Erythema Multiforme

EM is an acute, widely distributed hypersensitivity reaction associated with circulating immune complexes that are deposited in the basement membranes of the superficial vessels of the skin and mucosa. Subsequent complement activation produces vasculitis and thrombosis, leading to tissue ischemia and necrosis of the adjacent epithelium. The intensity of the skin and mucosal reaction varies from a localized minimal erythematous FIGURE 40 Erythema multiforme. Young adult male with rapid onset of...

Lyme Disease

Lyme disease, also termed Bannwarth's syndrome, is caused by an infection with the spirochete Borrelia burgdorferi transmitted by tick bites. It is a systemic disease affecting the skin, nervous system, heart, and joints. Symptoms may be mild and can include fever, fatigue, migratory arthritis, myalgia, headache, meningismus, lymphadenopathy, and skin lesions. Erythema migrans, a characteristic skin lesion found in Lyme disease, is defined as an enlarging, annular erythematous skin lesion seen...

Head and Neck Manifestations

Auricular chondritis is the most common presenting feature (40-50 ) and eventually occurs in 83 to 95 of patients. The inflammation of the external ear occurs suddenly and can be unilateral or bilateral. Pain and tenderness are frequently severe. The cartilaginous portion of the pinna becomes red violaceous and swollen while the noncartilaginous earlobe is spared. This helps to separate it from cellulitis. The auricular inflammation lasts a few days or can persist for weeks before subsiding...

Infection Viral

Adenovirus is the most common cause of viral pharyngitis. It is a double-stranded DNA virus. Serotypes 3,4, and 7 are frequently associated with viral pharyngitis. It is transmitted by either respiratory droplets or direct contact. School-aged children are most commonly affected. The classic presentation includes fever, sore throat, coryza, and red eyes. Adenovirus is cytolytic to the epithelial cells it invades and induces a localized inflammatory response in the surrounding...

Pemphigus Vulgaris

PV is a chronic autoimmune mucocutaneous disease in which autoantibodies directed at structural proteins of the desmosome destroy the inter-epithelial cell attachments, producing acantholysis and subsequent suprabasal, intraepithelial bullae (30,31). The targets of the autoantibodies are the transmembrane glycoproteins desmoglein 1 and 3. PV is one member of a group of diseases characterized by autoimmune attack on the desmosomal attachment apparatus. Other members of the group include...

Lymphoma Myeloproliferative Disorders and Leukemia TABLE 1 WHO Classification of Lymphoid Neoplasms

B-cell neoplasms Precursor B-cell neoplasm Precursor B-lymphoblastic leukemia lymphoma Precursor B-cell ALL Mature (peripheral) B-cell neoplasms B-cell chronic lymphocytic leukemia small lymphocytic lymphoma B-cell prolymphocytic lymphoma Lymphoplasmacytic lymphoma Splenic marginal zone B-cell lymphoma ( villous lymphocytes) Hairy cell leukemia Extranodal marginal zone B-cell lymphoma of MALT type Nodal marginal zone B-cell lymphoma ( monocytoid B-cells) Follicular lymphoma Mantle-cell lymphoma...

Epistaxis

Inch Vasoline Gauze For Packing

Albert Einstein School of Medicine and Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, New Hyde Park, New York, U.S.A. Physiology of the Nose and the Nasal Lining 443 Control of Epistaxis in the Outpatient Setting 447 Maxillary Artery Ligation 452 Endoscopic Management of Epistaxis 452 Endoscopic Ligation of the Sphenopalatine Artery 453 Ethmoid Artery Ligation 454 A clear understanding and knowledge of nasovascular anatomy is essential for...

Systemic Lupus Erythematosus

Systemic lupus erythematosus is a chronic autoimmune inflammatory disorder caused by abnormal deposition of antigen-antibody complexes. Kaposi is credited with the first description of the disorder in 1872 and noted disturbed neurologic function in his report (92). Although any organ system in the body can be affected, patients most often have arthritis (88 ), butterfly rash (79 ), pericarditis (64 ), and kidney dysfunction (48 ). Neurologic sequelae of lupus are common and have been estimated...

Juvenile Rheumatoid Arthritis

The classification system for juvenile inflammatory arthritis (JRA) divides this form of childhood arthritis into three categories systemic, pauciarticular (four or fewer affected joints), and polyarticular. Among children with JRA, the most important ocular disease is chronic, nongranulomatous anterior uveitis. It occurs in about 20 of children with pauciarticular JRA, 5 to 10 of children with polyarticular JRA, and rarely, if ever, in those with the systemic type. Young girls with the...

Clinical Manifestations

For patients with IK alone, the most common ocular complaints are pain, redness, and photophobia. Other eye symptoms may include excessive tearing, foreign body sensations, and blurry vision. Conjunctivitis, anterior uveitis, episcleritis, scleritis, and retinal vasculitis may be accompanied by eye pain, redness, photophobia, or reduced visual acuity. Acute angle glaucoma and proptosis have also been described in a few cases. The ophthalmological findings of IK may be relatively mild and...

