Diagnosis and Treatment of HIV-Associated Manifestations in Otolaryngology

Abstract

Almost 30 years after its first description, HIV still remains a global pandemic. The present paper aims to review the current knowledge on the ear, nose and throat (ENT) manifestations of HIV infection, and present the available diagnostic and treatment options. A literature review was conducted in Medline and other available database sources. Information from related books was also included in the data analysis. It is well acknowledged that up to 80% of HIV-infected patients eventually develop ENT manifestations; among which, oral disease appears to be the most common. Oro-pharyngeal manifestations include candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi's sarcoma, and non-Hodgkin's lymphoma. ENT manifestations in the neck can present as cervical lymphadenopathy or parotid gland enlargement. Respective nasal manifestations include sinusitis (often due to atypical bacteria), and allergic rhinitis. Finally, otological manifestations include otitis (externa, or media), inner ear involvement (sensorineural hearing loss, disequilibrium), and facial nerve palsy (up to 100 times more frequently compared to the general population). Although ENT symptoms are not diagnostic of the disease, they might be suggestive of HIV infection, or related to its progression and the respective treatment failure. ENT doctors should be aware of the ENT manifestations associated with HIV disease, and the respective diagnosis and treatment. A multi-disciplinary approach may be required to provide the appropriate level of care to HIV patients.

Otolaryngological, head and neck manifestations in HIV-infected patients seen at Steve Biko Academic Hospital in Pretoria, South Africa

“…Of HIV-infected patients, 80 -100% will present to the ENT clinic with early or late manifestations. [2,7,9,10] Previous studies have shown that oral manifestations are the most frequently presented symptoms, followed by cervical head and neck lymphadenopathy, sinusitis and otitis media. [1,2,9] No study of this nature has been conducted in SA; however, studies encompassing 1 155 patients from 3 developing countries; namely Nigeria (n=89), Iran (n=98) and India (n=968), have been conducted.…”

“…Otitis media ranges from 13 to 40%, closely followed by sensory-neural hearing loss and otitis externa. [7,8] There is lack of local information from SSA and SA regarding the otolaryngological (or ENT) and head and neck manifestations in HIV-infected individuals.…”

Immune deficiency in chronic rhinosinusitis: screening and treatment

“…These authors also mention that physicians and other healthcare providers need to have a high level of suspicion for atypical pathogens such as Alternaria alternata, Aspergillus, Pseudallescheria boydii Cryptococcus, Candida albicans, Acanthamoeba castellani, Microsporidium , and Legionella pneumophila [39,40]. …”

Otolaryngological Manifestations in HIV Infected Patients, Tehran, Iran

“…Early studies demonstrate that ENT symptoms may result in HIV, are associated with progression as well as treatment failure of HIV [6][7][8][9][10]. Therefore, while ENT symptoms are not diagnostic of HIV, it may suggest infection, and ENT specialists should be equipped with knowledge of ENT manifestations associated with HIV [11].…”