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ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013

ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013. Mohamed Ouda ST1. WHY ENT?. very common comprising 20% of presenting complaints to a primary care provider limited training in undergraduate and postgraduate medical education for primary care

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ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013

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  1. ENT UPDATE FOR PRIMARY CAREWEST CUMBERLAND HOSPITAL 05/06/2013 Mohamed Ouda ST1

  2. WHY ENT? • very common • comprising 20% of presenting complaints to a primary care provider • limited training in undergraduate and postgraduate medical education for primary care • What are the most common conditions ?

  3. Sore throat tonsillitis ear ache Otitis media Dysphagialump in the throat dizziness tinnitus deafness neck lump hoarseness anosmiaear discharge Facial palsy Facial swelling thyroid disease F.B EAR F.B nose F.Bthroat ,Nose bleeding ,wax nasalblockage Snoring StridorOtitisexternanasal polyps sinusitis Rhinitis

  4. Anatomy

  5. External Ear • Cellulitis • Erysiplas • Perichondritis,chondritis • Eczema ,Psoriais • Trauma (heamatoma) • Exostosis • Malignancy (BCC , SCC,Melanoma) • Bat ear • Preauricular sinus • Otitisexterna

  6. Bat ears 1

  7. Preauricular sinus ???????????

  8. Otitisexterna • Ask about :swimming, D.M, Eczema, Psoriasis. • Causative organism? • Treatment: Aural toilet Ear drops Ear wick Oral antibiotics ?IV antibiotics *Analgesia

  9. ????

  10. Necrotizing otitisexterna =Malignant O. E • NON Neoplastic • Osteomyelitis (canalskull base) • DM • Severe pain, granulations. • Diagnosis :history +C/P+ CT SCAN • Treatment • Admit • DM control • Systemic Abx(Oral or IV) FOR 6-12 WEEKS • Aural toilet • Surgery • Topical anti psudomonal • Death

  11. SOFRADEX GENTISONE HC

  12. `

  13. Otitis media • Inflammation of the middle ear caused by infective organism. • <3 weeKs=Acute Otitis Media • > or = 3 episodes in 6 months =Recurrent AOM. • INFECTION> 3 MONTHS =CSOM. Self limiting . Oral antibiotics(controversial)

  14. Acute OM • COMMON • Pain relief with perforation • 80% resolve in 4/7 days without treatment • Antibiotics (Amoxycillin):no improvement in 4 days, B/L OM,OM with otorrhoea, systemically unwell. • Delayed approach • ENT Referral : -Recurrent( >4 episodes in 6 months), -poerforation has not healed after 1 month.

  15. Acute mastoiditis Urgent ENT Referral

  16. Otitis media with effusion (OME)Serous OM=Secretory OM=Glue ear • NO infection • Fluid in the middle ear • E T dysfunction • Most common cause of hearing loss in children. • Down syndrome, cleft palate. • Adults :post URTI ,Resolve in 6/52 if not Refer?PNS tumour

  17. (NICE GUIDELINES) 2008Children who will benefit from surgical intervention • Children with persistent bilateralOME documented over a period of 3 monthswith a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz . • Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms

  18. Active monitoring (watchful waiting)* • Essential • 50% will recover with no treatment in the first three months. The following treatments are not recommended for the management of OME: − antibiotics − topical or systemic antihistamines − topical or systemic decongestants − topical or systemic steroids Browning GG. Watchful waiting in childhood otitis media with effusion.Editorial.Clin Otolaryngology 2001;26:417-424

  19. Otitis media with effusion (OME)Serous OM=Secretory OM=Glue ear Investigations • PTA ...Conductive deafness • Tympanometry....Type B curve(Flat) Treatment Watchful waiting (Valsalvamaneovre) Hearing aid Ventilation tubes

  20. CSOM without cholestatoma • Chronic otorroea(mucopurulent) + perforation (can be dry in inactive disease). • Pseudomonas aeruginosa,staphaureus • Otalgia is uncommon . • Peforation (safe versus unsafe) • Treatment: aural toilet, topical antibiotics ,surgical repair

  21. CSOM with cholestatoma • Skin in the wrong place.

  22. Sudden SNHL • IF UNILATERAL OR ONLY GOOD EAR...Refer • SAME day referral if within 24 hours • Acoustic neuroma=Vestibular schwanoma • Benign ,slow growing tumour. • 80% CPA tumour • B/L in NF2 • MRI

  23. ACOUSTIC NEUROMA • Acoustic neuromas (more correctly called vestibular schwannomas) account for approximately five percent of intracranial tumours and 90 percent of cerebellopontine angleFeatures can be predicted by the affected cranial nervescranial nerve VIII: hearing loss, vertigo, tinnitus • cranial nerve V: absent corneal reflex • cranial nerve VII: facial palsy • Bilateral acoustic neuromas are seen in neurofibromatosis type 2MRI of the cerebellopontine angle is the investigation of choice

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