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He doesn’t listen to a thing I say

He doesn’t listen to a thing I say. Case Summary. 6yo James was brought in 5 days ago by his parents, with a 1 day history of right sided earache, preceded by 2 days cold-like symptoms.

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He doesn’t listen to a thing I say

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  1. He doesn’t listen to a thing I say

  2. Case Summary 6yo James was brought in 5 days ago by his parents, with a 1 day history of right sided earache, preceded by 2 days cold-like symptoms. James suffers recurrent colds every few wks, and had at least 5 episodes of earache in the last 14 months. Usually Mx with paracetamol syrup, but on 2 occasions Rx with amoxycillin and clavulanic acid for AOM (most recently 2/52 ago). James also thought to be struggling this year at school in comparison to last year, and the teacher reports attention problems. On examination James was febrile at 38.4deg, had obvious nasal discharge and a cough. Tonsils were red and inflammed with white spots, and he had cervical lymphadenopathy. Right ear tympanic membrane was inflamed and bulging outwards, and the left was consistent with serous effusion in the middle ear. Rx with amoxycillin and clavulanic acid, and referred for hearing tests on suspicion of hearing impairment. On return to the practice today, his fever and pain have settled and both middle ears now contain serous fluid. Hearing tests revealed conduction deafness.

  3. Anatomy / physiology • Upper respiratory tract • External ear • Middle ear • Inner ear • Nasal cavity • How do we hear? • Reflexes

  4. Histology

  5. Cranial Nerves • Olfactory • Optic • Oculomotor • Trochlear • Trigeminal • Abducens • Facial • Vestibulocochlear • Glossopharyngeal • Vagus • Spinal Accessory • Hypoglossal

  6. Defences of the Resp Tract Can you come up with 5? • Mucociliary action • IgA • Normal flora (URT) • Alveolar macrophages • Cough & sneeze reflex • Nasal filtering / turbulence • Humidification • BALT • Epithelial regeneration “My God its Foul when Normal People Cough” ???

  7. Microbiology of the resp tract

  8. Otitis Media • Flow chart of pathophysiology

  9. Hearing impairment • Prevalence • Hearing impairment vs deafness • Impairment/disability/handicap • Psychosocial impacts • Conductive vsSensorineural (vs Mixed)

  10. Antibiotics • List some example classes • Targets of antimicrobial agents • Bacteriocidalvsbacteriostatic • MBC/MIC/breakpoint • Testing for sensitivity • Synergism & antagonism • Resistance • Intrinsic vs acquired • Howacquired? • Mechanisms of resistance

  11. Clinical • Testing for hearing loss • Communication strategies in hearing loss

  12. Questions a) Explain how middle ear infections interfere with hearing. b) How does the surgical implantation of grommets in the eardrums of patients with a history of recurrent middle ear infections accompanied by chronic fluid accumulation relieve the problem? a) Fluid accumulation in the middle ear in association with infection impedes the normal movement of the tympanic membrane, the ossicles and the oval window in response to sound. All these structures vibrate less vigorously in the presence of fluid, causing hearing impairment. b) Chronic fluid accumulation in the middle ear is sometimes relieved by the insertion of grommets which allow drainage of the fluid to the exterior. Usually, the grommet is pushed out as the eardrum heals.

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