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Eye Differential Diagnosis •Fed flag symptoms
-Severe pain
-Decreased Vision
-Foreign Body
-Photophobia
•Discharge?
-Purulent?
-Watery?-itching?
•Swelling of eyelid?
-Focal-Hordeolum/Chalazion
-Diffuse-cellulitis
•Enviro exposure: Pterygium
Common causes of throat pathology
Conjunctivitis- Allergic vs infectious
Conjunctivitis- Allergic Inflammation of the conjunctiva due to allergies is
Symptoms and Management common, occurring in up to 40% of the population.
Itching is the most consistent sign of allergic
conjunctivitis; it is also characterized by red eyes and
other allergic disease symptoms such as sneezing.
,Conjunctivitis- Infectious Bacterial Conjunctivitis: Bacterial conjunctivitis is the
Symptoms and Management second most common cause of infectious
conjunctivitis. Red, itchy eyes are associated with this
condition, as is purulent or mucopurulent discharge
in one or both eyes.
Toxic Conjunctivitis: Inflammation of the conjunctiva
due to medications, chemicals, or toxins can cause
red, itchy eyes.
Viral Conjunctivitis: Viral conjunctivitis is the most
common cause of infectious conjunctivitis. Red, itchy
eyes are associated with this condition, as is a watery
discharge.
Otitis externa Often bilateral
Pain on manipulation of pinna
Precipitated by:
excess moisture (swimmer's ear)
trauma
dermatitis (90% bacterial, 10% fungal)
otits media usually after URI
Pain is unilateral, deep, and severe
Irritability
Restlessness
Fever
Ear feels full
Physical findings:
tympanic membrane inflamed and bulging
Decreased light reflex
Decreased mobility on insufflation
Otitis barotrauma aggravated by URI
hay fever
middle ear effusions
stuffy nose
decent in airplane
,Eustachitis inflammation of the eustachian tube
Tympanic membrane shows decreased mobility
Decreased conductive hearing
Impedance
Ramsay Hunt Syndrome (RHS) Herpes zoster with vesicular rash,
ipsilateral facial paralysis,
ear pain with vesicles in auditory canal, auricle.
May cause vertigo, headache, fever, malaise.
Risk factors: past varicella infection, age,
immunocompromised, autoimmune disorders.
Malignant otitis externa (MOE) Necrotizing external otitis.
Severe otalgia and otorrhea unresponsive to topical
treatment. Pain worse at night and with chewing.
Risk factors: age, DM, immunocompromised.
Auricle Hematoma Collection of blood within the outer ear cartilage.
Also referred to as "cauliflower ear".
Typically occurs due to blunt trauma/sports.
Ear swelling with or without pain.
cholesteatoma Abnormal non-cancerous skin growth behind TM.
keratinized mass in the mastoid or middle ear which
can be associated with intracranial complications.
Patients suspected of having a cholesteatoma should
be assessed for facial nerve palsy and intracranial
abscess.
Causes: repeated AOM. Pain, foul-smelling drainage,
hearing loss, pressure, vertigo.
May cause facial muscle paralysis.
ROS: EAR Purulent drainage is a commonly reported finding
Have you noticed any drainage or with AOE and cholesteatoma but may not be present.
blood coming from the ear? Drainage is not associated with AOM and OME
unless the TM has ruptured.
, Ear pain/infection: Differentials
Otitis media with effusion (OME) Otitis media with effusion (OME) is fluid in the middle
ear, without the presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM
infection. Mild pain, conductive hearing loss may be
present.
Air bubbles are seen behind the TM.
Ear pain/infection: Management ear pain may be treated with OTC analgesics
avoid scratching, tugging, or inserting anything in the
ear, including cotton-tipped swabs
reinforce water precautions with TM ruptured
avoid getting water in the ear during bathing/shower
avoid submerging ear under water
Acute Mastoiditis Bacterial infection of the mastoid process
presents clinically with the same signs and symptoms
as acute otitis medial with the addition of
inflammation and palpatory tenderness over the
mastoid,
hearing loss is commonly associated with it,
tympanic membrane is red, bulging, and immobile bc
associated otitis media,
should be suspected when discharge from middle
ear is continuous for >10 days
TMJ Dysfunction referred ear pain
acute: pain with opening mouth extremely wide
chronic: malocclusion (from enlarged masseter
muscles)/arthritis of TMJ
clicking
palpable crepitus
impacted cerumen rarely bilateral
recurrent problem
normal otologic findings