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Dr Richard Isaacs

DR Richard Isaacs, MD joined Kaiser Permanente in 1995 and he has Advanced Certification in Head and Neck Oncologic Surgery. His specialties include: orbital, nasal, and maxillofacial surgery, as well as thyroid and parathyroid surgery. Additionally, Rich is trained in Facial Plastic and Reconstr.

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Dr Richard Isaacs

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  1. COMMON PROBLEMS IN ENT Dr. Richard Isaacs, MD

  2. OUTLINE • Nose • Epistaxis • Chronic Rhinosinusitis • Throat • Peritonsillar Abscess • Tonsillitis • Ear • Hearing Loss • Vertigo • Head & Neck Dr. Richard Isaacs, MD

  3. ACUTE EPISTAXIS • Nasal mucosa: rich blood supply, anastomoses between internal and external carotid supply • Causes • Trauma • Chronic irritation e.g. sinusitis, steroid spray abuse • Coagulopathies • Anatomical abnormalities • Vascular malformation • Tumour • 90% anterior (capillary, venous in origin) • 10% posterior (arterial in origin) – may present as haemoptysis, melaena, haematemesis etc. Dr. Richard Isaacs, MD

  4. MANAGEMENT • D R S A B C D • Anterior vs Posterior • Achieve Haemostasis • Pressure • Ice • Co-Phenylcaine/Cocaine • Cauteurisation • Packing • Balloon • Embolisation • Antibiotics (Flucloxacillin) • Complications Dr. Richard Isaacs, MD

  5. CHRONIC RHINOSINUSITIS • Inflammation involving nasal mucosa and paranasal sinuses lasting longer than 12 weeks • Criteria • Anterior and/or posterior mucopurulent drainage • Nasal obstruction • Facial pain, pressure and/or fullness • Decreased sense of smell • Subtypes • With nasal polyposis • Without nasal polyposis • Allergic fungal rhinosinusitis Dr. Richard Isaacs, MD

  6. MANAGEMENT • Medical Therapy • Nasal lavage – Normal Saline • Nasal glucocorticoid sprays • Oral glucocorticoid • Antibiotics (Augmentin, Doxycycline) • Antihistamines • Surgical Therapy • Functional Endoscopic Sinus Surgery (Category of Operation) • Complications • Recurrence • Epistaxis • (Very Rare) Blindness (Retrobulbar Haemorrhage) Dr. Richard Isaacs, MD

  7. TONSILLITIS/TONSILLECTOMY • Indications – controversial in adult population • Management • Analgaesia • +/- Antibiotics (GAS coverage) • Tonsillectomy • Contraindications – Velopharyngeal, Acute Tonsillitis • Knife vs Unipolar vs Bipolar • Complications: Haemorrhage, Haemorrhage, Haemorrhage, Pain (Otalgia) • Post tonsillectomy haemorrhage requires representation • Management involves vasoconstriction, pressure Dr. Richard Isaacs, MD

  8. PERITONSILLAR ABSCESS • Risk factors • Tonsillitis • Smoking • Symptoms • Trismus • Dysphagia • Systemically Unwell • Management • Drainage (Needle Aspiration vs Surgery) • Antibiotics (Not amoxicillin) • Analgaesia • Tonsillectomy (Acute vs Chronic) • +/- Glucocorticoids • Complications – Recurrence (10-15%) Dr. Richard Isaacs, MD

  9. HEARING LOSS • Sensorineural vs Conductive vs Mixed Dr. Richard Isaacs, MD

  10. CAUSES

  11. HISTORY/EXAMINATION • History • Onset/Time Course – Acute vs Chronic, Bilateral vs Unilateral • Aggravating/Relieving Factors – • Associated Symptoms – Tinnitus, Vertigo, Pain, Discharge • Trauma – Physical, Barotrauma, Noise Induced • Medications • Past History – Stroke Risk Factors • Examination • Otoscopy • Whispered Voice • Renee & Weber Tests • Pneumoscopy/Tympanoscopy Dr. Richard Isaacs, MD

  12. INVESTIGATION • Special Tests • Pure tone audiogram • Speech audiometry • Tympanogram • Imaging • CT Temporal Bone • +/- MRI Auditory Canal Dr. Richard Isaacs, MD

  13. CHOLESTEATOMA • Acquired vs Congential • Locally invasive overgrowth of epithelial cells – not cholesterol • Sx: Unilateral Conductive Hearing Loss, Discharge (often discoloured and malodorous) • Cx: Local invasion, CN VII palsy, Mastoiditis, Meningitis • Management: • Antibiotics • CT Temporal Bone • Surgery – Canal Wall Up vs Down • Follow Up – Local recurrence, Ossiculoplasty • Dr. Richard Isaacs, MD

  14. VERTIGO

  15. HISTORY/EXAMINATION • Vertigo vs Dizziness • Peripheral vs Central • History • Onset/Time Course – Seconds, Hours, Days • Aggravating/Relieving Factors – Movement, Tullio’s Phenomenon • Associated symptoms – Neurology, Nystagmus • Examination • Assess as per hearing loss • Neurological examination • Dix-Hallpike Test • Investigations • CTB

  16. MANAGEMENT • Non-pharmacological • Vestibular Rehabilitation • Pharmacological • Antiemetics – Prochlorperazine (Stemetil), Metoclopramide (Maxolon), Promethazine (Phenergan) • Vestibular Suppressants – Clonazepam (Rivotril), Amitriptyline (Endep) • Specific • BPPV – Epley’s Manoeuvre • Vestibular Neuritis – Vestibular Suppressants • Meniere’s Disease – Na restrict, Diuretics (HCT), Surgical • Migraine – Pizotifen, Amitriptyline, Aspirin • Stroke – As per Stroke

  17. HEAD & NECK TUMOURS • Fifth most common cancer worldwide • Most common histology squamous cell carcinoma • “Field Cancerization” • multiple primary and secondary tumours in upper aerodigestive tract • tobacco (smoked or smokeless) +/- alcohol – synergistic • HPV • betel nut chewing • previous radiation exposure • periodontal disease • occupational exposure e.g. wood-dust Dr. Richard Isaacs, MD

  18. Dr. Richard Isaacs, MD Thank You

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