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ENT for General Practice

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Presentation on theme: "ENT for General Practice"— Presentation transcript:

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

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

3 Quick recap of ear anatomy

4 Hearing tests Rinne and Weber tests Rinne Ac better than BC
Hearing loss 256Hz 512HZ 1024Hz < 15db 15-30db x 30-45db 45-60db

5 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

6 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

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

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

9 complications Acute mastoiditis Chronic otitis media
Intracranial complications

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

11 Intracranial complications
Vestibular symptoms Facial palsy Intracranial complications

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

13 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

14 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

15 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

16 Which ear needs syringing?
Syringing the ear Which ear needs syringing?

17 Occlusive cerumen Causing pain Hearing loss Tinnitus

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

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

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

21 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

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

23 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

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

25 CT sinuses

26 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

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

28 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,

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

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

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

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

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

34 Symptoms Hoareseness associated with Dysphagia Odynophagia Otalgia

35 Signs Dysplasia/Ca in situ Leukoplakia Ulcero/Exophytic growth

36 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

37 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

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

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

40 Investigations Ba meal Video fluroscopy Oesophagoscopy Imaging CT/MRI

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

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

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

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

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

46 Thankyou

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