References

Assessment of dizziness among older patients at a family practice clinic a chart audit study. BMC Fam Pract 2005 6(1) 2. 2. Sloane PD. Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. J Fam Pract 1989 29(1) 33-38. 3. Kroenke K, Hoffman RM, Einstadter D. How common are various causes of dizziness A critical review. South Med J 2000 93(2) 160-167. 4. Liu S, Tunkel R, Lachmann E, et al. Paraneoplastic cerebellar degeneration as the first...

Wegeners Granulomatosis

Wegener's granulomatosis is an idiopathic vasculitis of small arteries, arterioles, and capillaries primarily affecting the upper aerodigestive tract, lungs, and kidneys. Typical presentation is in middle-aged patients with a slight male predominance. Otologic manifestations are common and range from 19 to 45 of cases (103). They include conductive hearing loss, sensorineural hearing loss, otalgia, otorrhea, and serous otitis media. Neurologic involvement is frequent with nearly half of...

Treatment And Prognosis

Patients with symptoms of imbalance often require symptomatic relief as well as treatment of the underlying systemic disorder. Benzodiazepines such as clonazepam are particularly useful in controlling symptoms of vertigo, and to a lesser extent, disequilibrium, and offer a degree of anxiety reduction that meclizine does not. Essential to the treatment of imbalance is management of the underlying systemic condition. This may be relatively simple in cases where the symptoms are related to...

Lightheadedness

The primary systemic conditions causing lightheadedness affecting the heart and cere-brovascular circulation are related to anxiety or other psychiatric disorders. Sometimes, reproduction of a patient's symptoms during hyperventilation is indicative of anxiety-related dizziness these patients will often admit to generalized anxiety or even panic attack. When accompanied by horizontal nystagmus, however, the presence of cerebellopontine angle tumor must also be considered (19). A positive...

Human Immunodeficiency Virus

Infection with HIV is often heralded by presenting signs and symptoms involving systems of the head and neck. Hence, otolaryngologists must remain cognizant of this when evaluating patients whose findings may constitute those attributable to HIV infection, for which there is no definitive cure. HIV is discussed in greater detail in Chapter 16. Definition. HIV infection induces a disabling of T-cell immunocompetency, resulting in a constellation of findings associated with AIDS. Infection may be...

FIGURE 2 Wegeners granulomatosis saddle nose deformity

FIGURE 3 Wegener's granulomatosis cholesteatoma. FIGURE 3 Wegener's granulomatosis cholesteatoma. Wheezing and dyspnea in the setting of WG and chest imaging studies that rule out active lung disease should always raise the question of SGS. The diagnosis should be pursued by nasolaryngoscopy with adequate visualization of the subglottic region (Fig. 4). Ocular involvement may become apparent as eye or orbit pain, visual impairment, diplopia, episcleritis, scleritis, conjunctivitis, uveitis,...

TABLE 1 Diseases Associated with Relapsing Polychondritis

Autoimmune rheumatic diseases Rheumatoid arthritis Juvenile idiopathic arthritis Systemic lupus erythematosus Progressive systemic sclerosis Sj gren's syndrome Mixed connective tissue disease Ankylosing spondylitis Psoriatic arthritis Reiter's syndrome RS3PE Hematological disorders Myelodysplastic syndromes Hodgkin's disease MALT-type lymphoma Non-Hodgkin's lymphomas Acute lymphoblastic leukemia Pernicious anemia Endocrine diseases Diabetes mellitus type 1 Hashimoto's thyroiditis Graves'...

Leprosy

Leprosy, also known as Hansen's disease, is caused by an infection with the bacillus Mycobacterium leprae. It is most common in warm, wet areas in the tropics and subtropics. This chronic infectious disease usually affects the skin, peripheral nerves, and mucous membranes of the aerodigestive tract and eyes. In 2002, the number of new cases detected worldwide was 763,917, with the majority occurring in the endemic areas of Brazil, India, Madagascar, Mozambique, Tanzania, and Nepal. The number...

Dermatomyositis Polymyositis

DM also may include head and neck dermatologic manifestations that can have considerable diagnostic importance. Among these is the virtually pathognomonic heliotrope rash (Fig. 7). This lesion, which leads to edema and discoloration of the eyelids, takes its name from the deep purple flower of the heliotrope plant, although the lesion may vary in color from pink to red to brown. DM may also lead to an erythematous rash on many locations on the body, including the face and neck (Fig. 8). Nasal...

