rhinitis and nasal steroids

Bioavailability of nasal steroids Fluticasone Mometasone References Nasonex Summary of Product Characteristics. Date accessed April 2011 Kariyawasam H, Scadding G.Journal of Asthma and Allergy 2010: 3 19–28 Rhinocort Summary of Product Characteristics. Date accessed April 2011 Beconase Summary of Product Characteristics. Date accessed April 2011

mometasone allergic rhinitis adults and adolescents 12 years of age or more the recommended dose for treatment of nasal congestion associated with seasonal allergic rhinitis is two sprays (50 mcg of mometasone in each spray) in each nostril once daily (total daily dose of 200 mcg)

mometasone asthma adults and adolescents 12 years of age or more different sizes are available, which give 200 or 400 micrograms of mometasone per metered inhalation (puff)

Acute otitis media

Acute otitis media treatment?

Antibiotic use for acute otitis media varies from 31% in the Netherlands to 98% in the USA and Australia

acute otitis media and antibiotics

Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days.

Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain.

Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics.

Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears.

Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.

common nose mistakes

nose the clue in this case is the asthma – this is a very common condition with nasal polyps

nose polyps are bilateral and affect the sense of smell and loss or reduction in the sense of smell is a good discriminator of polyps

nose examine noses with an endoscope and get used to the normal appearance of the nasal turbinates. a common mistake is to confuse turbinates with polyps polyps are pale and mobile and have no sensation

BPPV

BPPV common, dramatic rotatory vertigo with the head extended, (usually) only to one side the hall pikes test involves lying the patient with the head extended to a 45 degree angle to one side, then sitting them up and lying back to the other side

Hall Pikes test

Epley, right ear down with the right ear down, initially and symptoms and torsional nystagmus, this means the crystals are in the right ear. Right ear BPPV

tinnitus

tinnitus 67 year old woman tinnitus for 6 months, getting worse anxious hearing not problem, audiogram shows symmetrical hearing loss

audiometry

tinnitus treatment?

tinnitus treatment? distraction hearing aids tinntius therapy CBT

tinnitus treatment? distraction hearing aids tinntius therapy CBT there is no treatment which can ‘cure’ tinnitus

tinntius MRC, 2000 (Davis 2000) longitudinal study of 48,313 people; 10.1% described tinnitus arising spontaneously and lasting for five or more minutes at a time and 5% described it as moderately or severely annoying However, only 0.5% reported tinnitus having a severe effect on their life