1. ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013
Mohamed Ouda ST1

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 ?

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

4. Anatomy

5. External Ear Cellulitis Erysiplas Perichondritis,chondritis
Eczema ,Psoriais
Trauma (heamatoma)
Exostosis
Malignancy (BCC , SCC,Melanoma)
Bat ear
Preauricular sinus
Otitis externa

8. Bat ears 1

9. Preauricular sinus
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11. Otitis externa Ask about :swimming, D.M, Eczema, Psoriasis.
Causative organism?
Treatment:
Aural toilet
Ear drops
Ear wick
Oral antibiotics
?IV antibiotics
*Analgesia

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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

14. SOFRADEX
GENTISONE HC

16. `

18. Otitis media
Inflammation of the middle ear caused by infective organism.
<3 weeKs =Acute Otitis Media
> or = 3 episodes in 6 months =Recurrent AOM.
INFECTION> 3 MONTHS =CSOM.
Self limiting . Oral antibiotics(controversial)

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.

20. Acute mastoiditis
Urgent ENT Referral

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

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

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:

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

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

26. CSOM with cholestatoma
Skin in the wrong place.

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

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

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