26 Aug

Since the discovery of HIV infection in the late 1950s, the burden of the disease
has been on the increase as more people get infected. In this extract, we will
look at the most common presentations in the ear nose and throat.

Oral cavity manifestations
Oral candidiasis is by far the most common manifestation of HIV in the mouth.
The classic presentation is of white patches in the mouth, frequently on the
tongue. It is usually painless unless irritated. The patches are limited to the
tongue but may be extensive involving the esophagus. Treatment is usually by
use of fluconazole and, rarely, amphotericin. Oral hairy leukoplakia could
mimic oral candidiasis in presentation; however, the lesion is frequently found
on the lateral aspect of the tongue.
Kaposi sarcoma is the most common oral cavity tumor in HIV and AIDS. Its
appearance is usually a symptom of poor control of the HIV virus. It presents as
dark purple marks on the tongue but most commonly on the hard palate.
Treatment is usually by adherence to antiretroviral drugs. Radiotherapy is
indicated in some cases.
Sinonasal manifestations

They mainly present as rhinosinusitis. In contrast to immunocompetent
individuals in whom the condition may be self-limiting, HIV sufferers
frequently experience severe and refractory presentations. In most cases there is
progression to complications. Children especially and rarely adults may have
adenoid hypertrophy as part of the spectrum of lymphoid hyperplasia. Such
patients will present with persistent nasal obstruction and sleep disordered
breathing marked by snoring. Surgery may be indicated for chronic
rhinosinusitis and for adenoid hypertrophy.
Otologic manifestations
These are the least frequent. Prevalence of ear conditions in HIV may not be
different from that of the general population. However, conditions like otitis
media with effusion has been shown to be higher in patients with HIV.
Sensorineural hearing loss may occur due to the presence of other conditions
like syphilis affecting the inner ear.

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