HEENT Exam (CDUpa2022) description of disorders

Blepharitis

Inflammation of the eyelid margins and skin (anterior) and meibomian glands (posterior), often because of an underlying skin condition like psoriasis, characterized by irritation, greasy/crusted eyelids, and redness.

Hordeolum

Eyelid abscess commonly caused by staph a. that infects the sebaceous glands of the eyelids (external) or the eyelid margin and Meibomian gland (internal) causing a tender, painful, focal papule or pustule at the eyelid margin caused by an infection within the follicle.

Chalazion

Lipogranuloma of the meibomian gland that occurs secondary to obstruction of the gland and characterized by a painless, rubbery, non-tender nodule along the eyelid margin.

Entropion

Inward turning of the margin of the eyelid that may occur secondary to aging, infection, or surgery, patient will sense something in the eye and experience tearing.

Ectropion

Outward turning of the margin of the eyelid, preventing the eye from fully closing and may occur secondary to aging, Bell's palsy, or injury.

Xanthelasma

Benign, yellow plaques distributed perioricularlly in a butterfly pattern near the medial canthus of the eyelid, associated with hyperlipidemia, warranting a lipid panel in the diagnostic work up.

Dacryostenosis

Congenital nasolacrimal duct obstruction causing overflow tearing and matting of the eyelashes, secondary to failure of distal membranous end of nasolacrimal duct to open.

Dacryocystitis

Infection of the lacrimal sac and nasolacrimal system, secondary to dacryostenosis, characterized by pain, swelling, erythema, and warmth of the lacrimal sac at the medial canthus of the eye. Palpation of the puncta expresses purulent discharge.

Dacryoadenitis

Infection and/or inflammation of the lacrimal gland causing pain and swelling to the upper outer 1/3 of the eyelid, and characterized by an "S-shaped" ptosis. Can be acute (infection) or chronic (granulation tissue, tuberculosis, etc..)

Pterygium

Fibrovascular, triangular-shaped growth that begins nasally and grows towards the cornea. Can encroach on the cornea and obscure vision. Common with outdoor exposure.

Pinguecula

A benign, yellow, non-vascular, nodular growth confined to the conjunctiva that does not affect vision. More common in individuals with outdoor exposure.

Viral Conjunctivitis

Highly contagious form of conjunctivitis commonly caused by adenovirus. Sudden onset of watery eyes, redness, serous discharge, preauricular lymphadenopathy, URI s/x.

Bacterial Conjunctivitis

Highly contagious type of conjunctivitis caused by Staph aureus, Pseudomonas aeruginosa (contact lense wearers), chlamydia/gonorrhea (sex), causing a red, irritated eye, with mucopurulent discharge that may stuck eyes shut. Unilateral but can be spread manually to other eye. No flu-like symptoms.

Hyperacute Conjunctivitis

Abrupt onset of profuse, copious thick green-yellow discharge, caused by Neiserria gonorrhoeae. Marked chemosis, lid swelling, and preauricular lymphadenopathy. Culture of discharge recommended. Gram negative diplococci

Allergic conjunctivitis

Very common, non-infectious form of conjunctivitis associated with allergens and pollen. Manifested by bilateral redness, watery discharge, and ocular itching. On exam, edema, cobblestone papillae, and allergic shiner may be present.

Ophthalmia Neonatorum

A condition of conjunctivitis that develops in neonates within the first few days to weeks of life causing profuse exudate and swelling of the eyelids, and caused by bacterial infection (Neisseria gonorrhoeae or Chlamydia trachomatis), viral infection (herpes simplex virus), or chemical exposure.

Sicca

Condition where the eye does not produce enough tears or tears evaporate too quickly, OR both. Multiple etiologies like Sjogren's, LASIK, contact lens etc. S/x usually bilateral

Subconjunctival hemorrhage

Condition secondary to rupture of small blood vessels between episclera and conjunctiva, causing violently red, but painless eyes. Caused by vigorous coughing, blunt trauma, eye rubbing, straining. Common in newborns.

Episcleritis

Sudden onset of irritation or inflammation of the episclera. Idiopathic but associated with dry eye and systemic diseases. No visual disturbance, pain is unusual. Vessels will blanch with Phenylephrine HCl solution. Often benign and self-limited but can be reccurent.