Headache

Department of Neurosciences and School of Medicine, University of California, San Diego, California, U.S.A. Analgesic Rebound (Medication Overuse) Headaches 432 With the development of more effective headache therapy, headache sufferers are becoming more educated and are seeking physician advice for pain control. The magnitude of headache and its impact on quality of life and work productivity is significant. With the introduction of subcutaneous sumatriptan in 1993, physicians entered a new...

Complications And Prognosis

A phenomenon known as the Jarisch-Herxheimer reaction is a known complication resulting from antibiotic treatment of syphilis, and patients should be informed before initiating therapy. This typically develops within the first few hours of treatment and presents with fever, tachycardia, mild hypotension, headache, myalgias, arthralgias, exacerbation of skin lesions, and sometimes obtundation. The reaction is self-limited, but tends to last 12 to 24 hours. It is more likely to occur in patients...

Index

ACAID, See Anterior-chamber associated immune deviation ACE, See Angiotensin converting enzyme Acetazolamide, 348 Acetylsalicylic acid (ASA), 383 'Acid-fast bacilli' (AFB), 170 Acquired immune deficiency syndrome (AIDS), 204, 230-250, 405-406, See also Human immunodeficiency virus Acral keratoses, 545 ACS, See Acute chest syndrome Active pulmonary disease, 102 Acute anterior uveitis, 301 Acute bacterial otitis externa, 363 Acute chest syndrome (ACS), 289 Acute invasive fungal sinusitis, 191-193...

Rheumatoid Arthritis

RA can affect any diarthrodial joint. The temporomandibular and cricoarytenoid joints and ossicles of the ear may be among those affected. The temporomandibular joint (TMJ) is symptomatic in over half of patients with RA, and radiographic evidence of involvement may be even more common. The TMJ may be tender to palpation and crepitus may be present. Patients may experience an acute onset of pain and be unable to fully close the mouth. Over time, an overbite may develop if the mandibular condyle...

Vogt KoyanagiHarada Disease

Vogt-Koyanagi-Harada (VKH), also known as an uveomeningoencephalitis, is characterized by a chronic granulomatous panuveitis affecting both of the eyes. Patients typically present with acute loss of vision and pain in one or both eyes. Inflammation can affect virtually any of the ocular structures. Early findings may include optic disc swelling, thickening of the posterior choroid with elevation of the peripapillary retinochoroidal layer, and exudative retinal detachments. Later findings may...

TABLE 1 Clinical Manifestations in Wegeners Granulomatosis

Prevalence during course of disease ( ) lubrication and immunity. Consequently, patients frequently suffer from recurrent infections. Collapse of the nasal bridge (saddle nose deformity) may occur due to nasal chondritis (Fig. 2). Nasal examination typically reveals crusting, discharge, friable erythematous mucosa, and granulation tissue. Nasal septum perforation may occur. The paranasal sinuses, most commonly the maxillary and ethmoid sinuses, are affected in at least two-thirds of patients....

Myeloproliferative Disorders

PRV is frequently discovered incidentally when a complete blood count is performed for another reason. When symptoms are present, they are usually nonspecific. Fatigue, headache, and diaphoresis are common. Pruritis, often following a hot shower, is a frequent complaint. Up to 15 of patients may present with a thrombotic episode. Thrombotic cerebrovascular accidents, coronary artery thrombosis, Budd-Chiari syndrome, and pulmonary embolus all occur. Cavernous sinus thrombosis may also occur in...

Treatment

Treatment of primary HSV-1 infection is well established however, treatment of muco-cutaneous, recurrent HSV-1 infection is less well defined, and treatment of polyganglionitis is controversial (8). Symptomatic and asymptomatic recurrent disease accompanied by viral shedding is self-limited therefore, therapy is designed to reduce severity, duration, and frequency of symptoms. In general, early treatment achieves the best therapeutic response. Acyclovir binds viral DNA and ends viral...

Infectious Diseases Mycobacterial Infection

Necrotic Cervical Lymph Node

The incidence of mycobacterial infections has undergone a varied course over the past 50 years. For an approximate 30-year period following 1950, the incidence in mycobacterial infection declined annually in excess of 5 . This was followed by a paradoxical sharp increase at the rate of approximately 20 during the late 1980s and early 1990s, due to multiple factors such as acquired immunodeficiency syndrome (AIDS), drug resistance, and population influx from endemic areas. With improved...

Migraine Syndrome

Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A. Clinical Manifestations 336 Complications and Prognosis 340 Migraine is a syndrome characterized by periodic headaches. Often, however, patients experience other symptoms, including hearing loss, tinnitus, and dizziness and in some cases, these can be the only symptoms. Migraine is nearly always familial and occurs in complex patterns and settings. The association of migraine and...

