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