Scleritis

Deep, severe inflammatory process associated w/ connective tissue disease. Anterior: violaceous sclera w/ severe, constant boring ocular pain (worse at night). Posterior: less pain, but proptosis, reduced EOM, and vision loss may be present. Vessels do not blanch to Phenylephrine HCl

Bacterial keratitis

Inflammation of the cornea due to pseudomonas and strep pneumoniae infection from contact lens use and corneal ulcerations, causes ciliary flush, pain, foreign body sensation, and visual loss. Ulceration of the epithelium presents as corneal opacity; corneal perforation or hypopyon may be present.

Viral keratitis

Inflammation of the cornea caused by mainly HSV-1. 2 types: primary - self limiting, occurs in childhood, mild sublinical s/x. Recurrent - unilateral dendritic keratitis, preauricular lymph node, dendrites with branching with fluoroscein.

Herpes zoster opthalmicus

"Shingles" virus that affects trigeminal nerve-ophthalmic branch. Secondary to primary infection with Varicella virus during childhood. Patients present with a prodrome of symptoms - low grade fever and malaise, significant head/facial pain, unilateral rash will develop 24hrs to several days later.

Uveitis

Inflammation of uveal tract secondary to systemic disease (eg Crohn's). Anterior form (M/C) presents as rapid onset of unilateral pain, ciliary flush, photophobia, watery discharge, impaired visual acuity, sluggish pupil, miosis, hypopyon, and keratic precipitates. Posterior form presents as impaired vision and floaters.

Myopia

Nearsightedness. Alteration in refraction causes light rays to miss just short of the retina, causing blurry vision and headache. Increased risk for retinal detachment

Hyperopia

Farsightedness. Alteration in refraction causes light rays to go past the retina, causing difficulty in reading fine print.

Astigmatism

Alteration in refraction caused by an unequal/warped curvature of the cornea. Light rays are bent unevenly and do not come into a single focus on the retina. Often coexists with other alteration disorders. Patients will report blurry vision.

Presbyopia

Loss of accommodation in adults beginning at the age of 45-50 years. Ocular lens becomes larger, firmer, and less elastic in response to ciliary muscle contraction. Patients will present with reduced near vision.

Strabismus

Misalignment of the eye. Primary symptom is diplopia as two eyes fail to simultaneously focus on the same image.. Can sometimes be a presenting sign of a retinoblastoma.

Amblyopia

"Lazy eye". Reduction of visual acuity related to altered development of the visual cortex. Results from non-treatment of strabismus.

Cataracts

Opacity within the lense caused by insoluble proteins, can be due to older age or may be congenital secondary to Rubella or fetal hypoxia. Loss of red light reflex

Open angle glaucoma

Gradual loss of vision due a decrease in the angle between the cornea and iris, causing IOP to increase, resulting in optic nerve atrophy.

Acute Closed Angle Glaucoma

Sudden onset loss of vision due to a near-complete closure of aqueous humor outflow, causing a rapid increase of IPO, resulting in abrupt pain, redness, and headache.

Preseptal cellulitis

Bacterial infection of the eyelid and soft tissues anterior to the orbital septum, secondary to a wound.

Orbital cellulitis

A serious and life threatening bacterial infection of the orbit, causing proptosis, ophthalmoplegia, fever, and chemosis, secondary to a predisposing sinus or dental infection.

Orbital blowout fracture

Shattering of the orbital floor secondary to a major trauma, resulting in impaired visual acuity and movement of the eyes.

Ocular foreign body

A foriegn material that either irritates the surface of the cornea or penetrates into the globe, sometimes producing a rust ring in the case of metal foreign bodies.

Corneal abrasion

A defect in (and subsequent irritation of) the superficial surface of the cornea caused by a small foreign body, improper contact lens use, or recent trauma.

Ruptured globe

Extrusion or prolapse of internal ocular structures of the eye secondary to a high-risk trauma involving a projectile, blunt trauma, or sharp object penetration, resulting in a teardrop pupil and subsequent decreased visual acuity.

