INFECTION OF

NOSE, SINUS AND EAR

Prof. Dr. dr. Efrida Warganegara, M.Kes.,
Sp.MK
Content
Introduction
Common Cold
Sinusitis Acute Sinusitis
Otitis Acute Otitis Media
Otitis Externa

INTRODUCTION
The air we inhale contain millions of
suspended particle, including
microorganism

Nearly all these m.o. are harmless, but in
the vicinity of infected individuals the air
may contain large number of pathogenic
m.o.

Efficient cleansing mechanism are there
fore essential to keep the respiratory
tract clean, and are vital components of
the defence against infection of the
upper as well as the lower respiratory
tract.
It is against the background of these natural defence
mechanism that infection take place, and it is then fitting
to ask why the defences have failed.

In the nasopharynx mucociliary system is important;
and in the oropharynx the flusahing action of saliva.

A variety of m.o. live harmlessly in the upper resp tract
and oropharynx they colonize the nose, mouth,
throat, teeth and are well adapted to life in these site.
FLORA NORMAL OF THE RESPIRATORY TRACT

Normally they are not causes disease. However, as in
other parts of the body, resident m.o. may cause trouble
when host resistance is weakened

The respiratory tract, from nose to alveoli, is a
continuum as far as infectious agent are concerned.
There may be a preferred focus of infection
INTRODUCTION
Two useful generalization can be made about upper and
lower resp. tract. Infection :

1) Many m.o. are restricted to the surface epithelium, but
other spread to other parts of the body, before
returning to the resp. tract, oropharynx, salivary glang
etc.

2) Two groups of microbes can be distinguish :
a. Professional invaders succesfully infect
the healthy resp tract they have posses psesific
properties that enable them to evade local host
defence,
such as the attachment mechanism of resp. viruses
b. Secondary invaders those which cause
disease only
when host defences are already impaired
INTRODUCTION
THE COMMON COLD
Aetiology, Transmission, Pathogenesis, and Clinical
Features
Virus causing Common Cold
Virus Type Involved
Attachment
Mechanism Diasease
Rhinovirusses
(>100 type)
Several at any given
time in the
community
capsid protein binds to
ICAM-1 type molecule
on cell Common Cold
Coxsackie virus A especially A21
capsid protein binds to
ICAM-1 type molecule
on cell Common Cold
Corona virusses
several type) all
Viral envelop protein,
binds to glycoprotein
receptors on cell Common Cold
Echovirusses (34
type) 11, 20 - Common Cold
Virus are the commonest invaders of the nasopharynx
there is a great variety of type though rhinoviruses and
coronaviruses together cause more than 50% of colds

They induce a flow of virus-rich fluif from the nasopharynx,
and when the sneezing reflex is trigerred, large number of
virus particles are discharge into the air

Transmission is therfore by aerosol and also by virus-
contaminated hand.

Most of these virus posses surface molecules which binds
them firmly to host cell, or to cilia or microvilli protruding from
these cells as a result they are not washed away in
sectretion and are able to initiate infection in the normal
individual

Virus progeny from the first infected cell then spread to
neighbouring cells and, via surface secretion to new site on
the mucosal surface.

After a few days, damage to epithelial cells and the secretion
of fluid containing inflamatory mediatory such as bradykinin
leads to the common cold type symptom.
THE COMMON COLD
Aetiology, Transmission, Pathogenesis, and Clinical
Features
Common cold virus infection are diagnosted by clinical
appearance, because of the large variety of virus, and
because of illness is generally mild and self-limiting with no
sysyemic spread, laboratory test are nor worthwhile

Diagnosis become important when the lower resp tract is
involved, as for intance with influenza virus or in children
resp syncitial virus (RSV) infection.

The antigens of these viruses can be detected in exfoliated
cells present in nasopharyngeal aspirates from children,
and a rise of virus-specific antibodies may give a (generalyy
retrospective) diagnosis

Virus isolation is tedious and can be difficult, but iti is usually
carries out for public health purpose by central laboratory
when, for instance, a new pamdemic strain of influenzae
virus has arisen
THE COMMON COLD
Laboratory Diagnosis
It is often said if vigorous treatment
with anticongestants, analgetics and
antibiotics is undertaken, the common
cold may resolve in 48 hours;
untreated it will take two days.