Cutaneous Bullous Diseases

Many cutaneous disorders have associated esophageal involvement. The more common of these disorders include epidermolysis bullosa, cicatricial pemphigoid (CP), lichen planus, and pemphigus vulgaris. Epidermolysis bullosa is a relatively rare cutaneous disease mediated by circulating IgG antibodies directed against type VII collagen. Clinically, patients develop intradermal blistering lesions with scarring at sites of trauma (hands and feet are most common). The proximal third of the esophagus,...

Pernicious Anemia

Tongue Papillae

Pernicious anemia is associated with atrophic gastritis. The marked loss of gastric parietal cells results in a deficiency of intrinsic factor, which is required to transport Vitamin B12 across the intestinal mucosa. The resulting deficiency of Vitamin B12, which is necessary FIGURE 43 Pernicious anemia. This elderly female complained of a painful tongue. The mucosa of the anterior portion of the tongue was severely atrophic and totally devoid of lingual papillae. Posteriorly, the mucosa was...

Guillain Barre Syndrome

Guillain-Barre syndrome, also known as Landry's ascending paralysis or acute inflammatory demyelinating polyneuropathy, is characterized by rapidly progressive ascending paralysis following a viral or bacterial infection. The incidence is approximately one per 50,000 individuals in the United States (84). Initially, patients exhibit weakness or abnormal sensations in the extremities. Paralysis often ensues, with progression of the extremity weakness involving the muscles of respiration and...

Fibrous dysplasia

Fibrous dysplasia (FD) is a genetic disease that causes deformities in soft tissue and bone. DEFINITION FD is a benign, usually self-limited, focal fibro-osseous disease of bone. Lesions may be single (monostotic) or multiple (polyostotic), or may occur as part of the McCune-Albright syndrome (MAS). MAS is a rare disorder characterized by a classic triad of polyostotic FD, cafe-au-lait spots, and peripheral precocious puberty. Other endocrine disorders, including hyperthyroidism and...

Mycobacterial Infections

Tuberculosis (TB, from Mycobacterium tuberculosis and or Mycobacterium bovis) is a major cause of morbidity and mortality in HIV disease. It usually presents as reactivation of a pulmonary primary focus, with a risk of 7 to 10 per year for HIV-infected persons regardless of CD4 lymphocyte count, versus 10 per lifetime for HIV-negative persons. There can be involvement of the lungs, central nervous system (CNS), or other organs, with rhinosinusitis, diffuse or localized (scrofula)...

Vertigo

Anasarca Bladder Cancer

Systemic diseases that affect the labyrinth or eighth nerve to cause vertigo can be infectious, inflammatory, primary neoplastic, paraneoplastic, metastatic, autoimmune, or degenerative. Infectious causes for vertigo include suppurative or toxic labyrinthitis secondary to otitis media, viral labyrinthitis or neuritis (frequently from the herpes virus family), otosyphilis, Lyme disease, and bacterial and viral meningitis. In such cases, accompanying signs of middle ear or meningeal involvement...

Other Causes

Although infections of the various structures of the ear might well be expected to affect hearing and thus trigger tinnitus, infections of locations remote to the ear can do the same. Meningitides can cause tinnitus, as can Bell's palsy. Syphilis (Chapter 15) can affect the labyrinth as well as the rest of the nervous system. Finally, it is curious that Lyme disease can have a hearing manifestation. As described above under endocrine disorders with Addison's disease, hyperacusis is...

Subjective Tinnitus

In contrast to objective tinnitus, subjective tinnitus appears to be an inappropriate activation of the auditory system. At some point in the multilink pathway of translation of sound pressure waves in the air to neural code in the brain, there is activity that is not normally present. The higher centers in the brain interpret this inappropriate activity as a sound, despite the absence of a true sound stimulus. It appears that there can be triggers for the inappropriate activity anywhere along...

Sarcoidosis

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology, characterized by the presence of noncaseating granulomas in any organ system of the body. Involvement of the head and neck is noted in 10 to 15 of patients (17). Please see Chapter 6 for a detailed discussion of sarcoidosis. Epidemiology. Sarcoid has a slight female preponderance and occurs in all age groups, although more commonly in young adults. Pathogenesis. An etiology for sarcoid has not been established....

Differential Diagnosis

The differential diagnosis of desquamative gingivitis includes erosive lichen planus (Fig. 28), lichenoid drug reaction, MMP (Fig. 32), and PV (Fig. 37). Often, a positive Nikolsky sign (Figs. 33 and 37) may be demonstrated. The Nikolsky sign indicates mucosal fragility and is seen in diseases with defective epithelial attachment and cell adhesion. In MMP, it is often possible to cause a large flap of gingival epithelium to balloon up (Fig. 33) by blowing a gentle, tangential stream of...

Herpes Zoster Oticus Varicella Zoster Chicken

The varicella-zoster virus is a neurotropic DNA virus. Initial infection with the varicella-zoster virus is commonly known as chicken pox and displays a very characteristic vesicular cutaneous eruption. The virus can remain dormant in ganglion cells for many years, with subsequent reactivation of the dormant virus resulting in shingles. Neurologic involvement has been found in chicken pox and includes encephalitis, myelitis, and cerebellar ataxia. Chicken pox has very rarely been associated...

