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anatomy
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1:posterior chamber
2:ora serrata
3:ciliary muscle
4:ciliary zonules
5:canal of Schlemm
6:pupil
7:anterior chamber
8:cornea
9:iris
10:lens cortex11:lens nucleus
12:ciliary process
13:conjunctiva
14:inferior oblique muscle
15:inferior rectus muscle
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16:medial rectus muscle
17:retinal arteries and veins
18:optic disc19:dura mater
20:central retinal artery
21:central retinal vein
22:optic nerve
23:vorticose vein
24:bulbar sheath25:macula
26:fovea
27:sclera
28:choroid
29:superior rectus muscle
30:retina
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As a conscious sense organ, the eyeallows vision. Rod and cone cells inthe retina allow conscious light perceptionand vision including color differentiationand the perception of depth. The humaneye can distinguish about 10 million colors.
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The posterior chamber◦ a narrow chink behind the peripheral part of the
iris of the human eye, and in front of thesuspensory ligament of the lens and the ciliary
processes the Posterior Chamber consists of smallspace directly posterior of the Iris but anterior tothe lens.
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Schlemm's canal, also known as canal of Schlemmor the scleral venous sinus, is a circular channel inthe eye that collects aqueous humor from theanterior chamber and delivers it into the
bloodstream. On the inside of the canal, nearest to the aqueous
humor, it is covered by the trabecular meshwork,this region makes the greatest contribution to
outflow resistance of the aqueous humor. Named after Friedrich Schlemm (1795-1858), a
German anatomist.
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The pupil is a circular opening located in thecenter of the iris of the eye that allows lightto enter the retina
The anterior chamber is the fluid-filledspace inside the eye between the iris andthe cornea's innermost surface, theendothelium.
Aqueous humor is the fluid that fills theanterior chamber.
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The cornea is the transparent front part of the eye that covers the iris, pupil, andanterior chamber. Together with the lens,the cornea refracts light, accounting forapproximately two-thirds of the eye's totaloptical power
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The iris is a membrane in the eye,responsible for controlling the diameter andsize of the pupil and the amount of lightreaching the retina. "Eye color" is the color of
the iris, which can be green, blue, or brown.In some cases it can be hazel (light brown).In response to the amount of light enteringthe eye, muscles attached to the iris expandor contract the aperture at the center of theiris, known as the pupil. The larger the pupil,the more light can enter.
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The lens is a transparent, biconvexstructure in the eye that, along with thecornea, helps to refract light to be focusedon the retina. The lens, by changing shape,functions to change the focal distance of the eye so that it can focus on objects atvarious distances, thus allowing a sharp realimage of the object of interest to be formedon the retina. This adjustment of the lens isknown as accommodation.
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retina is a light sensitive tissue lining theinner surface of the eye. Light striking theretina initiates a cascade of chemical andelectrical events that ultimately triggernerve impulses. These are sent to variousvisual centers of the brain through thefibers of the optic nerve.
Rods provide black-and-white vision cones support daytime vision and the
perception of colour.
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The macula or macula lutea (from Latinmacula, "spot" + lutea, "yellow") is an oval-shaped highly pigmented yellow spot nearthe center of the retina of the human eye.
Because the macula is yellow in colour itabsorbs excess light that enters the eye andacts as natural sunglasses.
Within the macula are the fovea and foveolawhich contain a high density of cones
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The sclera, also known as the white of theeye, is the opaque fibrous, protective, outerlayer of the eye containing collagen andelastic fiber
the conjunctiva is a thin layer covering thesclera. Along with the vessels of theconjunctiva, those of the sclera renders the
inflamed eye bright red.
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The choroid is the vascular layer containingconnective tissue, of the eye lying betweenthe retina and the sclera. In humans itsthickness is about 0.5 mm. The choroidprovides oxygen and nourishment to theouter layers of the retina. Along with theciliary body and iris, the choroid forms theuveal tract.
