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ENT for General Practice George Vattakuzhiyil MBBS;MS(ENT);FRCS.

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Presentation on theme: "ENT for General Practice George Vattakuzhiyil MBBS;MS(ENT);FRCS."— Presentation transcript:


2 ENT for General Practice George Vattakuzhiyil MBBS;MS(ENT);FRCS

3 Objectives Detailed examination of ENT/H&N Learn to diagnose & treat common ENT pathology Recognise serious complication, request additional tests, specialty referral

4 Quick recap of ear anatomy

5 Hearing tests Rinne and Weber tests Rinne Ac better than BC Hearing loss 256Hz512HZ1024Hz < 15db 15-30dbxx 30-45dbxx 45-60dbxxx

6 Weber test Hold the base of the tuning fork in the midline (forehead, incisor teeth) Laterelising to the left: conductive loss on left or SNHL on right

7 Otitis Externa Inflammatory disorder of skin lined EAC Acute/Chronic Generelised skin disorder Pathogens: staph, pseudomonas, Fungus Topical antibiotic/steroid Sofradex,otomize spray,otosporin,GHC, locorten- vioform

8 Otitis externa Extension to pre/post auricular area Microsuction/IV antibiotics Diabetic patient/ Pseudomonas inf ? Malignant otitis externa

9 Acute otitis media Common in children otalgia/discharge Unwell/pyrexia TM: red, bulging,oedematous Streptococcus/Haemo philus Amoxycillin 5-7 days

10 complications Acute mastoiditis Chronic otitis media Intracranial complications

11 CSOM Recurrent ear discharge Hearing loss Perforation of the TM – central Presence of cholesteatoma Marginal, Attic perforation Offensive discharge, bleeding, granulations

12 Complications Vestibular symptoms Facial palsy Intracranial complications

13 Management Medical: Dry mopping,suction clearance,/ Ear drops, rarely systemic antibiotics Surgical Myringoplasty/ Tympanoplasty Combined Mastoidectomy/Tympanoplasty

14 Otitis media+effusion-Glue ear Common in children Reduced hearing noticed by parents/teacher Recurrent ear infection Unsteadiness- child falling over Effusions persist for weeks after AOM 80% clear at 8 weeks

15 Signs of OME Dull retracted TM May show air-fluid level Conductive hearing loss(whisper test, Rinne/weber tests) OME persistant over 3 months ENT referral

16 Treatment Failed audio Flat tympanograms h/o >3 episodes in 6/12 or >4 in 12/12 Grommet insertion Evaluate adenoids, especially in recurrent grommet insertions

17 Syringing the ear Which ear needs syringing?

18 Occlusive cerumen Causing pain Hearing loss Tinnitus

19 Avoid syringing Non occlussive cerumen Previous ear surgery Only hearing ear Perforated TM Kerotosis obturans

20 Acute/Chronic tonsillitis Sorethroat, fever, malaise Tender cervical lymph nodes Enlarged congested tonsils with pus Analgesia Penicillin Prolonged course, worsening symptoms consider glandular fever

21 Quincy (peritonsillar abscess) pain + trismus Swelling of the soft palate Displacement of uvula Refer for I/V antibiotics drainage

22 Allergic rhinitis Seasonal : allergen usually outdoor perennial: indoor dust, mite, cat dander O/E pale mucosa, boggy turbinate Avoid allergen, antihistamines, topical vasoconstrictors, steroids Surgery- SMD, laser, Turbinectomy

23 sinusitis Facial pain/ pressure/ fullness Nasal obstruction/ discharge Altered smell Pyrexia in acute sinusitis Headache, halitosis, dental pain Minor factors: cough,ear pressure, fatigue

24 sinusitis Acute sinusitis < 4/52 Chronic >4/52 or 4 or more episodes O/E nasal congestion, polyps, pus in MM Structural changes: DNS, concha bullosa

25 sinusitis Sinus X ray usually unhelpful CT sinuses Acute: amoxicillin clavulonate, oxymetazoline Chronic: Pus c/s, augmentin+metronidazole, Treat the cause: allergy, surgery(FESS)

26 CT sinuses

27 Epistaxis Most common site – littles area Cause: Idiopathic, trauma (nose picking), dry mucosa, hypertension, coagulopathy, NSAID, Warfarin, tumours Try naseptin cream for a short course Silver nitrate cautery Electrocautery/ packing/ surgery

28 Common Pathology Viral laryngitis Viral URTI preceding aphonia Hx sorethroat B/L V.c. oedema/erythema voice rest, antibiotics

29 Hoarseness Symptom of both local, systemic pathology Often the early symptom of ca larynx Persistent > 2/52 or worsening Associated with loss of weight, smoking,

30 Vocal cord nodules Vocal cord nodules Singer / teacher / children / Often B/L – Junction ant/ middle 1/3 Voice rest / speech therapy Rarely – MLS excision

31 Laryngitis - GORD Laryngitis - GORD Hx of GORD Inflammation of Post larynx Treatment for reflux Raising head end of cot

32 Vocal polyp/Reinkes oedema Male Smoker Irritant exposure Hoarseness Dyspnoea Irritant cough Treatment: Voice rest, speech therapy,stop smoking, Microlaryngoscopy and vc stripping

33 Sq papilloma Anterior commissure/ true VC Complete excision Laser treatment

34 Laryngeal Malignancy Risk factors Smoking Alcohol Radiation exposure HPV Nickel exposure

35 Symptoms Hoareseness associated with Dysphagia Odynophagia Otalgia Haemoptysis

36 Signs Dysplasia/Ca in situ Leukoplakia Ulcero/Exophytic growth Neck mass URGENT REFERRAL

37 Cord paralysis Breathy voice (air escape) B/L airway compromise P/H of thyroid, cardiovascular Sx Cord in paramedian position Refer for investigations and treatment

38 Functional aphonia Psychogenic Only able to speak in forced whisper Normal cough Spastic dysphonia strained/strangled voice Onset related to major life stress Hyperadduction of true/false cord Speech therapy, ? Botulinum toxin inj

39 Dysphagia Progressive dysphagia for solids structural lesion Dysphagia for liquids Neurological Painful swallow spasm of cricopharynx, ulcer Signs of reflux Signs of aspiration

40 Examination-key points Oral cavity Tongue, gag reflex,soft palate Pharynx pooling, lesions larynx Elevation of larynx, scopy Neck masses

41 Investigations Ba meal Video fluroscopy Oesophagoscopy Imaging CT/MRI

42 Salivary glands Painful diffuse swelling sailadinitis Plus fluctuation with meals calculi Non painful swelling Tumour

43 Examination Unilateral/bilateral ? Diffuse/well circumscribed? Is it tender? Any discharge from the ducts? Enlarged nodes? Palpable calculi?

44 Investigations Plain X-ray lateral view FNAC CT scan Sialogram

45 Tinnitus SNHL Drugs-NSAID, Aminoglycosides, Antidepressants Tumors- Acoustic neuroma, Temporal lobe tumor Anxiety/ Depression

46 Tinnitus If unilateral refer: MRI Serology: FTA Haematocrit Lipids Audiogram/ ABR Consider hearing therapy referral councilling/ tinnitus masker


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