Scleroderma

Scleroderma can involve limited or widespread changes in the skin, with a host of associated internal organ manifestations. In cases of limited skin involvement, the acronym CREST has been widely used to denote the characteristic features of calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias. In cases of widespread skin involvement, the term systemic sclerosis may be used. Additional features include fibrotic lung disease, pulmonary hypertension, and...

FIGURE 1 Glottic and subglottic stenosis in a patient with Wegeners granulomatosis

Arthritis may also occur in patients with other rheumatoid diseases such as Sjogren's syndrome or systemic lupus erythematosus (SLE). Laryngoscopy in cricoarytenoid arthritis reveals inflammation of the overlying mucosa and limited vocal-fold mobility. Diagnosis is established by palpation during direct laryngoscopy, which can demonstrate mechanical restriction of joint motion. Computed tomography (CT) imaging often demonstrates erosion of the cricoarytenoid joint, with surrounding soft-tissue...

Iatrogenic Causes of Dysphagia

Chemotherapy and radiation therapy are becoming mainstays in the treatment of head and neck cancer. The mucosa of the oropharyngeal swallowing tract is lined with cells with rapid turnover, providing a prime target for cytotoxic chemotherapeutic agents and radiation. Irradiation induces the mitotic death of the basal cells of the mucosa. With traditional radiotherapy, there is a two-week delay before the onset of symptoms. Once the radiotherapy is completed, there is complete reepithelization...

Complicationsprognosis

The prognosis for patients with AIED is quite variable. Part of this variability can be explained by the diverse nature of the disorder. Autoimmune injury in general can be from direct antibody injury toward specific epitopes, from immune complex deposits, or from cellmediated attacks by T cells. Depending on the cause of the autoimmune process and the speed with which it is treated, the damage to the cochlea and vestibule can be reversible or permanent. Cogan's syndrome, for example, carries a...

Diagnosis

The diagnosis of PMR GCA is based upon typical clinical signs and symptoms, including shoulder and hip girdle aching and an elevated sedimentation rate in patients older than 50 years, and in GCA, new onset of localized headache with temporal artery tenderness, positive ESR, and an abnormal temporal artery biopsy. GCA occasionally can occur with a low sedimentation rate. In a population-based study of 167 patients diagnosed between 1950 and 1998, 11 had an ESR of less than 50 mm in the first...

Infectious Diseases

Hearing loss is an uncommon presenting symptom of a systemic infectious disease but may develop during the course of several viral and bacterial infections. Pathogens may infect the inner ear and auditory pathways in utero, resulting in congenital syndromes that often include deafness, or infection may be acquired after birth. As the fluids of the inner ear are not easily accessible for sampling, the implication of viral pathogens as the causes of sensorineural hearing loss has often depended...

Idiopathic Diseases Sarcoidosis

Sarcoidosis is a chronic, idiopathic, granulomatous disease with a strong predilection for African American and Puerto Rican women in their third or fourth decades of life. Patients most often present with pulmonary symptoms, including shortness of breath, hemoptysis, nonproductive cough, and dyspnea on exertion however, the spectrum of patient presentation can range from asymptomatic to involvement of any organ system. When neurologic involvement is present, the term neurosarcoidosis has been...

Melkersson Rosenthal Syndrome

Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial...

Introduction

Hoarseness is an extremely common yet varied symptom. An abnormal voice may sound raspy, breathy, or weak, or the pitch may be inappropriate. Often when a patient complains of hoarseness, the voice actually sounds normal but fatigues too quickly or requires too much effort. All of these symptoms indicate a problem with sound production within the larynx. Sometimes voice production is normal, but the sound is altered by abnormal resonance. For example, a peritonsillar abscess can cause a hot...

Genetic Diseases

Congenital hearing loss is common, and about one-half of cases are thought to be genetic. Genetic hearing loss is typically classified as syndromic or nonsyndromic. When hearing loss consistently coexists with other pathologic findings, it is considered part of a syndrome when it exists in isolation, it is nonsyndromic. As our focus is on systemic diseases, nonsyndromic hearing loss, which accounts for two-thirds of hereditary hearing loss, will not be discussed extensively. Mutations in the...

Pseudotumor Cerebri and Jugular Foramen Syndrome

Salley Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, U.S.A. Pseudotumor Cerebri Syndrome 344 Clinical Manifestations 346 Jugular Foramen Syndrome 349 Etiology and Epidemiology 350 Anatomy of the Jugular Foramen 350 Clinical Manifestations 351 Complications and Prognosis 355 PSEUDOTUMOR CEREBRI SYNDROME INTRODUCTION Pseudotumor cerebri (PC) syndrome may present with otologic neurotologic...

