HEENT Part 1

Allergic Rhinitis AKA Hay Fever

• triggers

  • Pollen

  • Dust mites

  • Pet dander

• Treatment

  • fluticasone or flonase

Sinusitis

• signs

  • facial pressure

  • nasal congestion

  • reduced smell

• First treatment step

  • Symptom relief through nasal decongestants and corticosteroids

    • because most cases are viral in origin and will resolve on their own

  • ABX was added after 10 days, which suggests that there is a bacterial infection

    • The first line is amoxicillin or Augmentin

• Complications

  • Orbital Cellulitis - THIS IS A PROBLEM, SEND TO ED

    • Involving tissues within the orbit can lead to vision loss

      • severe eye pain,n swelling, and vision changes

      • Eyes can also bulge

  • Preseptal Cellulitis

    • Infection of the eyelid in front of the orbital septum

    • does not affect vision

    • presents with swelling and redness of the eyelid, DOES NOT CAUSE bulging or pain with/ eye movement

Pharyngitis

• How can we tell the difference

• Viral

  • COUGH

  • runny nose

  • conjunctivitis

• Bacterial (Strept)

  • Sudden Onset

  • COUGH ABSENT

  • palatal petechia

  • When it’s strep and looking at the throat, we may see white plaques, palatal petechia

  • What diagnostic test

    • Rapid strep or throat culture

  • Treatment for Strep

    • Penicillin V potassium first choice

    • But amoxicillin is also a great choice, especially because it tastes better for kids

Epistaxis or nose bleeds

• Anterior bleeds are more common

  • come from Kiesselback plexus

• Posterior is less common but more serious

  • Often need medical intervention

• Steps for nose nosebleed

  • sit up and lean forward

  • Pinch the soft part of the nose for 10-15 minutes

    • If pressure fails, packing may be needed

• If needed topical vasoconstrictor can also help here

  • Oxymetazoline

  • Afrin

• if bleeding persists or recurs we may need to figure out the underlying cause

Epiglottitis

• STRIDOR

• tri tri-pod position is the hallmark

• GET TO ED

• How to prevent

  • HIB VACCINE

Aphthous Stomatitis (Canker Sore)

• painful

• treatment

  • topical corticosteroids/ mouth rinse

• Chronic ulcerative stomatitis

  • The chronic form, the ASCS, lasts longer and may need medical management

    • Medications like hydroxychloroquine or Plaquenil may be needed to help

    Luekoplakia

• can be a sign of oral cancer or benign

• typically can be fixed by removing irritants like tobacco

• Oral hairy leukoplakia

  • Usually found on the sides of the tongue

  • not cancerous but can have EBSTEIN-BARR in immunocompromised patients

    • especially in patients with HIV

Oral Candidiasis - can be scraped off, but in Leukoplakia, they cannot scrape off the white patches