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The ciliary body is the circumferential tissueinside the eye which secretes aqueoushumour
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the leading cause of blindness in those 40 years or
older
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The earliest reference to cataracts can befound in Hindu writings from the 5th century BC
The word Cataract comes from the Greekword meaning “Waterfall” Until the mid 1700’s, it was thought that
cataract was formed by opaque material
flowing, like a waterfall into the eye
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The human lens is anaturally clearstructure located
behind the iris andsupported by thezonules
The lens isavascular-It does not
have a vascularsupply
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The basic lensconsists of a
central nucleussurrounded bythe cortexcontained within
the lens capsule
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The lens is made mostly of water andprotein fibers
The protein fibers are arranged in aprecise manner that makes the lens clear
and allows light to pass through withoutinterference With aging, the composition of the lens
undergoes changes and the structure of the protein fibers breaks down
Some of the fibers begin to clumptogether, clouding areas of the lens, andleading to the loss of transparency
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This loss of transparency, or
opacity formationis called Cataract
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Clouding of the lens is a normal part of aging
About half individuals older than 65 have
some degree of clouding of the lens According to one study, after age 75, 39%
of men, and 46% percent of women in theU.S. have visually significant cataracts
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Cataracts produce a gradual, painless,progressive loss of vision, and manypatients are unaware of vision problems
Generally do not cause pain, or abnormal
tearing But as the clouding progresses, the cataract
eventually interferes with your vision
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Commonly affect distance vision Cause problems with glare In the early stages, stronger lighting and
eyeglasses can help deal with the vision
problems If impaired vision jeopardizes your normal
lifestyle, you might need surgery
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Blurred vision Increasing difficulty with vision at night
Glare, especially at night Halos around lights The need for brighter light for reading Double vision in a single eye Fading or yellowing of colors
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Due to increase of yellow-brown
pigment in thelens, colorperception also isaffected
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These may also be symptoms of other eyeconditions, therefore it is important to seeyour ophthalmologist annually, or if there isa persistent change in vision
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Pain, redness, discharge, or irritation in theeye are usually not signs or symptoms of acataract, but may be signs and symptomsof other eye disorders
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A cataract isn'tdangerous to the eyeunless the cataractbecomes completelywhite, a conditionknown as an overripe(hypermature) cataract
This can causeinflammation, eye pain
and headache A hypermature cataract
is extremely rare andneeds removal
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Responsible for nearly 10% of all visualloss in children worldwide
Approximately 0.03% of newborns havesome form of congenital cataract
Most are not associated with additionaldevelopmental problems
Around one fifth of these patients have afamily history of congenital cataract but in
up to half of all cases there is no familyhistory
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In the case of a newborn infant, a cataractcauses the immature visual system to bedeprived of the stimulation needed fornormal development
If left untreated, permanent visual lossmay occur
Unilateral cataracts are more likely to
cause visual loss because of thecompetition between the two eyes
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If the cataract is small there may be onlyslight blurring of vision with near normalvisual development
If the cataract is larger, or located more
posteriorly, it can effect visualdevelopment
In some cases this can lead to permanentamblyopia (lazy eye)
Without adequate stimulation centralvision can be permanently effected
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Outcome is very much dependent onthe type of cataract
Some congenital cataracts impairvisual development only to a small
degree and may never require surgery If the cataract is only in one eye, there
is a strong tendency for the child to
prefer the healthy eye◦ The eye affected by the cataract rarely
achieves normal vision, therefore removal of the cataract is indicated
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Hereditary◦ Autosomal dominant form most common
Genetic and Metabolic Diseases◦ Down syndrome
◦
Marfan’s syndrome◦ Myotonic Dystrophy
Maternal Infections◦ Rubella, Syphilis, Toxoplasmosis, Varicella
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Ocular Anomalies◦ Aniridia-Absence of iris at birth
Toxic◦ Corticosteroids, Radiation
Trauma
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Exposure to sunlight (UV light) Smoking Diabetes Trauma (blunt or penetrating) Family history of cataracts Corticosteroid therapy Radiation exposure Electrical injury Myotonic dystrophy Uveitis- Ocular inflammation
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Everyone is at risk of developing cataractssimply because age is the single greatestrisk factor
By age 65 about half of all Americans havedeveloped some degree of lens clouding
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The most commonobjective findingassociated with
cataracts isdecreased visualacuity
This is measured
with an office wallchart or near-visioncard
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Acuity refers to the sharpness of vision orhow clearly you see an object
In this test, your eye doctor checks to seehow well you read letters from across the
room Eyes are tested one at a time, while the
other eye is covered. Using the chart with progressively smaller
