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ENT. P Feldman. The External Ear. Bat ears Chondrodermatitis chronica helicis Basal cell carcinoma. External auditory meatus. Congenital stenosis Foreign bodies wax. Otitis externa. Otitis externa. Tragus tender Ear canal swollen, red, weeping

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slide1

ENT

P Feldman

the external ear
The External Ear
  • Bat ears
  • Chondrodermatitis chronica helicis
  • Basal cell carcinoma
external auditory meatus
External auditory meatus
  • Congenital stenosis
  • Foreign bodies
  • wax
otitis externa1
Otitis externa
  • Tragus tender
  • Ear canal swollen, red, weeping
  • Staph pyogenes, pseudomonas, e coli, candida.
  • Swabs unhelpful
  • Gentisone hc, if severe add augmentin
  • If recurrent moisturising cream + hydrocrtiosne
external ear
External ear
  • Furuncle painful tender tragus
  • Osteomata smooth hard tender lump in canal
  • Malignancy intractable pain, blood stained discharge, spreads to facial nerve tm joint, cervical glands.
tympanic membrane injury
Tympanic membrane injury
  • Symptoms
    • Pain, vertigo, deafness, bleeding from ear, blood clot in meatus
  • DO NOT CLEAN OUT EAR OR INSERT DROPs
  • Watch tear shouls heal gradually, if infection present give antibiotics
otitis media1
Otitis Media
  • Organisms
    • H Influenzae, B strep, Pneumococcus, staph
  • Symptoms
    • Persitent pain, discharge, temp, deafness,red ear drum
  • Treatment
    • Mild painkillers
    • Severe antibiotics
complications
Complications
  • Acute mastoiditis
  • Meningitis
  • Facial palsy
  • Labyrinthitis
  • Lateral sinus thrombosis
  • Brain abscess
  • Temporal lobe abscess
  • Cerebellar abscess
secretory otitis media1
Secretory Otitis Media
  • Causes
    • Follows URTI
  • Symptoms
    • Deafness, discomfort , pain.
  • Signs
    • Blue drum, conductive deafness.
  • Treatment
    • Wait for improvement if not refer
cholosteatoma1
Cholosteatoma
  • Keratotic material that forms in a retraction pocket in the attic.
  • Gradually enlarges and erodes the surrounding tissues, destroying the auricles.
  • Creates a large cavity allowing infection to spread into middle ear and post cranial fossa
cholosteatoma2
Cholosteatoma
  • Signs
    • Chronic discharging ear
    • Awful smell - cats pee
  • Management
    • Refer urgently
earache
Earache
  • Causes
    • Furuncle
    • Otits externa
    • Otitis media
    • Mastoiditis
    • Wax
    • malignancy
referred pain
Referred pain
  • Dental abscess
  • Tonsillitis
  • Impacted wisdom teeth
  • Tm joint pain
  • Cancer
    • Post third of tongue
    • Throat
    • temporal arteries
tinnitus
Tinnitus
  • Buzzing hissing noise in ears
  • Causes
    • Any ear disease, loud noises
  • Management
    • explanation
    • White sound from radio
    • Underpilow microphone
    • Worse if depressed treat that
vertigo
Vertigo
  • Chronic
    • Benign positional vertigo
    • Chronic middle ear disease
    • Meniere’s disease
    • Vertebro basilar ischaemia
    • Acoustic neuroma
    • Posterior fossa tumour
    • Multiple sclerosis
vertigo1
Vertigo
  • Acute
    • Labyrinthitis
    • Head injury
    • Drugs/Alcohol
    • Vascular
    • Infection
examination
Examination
  • BP
  • Nystagmus
  • Pupils
  • Fundi
  • Cr nerves
  • Neck movements
  • Ear drums
management
Management
  • Prochlorperazine 5mg tds
  • Cinnarizine 15-30mg tds
  • Prochlorperazine supp 25mg
  • If persists for 4-8 weeks refer
deafness
Deafness
  • Acute onset
  • ? Vascular spasm
  • Refer immediately
deafness1
Deafness
  • Chronic
    • Wax
    • Age
    • Congenital
    • Familial
    • Drugs
deafness2
Deafness
  • Barotrauma
  • Injury to TM
  • Infection
  • Acoustic neuroma
  • If > 60 no wax or apparent cause refer hearing aid clinic special forms
rareties
Rareties
  • Otosclerosis
    • Famial
    • New bone formation at stapes
    • Conductive loss
    • Aggravated by COC, pregnancy, HRT
    • Treatment stapedectomy
facial palsy
Facial palsy
  • Bell’s palsy
  • Trauma
  • Tumour
  • Infection
  • Multiple sclerosis
  • Guillain barre syndrome
bells palsy
Bells’palsy
  • Management controversial
    • If complete get ENT assesment
    • If resolving watch
    • If incomplete ? steroids
foreign bodies
Foreign bodies
  • Use wax hook
  • Caution can push into larynx and lung
  • Refer if unhappy
fractured nasal bones
Swollen

