OM in the neonatal period. Viruses that infect the upper respiratory tract also frequently cause OM.
EPIDEMIOLOGY
Young children compromise the majority of cases of OM. Children with craniofacial syndromes or trisomy 21 (Down syndrome) may be particularly prone to OM. Children with a cleft palate or submucous cleft palate are at high risk for persistent or recurrent acute OM.
Some adults also may be predisposed to OM, including those with HIV and concomitant adenoid hypertrophy that obstructs the eustachian tube orifice, as well as recipients of head and neck radiation. Additionally, certain ethnic groups, including Native Americans, have a higher incidence of OM. An otherwise healthy adult with persistent unilateral OM warrants additional work-up for a possible underlying malignancy.
CLINICAL FEATURES
Acute OM is one of the most frequently encountered otologic infections in children (Table 5.1). Young children may be inconsolable and will sometimes tug or pull on the affected ear, though this sign is very nonspecific in children under 2. They will often complain of pain or otalgia as a prominent symptom.