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ENT Infections: an Atlas of Investigation and Management

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ENT Infections: an Atlas of Investigation and Management An Atlas of Investigation and Management Paleri • Hill An Atlas of Investigation and Management ENT INFECTIONS ENT INFECTIONS An illustrated guide to the investigation, diagnosis and management of infectious diseases of the ear, nose and throat. The authors lead the reader through physical Vinidh Paleri • John Hill examination followed by an overview of the microbiology of ENT infections, describing the main infective organisms and the tests by which the presence of bacterial, viral, fungal and other infections can be confirmed. This is followed by a brief summary of the principles of pharmacological management, the agents currently in use and their mode of action. The ensuing sections of the atlas focus separately on infections of the ear, the nose and paranasal sinuses, the mouth, the pharynx, the larynx and the neck. All chapters present an illustrated discussion of relevant infections, covering various possible diagnoses, the causative organisms and the means by which the infection can be ENT INFECTIONS ENT treated. Information is supported by high quality colour photographs, diagnostic algorithms and tables throughout. The concluding chapter deals with some of the most important tropical infections which are encountered with increasing frequency and with which the clinician needs to be familiar. Related title: Problem Solving in Infection, S Dancer, A Seaton ISBN 978 1 904392 83 5 Website: www.clinicalpublishing.co.uk ISBN: 978 1 84692 006 6 Barcode Scaled PUBLISHING CLINICAL CLINICAL PUBLISHING ENT Infections CMYK ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page ii Dedication This book is dedicated to the memory of both our fathers. They inspired us, believed in us, and were our heroes. ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page iii An Atlas of Investigation and Management ENT INFECTIONS Vinidh Paleri Consultant Surgeon and Honorary Senior Lecturer Department of Otolaryngology – Head and Neck Surgery Newcastle-upon-Tyne Hospitals Newcastle-upon-Tyne, UK John Hill Consultant Surgeon and Honorary Senior Lecturer Department of Otolaryngology – Head and Neck Surgery Newcastle-upon-Tyne Hospitals Newcastle-upon-Tyne, UK CLINICAL PUBLISHING OXFORD ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page iv Clinical Publishing an imprint of Atlas Medical Publishing Ltd Oxford Centre for Innovation Mill Street, Oxford OX2 0JX, UK Tel: +44 1865 811116 Fax: +44 1865 251550 Email: [email protected] Web: www.clinicalpublishing.co.uk Distributed in USA and Canada by: Clinical Publishing 30 Amberwood Parkway Ashland OH 44805 USA Tel: 800-247-6553 (toll free within US and Canada) Fax: 419-281-6883 Email: [email protected] Distributed in UK and Rest of World by: Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN, UK Tel: +44 1235 465500 Fax: +44 1235 465555 Email: [email protected] © Atlas Medical Publishing Ltd 2010 First published 2010 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Clinical Publishing or Atlas Medical Publishing Ltd. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A catalogue record of this book is available from the British Library ISBN print 978 1 84692 006 6 ISBN e-book 978 1 84692 607 5 The publisher makes no representation, express or implied, that the dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publisher do not accept any liability for any errors in the text or for the misuse or misapplication of material in this work. Printed by Marston Digital Ltd, Didcot, Oxon, UK ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page v Contents Foreword vii 4 Infections of the ear 25 Preface viii JOHN HILL Acknowledgements viii Introduction 25 Contributors xi Infections of the pinna 25 Abbreviations x Infections of the external ear canal 25 Furunculosis 26 1 Clinical examination 1 Acute otitis externa 26 Ear 1 Chronic otitis externa 28 JOHN HILL Fungal otitis externa 30 Examination of the ear 1 Sequelae of chronic otitis externa 30 Viral infections 31 Nose 3 Bullous myringitis 31 WOLFGANG ISSING Herpes zoster 31 Examination of the nose 3 Infections of the middle ear 32 Radiological examination 3 Viral acute otitis media 32 Oral cavity, o ro pharynx, larynx and Acute otitis media 32 hypopharynx, and neck 5 Acute mastoiditis 33 VINIDH PALERI Infected perforated tympanic membrane 34 Examination of the oral cavity 5 Infected grommets or ventilation tubes 34 Examination of the oropharynx 7 Cholesteatoma 