Threre no worthwhile vaccines for the
common cold virusses and treatment
is for the most part symptomatic
there are, however, vaccines for
influenza virus

THE COMMON COLD
Treatment and Prevention
Many viruses are capable of invading the air space
associated with the upper resp tract ( sinuses, midle ear,
mastoid)

Mumps virus or resp syncitial virus for instance, can cause
vestibulitis or, generally temporarily, deafness.

The range of secondary bacterial invaders is the same as in
other upper resp tract infection, that is Streptococcus
pneumoniae, Hemophylus influenzae, sometimes with
anaerobes such as Bacteroides fragilis.

Brain abses is a mayor complication

Blockage of the eustachian (auditory) tube or the opening of
sinus due to allergic swelling of the mucosa, prevents
mucocilliary clearance of the infection, and the local
accumulatiio of inflamatory bacterial product cause further
swelling and blockage
OTITIS AND SINUSITIS
Aetiology and Pathogenesis
This condition is extremely common in infants
and small children, partly because the
eustachian (auditory) tube is more widely
open at this age.

A recent study in Boston : 83% of three years
old had had at least one episode, and 46%
three or more episode since birth.

At least half of the attacks are viral in origin
and the bacterial invaders are
nasopharyngeal residents, most commonly :
Strep. pneumoniae, or Hem. infuenzae, and
sometimes Strep. Pyogenes or Staph. aureus
OTITIS AND SINUSITIS
Acute Otitis Media
Infection of the outer ear can cause irritation and pain,
and must be distinguish from otitis media.

In contrast to the middle ear, the external canal has a
bacterial flora similar to the skin (Staphylococcus,
corynebacterium, and to a lesser extent propionibacteria),
and the pathogens responsible for otitis media are rarely
found in otitis externa.

The warm moist environment favour Staph. Aureus,
Candida albicans and gran negative opportunistic such
as Proteus and Pseudomonas aeruginosa.

Ear drops containing polymixin or other antibiotics are
usually efective
OTITIS AND SINUSITIS
Otitis Externa
Aettiology and pathogenesis are similar to
otitis media.

Clinical features include facial pain and
localized tenderness.

It may be possible to identify the causative
bacteria by microscopy and culture of pus
aspirated from the sinus, but sinus pucture is
not often carry out and, as in the case otitis
media, the patient is usually treated
empirically with ampicillin or amoxycillin
OTITIS AND SINUSITIS
Acute Sinusitis
Rhino viruses
Poliovirus
Enterovirus Echovirus
Coxsackievirus
Picornaviridae

Rhinovirus


To cause URTI.
The most frequent : common cold.
Acid labile, consist of 100 serotypes.
Isolation : nose & throat swab
Pathogenesis
Port of entry : URT droplet infection.
Virus can find from nose secretion after 2 4 days
post contact
There are limited histopathologic alteration at
sub mucous & surface epithelial.
Rhino viruses
Preventing & Control

Vaccine production, still in research, in developed
country has been trial.

Natural immunity only in short time.

Ig A 11 S antibody that locally produced can hold out
for 2-6 weeks

Rhino viruses
Pneumonia due to H.influenza
- occur predominantly among children < 3 years

- may also occurs in adults

- are lobar or diffuse broncho pneumonia

- both types occur mainly in patient with serious illness
chronic obstructive lung disease

- similar to pneumococcal pneumonia:
the ouset of chills; pleuritic chest pain; purulent sputum

- pleura effusion is common

- cavitation may develop, but is not common

Diagnosis

- smears of sputum: gram-negative bacilli &
PMN
- culture: require special attention

* Chocolate agar with X & V factor require
for growth & primary isolation of
H.influenza

- demonstration of capsular antigen by
counterimmunoelectrophoresis

Treatment : ampicillin
chloramphenicol