Hyphema

An accumulation of blood in the anterior chamber of the eye secondary to a blunt or penetrating injury to the eye, sometimes resulting in permanent vision loss.

Chemical Injury

Chemical (acid or alkaline) exposure to the eye causing ischemia of the conjunctiva and scleral vessels.

Hypertensive retinopathy

A retinal microvascular complication of hypertension that results in a gradual decrease in visual acuity, marked by copper wiring, AV nicking, cotton wool spots, and a macular star.

Proliferative diabetic retinopathy

A retinal microvascular complication of diabetes that results in a gradual decrease in visual acuity, marked by neovascularization from the optic disc or retinal vessels. Proliferative retinopathy, as evidenced by neovascularization, is associated with an increased risk of vitreous hemorrhage.

Nonproliferative diabetic retinopathy

A retinal microvascular complication of diabetes that results in a gradual decrease in visual acuity, marked by intraretinal hemorrhage, cotton wool spots, hard exudates, and microvascular abnormalities.

Retinal detachment

A sudden onset of blindness, preceded by floaters and photopsia, caused by separation of the retina from the retinal pigmented epithelium.

Dry macular degeneration

A progressive old age eye condition that leads to a loss of central vision and metamorphopsia, caused by an accumulation of drusen and atrophy of the retinal pigment epithelium.

Wet macular degeneration

A progressive old age eye condition that leads to a loss of central vision and metamorphopsia, caused by a large soft drusen and neovascularization beneath the retina. More rapid and severe onset than in dry macular degeneration.

Retinitis pigmentosa

A rare inherited retinal dystrophy that causes a breakdown and loss of rods leading to progressive night blindness and gradual loss of peripheral vision.

Vitreous (retinal) hemorrhage

Hemorrhage in the vitreous body with possible retinal detachment usually secondary to head trauma and abuse of young children.

Central Retinal Artery Occlusion

Sudden painless loss of vision in one eye caused by an embolus or thrombus within a retinal artery leading to retinal ischemia or infarction, leading to cherry red spots on the macula and box carring of vessels on examination.

Central Retinal Vein Occlusion

Sudden painless loss of vision in one eye caused by vasculitis or pressure from an adjacent retinal artery leading to macular edema and a blood and thunder appearance on examination.

Giant Cell Arteritis

Monocular vision loss caused by vasculitis of large and medial sized blood vessels like the temporal artery and associated with polymyalgia rheumatica.

Amaurosis Fugax

A transient loss of vision, either unilaterally or bilaterally, secondary to a TIA or stroke.

Optic Neuritis

An acute unilateral loss of vision or loss of color vision caused by an inflammatory demyelination of the optic nerve related to multiple sclerosis or neuromyelitis optica.

Internuclear ophthalmoplegia

A gaze abnormality associated with multiple sclerosis in which there is impaired horizontal eye movement and double vision when attempting to look laterally.

Papilledema

Optic disc swelling secondary to elevated intracranial pressure caused by any disease that has the potential to raise ICP.

Anisocoria

A benign or life threatening (depending on etiology) condition in which one eye has a significantly larger/smaller pupil than the other side, leading to impaired accommodation and light sensitivity.

Adie's Tonic Pupil

A pupil that is sluggish to react when a light is being shone directly into it, that reacts much better during accommodation, and is caused by damage of the parasympathetic ganglion.

Argyll-Robertson Pupil

Syphilis related bilateral miosis in which pupils don't react to direct or indirect light, but are able to accomodate and converge normally.

Marcus Gunn Pupil (RAPD)

A defect in the direct response of a pupil of an eye when a light is being shone directly into it, dilating when it should constrict, most commonly seen in optic neuritis and ruptured globe.

Horner's syndrome

The loss of sympathetic innervation of the eye is caused by several conditions and leads to miosis, ptosis, and anhidrosis.

Nystagmus

Rhythmic oscillation of the eyes caused by many ENT and neurology conditions that can lead to vertigo or inability to fixate on an object.

Auricle Hematoma

Collection of blood within the auricle caused by blunt trauma (from boxing or wrestling); requires aspiration or drainage if larger than 2cm and less than 48hrs, and prophylactic antibiotics.

