1 / 45

DIZZINESS

DIZZINESS. History. Spinning History of 1 st episode Predisposing factors Associated symptoms How long? Single or recurrent. Homework. Chondrodermatitis nodularis chronica helicis Hallpike test Epley’s manouver. The Nose. Anatomy. Anatomy. # nasal bones. Epistaxis.

mairi
Download Presentation

DIZZINESS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIZZINESS History • Spinning • History of 1st episode • Predisposing factors • Associated symptoms • How long? • Single or recurrent

  2. Homework • Chondrodermatitisnodularischronicahelicis • Hallpike test • Epley’smanouver

  3. The Nose

  4. Anatomy

  5. Anatomy

  6. # nasal bones

  7. Epistaxis

  8. Septal perforation

  9. Septal perforation • Trauma ,iatrogenig,Wegner’s ,sarcoidosis,TB,Syphilis, COCAINE,NEOPLASTIC. • Asynptomatic, wistling,blockage,epistaxis • FBC,ESR,CANCA,ACE level?VDRL.Biopsy • Saline nasal douches ,surgical

  10. Rhinitis • 2 out of 3 for >1 hour every day for >2 weeks. -Nasal congestion -rhinorrhoea (Ant. Or Post.) -sneezing - itching (nasal cavity),facial pain ,anosmia *RAST *steroides (beclomethazone,fluticasone,mometasone) *Antihistaminics *Oral steroides *Montelukast *saline douches *surgical NB Rhinits and sinusits usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusits.

  11. Sinusitis • Acute:<4 weeks 1-Broad spectrum antibiotics 2-Betnesol nasal drops(2 drops BD) 3-Steam inhalation 4-Xylometazoline 0.5% 2 drops tds • Chronic >12 weeks RAST ,ESR,CANCA,ACE,CT scan Sinuses Medical treatment for 3 months mild :fluticasone 2 puffs OD Severe (polyps) :Betamethasone 2 drops for 6 weeks followed by steroides spray Oral antihistaminics (if allergic) Oral steroids (very severe) Oral antibiotics (clarythromycin) Surgical: FESS Referral: failure of treatment red flags patient willing to have surgery.

  12. Periorbitalcellulitis

  13. Nasal polyps Around in 1% of adults in the UK have nasal polyps. They are around 2-4 times more common in men and are not commonly seen in children or the elderly. • What are they? • Paediatric polyps? • ?Unilateral polyps?( neoplastic until proven otherwise) • Associated with Asthma (particularly late-onset asthma) Aspirin sensitivity..........Samter's triad infective sinusitis cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome • all patients with suspected nasal polyps should be referred to ENT for a full examination • topical corticosteroids shrink polyp size in around 80% of patients

  14. Red flags Unilateral blockage Unilateral discharge Blood stained discharge Eye signs /symptoms Facial swelling (smokers, elderly)

  15. SNORING • Causes • Epworth sore...?sleep apnoea(is it witnessed) • Day time somnolesence • Treatment Wight loss Surgical UVPPP CPAP • DLVA Patient’s responsibility to inform DVLA when OSA suspected/investigated. Doctors responsibility to inform DVLA if untreated OSA pt is witnessed driving

  16. Homework • CSF rhinorrhoea

  17. Throat

  18. Anatomy

  19. Acute tonsillitis Acute tonsillitis

  20. NICE indications for antibiotics • features of marked systemic upset secondary to the acute sore throat • unilateral peritonsillitis • a history of rheumatic fever • an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency) • patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centorcriteria are present • WHICH ANTIBIOTICS? Presence of tonsillarexudate Tender anterior cervical lymphadenopathy or lymphadenitis History of fever Absence of cough

  21. Quinsy

  22. Glandular fever

  23. Laryngology

  24. Hoarseness • Causes: URTI (Most common) Trauma(shouting/nodules). Iatrogenic tumour neurological (?) functional(young women) Ask about ? Reflux symptoms , Wight loss, inhalers use, voice misuse, stress ,swallowing, breathing • Investigations :TFT,weight ,indirect laryngoscopoy. • Urgent Chest XRAY (IF SYMPTOMS >3 WEEKS) • If X-ray shows positive signs ..urgent referral to chest physician • If X-ray shows negative signs ..urgent referral to ENT • Early laryngeal tumours confined to vocal cords have 80-90% 5 Y survival .

  25. 2WW Red flags Persistent hoarseness > 3 weeks Pain Dysphagia Haemoptysis Otalgia Neck lump Especially in - smokers - over 40yrs

  26. Croup versus epiglottitis

  27. Neck lumps • Lymphadenopathy • Branchial cyst • Thyroglossal cyst • Salivary glands • Refer urgently to ENT

  28. Urgent referral • Mouth ulcers> 3weeks. • Lumps in mouth >3 weeks • Ubexplained sore throat>1 month • Hoarseness >3 weeks, negative CXR. • Unexplained salivary gland swelling>4 weeks • Unilateral unexplained ear ache with normal otoscopy • Asymmetrical /unilateral deafness • Unilateral tinnitus

  29. The ear http://www.youtube.com/watch?feature=player_embedded&v=0kEKoQ33dB0

More Related