Rhinocerebral Mucormycosis

RCM represents one-third to one-half of all cases of Zygomycosis. The process originates in the nose and paranasal sinuses following inspiration of fungal spores. It is estimated that 70 of the cases of rhinocerebral zygomycosis occur in the setting of DKA (7). Disease starts with symptoms consistent with sinusitis. Low-grade fever, dull sinus pain, drainage, and soft-tissue swelling are initially seen, followed in a few days by double vision, increasing fever, and obtundation. Examination...

Primary Syphilis

Primary syphilis is defined by the presence of a chancre that develops at the site of inoculation. The initial lesion usually appears approximately three weeks after infection, although the incubation period can range from 10 to 90 days. The primary chancre appears as a single painless papule, and can often go unnoticed by the patient. After a short time, the lesion will become indurated, and then erode and ulcerate. The lesion generally remains clean and dry unless secondary infection occurs....

Treatment Lymphoma

The treatment of lymphoma depends primarily on the histologic subtype and the stage. HL is treated with chemotherapy, or for more limited-stage disease, combination chemotherapy and radiotherapy. In this situation, the dose of both radiation and chemotherapy is less than if either modality is used alone. The advantage is a reduction in toxicity of each modality used alone. In some cases of very limited disease without B symptoms, radiation alone may be used. The current standard chemotherapy...

Disequilibrium

Any of the abovementioned disease processes may cause disequilibrium rather than vertigo if they do not involve the labyrinth itself but instead cause dysfunction with brainstem integration, cortical perception, or musculoskeletal function. In such cases, other cranial nerve or somatic deficits point toward the etiology of the problem. Common examples include loss of vibration sensation and joint proprioception in diabetic and hypertensive patients, poor muscle strength, and joint deformity in...

Pathogenesis Infection Bacterial

Infection Oropharynx

At birth, the upper respiratory tract is colonized with multiple organisms and the normal bacterial flora is established. It consists primarily of Gram-positive aerobic organisms and anaerobic organisms. Infectious pharyngitis represents a change in this normal flora. Streptococcus. Streptococcus species are Gram-positive cocci bacteria arranged most commonly in chains. They are ubiquitous inhabitants of the oral and nasal cavities. Members of this bacterial family are classified...

Stevensjohnson syndrome

Stevens Syndrome Disease

In 1922, Stevens and Johnson described two boys who had an extraordinary, generalized eruption with continued fever, inflamed buccal mucosa, and severe purulent conjunctivitis (27). Stevens-Johnson syndrome (SJS) (Figs 2 and 3) is a severe mucocutaneous disorder that is usually drug induced and associated with high morbidity and poor prognosis. Identifying patients with SJS is crucial, because these patients should be referred to intensive care units or burn centers for management. FIGURE 2...

Lymphoma Involving Specific Head and Neck Sites

Steve Mcqueen Swollen Salivary

Lymphoma involving the thyroid gland is rare, accounting for only 2 to 3 of all cases of lymphoma and less than 10 of thyroid malignancies. Women are affected more frequently than men are by a ratio of 2.7 1. The median age at presentation is over 60 years. The most common subtypes are DLBCL and follicular Grade-3 lymphoma, accounting for at least 80 of cases. A rare but interesting subtype is marginal zone B-cell lymphoma, which arises from MALT. In many cases, this lymphoma...

Inflammatory Autoimmune

Pemphigus is a rare disease that affects mucosal membranes. Although the term pemphigus may be erroneously used interchangeably with the condition bullous pemphigoid, it is a separate entity warranting a separate discussion. Pemphigus is characterized by vesicular lesions and bulla. There are multiple subtypes, with pemphigus vulgaris and pemphigus foliaceus being the most common (7). Other subtypes include pemphigus vegetans, pemphigus erythematosus, pemphigus herpetiformis,...

Benzathine Penicillin G Doses For Otosyphilis

Parenteral penicillin G is the standard therapy for syphilis. While this treatment has been used for over 50 years and its efficacy is well established, the recommendation is based on clinical studies and expert opinion rather than randomized clinical trials (16). It has been found that adequate treatment requires serum concentrations to be maintained above a threshold of 0.03 units mL for 10 days (17). A single intramuscular dose of 2.4 million units of penicillin G will maintain a...

Stomatitis

Geographical Tongue Homoeopathy Remedies

Stomatitis refers to an inflammatory process involving the mucous membrane of the mouth that may manifest itself through a variety of signs and symptoms including erythema, vesiculation, bulla formation, desquamation, sloughing, ulceration, pseudomembrane formation, and associated discomfort. Stomatitis may arise due to factors that may be of either local, isolated conditions or of systemic origin. For example, a solitary oral ulcer with a history of a recurrent pattern may be classified as...