Cerumen Impaction

Buildup of cerumen that can cause conductive hearing loss or vertigo; managed with removal of cerumen with cerumenolytic agents and irrigation.

Ear Foreign Bodies

Primarily a complication in peds, is a foreign object in the external auditory canal or the earlobe and pinna causing pain, purulence, swelling, and edema; requires removal and prophylactic antibiotics.

Otitis Externa

Inflammation of the external ear canal due to minor trauma or swimming, tenderness with palpation of tragus or pinna, otalgia, itching, hearing loss, and otorrhea; requires topical antibiotics.

Chronic Otitis Externa

Repeated local irritation of the external ear canal, usually from persistent drainage of a chronic middle ear infection, causing erythematous, scaling skin changes and pruritus; treat the underlying cause.

Malignant Otitis Externa

ENT emergency caused by a pathogen causing severe, deep otalgia, granulation tissue posteroinferior to wall of external canal, and purulent otorrhea; primarily affects diabetics; requires ENT consult and IV antibiotic therapy

Herpes Zoster Oticus

Reactivation of Varicella within the geniculate ganglion causing otalgia, prodrome, and vesicles inside and outside of the ear; requires anti-virals. Ramsay Hunt Syndrome triad: ipsilateral facial paralysis, ear pain, vesicles in EAC/AC

Eustachian Tube Dysfunction

Condition of many etiologies that causes ear fullness, pressure, otalgia, muffled hearing, and difficulty equalizing pressure; managed by treating the underlying condition.

Barotrauma

Pressure sensation and possible tympanic membrane rupture caused by a sudden pressure change occurring within confined air spaces; can rupture the oval or round window and leak perilymph fluid into the middle ear; heals with time.

Otitis Media with Effusion

Pressure sensation caused by fluid presence in the middle ear for an extended period of time without signs or symptoms of infection; self limiting but requires ENT consult if persistent for > 12 weeks.

Acute Otitis Media

An infection of the middle ear that typically follows an upper respiratory tract infection in children < 5 years old. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common causes. It is characterized by an acute onset of otalgia and fever; examination shows a hypo-mobile bulging tympanic membrane and effusions.

Bullous Myringitis

An infection of the TM caused by viral or bacterial infection that manifests with painful vesicles and bullae on the TM; managed with pain control and antibiotics if indicated

Chronic Otitis Media

Persistent effusion/infection of the middle ear lasting over 3 months causing purulent aural discharge, otalgia, crackling in the ear, and hearing loss; requires ENT referral. The bacteriology of chronic otitis media differs from that of acute otitis media. Common organisms include P aeruginosa, Proteus species, Staphylococcus aureus, and mixed anaerobic infections.

Cholesteatoma

Complication of either eustachian tube dysfunction (primary) or TM perforation or surgery (secondary), that creates a squamous epitheliumlined sac, which when its neck becomes obstructed, may fill with desquamated keratin that becomes chronically infected, causing hearing loss, dizziness, malodorous otorrhea; crusting and pearly masses on exam. Treatment requires excision.

Mastoiditis

Severe inflammatory complication of acute otitis media, in which there is otalgia and mastoid pain, erythema, and swelling of the mastoid process; requires gram staining, CBC, CT of temporal bone, empiric IV antibiotics

Otosclerosis

Bony overgrowth involving the stapes caused by an inherited autosomal dominant disorder that cause conductive hearing loss, tinnitus, and mild vertigo.

Tympanosclerosis

Asymptomatic white plaques of the TM due to recurrent ear infections or otitis media with effusion

Tympanic Membrane Perforation

TM complication of different etiologies in which there is a tear in the TM, can have otalgia, audible whistling sound, hearing loss, bloody otorrhea; most heal without treatment.

Hemotympanum

Blood behind the tympanic membrane due to severe head trauma, causing impaired hearing, bloody otorrhea, nystagmus, ataxia, and battle sign.

