Sssm common problems in ent
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SSSM: COMMON PROBLEMS IN ENT. PETER TAO INTERN. OUTLINE. Nose Epistaxis Chronic Rhinosinusitis Throat Peritonsillar Abscess Tonsillitis Ear Hearing Loss Vertigo Head & Neck. ACUTE EPISTAXIS. Nasal mucosa: rich blood supply, anastomoses between internal and external carotid supply

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Sssm common problems in ent

SSSM: COMMON PROBLEMS IN ENT

PETER TAO

INTERN


Outline

OUTLINE

  • Nose

    • Epistaxis

    • Chronic Rhinosinusitis

  • Throat

    • Peritonsillar Abscess

    • Tonsillitis

  • Ear

    • Hearing Loss

    • Vertigo

  • Head & Neck


Acute epistaxis

ACUTE EPISTAXIS

  • Nasal mucosa: rich blood supply, anastomoses between internal and external carotid supply

  • Causes

    • Trauma

    • Chronic irritation e.g. sinusitis, steroid spray abuse

    • Coagulopathies

    • Anatomical abnormalities

    • Vascular malformation

    • Tumour

  • 90% anterior (capillary, venous in origin)

  • 10% posterior (arterial in origin) – may present as haemoptysis, melaena, haematemesis etc.


Management

MANAGEMENT

  • D R S A B C D

  • Anterior vs Posterior

  • Achieve Haemostasis

    • Pressure

    • Ice

    • Co-Phenylcaine/Cocaine

    • Cauteurisation

    • Packing

    • Balloon

    • Embolisation

    • Antibiotics (Flucloxacillin)

  • Complications


Chronic rhinosinusitis

CHRONIC RHINOSINUSITIS

  • Inflammation involving nasal mucosa and paranasal sinuses lasting longer than 12 weeks

  • Criteria

    • Anterior and/or posterior mucopurulent drainage

    • Nasal obstruction

    • Facial pain, pressure and/or fullness

    • Decreased sense of smell

  • Subtypes

    • With nasal polyposis

    • Without nasal polyposis

    • Allergic fungal rhinosinusitis


Management1

MANAGEMENT

  • Medical Therapy

    • Nasal lavage – Normal Saline

    • Nasal glucocorticoid sprays

    • Oral glucocorticoid

    • Antibiotics (Augmentin, Doxycycline)

    • Antihistamines

  • Surgical Therapy

    • Functional Endoscopic Sinus Surgery (Category of Operation)

  • Complications

    • Recurrence

    • Epistaxis

    • (Very Rare) Blindness (Retrobulbar Haemorrhage)


Tonsillitis tonsillectomy

TONSILLITIS/TONSILLECTOMY

  • Indications – controversial in adult population

  • Management

    • Analgaesia

    • +/- Antibiotics (GAS coverage)

  • Tonsillectomy

    • Contraindications – Velopharyngeal, Acute Tonsillitis

    • Knife vs Unipolar vs Bipolar

    • Complications: Haemorrhage, Haemorrhage, Haemorrhage, Pain (Otalgia)

    • Post tonsillectomy haemorrhage requires representation

    • Management involves vasoconstriction, pressure


Peritonsillar abscess

PERITONSILLAR ABSCESS

  • Risk factors

    • Tonsillitis

    • Smoking

  • Symptoms

    • Trismus

    • Dysphagia

    • Systemically Unwell

  • Management

    • Drainage (Needle Aspiration vs Surgery)

    • Antibiotics (Not amoxicillin)

    • Analgaesia

    • Tonsillectomy (Acute vs Chronic)

    • +/- Glucocorticoids

  • Complications – Recurrence (10-15%)


Hearing loss

HEARING LOSS

Sensorineural vs Conductive vs Mixed


Causes

CAUSES


History examination

HISTORY/EXAMINATION

  • History

    • Onset/Time Course – Acute vs Chronic, Bilateral vs Unilateral

    • Aggravating/Relieving Factors –

    • Associated Symptoms – Tinnitus, Vertigo, Pain, Discharge

    • Trauma – Physical, Barotrauma, Noise Induced

    • Medications

    • Past History – Stroke Risk Factors

  • Examination

    • Otoscopy

    • Whispered Voice

    • Renee & Weber Tests

    • Pneumoscopy/Tympanoscopy


Investigation

INVESTIGATION

  • Special Tests

    • Pure tone audiogram

    • Speech audiometry

    • Tympanogram

  • Imaging

    • CT Temporal Bone

    • +/- MRI Auditory Canal


Cholesteatoma

CHOLESTEATOMA

  • Acquired vs Congential

  • Locally invasive overgrowth of epithelial cells – not cholesterol

  • Sx: Unilateral Conductive Hearing Loss, Discharge (often discoloured and malodorous)

  • Cx: Local invasion, CN VII palsy, Mastoiditis, Meningitis

  • Management:

    • Antibiotics

    • CT Temporal Bone

    • Surgery – Canal Wall Up vs Down

  • Follow Up – Local recurrence, Ossiculoplasty


Vertigo

VERTIGO


History examination1

HISTORY/EXAMINATION

  • Vertigo vs Dizziness

  • Peripheral vs Central

  • History

    • Onset/Time Course – Seconds, Hours, Days

    • Aggravating/Relieving Factors – Movement, Tullio’s Phenomenon

    • Associated symptoms – Neurology, Nystagmus

  • Examination

    • Assess as per hearing loss

    • Neurological examination

    • Dix-Hallpike Test

  • Investigations

    • CTB


Management2

MANAGEMENT

  • Non-pharmacological

    • Vestibular Rehabilitation

  • Pharmacological

    • Antiemetics – Prochlorperazine (Stemetil), Metoclopramide (Maxolon), Promethazine (Phenergan)

    • Vestibular Suppressants – Clonazepam (Rivotril), Amitriptyline (Endep)

  • Specific

    • BPPV – Epley’s Manoeuvre

    • Vestibular Neuritis – Vestibular Suppressants

    • Meniere’s Disease – Na restrict, Diuretics (HCT), Surgical

    • Migraine – Pizotifen, Amitriptyline, Aspirin

    • Stroke – As per Stroke


Head neck tumours

HEAD & NECK TUMOURS

  • Fifth most common cancer worldwide

  • Most common histology squamous cell carcinoma

  • “Field Cancerization”

    • multiple primary and secondary tumours in upper aerodigestive tract

    • tobacco (smoked or smokeless) +/- alcohol – synergistic

    • HPV

    • betel nut chewing

    • previous radiation exposure

    • periodontal disease

    • occupational exposure e.g. wood-dust


Thank you

Thank You


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