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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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Presentation Transcript
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

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
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
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