1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

The presenting features are dysphagia, local pain, fever, gross swelling in the floor ofthe mouth and a compromised airway. The tongue often protrudes or is displaced superiorly.Therapy includes hospitalization, intravenous antibiotics and hydration. A tracheotomywill circumvent airway obstruction. Endotracheal intubation is difficult and should not beattempted. Wide surgical drainage is necessary if abscess formation has taken place.Complications include gross fibrosis, aspiration and asphyxia.CommentAcute Infections of the Ear and Upper Aerodigestive TractP SellarsThis is a very large subject and reference to the bibliography provided is necessaryfor a fuller understanding of the various subsections of this chapter.The ear is a complex organ which commonly suffers from both dermal and mucosaldisease. The principles of management of acute infections of the outer ear including theexternal ear canal are essentially dermatological and if these are adhered to, the results areinvariably satisfying.Acute infections of the mucosal-lined middle ear cleft are common, especially inchildren and tend to produce symptoms excessive for the extent of the disease process.Nonetheless prompt treatment based on the correct diagnosis is required to arrest the process.The distinction between early acute suppurative bacterial otitis media and viral otitis mediaor myringitis is often clinically difficult. However, when in doubt, systemic antibiotics areappropriate. Surgery (myringotomy) is rarely now utilized for acute otitis media, but acutemastoiditis is a surgical emergency. Although this latter has now become an uncommondisorder, it remains a dangerous complication of middle ear cleft infection. When it occursin the presence of chronic atticoantral (cholesteatoma) disease the risk of intracranial infectionis high.The diagnosis of infection of the middle ear requires good otoscopical examination,and if possible, this should be carried out with the operating microscope and if necessary evenunder general anaesthetic.Acute infections of the nasal cavities are common and usually self-limiting. Diagnosisis self-evident and treatment is symptomatic and palliative. Infection of the paranasal sinusesbecomes more problematical as a consequence of interrupted drainage of secretions, the resultof sinus ostia obstruction. These infections produce a severe symptomatology and whensuppurative require a curative approach to therapy. Antibiotics in the first instance will bringabout satisfactory resolution in most cases, but when symptoms are incapacitating, promptresolution has failed to occuyr and when complications are present, surgical drainage of theentrapped pus becomes necessary.Acute infections of the throat are likewise common and their natural history is alsoone of self-resolution. However, the condition of B. haemolytic streptococcal tonsillitis,18