Loco Regional Disease Nodal Assessment

After initial pathological assessment by punch or excisional biopsy, the next step is treatment of the primary site and staging of the regional lymph nodes. Treatment for the primary tumor consists of wide local excision. Local recurrence can be as high as 40 for primary melanomas that are not reexcised after biopsy (3). Melanoma-in-situ is treated by reexcision with at least 0.5-cm margins around the primary lesion or biopsy scar. When primary invasive melanomas are < 1 mm thick or Clark's...

Cat Scratch Disease

Cat Scratch Cervical

Cat-scratch disease, first described in 1931, has received little notoriety in the head and neck literature, despite the fact that 50 of patients present with cervical lymphadeno-pathy. The most extensive reports are noted in the pediatric literature, where it accounts for a sizable proportion of unilateral lymphadenopathy in children and adolescents (5). Definition. Cat-scratch disease has been alternatively termed cat-scratch fever, benign lymphoreticulosis, or nonbacterial lymphadenitis. The...

Secondary Syphilis

Secondary Syphilis

Approximately eight weeks after the initial presentation of a chancre, a generalized infection ensues. This is a result of proliferation and systemic dissemination of T. pallidum and persists until a sufficient immune response develops. Constitutional symptoms including fever, headache, arthralgias, malaise, pharyngitis, and generalized lymphadeno-pathy are common. The dominant feature of secondary syphilis is a mucocutaneous rash, which appears in 90 of patients. While there is significant...

Diagnosing Otosyphillis

The diagnosis of AIED is made by a combination of the clinical presentation, audiometric testing (including test of vestibular function), laboratory evaluation, and response to immunosuppressive therapy. The clinical presentation is by far the most important of these parameters. Some patients note a preceding viral infection, although this is not always apparent. Patients typically present with fluctuating bilateral sensorineural hearing loss, which is progressive over several weeks, with or...

Mucous Membrane Pemphigoid

Crack Cocaine Effects Teeth

MMP is a chronic autoimmune mucocutaneous disease in which autoantibodies directed at structural proteins of the hemidesmosome destroy the epithelial-connective tissue attachment at the level of the basement membrane, producing a subepithelial separation (24,25). The protein targets of the autoantibodies include BP-1, BP-2, and laminin-5 (epiligrin), all components of the epithelial anchoring apparatus. MMP is a generalized term for a group of closely related disease processes (26). The term...

Head and Neck

A plethora of head and neck symptoms and signs are associated with GCA. These are summarized in Table 3. TABLE 1 The Initial Clinical Manifestations in 100 Consecutive Patients with GCA TABLE 1 The Initial Clinical Manifestations in 100 Consecutive Patients with GCA Abbreviation GCA, giant cell arteritis. Source From Ref. 7. Abbreviation GCA, giant cell arteritis. Source From Ref. 7. TABLE 2 Prevalence of Selected Clinical Features in 100 Patients with GCA TABLE 2 Prevalence of Selected...

Part D Other Systemic Disorders

Crohn's Disease and Ulcerative Colitis 297 Maria T. Abreu and Junsuke Maki 21. Paget's Disease of Bone and Fibrous Dysplasia 307 Edwin M. Monsell and Geetha Subramanian 22. Systemic Allergic Disorders IgE-Mediated Disorders, Angioedema, Nonsteroidal Anti-Inflammatory Drug Sensitivity, and Stevens-Johnson Syndrome 315 Michelle Hernandez and Stephen I. Wasserman 23. Migraine Syndrome 333 Robert W. Baloh 24. Pseudotumor Cerebri and Jugular Foramen Syndrome 343 Aristides Sismanis and David R....

Systemic Manifestations

Polyarteritis Chondtritis

Joint involvement is the most common manifestation outside the head and neck. Arthritis is present in 35 to 40 of patients at the time of diagnosis and occurs in 50 to 85 during the course of RP (24). Joint involvement can consist of arthralgias or active synovitis. Peripheral arthritis involves the small and large joints and can be mono-, oligo-, or polyarticular. It is usually asymmetric but can be symmetric, resembling rheumatoid arthritis. Unlike rheumatoid arthritis, however, the arthritis...

Objective Tinnitus

Objective tinnitus is a physical sound that emanates from the body, such as pulsing blood flow through the great vessels in the neck or tetanic contractions of the stapedius muscle on the tympanic membrane. With a stethoscope, microphone, or just the unaided ear, an observer can sometimes hear an objective tinnitus. Objective sounds in the head are relatively rare. In objective tinnitus, etiologies can be separated in terms of whether the tinnitus is pulsatile or nonpulsatile. Pulsatile...

