ENT

1. ENT P Feldman

2. The External Ear • Bat ears • Chondrodermatitis chronica helicis • Basal cell carcinoma

3. External auditory meatus • Congenital stenosis • Foreign bodies • wax

4. Otitis externa

5. 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

6. 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.

7. 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

8. Perforated Tympanic Membrane

9. Middle Ear

10. Otitis Media

11. Otitis Media • Organisms • H Influenzae, B strep, Pneumococcus, staph • Symptoms • Persitent pain, discharge, temp, deafness,red ear drum • Treatment • Mild painkillers • Severe antibiotics

12. Complications • Acute mastoiditis • Meningitis • Facial palsy • Labyrinthitis • Lateral sinus thrombosis • Brain abscess • Temporal lobe abscess • Cerebellar abscess

13. Secretory Otitis Media

14. Secretory Otits Media

15. Secretory Otitis Media • Causes • Follows URTI • Symptoms • Deafness, discomfort , pain. • Signs • Blue drum, conductive deafness. • Treatment • Wait for improvement if not refer

16. Chlosteatoma

17. Cholosteatoma

18. 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

19. Cholosteatoma • Signs • Chronic discharging ear • Awful smell - cats pee • Management • Refer urgently

20. Earache • Causes • Furuncle • Otits externa • Otitis media • Mastoiditis • Wax • malignancy

21. Referred pain • Dental abscess • Tonsillitis • Impacted wisdom teeth • Tm joint pain • Cancer • Post third of tongue • Throat • temporal arteries

22. 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

23. Vertigo • Chronic • Benign positional vertigo • Chronic middle ear disease • Meniere’s disease • Vertebro basilar ischaemia • Acoustic neuroma • Posterior fossa tumour • Multiple sclerosis

24. Vertigo • Acute • Labyrinthitis • Head injury • Drugs/Alcohol • Vascular • Infection

25. Examination • BP • Nystagmus • Pupils • Fundi • Cr nerves • Neck movements • Ear drums

26. Management • Prochlorperazine 5mg tds • Cinnarizine 15-30mg tds • Prochlorperazine supp 25mg • If persists for 4-8 weeks refer

27. Deafness • Acute onset • ? Vascular spasm • Refer immediately

28. Deafness • Chronic • Wax • Age • Congenital • Familial • Drugs

29. Deafness • Barotrauma • Injury to TM • Infection • Acoustic neuroma • If > 60 no wax or apparent cause refer hearing aid clinic special forms

30. Rareties • Otosclerosis • Famial • New bone formation at stapes • Conductive loss • Aggravated by COC, pregnancy, HRT • Treatment stapedectomy

31. Facial palsy • Bell’s palsy • Trauma • Tumour • Infection • Multiple sclerosis • Guillain barre syndrome

32. Bells’palsy • Management controversial • If complete get ENT assesment • If resolving watch • If incomplete ? steroids

33. The nose

34. Foreign bodies • Use wax hook • Caution can push into larynx and lung • Refer if unhappy

35. Swollen Distorted Tender Increased mobilty To a&e Fractured nasal bones

36. Deviated nasal septum

37. Sinusitis

38. Sinusitis • Follows URTI, dental abscess. Injury, blocked ostia. • Symptoms – ill, temp, facial pain, sinus tenderness • Treatment – antibiotics, ephedrine nasal drops, steam inhalations.

39. Sinus pain • Symptoms – pain in and over sinuses often follows urti • Less ill than sinusitis • Causes – blocked ostia • Treatment – ephedrine nasal drops, steam inhalations

40. Swollen cheek • Usually due to dental abscess • Advise see dentist • Antibiotics – amoxicillin or metronidazole

41. Carcinoma • Maxilliary antrum • Cheek swelling • Swelling/ulceration buccal alveolar sulcus • Swelling ulceration palate • Epiphora • Proptosis, diplopia • pain

42. Carcinoma • Nose • Nasal obstruction • Blood stained discharge • Epistaxis • Diplopia • Enlarged cervical nodes • Conductive deafness

43. Rhinitis

44. Rhinitis • Symptoms • Sneezing • Watery nasal discharge • Causes • Allergy – cats, pollens, perfumes • vasomotor

45. Non allergic rhinitis

46. Rhinitis • Treatment • Antihistamines • Cetrizine 10mg • Neoclarityn 5mg • Son of trilludan • Steroid spray • Beconase 2 puffs bd en • Flixonase 2 pyf od en

47. Sore throat • Causes • 70% viral • 30% bacterial • Treatment • Mild – paracetamol gargles lozenges • Severe – antibitocs penicillinv 250 qds or erythromycin

48. 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.

49. Tonsillitis

50. 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