letters from top to bottom, to determinethe level of vision
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This is performedby your doctor tosee if the
decrease in visionis simply due forneed for newglasses, or if thereis another process
at work thataccounts for thedecrease in visualacuity
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Dilating drops areplaced in the eyes todilate the pupils wideand provide a better
view to the back of theeyes
It allows theophthalmologist toexamine the lens for signs of a cataract and,if needed, determinehow dense theclouding is
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It also allows forexamination of the retina and the
optic nerve. Dilating drops
usually keep yourpupils open for afew hours beforetheir effectgradually wearsoff
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Cataract Retinal detachment Macular degeneration
Diabetes mellitus Glaucoma Retinal artery occlusion
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Macular degeneration usually causes aslow, progressive loss of central vision
Symptoms of acute vision loss anddistortion result from leakage from
abnormal subretinal vessels Patients should be referred to a retina
specialist immediately
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Diabetic retinopathy may also contributeto vision loss
Findings include dot-and-blothemorrhages, microaneurysms, dilatedand tortuous vessels, andneovascularization of the disk and retina
Cataracts often obscure the fundus,
making assessment of diabeticretinopathy difficult
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Open-angle glaucoma produces slow,painless visual field loss that usuallybegins peripherally
Optic nerve damage and subsequent lossof peripheral vision occur at normal aswell as elevated intraocular pressures
With progressive optic nerve damage and
visual field loss, central vision is the last tobe affected
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Cataracts are the most treatable cause of decreased vision in the United States
For most patients, observation and
frequent eyeglass prescription changesare sufficient When activities of daily living, such as
driving, reading, working, and self-care
are affected surgery should be discussed
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Cataract Surgery should be consideredwhen changes in eyeglasses no longer help,quality of life is jeopardized, and cataractremoval is likely to have an impact on vision
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Think about how the cataract affects yourdaily life◦ Can you see to do your job and drive safely
◦ Do you have problems reading or watching
television?◦ Is it difficult to cook, shop, climb stairs or take
medications?◦ How active are you? Does lack of vision affect
your level of independence?◦ Are you afraid you'll trip or fall or bump into
something?
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Sometimes a cataract should be removedeven if it doesn't cause major problems withvision◦ If it is preventing the treatment of another eye
problem, such as age-related maculardegeneration, diabetic retinopathy or retinaldetachment
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If you have cataracts in both eyes anddecide to have surgery, your eye doctortypically removes the cataract in one eye ata time
This allows time for the first eye to healbefore the second eye surgery
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Cataract surgery is the most common operationperformed on patients over 65 years of age
More than 95% of patients have improved visionafter surgery
Benefits include improvement in uncorrected andbest-corrected visual acuity, improvedbinocularity, depth perception, and increasedperipheral vision to enhance patients' ability todrive, read, work, and manage their ownmedications
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Advances in surgical technique and moresophisticated technology have helpedmake surgery a safe and effectivetreatment for cataracts
Prior to surgery, your eye doctor measuresthe size and shape of your eye todetermine the proper lens implant power
This measurement is made with a painlessultrasound test
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Two things happenduring cataractsurgery — the
clouded lens isremoved, and a clearartificial lens isimplanted
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Duringphacoemulsification, phaco forshort, thesurgeon makes asmall incision,
where the corneameets theconjunctiva
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Some IOLs are rigidplastic and implantedthrough an incision thatrequires several stitches
(sutures) to close However, many IOLs are
flexible, allowing asmaller incision thatrequires no stitches
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Patients are usually examined 1 day, 1week and then one month after the surgerydate
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This condition occurswhen the back of thelens capsuleeventually becomes
cloudy and blurs vision PCO can develop
months or years aftercataract surgery
Occurs approx. 20%
percent of the time
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Treatment for PCO is simple and quick Laser capsulotomy is a quick, painless
outpatient procedure that usually takes lessthan five minutes
Capsulotomy means "cutting into thecapsule" and YAG is an abbreviation of yttrium-aluminum-garnet, the type of laserused for the procedure
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A technique inwhich a laser
beam is used tomake a smallopening in theclouded capsule
to let light passthrough
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Afterward, patients typically stay in thedoctor's office for about an hour to makesure the eye pressure is not elevated
In some people, particularly those whohave glaucoma or are extremelynearsighted, YAG laser surgery can raiseeye pressure
Other complications are rare but caninclude swelling of the macula and adetached retina
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Most cataracts occur with age and can't beavoided altogether
Regular eye exams remain the key to earlydetection
You can take steps to help slow or preventthe development of cataracts
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Do not smoke◦ Smoking produces free radicals, increasing
your risk of cataracts.