36 Examination of the larynx and hypopharynx 7 Infected mastoid cavity 39 Examination of the neck 8 Aural polyp 39 Ototoxicity 41 2 Microbiology of ENT infections 11 Infections of the inner ear 41 MANJUSHA NARAYANAN Osteomyelitis of the skull base 41 Microorganisms that cause human infections 11 Pyogenic infection of the inner ear 42 Commensals 13 Bell’s palsy 42 Principles of microbiological diagnosis 13 Vestibular neuronitis or labyrinthitis 42 Causative organisms 18 Upper aerodigestive tract and sinus infections 19 5 Infections of the nose and paranasal sinuses 43 Ear infections 19 WOLFGANG ISSING AND ANDREAS LEUNIG Introduction 43 3 Principles and practice of anti-infective Infections of the external nose 43 therapy in ENT infections 21 Erysipelas 43 VINIDH PALERI AND JOHN HILL Herpes simplex 43 Introduction 21 Fistula of the nasal dorsum 44 Resistance 21 Foreign bodies 44 Parenteral therapy 22 Infections of the nasal cavity 45 Frequently used antibiotics in ENT practice 22 Vestibulitis 45 Choice of antibacterial therapy 24 Viral papilloma 45 Septal haematoma and septal abscess 45 Nasal polyposis 47 ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page vi vi Contents Nasal foreign bodies 47 Acute suppurative sialadenitis 74 Adenoiditis 47 Submandibular salivary gland infections 76 Infections of the paranasal sinuses 48 Chronic recurrent parotitis of childhood 77 Rhinitis, sinusitis, and rhinosinusitis 48 Granulomatous infections 77 Viral rhinosinusitis 48 Tuberculosis 77 Acute and chronic bacterial rhinosinusitis 48 Fungal sinusitis 50 9 Infections of the larynx 79 Complications of paranasal sinus infections 50 VINIDH PALERI Orbital cellulitis 50 Introduction 79 Pott’s puffy tumour (osteomyelitis of Laryngeal infections 80 the frontal bone) 52 Supraglottitis in children 80 Frontal sinus mucocoele and pyocoele 50 Supraglottitis in the adult 81 Laryngotracheobronchitis (croup) 81 6 Infections of the oral cavity 55 Bacterial tracheitis 82 VINIDH PALERI AND KONRAD STAINES Chronic infective laryngitis 82 Introduction 55 Laryngeal papillomatosis 84 Viral infections 55 Laryngopyocoele 84 Primary herpetic gingivostomatitis 55 Chondronecrosis 84 Recurrent herpetic infections (cold sores) 57 Chickenpox (varicella) 57 10 Infections of the neck 87 Shingles (zoster) 57 VINIDH PALERI Hairy leukoplakia 58 Introduction 87 Papillomatosis 58 Neck infections 87 Bacterial infections 58 Cervical lymphadenitis 87 Acute ulcerative gingivitis 58 Monomicrobial infections 88 Fungal infections 61 Cat scratch disease 88 Candidiasis 61 Toxoplasmosis 89 Mycobacterial infections 89 7 Infections of the oropharynx 65 Actinomycosis 90 VINIDH PALERI Polymicrobial infections 90 Introduction 65 Cellulitis of the neck 90 Viral infections 67 Necrotizing cervical fasciitis 91 Infectious mononucleosis 67 Infection of branchial and thyroglossal cysts 91 Herpes simplex 68 Deep neck space infections 93 Human papilloma virus 68 Post-operative infection 97 Bacterial infections 69 Infective thyroiditis 98 Group A beta haemolytic streptococci Atlanto-axial subluxation (Grisel syndrome) 98 (GABHS) 69 Diphtheria 69 11 Tropical ENT infections 101 Peritonsillar abscess 70 SURIANARAYANAN GOPALAKRISHNAN AND Candida 71 VINIDH PALERI Common infections 101 8 Infectio ns o f the salivary glands 73 Rhinoscleroma 101 VINIDH PALERI Leishmaniasis 102 Introduction 73 Rhinosporidiosis 103 Viral infections 73 Leprosy of the nose 103 Mumps 73 Anthrax 104 Human immunodeficiency virus 74 Bacterial infections 74 Index 105 ENT Final.qxd:Dementia final.qxd 12/2/10 06:23 Page vii vii Foreword It is indeed a great honour and pleasure to be asked to write that each such clinical scenario is treated by a course of ‘an a Foreword to accompany this publication. ENT Infections: antibiotic’. While the result of such intervention would seem an Atlas o f Investigatio n and Managem ent is a quality appropriate as the condition, in the acute phase, seems to publication which brings together clinical scenarios that abate with the easing of ‘pain’ symptoms, often the infection present to a diversity of clinicians on a daily basis. By lingers with the result that it returns with a vengeance within dividing the ear, nose, and throat into its appropriate a short period of time. The symptom of ‘sore throat’, anatomic sites, the consulting clinician can refer to the Atlas depending on the age of the patient, maybe called tonsillitis and confirm with a greater degree of accuracy what the or pharyngitis, but is usually treated the in the same way; diagnosis is or likely to be. As well as covering the
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