1 / 29

Key issues in ENT for GP Registrars

Key issues in ENT for GP Registrars. Haytham Kubba Consultant Paediatric Otolaryngologist Yorkhill, Glasgow. Permanent congenital hearing impairment Glue ear Recurrent acute otitis media Adenoids and tonsils Services on offer at Yorkhill. Permanent congenital hearing impairment.

slade
Download Presentation

Key issues in ENT for GP Registrars

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. Key issues in ENTfor GP Registrars Haytham Kubba Consultant Paediatric Otolaryngologist Yorkhill, Glasgow

  2. Permanent congenital hearing impairment • Glue ear • Recurrent acute otitis media • Adenoids and tonsils • Services on offer at Yorkhill

  3. Permanent congenital hearing impairment

  4. Why screen? • Serious • Asymptomatic phase • Treatment available • Outcome better when treated early • Test available and acceptable

  5. How have we screened? • Universal behavioural tests in infants • Health visitor distraction test at 8 months • Targeted objective tests for high risk neonates • Evoked response audiometry within 6 weeks

  6. Who is considered high risk? • Sensorineural deafness in 1st degree relative • Bacterial meningitis • SCBU graduates • preterm < 32 weeks • very low birthweight <1500g • required ventilation • known toxic levels of aminoglycosides • serum bilirubin >400mmol/l at term

  7. Health visitor distraction tests • Distraction test can be effective • Requires • good technique • equipment • quiet environment • cooperative child • Results often poor - 50% deaf children missed by HV tests

  8. NDCS targets • National Deaf Children’s Society 1994 • 40% deaf children identified by 6 months • 80% by 1 year of age • Ayrshire results (Kubba, 1996): • 17% by 6 months • 40% by 1 year • UK average age at diagnosis 18 months

  9. How can we improve? • Universal neonatal screening • May use • evoked response audiometry • automated response cradle • otoacoustic emissions

  10. Universal Neonatal Screening • Pilot sites - Dundee, Edinburgh, Highlands • Implemented across Scotland Oct 2005 • Local policies • test methods • pass criteria • infrastructure

  11. UNHS in Glasgow • Automated ABR • 13 screeners in 3 maternity units • Community follow up clinics • 95% screen coverage • 15 new cases of PCHI in 1st year • Only ½ had risk factors • Mean age at diagnosis 9 weeks • Prev 20 months

  12. Haytham’s 1st law of screening “those most at risk of the disease are also the ones LEAST LIKELY TO ATTEND for screening”

  13. Prevalencebetter ear >40dBHL Fortnum et al, BMJ 2001

  14. Take-home message 1Permanent hearing impairment • UNHS is fantastic, but… • UNHS is not the end of the story • Constant vigilance throughout childhood

  15. Otitis media with effusion

  16. Bacterial biofilm disease • Eustachian tube dysfunction is old hat

  17. Discredited: Auto-inflation Antihistamines Mucolytics Decongestants Steroids Antibiotics Shown to work: Adenoidectomy Grommets

  18. Take-home message 2Otitis media with effusion • If the child is bad enough to need treatment, they need an operation

  19. Recurrent acute OM • Treat as & when • Antibiotics • 35 RCTs 3/12 prophylaxis • Effective, side effects + • Grommets • Le 1991, RCT n=44 • 1.2 fewer infections in 6/12 • Adenoidectomy • Paradise 1999, Koivunen 2004 • Little or no benefit

  20. Take-home message 3Recurrent acute otitis media • Our treatments are largely unsatisfactory • Watch and wait is often the best approach

  21. Acute OM • Antibiotics • 4 systematic reviews • no effect on pain scores • shorten illness • Outcomes? • Diagnostic criteria?

  22. Take-home message 4Acute otitis media • Antibiotics – never say never • Beware under 2 years of age • Incidence of complications is rising

  23. Chronic otitis mediarecurrent or persistent otorrhoea

  24. refer Take-home message 5recurrent or persistent otorrhoea

  25. Sore throats: • SIGN guidelines • Often settle without surgery • Nasal congestion • Preschool = ads • Settles with time • School = allergy • Nasal steroids

  26. Features: Heavy snoring Snort arousals Disturbed sleep Enuresis Night terrors Fatigue Effects: Poor concentration Cognitive impairment Fatigue Hyperactivity Hypertension Cor pulmonale Obstructive sleep apnoea

  27. Sore throats, nasal congestion usually benign, avoid surgery Always enquire about sleep apnoea this is serious and needs treating Take-home message 6T&A

More Related