Presentation on theme: "ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013"— Presentation transcript:
1ENT UPDATE FOR PRIMARY CARE WEST CUMBERLAND HOSPITAL 05/06/2013 Mohamed Ouda ST1
2WHY ENT?very commoncomprising 20% of presenting complaints to a primary care providerlimited training in undergraduate and postgraduate medical education for primary careWhat are the most common conditions ?
13Necrotizing otitis externa =Malignant O. E NON NeoplasticOsteomyelitis (canalskull base)DMSevere pain, granulations.Diagnosis :history +C/P+ CT SCANTreatmentAdmitDM controlSystemic Abx(Oral or IV)FOR 6-12 WEEKSAural toiletSurgeryTopical anti psudomonalDeath
18Otitis mediaInflammation 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)
19Acute OM COMMON Pain relief with perforation 80% resolve in 4/7 days without treatmentAntibiotics (Amoxycillin):no improvement in 4 days, B/L OM,OM with otorrhoea, systemically unwell.Delayed approachENT Referral :-Recurrent( >4 episodes in 6 months),-poerforation has not healed after1 month.
21Otitis media with effusion (OME) Serous OM=Secretory OM=Glue ear NO infectionFluid in the middle earE T dysfunctionMost 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 of3 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
23Active monitoring (watchful waiting)* Essential50% 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 steroidsBrowning GG. Watchful waiting in childhood otitis media with effusion.Editorial.Clin Otolaryngology 2001;26:
24Otitis media with effusion (OME) Serous OM=Secretory OM=Glue ear InvestigationsPTA ...Conductive deafnessTympanometry....Type B curve(Flat)TreatmentWatchful waiting (Valsalva maneovre)Hearing aidVentilation tubes
25CSOM without cholestatoma Chronic otorroea (mucopurulent) + perforation (can be dry in inactive disease).Pseudomonas aeruginosa,staph aureusOtalgia is uncommon .Peforation (safe versus unsafe)Treatment: aural toilet, topical antibiotics ,surgical repair
28Sudden SNHL IF UNILATERAL OR ONLY GOOD EAR...Refer SAME day referral if within 24 hoursAcoustic neuroma=Vestibular schwanomaBenign ,slow growing tumour.80% CPA tumourB/L in NF2MRI
29ACOUSTIC NEUROMAAcoustic 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, tinnituscranial nerve V: absent corneal reflexcranial nerve VII: facial palsyBilateral acoustic neuromas are seen in neurofibromatosis type 2 MRI of the cerebellopontine angle is the investigation of choice