Eat a balanced diet◦ Include plenty of fruits and vegetables.
Ultraviolet light protection since UV lightmay contribute to the development of cataracts
Diabetes Control
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Researchers are continuing to explore newways to prevent and treat cataracts, suchas developing medications that wouldreduce or eliminate the need for surgery
Until then, cataract surgery is the methodto restore vision
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Sufficient rise in intraocular pressure tocause visual damage
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Congenital Glaucoma Primary Glaucoma 1- Open angle 2- closed angle Secondary Glaucoma Absolute Glaucoma
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Features Buphthalmos
corneal diameter 12 mm < 1 yr Tears of descemet’s membrane Corneal haze Increased A/C depth Optic disc cupping
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Angle closure Acute
Very painful
Reduced visionNausea vomiting
Can be triggered by dilating drops
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Lens Intumescence Dislocation Phacolytic Trauma Uveitis
Neovascular
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Blind Painful
Treatment Enucleation Laser/Cryotherapy Absolute alcohol
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Medical
Beta blockers (Timolol) Carbonic anhydraze inhibitors
Azopt and Trusopt Sympathomimetics
Propine and Apraclonidine Parasympathomimetics (pilocarpine) Prostaglandin Derivatives (Xalatan)
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LaserSurgical◦ Trabeculectomy
◦ Trabeculoplasty
◦Sclerostomy
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is a disorder of the eye inwhich the retina peels
away from its underlyinglayer of support tissue. It isa medical emergency.
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flashes of light (photopsia) - very brief in theextreme peripheral (outside of center) part of vision
a sudden increase in the number of floaters a ring of floaters or hairs just to the temporal side
of the central vision a slight feeling of heaviness in the eye Although most posterior vitreous detachments do
not progress to retinal detachments, those that doproduce the following symptoms: veil or curtain vision central visual loss
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Surgical:◦ Scleral bucklingPost op: must be in prone position
◦ Silicone Oil injectionPost op: must be in supine or lowfowler’s
◦
Cryopexy and LaserPhotocoagulation
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Auricle is mostlyskin-lined cartilage
External auditory
meatus◦ Cartilage: ~40%
◦ Bony: ~60%
◦ S-shaped
◦
Narrowest portion atbony-cartilage junction
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EAC is related tovariouscontiguous
structures◦ Tympanic
membrane
◦ Mastoid
◦ Glenoid fossa
◦ Cranial fossa
◦ Infratemporal fossa
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Innervation: cranial nerves V, VII, IX, X, andgreater auricular nerve
Arterial supply: superficial temporal,posterior and deep auricular branches
Venous drainage: superficial temporal andposterior auricular veins
Lymphatics
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Bacterial infection of external auditory canal Categorized by time course
◦ Acute
◦ Subacute
◦ Chronic
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“swimmer’s ear” Preinflammatory stage Acute inflammatory stage
◦ Mild
◦ Moderate◦ Severe
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Edema of stratum corneum and plugging of apopilosebaceous unit
Symptoms: pruritus and sense of fullness Signs: mild edema Starts the itch/scratch cycle
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Progressiveinfection
Symptoms◦ Pain◦ Increased pruritus
Signs◦ Erythema
◦
Increasing edema◦ Canal debris,
discharge
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Severe pain,worse with earmovement
Signs◦ Lumen obliteration
◦ Purulent otorrhea
◦ Involvement of
periauricular softtissue
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Most common pathogens: P. aeruginosa andS. aureus
Four principles◦ Frequent canal cleaning
◦ Topical antibiotics◦ Pain control
◦ Instructions for prevention
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Chronic inflammatory process Persistent symptoms (> 2 months) Bacterial, fungal, dermatological etiologies
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Unrelenting pruritus Mild discomfort Dryness of canal skin
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Similar to that of AOE Topical antibiotics, frequent cleanings Topical Steroids Surgical intervention
◦ Failure of medical treatment
◦ Goal is to enlarge and resurface the EAC
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In 1861 Prosper Meniere described asyndrome characterized by deafness,tinnitus, and episodic vertigo. He linked thiscondition to a disorder of the inner ear.
