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ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013 Mohamed Ouda ST1 Slide 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 ? Slide 3 Sore throat tonsillitis ear ache Otitis media Dysphagia lump in the throat dizziness tinnitus deafness neck lump hoarseness anosmia ear discharge Facial palsy Facial swelling thyroid disease F.B EAR F.B nose F.B throat,Nose bleeding,wax nasal blockage Snoring Stridor Otitis externa nasal polyps sinusitis Rhinitis Slide 4 Anatomy Slide 5 External Ear Cellulitis Erysiplas Perichondritis,chondritis Eczema,Psoriais Trauma (heamatoma) Exostosis Malignancy (BCC, SCC,Melanoma) Bat ear Preauricular sinus Otitis externa Slide 6 Slide 7 Slide 8 Bat ears 1 Slide 9 Preauricular sinus ??????????? Slide 10 Slide 11 Otitis externa Ask about :swimming, D.M, Eczema, Psoriasis. Causative organism? Treatment: Aural toilet Ear drops Ear wick Oral antibiotics ?IV antibiotics *Analgesia Slide 12 ???? Slide 13 Necrotizing otitis externa =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 Slide 14 SOFRADEXGENTISONE HC Slide 15 Slide 16 ` Slide 17 Slide 18 Otitis media Inflammation of the middle ear caused by infective organism.or = 3 episodes in 6 months =Recurrent AOM. INFECTION> 3 MONTHS =CSOM. Self limiting. Oral antibiotics(controversial) Slide 19 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. Slide 20 Acute mastoiditis Urgent ENT Referral Slide 21 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 Slide 22 (NICE GUIDELINES) 2008 Children who will benefit from surgical intervention Children with persistent bilateral OME documented over a period of 3 months with 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 Slide 23 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 Slide 24 Otitis media with effusion (OME) Serous OM=Secretory OM=Glue ear Investigations PTA...Conductive deafness Tympanometry....Type B curve(Flat) Treatment Watchful waiting (Valsalva maneovre) Hearing aid Ventilation tubes Slide 25 CSOM without cholestatoma Chronic otorroea (mucopurulent) + perforation (can be dry in inactive disease). Pseudomonas aeruginosa,staph aureus Otalgia is uncommon. Peforation (safe versus unsafe) Treatment: aural toilet, topical antibiotics,surgical repair Slide 26 CSOM with cholestatoma Skin in the wrong place. Slide 27 Slide 28 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 Slide 29 ACOUSTIC NEUROMA Acoustic neuromas (more correctly called vestibular schwannomas) account for approximately five percent of intracranial tumours and 90 percent of cerebellopontine angle Features can be predicted by the affected cranial nerves cranial 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 2 MRI of the cerebellopontine angle is the investigation of choice Slide 30 Slide 31 Slide 32 Slide 33 Slide 34 ???????????????????? Slide 35 Slide 36 Slide 37 Slide 38 Slide 39