Jugular foramen syndrome

Jugular foramen syndrome (JFS) is an uncommon clinical entity that often presents a diagnostic and management challenge to the otolaryngologist. The purpose of this section is to define this syndrome and elucidate the epidemiology, pathogenesis, clinical manifestations, diagnostic workup, and general treatment options for the syndrome. Various combinations of palsies of cranial nerves IX, X, and XI resulting from lesions in the area of the jugular foramen have been referred to as JFS. Eponyms...

Neuromuscular Disorders

Many neuromuscular diseases cause dysphagia in fact, the presenting symptom is often dysphagia. This is not surprising, considering the complex neuromuscular coordination required to execute a normal swallow. Although stroke patients develop sudden dysphagia, patients with other degenerative and nondegenerative neuromuscular diseases have a more insidious onset of dysphagia. Motor neuron diseases causing bulbar palsy or pseudobulbar palsy usually develop a progressive dysphagia and dysarthria...

FIGURE 19 Aphthous ulcers Source Courtesy of the International AIDS SocietyUSA From Refs 3 4

The color of the surrounding skin or mucosa. Typically asymptomatic, they may become painful when ulcerated and secondarily infected. Oral mucosal lesions are the most common and usually occur in the palate (Fig. 19), gingiva, or lips they can grow and become bulky, causing mechanical problems or bleeding. Cutaneous lesions can be seen in the trunk, distal limbs, tip of the nose, and other areas of the head and neck. Due to the location and association with AIDS, they can be aesthetically...

Pagets Disease of Bone and Fibrous Dysplasia

Monsell and Geetha Subramanian Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A. Clinical Manifestations 309 Complications and Prognosis 310 Clinical Manifestations 311 Complications and Prognosis 313 Paget's disease is a progressive disease of bone affecting primarily the middle aged and elderly. The most common otolaryngic manifestation is hearing loss, which is related to involvement of the skull (1,2). Paget's...

FIGURE 16 Oral hairy leukoplakia associated with EBV Source From

Oral Hairy Leukoplakia Ebv

(PCR) for CMV viral load in serum can be used, but the clinical utility of the test is not yet clear. Whether treatment is beneficial for oral ulcers caused by CMV is not clear. Ulcerative esophagitis-causing symptoms can be treated with IV antivirals such as ganciclovir, foscarnet, or cidofovir, followed by oral maintenance, usually with oral valganciclovir. Epstein-Barr Virus and Oral Hairy Leukoplakia. OHL has been encountered since the early epidemic and has been strongly linked to...

Definition

Uveitis is a generic term for inflammation of the uveal tract, which includes the iris, ciliary body, and choroid. By definition, uveitis is chronic when it persists longer than three months. Acute uveitis may vary in its course, resolving completely without recurrence, recurring intermittently, or evolving into chronic uveitis. The anterior part of the uveal tract includes the iris and ciliary body. In most cases of anterior uveitis (also called iridocyclitis), inflammation is present at both...

Pathology

Rhabdomyosarcoma is classified into three cell types embryonal, alveolar (which has botryoid and spindle cell variants), and pleomorphic. The embryonal subtype accounts for 60 to 70 of childhood cases and is the most common subtype. It is also the most common subtype presenting in the head and neck (20-22). Rhabdomyosarcomas are malignant tumors of skeletal muscle. They are part of the larger group of soft-tissue sarcomas. Sarcomas of bony origin are classified separately. Like most malignant...

Clinical Manifestations Primary Lesion

Vulvar Melanoma Primary Satellite

A primary lesion is the most common manifestation of malignant melanoma of the head and neck region. This lesion can vary in appearance from the classical black-pigmented, raised lesion to an enlarging, skin-colored (amelanotic) mole (Fig. 1A and B). Melanoma can arise from a preexisting nevus or normal skin. The appearance of melanoma may be FIGURE 1 Primary melanoma has a wide range of appearances. (A) Superficial-spreading melanoma. (B) Amelanotic nodular melanoma of the scalp. (C) Lentigo...

Crohns Disease and Ulcerative Colitis

Department of Medicine, Division of Gastroenterology, Inflammatory Bowel Disease Center, Mount Sinai School of Medicine, New York, New York, U.S.A. Clinical Manifestations 299 Crohn's disease (CD) and ulcerative colitis, collectively part of the inflammatory bowel diseases (IBD), are both diseases of the gastrointestinal tract that arise in genetically susceptible individuals. Both CD and ulcerative colitis, though clinically different entities, are thought to be part of a spectrum of diseases...

Aspirin nsaid hypersensitivity

Three manifestations of sensitivity to NSAIDs are of importance to the head and neck. They include urticaria angioedema, anaphylaxis, and rhinoconjunctivitis asthma. These appear to occur separately, and, in most instances, cross-reaction with other drugs in the class is common. By definition, NSAID hypersensitivity is present in patients who react adversely to the administration of this class of drug. It was originally described by Widal as a symptom complex of aspirin sensitivity, asthma, and...