In 1938 Hallpike and Cairns described theunderlying pathology of Meniere’s diseaseas being endolymphatic hydrops but theprecise etiology still remains elusive.
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Anatomical-abnormalities
Genetic-autosomaldominant
Immunological-immune complexdeposition
Viral-serum IgE toherpes simples virustypes I and II, Epstein-Barr virus and CMV
Vascular-associatedwith migraines
Metabolic-potassiumintoxication
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Normal membranous labyrinthDilated membranous labyrinth
in Meniere's disease (Hydrops)
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Women>Men
In the US: 50% of patients have a positive family history.
The estimated prevalence is 150 cases per 100,000 population
40’s and 50’s
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The diagnosis of Meniere disease is madebased on a careful history and physical exam.
If the work-up is normal and the classic
symptoms continue, the diagnosis of Meniere
disease is made.
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Most important part of the diagnosis Pattern of symptoms Association between hearing loss, tinnitus, and
vertigo
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Examination results vary, depending upon the phase
of disease. During remission, physical examinationfindings may be completely normal, particularly if thepatient is symptom free.
During an acute attack, the patient has severevertigo.
Patients are sometimes diaphoretic and pale. Vital signs may show elevated blood pressure, pulse,
and respiration.. Spontaneous nystagmus directed toward affected ear
is typical during an acute attack.
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No lab studies are specific for Meniere disease. A CBC, urinalysis, chemistry panel, and alcohol and
drug screening may be helpful if other causes are
considered. If an infectious cause is suspected, consider blood
cultures, urine culture, and a cerebral spinal fluid (CSF)
examination.
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Diuretics or diuretic-like medications (eg,hydrochlorothiazide) actually decrease the fluid
pressure load in the inner ear. These medications
help prevent attacks but do not help once an
acute attack has started.
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Anti-inflammatory properties of steroids are helpfulin endolymphatic hydrops. This is probably due to
reduced endolymphatic pressure. Steroids
actually can reverse vertigo, tinnitus, and hearing
loss.
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Aminoglycosides are a class of antibiotics that werediscovered serendipitously to be preferentially toxicto the vestibular end organ.◦ Destruction of the vestibular end organ renders the
brain insensitive to the fluctuations in the inner ear pressure during an acute Ménière attack.
◦ If given systemically, aminoglycosides affect both ears.◦ Although these drugs can be used to treat extremely
severe bilateral Ménière disease, they leave thepatient with little or no balance function. The resultingDandy syndrome, a complete loss of inner ear
function, can be debilitating.
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During the quiescent phase, medical treatment of Ménière disease is tailored to each patient.
Lifestyle and dietary changes are usually the first
step. Avoiding trigger substances (eg, caffeine)
alone may be sufficient. Smoking cessation also isrecommended.
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Surgical Care:◦ Surgical therapy for Ménière disease is reserved for
medical treatment failures and is otherwise controversial.
