1. rhinitis and nasal steroids

5. 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

6. 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)

7. 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)

8. Acute otitis media

9. Acute otitis media
treatment?

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

11. acute otitis media and antibiotics

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

13. 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.

14. 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.

15. 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.

16. 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.

17. common nose mistakes

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

20. 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

21. 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

22. BPPV

23. 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

24. Hall Pikes test

25. 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

26. tinnitus

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

28. audiometry

29. tinnitus
treatment?

30. tinnitus
treatment?
distraction
hearing aids
tinntius therapy
CBT

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

32. 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