Distorted

Tender

Increased mobilty

To a&e

Fractured nasal bones
sinusitis1
Sinusitis
  • Follows URTI, dental abscess. Injury, blocked ostia.
  • Symptoms – ill, temp, facial pain, sinus tenderness
  • Treatment – antibiotics, ephedrine nasal drops, steam inhalations.
sinus pain
Sinus pain
  • Symptoms – pain in and over sinuses often follows urti
  • Less ill than sinusitis
  • Causes – blocked ostia
  • Treatment – ephedrine nasal drops, steam inhalations
swollen cheek
Swollen cheek
  • Usually due to dental abscess
  • Advise see dentist
  • Antibiotics – amoxicillin or metronidazole
carcinoma
Carcinoma
  • Maxilliary antrum
    • Cheek swelling
    • Swelling/ulceration buccal alveolar sulcus
    • Swelling ulceration palate
    • Epiphora
    • Proptosis, diplopia
    • pain
carcinoma1
Carcinoma
  • Nose
    • Nasal obstruction
    • Blood stained discharge
    • Epistaxis
    • Diplopia
    • Enlarged cervical nodes
    • Conductive deafness
rhinitis1
Rhinitis
  • Symptoms
    • Sneezing
    • Watery nasal discharge
  • Causes
    • Allergy – cats, pollens, perfumes
    • vasomotor
rhinitis2
Rhinitis
  • Treatment
    • Antihistamines
      • Cetrizine 10mg
      • Neoclarityn 5mg
      • Son of trilludan
    • Steroid spray
      • Beconase 2 puffs bd en
      • Flixonase 2 pyf od en
sore throat
Sore throat
  • Causes
    • 70% viral
    • 30% bacterial
  • Treatment
    • Mild – paracetamol gargles lozenges
    • Severe – antibitocs penicillinv 250 qds or erythromycin
sore throat1
Sore throat
  • Indications for antibiotics
    • High temp
    • Enlarged tonsils with exudate
    • Enlarged cervical galnds
    • Present >3 days
  • Very ill ? glandular fever
    • Fbc, paul bunnel, throat swab.
tonsillitis1
Tonsillitis
  • Referral
    • 6-8 episodes/year
    • Lasting 2/52
    • Loosing time from school/job
    • Failure to gain weight
    • Difficulty breathing/swallowing
  • Progressive unilateral tonsillar enlargement refer ? ca
quinsy1
Quinsy
  • Unilateral peritonsillar swelling
  • High temp
  • Very ill
  • Trismus
  • Admit
adenoids1
Adenoids
  • Normally enlarged age 4-7 years
  • Can’t visualise
  • Lateral xray of neck but high dose radiation not indicated
  • Refer if recurrent otitis media
mouth ulcers
Mouth ulcers
  • Apthous ulcer
  • Vincents angina – tender red swelling and ulceration of gingiva needs antibiotic
  • Glandular fever
  • Agranulocytosis
mouth ulcers1
Mouth ulcers
  • Herpes
  • Syphilis
  • Diptheria
  • Cancer fails to heal
larynx
Larynx
  • Injuries
    • May lead to infection causing perichondritis, necrosis, fibrosis and laryngeal stridor admit
infections
Infections
  • Acute epiglottis
    • Sudden onset high temp
    • Resp stridor
    • Distress
    • Restless
    • Admit
  • Cause – h influenzae
infections1
Infections
  • Croup
    • Lower temp
    • Slow onset
    • Less il
  • Management
    • Steam
    • Oral dexamethasone
    • admit
chronic laryngitis
Chronic laryngitis
  • Misuse of voice
    • Shouting
    • Talking +++
    • smoking
  • Management
    • Voice modulation
    • Speech therapy
stridor
Stridor
  • Vocal cord paralysis
    • Ca bronchus
    • Ca oesophagus
    • Ca thyroid
    • Ca pharynx
    • TB
    • Aortic aneurysm
plummer vinson syndrome
Plummer vinson syndrome
  • Dysphagia
  • Weight loss
  • Tiredness
  • Anaemia
  • Pharyngeal web
  • Precursor to ca oesophagus
pharyngeal pouch
Pharyngeal pouch
  • Dysphagia
  • Regurgitation of undigested food
  • Gurgling noises in throat
  • Refer
ca hypopharynx
Ca hypopharynx
  • Can’t be visualised in pyriform fossa or post cricoid region
  • Symptoms
    • Pain
    • Weight loss
    • Hoarseness
    • Lump in neck
    • refer
cancers
Cancers
  • Hoarseness > 6/52
  • Ulceration buccal mucosa > 3/52
  • Oral swellings . 3/52
  • All red or white patches of oral mucosa
  • Dysphagia > 3/52
  • Unlareal nasal obstruction with purulent discharge
cancers1
Cancers
  • Un explained tooth mobility not related to periodontal disease
  • Unresolved neck masses > 3/52
  • Cranial neuropathies
  • Orbital masses