◦ Surgical procedures are divided into 2 major
classifications as follows:
Destructive surgical procedures
Nondestructive surgical procedures
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Destructive surgical procedures◦ Rationale to control vertigo: Endolymphatic hydrops
causes fluid pressure accumulation within the inner ear, which causes temporary malfunction and misfiringof the vestibular nerve. These abnormal signals cause
vertigo. Destruction of the inner ear and/or thevestibular nerve prevents these abnormal signals. Aslong as the opposite inner ear and vestibular apparatus function normally, the brain eventually willcompensate for the loss of one labyrinth.
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Problems with destructive procedures:◦ Destruction of one inner ear depends on the adequate
function of the opposite ear. Unfortunately, Ménière
disease can be bilateral (7-50%), in which case this
method is contraindicated. Since balance and hearing
are closely intertwined within the labyrinth, destruction
of the balance portion carries a high risk of hearing
loss. Note that destructive procedures are irreversible
and reserved for severe cases.
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Nondestructive surgical procedures:◦ These are directed toward improving the
state of the inner ear. They are less invasivethan destructive procedures :
1. endolymphatic sac decompression or shunt
2. vestibular nerve section
3. Labyrinthectomy
4. transtympanic medication perfusion.
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Vestibular nerve section◦ For patients with useful hearing in the affected ear,sectioning the diseased vestibular nerve can be theultimate solution.
◦ Although the hearing and balance functions are housed
in one common chamber within the inner ear, their neural connections to the brain separate into distinctnerve bundles as they course through the internalauditory canal.
◦ This anatomical separation allows balance function to
be isolated and ablated without affecting hearingfunction.
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Labyrinthectomy◦ This management option for Ménière disease has the
advantage of a high cure rate (>95%) and is useful in thepatient whose hearing on the diseased side has beendestroyed already by Ménière disease.
◦
Labyrinthectomy involves ablation of the diseased inner ear organs.
◦ This procedure is less complex than vestibular nervesection because labyrinthectomy does not require entryinto the cranial cavity.
◦ Labyrinthectomy is less invasive than vestibular nerve
section.
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This procedure carries less danger of cerebrospinalfluid leak and meningitis since craniotomy is notrequired.
Like those who undergo vestibular nerve section,patients require a few days of inpatient care.
Accommodation to the surgical loss of onevestibular apparatus usually takes weeks or months.
Vestibular rehabilitation during this time period isalso helpful.
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Transtympanic perfusion of medication◦ Medications for Ménière disease are applied through a
myringotomy within the middle ear cavity, where they
presumably are absorbed through the round window
membrane into the inner ear.
◦ Transtympanic perfusion is a relatively low-risk, simple
procedure that applies a high concentration of
medicine with minimal systemic effects.
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Diet:◦ Dietary management is appropriate in patients notseverely affected; patients avoid substances that maytrigger or exacerbate fluid pressure buildup in the inner ear.
◦ Similar to managing systemic hypertension, the goalfor Ménière disease is to reduce the total body fluidvolume. This, in turn, may reduce the inner ear fluidvolume.
◦ Since sodium seems to play a major role in fluid
retention within the inner ear, avoiding salt (eg, pizza,preserved foods, smoked fish) is paramount.
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Consult with a nutritionist to establish a rigidsalt-restricted diet (1.5 g sodium per day). Avoiding other trigger substances (eg, caffeine,
nicotine, alcohol, high-carbohydrate substances,
high-cholesterol/triglyceride foods) also canhelp.
Note that many preserved and smoked foods
contain sodium nitrite, which can contribute to
high sodium content.
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Activity:◦ Endolymphatic hydrops does not preclude regular
activity. Exercise is recommended in moderation.
◦ Because of the unpredictable nature of the disease,
balance-intensive, dangerous tasks (eg, especially
climbing ladders) should be avoided..
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Definition◦Otosclerosis is an abnormalbone growth in the middle ear
that causes hearing loss.
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Symptoms◦ Hearing loss
◦ Slow hearing loss that continues to
get worse◦ Hearing may be better in noisyenvironments than quiet areas.
