dizziness history dizziness vertigo inner ear single episode multiple episodes disequilibrium...

DIZZINESS

HistoryDizziness

VertigoINNER EAR

Single episode Multiple episodes

DisequilibriumPresyncope

Other

• Spinning • History of 1st episode• Predisposing factors• Associated symptoms• How long?• Single or recurrent

able: Summary of typical clinical features of common causes of vertigo

Onset Duration Precipitants

Associations

Vestibular neuronitis (neuritis)

Sudden Constant for many hours or even a day

Viral illness (occasionally)

Nausea and vomiting

BPPV Intermittent

Episodes up to 60 seconds

Head movements

None

Ménière's disease

Intermittent

Unpredictable, episodes may last hours

- DeafnessTinnitusAural fullness

Recurrent vestibulopathy

Intermittent

Episodes lasting minutes to hours

- -

able: Summary of typical clinical features of common causes of vertigo

Onset Duration Precipitants Associations

Vestibular neuronitis (neuritis)

Sudden Constant for many hours or even a day

Viral illness (occasionally)

Nausea and vomiting

BPPV Intermittent Episodes up to 60 seconds

Head movements

None

Ménière's disease

Intermittent Unpredictable, episodes may last hours

- DeafnessTinnitusAural fullness

Recurrent vestibulopathy

Intermittent Episodes lasting minutes to hours

- -

Homework

• Chondrodermatitis nodularis chronica helicis

• Hallpike test• Epley’s manouver

The Nose

Anatomy

Anatomy

# nasal bones

Epistaxis

Septal perforation

Septal perforation

• Trauma ,iatrogenig,Wegner’s ,sarcoidosis,TB,Syphilis, COCAINE,NEOPLASTIC.

• Asynptomatic, wistling,blockage,epistaxis• FBC,ESR,CANCA,ACE level?VDRL.Biopsy• Saline nasal douches ,surgical

Rhinitis• 2 out of 3 for >1 hour every day for >2 weeks. -Nasal congestion -rhinorrhoea (Ant. Or Post.) -sneezing - itching (nasal cavity),facial pain ,anosmia*RAST *steroides (beclomethazone,fluticasone,mometasone) *Antihistaminics*Oral steroides*Montelukast*saline douches*surgical

NB Rhinits and sinusits usually coexist and areconcurrent in most individuals; thus, the correctterminology is now rhinosinusits.

Sinusitis

• Acute:<4 weeks 1-Broad spectrum antibiotics 2-Betnesol nasal drops(2 drops BD) 3-Steam inhalation 4-Xylometazoline 0.5% 2 drops tds

• Chronic >12 weeks RAST ,ESR,CANCA,ACE,CT scan Sinuses

Medical treatment for 3 months mild :fluticasone 2 puffs OD Severe (polyps) :Betamethasone 2 drops for 6 weeks followed by steroides sprayOral antihistaminics (if allergic)Oral steroids (very severe)Oral antibiotics (clarythromycin)Surgical: FESSReferral: failure of treatment red flags patient willing to have surgery.

Periorbital cellulitis

Nasal polyps

• What are they?• Paediatric polyps?• ?Unilateral polyps?( neoplastic until proven otherwise)• Associated withAsthma (particularly late-onset asthma)Aspirin sensitivity.......... Samter's triadinfective sinusitiscystic fibrosisKartagener's syndromeChurg-Strauss syndrome• all patients with suspected nasal polyps should be referred to ENT for a

full examination• topical corticosteroids shrink polyp size in around 80% of patients

Around in 1% of adults in the UK have nasal polyps. They are around 2-4 times more common in men and are not commonly seen in children or the elderly.

Red flags

Unilateral blockageUnilateral dischargeBlood stained dischargeEye signs /symptomsFacial swelling (smokers, elderly)

SNORING

• Causes• Epworth sore...?sleep apnoea(is it witnessed)• Day time somnolesence • Treatment Wight lossSurgical UVPPPCPAP• DLVA Patient’s responsibility to inform DVLA when OSA

suspected/investigated. Doctors responsibility to inform DVLA if untreated OSA pt is witnessed driving

Homework

• CSF rhinorrhoea

Throat

Anatomy

Acute tonsillitis

Acute tonsillitis

NICE indications for antibiotics• features of marked systemic

upset secondary to the acute sore throat

• unilateral peritonsillitis• a history of rheumatic fever• an increased risk from acute

infection (such as a child with diabetes mellitus or immunodeficiency)

• patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more

Centor criteria are present • WHICH ANTIBIOTICS?

Presence of tonsillar exudate

Tender anterior cervical lymphadenopathy or lymphadenitis

History of fever

Absence of cough

Quinsy

Glandular fever

Laryngology

Hoarseness • Causes: URTI (Most common)Trauma(shouting/nodules).Iatrogenictumour neurological (?)functional(young women)Ask about ? Reflux symptoms , Wight loss, inhalers use, voice misuse,

stress ,swallowing, breathing• Investigations :TFT,weight ,indirect laryngoscopoy.

• Urgent Chest XRAY (IF SYMPTOMS >3 WEEKS)• If X-ray shows positive signs ..urgent referral to chest physician• If X-ray shows negative signs ..urgent referral to ENT • Early laryngeal tumours confined to vocal cords have 80-90% 5 Y

survival .

2WWRed flags

Persistent hoarseness > 3 weeksPainDysphagiaHaemoptysisOtalgiaNeck lumpEspecially in - smokers- over 40yrs

Croup versus epiglottitisFeatures CROUP Epiglottitis

Organism Para influanze virus H Influanza

Age < 2 years 2-6

Onset gradual rapid

Previous attack often no

Cough Parking no

Dysphagia NO +++

stridor inspiratory Insp/expiratory

Pyrexia + ++

position Lying Down Sitting forward

drooling No +++

nodes +++ +

behavior struggling Quiet

voice hoarse muffled

colour pink grey

Neck lumps

• Lymphadenopathy• Branchial cyst• Thyroglossal cyst• Salivary glands• Refer urgently to ENT

Urgent referral

• Mouth ulcers> 3weeks.• Lumps in mouth >3 weeks• Ubexplained sore throat>1 month• Hoarseness >3 weeks, negative

CXR.• Unexplained salivary gland

swelling>4 weeks• Unilateral unexplained ear ache

with normal otoscopy• Asymmetrical /unilateral deafness• Unilateral tinnitus

The ear

http://www.youtube.com/watch?feature=player_embedded&v=0kEKoQ33dB0