Tinnitus

Abnormal buzzing/ringing noise in ear or head that is secondary to auditory or neurological reactions to hearing loss or other causes like medications, vascular lesions, or intracranial hypertension; no definitive cure

Vertigo

Transient sense of swaying or tilting secondary to labryinth, vestibular nerve, or CNS dysfunction; managed by treating underlying condition

Benign Paroxysmal Positional Vertigo (BPPV)

Common cause of peripheral vertigo lasting less than a minute, sometimes accompanied by nausea/vomiting, absent auditory or neurological symptoms; managed with epley or sermont maneuver

Meniere's Disease

Dysfunction of the endolymphatic sac causing episodic vertigo, tinnitus, and hearing loss, manifesting between the ages of 20 and 40; managed with dietary changes, diuretics, and vestibular suppressants

Vestibular Neuritis

Idiopathic vestibular disease presenting with acute-onset vertigo, nausea, vomiting, and gait instability with increased risk of falling to the affected side; managed with corticosteroids, antiemetic and anti vertigo meds. Associated with viral URI.

Acoustic Neuroma (Vestibular Schwannoma)

A rare, benign tumor that arises from the Schwann cells of the eighth cranial nerve and/or peripheral nerves causing gradual or sudden unilateral hearing loss with a deterioration of speech discrimination, and prolonged vestibular dysfunction (vertigo) that is longer than just episodic. Symptoms worsen as the tumor grows; requires MRI and excision for large tumors

Presbycusis

Loss of hearing due to cochlear and other ear structure degeneration in old age, affects high frequency sounds and can be bilateral; managed with hearing aids and cochlear implants

Noise-Induced Hearing Loss

Hearing loss caused by acoustic trauma related to occupational or recreation exposure to loud noise; not reversible, but preventable with hearing protection

Sudden Sensorineural Loss (SSNHL)

Hearing loss in one or both ears within 72 hrs or less. Loss of 30 dB or more; ENT emergency. Can recover spontaneoulsy

Upper Respiratory Infection

Acute, nonspecific, and uncomplicated condition of self-limiting upper respiratory symptoms such as cough, congestion, coryza, and sore throat caused by mainly Rhinoviruses and Influenza virus.

Viral Sinusitis/Rhinosinusitis

Usually preceeded by viral URI. MCC: rhinovirus, parainfluenza, influenza. Acute if <4 wks. S/x include rhinorrhea, facial/sinus pain/pressure, postnasal drip, maxillary tooth discomfort. May include other nonspecific s/x like cough and fever.

Acute Bacterial Rhinosinusitis

Inflammation of the nasal cavity and/or paranasal sinuses due to bacteria that lasts less than four weeks and accounts for <2% of acute rhinosinusitis episodes (the rest being viral). Most commonly caused by S. pneumoniae, H. influenzae, and M. catarrhalis. Causes purulent discharge and pain, although neither are specific; more specific associations are duration >10 days or a worsening of symptoms after initial improvement.

Acute Fungal Sinusitis

Aggressive and life-threatening form of sinusitis caused by pathogens like Aspergillus and Rhizopus causing URI symptoms along with cellulitis, proptosis, ptosis, epistaxis, neuro deficits and compounded by risk factors like DM and HIV.

Chronic Sinusitis

12 weeks or greater of two or more symptoms like mucopurulent discharge, nasal congestion, facial pain, facial pressure, facial fullness, decreased sense of smell, and inflammation (purulent mucus, edema, polyps).

Chronic Fungal Sinusitis

Non-invasive sinusitis caused by pathogens like Aspergillus fumigatus that presents with URI symptoms, facial pain, and mycetomas seen in older, immunocompetent patients with repeated failed attempts at antibiotics.

Allergic Rhinitis

IgE mediated hypersensitivity to airborne allergens that presents with URI symptoms and pale and boggy hypertrophic turbinates on exam.

Vasomotor Rhinitis

Non-allergic, non-pathogenic rhinitis caused by changes in temperature, strong odors, stress or inhaled irritants, humidity, or alcohol.

Rhinitis Medicamentosa

Complication secondary to prolonged use of nasal decongestant spray, leading to rebound nasal congestion as the medicine wears off, causing significant congestion and discomfort, along with hyperemic, granular, and boggy nasal mucosa.

Epistaxis

Acute hemorrhage from the nostrils, nasal cavity, or nasopharynx caused by multiple etiologies: digital trauma, mucosal irritation, cocaine use, granulomatosis disease, arteriosclerosis, etc.