◦
Ringing in the ears (tinnitus)
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Signs and tests◦A hearing test (audiometry/audiology) may determine the
extent of hearing loss.◦ Temporal-bone CT may be usedto distinguish otosclerosis from
other causes of hearing loss.
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Treatment◦A hearing aid may be used totreat the hearing loss.
◦Surgery: Stapedectomy -replacement of the stapes witha prosthesis
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To reduce the risk of complications after surgery:
◦ Do not blow your nose for 1 week after surgery.
◦ Avoid people with respiratory or other infections.
◦ Avoid bending, lifting, or straining, which may causedizziness.
◦Avoid loud noises or sudden pressure changes such asscuba diving, flying, or driving in the mountains untilhealed.
◦ If surgery is unsuccessful, total hearing loss may occur. Treatment then involves developing skills to cope with
deafness, including use of hearing aids and visual cues.
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Surgery Complications◦Complete deafness
◦ Infection, dizziness, pain, or
blood clot in the ear aftersurgery
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Definition
◦ Tonsillitis is inflammation of the tonsils.
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Causes:◦ Infection of tonsils, pharynx,and surrounding regions
Commonly by: Group A beta-hemolytic Streptococci
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Symptoms◦ Difficulty swallowing
◦ Ear pain
◦ Fever, chills
◦ Headache◦ Sore throat - lasts longer than 48 hours andmay be severe
◦ Tenderness of the jaw and throat
◦ Voice changes, loss of voice
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Signs and tests◦ Inspection of tonsils by use of tongue depressor
Tests that may be doneinclude:◦Rapid strep test
◦ Throat swab culture
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Treatment◦Antibiotic therapy Per oremMust be taken throughout the entire
regimen
Intramuscular injection
Usually given in 1 shot
◦Surgery: tonsillectomy
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Complications◦ Blocked airway from swollen tonsils
◦ Dehydration from difficulty swallowing fluids
◦ Kidney failure
◦ Peritonsillar abscess or abscess in otherparts of the throat
◦ Post-streptococcal glomerulonephritis
◦ Rheumatic fever and related cardiovascular
disorders
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Surgical removal of tonsils The tonsillectomy has been practiced for 2000
years, with varying popularity over thecenturies. The procedure is first mentioned in
"Hindu medicine" about 1000 BC; roughly amillennium later the Roman aristocrat Celcus(25 AD – 50 AD) described a procedurewhereby using the finger (or a blunt hook if necessary), the tonsil was separated from theneighboring tissue prior to being cut out.
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Pre operative phaseEnsure a signed informed consent, &CP clearance
NPO 8-12 hrs prior to procedureGive pre meds as orderedMonitor for untoward signs andsymptoms
Refer to the medical teamAccomplish pre-op checklist
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Ensure safety- keep side rails up Ensure patent airway, oxygen therapy, DBE Orient to time, person, and place Assess LOC periodically
Close monitoring of vital signs – v/s q15mins Positioning – supine with head turned to the side Give due medications and IV’s as prescribed Watch out for dyspnea, hemmorrhage (common
sign is frequent swallowing)
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Provide a safe environment◦ Sharp objects must kept away
◦ Heating devices must be secured
◦ Non slip surfaces and ramps must be provided
◦ Furniture must not be moved often
◦ Identify yourself when approaching them
◦ Ask for permission when touching them
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Speak in a normal tone Refer to special education for specific needs
such as:◦ Walking canes
◦
Guide dogs◦ The use of braile
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The hearing impaired are persons with nosense of hearing
In the absence of hearing other senses maycompensate for its loss (especially sight).
Involve the family and significant other inthe care and treatment of the patient
Alternative communication methods mustbe explored
Refer to proper resources for education of the patient and family. E.g. sign language
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Speak to them normally, there is no need toshout
If the patient still has a functioning ear,speak in to it as much as possible
Accentuate speech with hand gestures Articulate speech well and not too fast for
them to read lips
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Do not cover your mouth when speaking tothem
Do not chew gum or speak with anything inour mouth when communicating with them
Always face the patient when talking tothem
Sounds of household items like thetelephone or doorbell maybe fitted with
lights for them to have a visual cue.
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