tailieunhanh - Otolaryngolog Head and Neck Surgery - part 4

Vi sinh vật: Aspergillus loài chiếm ưu thế. Aspergillus niger (màu đen), Aspergillus flavus (màu vàng), Aspergillus fumigatus (màu xám), Candida albicans (màu trắng), và các loại nấm khác nhau có thể được nhân gây bệnh. Làm sạch ống tai là một điều kiện tiên quyết để điều trị thành công. | OTOMYCOSIS FUNGUS-EAR JUNGLE-EAR . Microbiology Aspergillus species predominate. Aspergillus niger black Aspergillus flavus yellow Aspergillus fumigatus gray Candida albicans white and various other fungi can be causative. Cleansing of the ear canal is a prerequisite to successful therapy. Drug choices See Section page 54 re ototopical therapy Primary 2 acetic acid otic Domeboro or Acetic citric acids in alcohol VõSol or 3 boric or 2 acetic acid in 70 isopropyl alcohol or Ketoconazole cream Alternatives Aqueous merthiolate Povidone-iodine Betadine Gentian violet 2 in 95 alcohol M-cresyl acetate Cresylate Boric acid iodine powder CHRONIC RECURRING OTITIS EXTERNA ECZEMATOUS SEBORRHEIC ATOPIC ALLERGIC PSORIATIC etc. OTITIS EXTErNa . Microbiology During active infections pathogens may be those of otomycosis or acute otitis externa. Treatment then would be as listed above. Prevention control needs dandruff shampoos such as selenium sulfide Selsun or ketoconazole Nizoral shampoo and nightly applications of topical corticosteroids VõSol HC or cortisporin ointment . See also Terbinafine page 23 Section . NECROTIZING MALIGNANT OTITIS EXTERNA. Microbiology Pseudomonas aeruginosa in diabetic patients . Consider hyperbaric oxygen. Drug choices Topical plus oral plus IV IM antipseudomonals see pages 50-51 . Topical ciprofloxacin Cipro HC or topical ofloxacin Floxin otic PLUS oral or IV levofloxacin or meropenem IV PLUS Added intravenous antipseudomonals Piperacillin tazobactam Zosyn plus gentamicin or tobramycin or amikacin Ceftazidime Fortaz or cefepime Maxipime ACUTE BACTERIAL RHINOSINUSITIS is an infection equivalent to acute otitis media but in a different complex of air spaces in the skull. Similarly many clinically suggestive cases are not bacterial infections at all but are virus infections colds Children Adults allergies headaches from other causes etc. The S. pneumoniae 35-42 20-43 accompanying table refers to only culture-positive H. influenzae 21-28 22-35 .