ear nose and throat overview for school nurses dr. robert pollard ear nose and throat physicians and...
TRANSCRIPT
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Ear Nose and Throat Overviewfor school Nurses
Dr. Robert PollardEar Nose and Throat Physicians and Surgeons of Charleston 3043579049
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OVERVIEW
• OVERVIEW OF HEARING SCREENING• COMMON THROAT ISSUES• OTITIS MEDIA• OTITIS EXTERNA• NECK AND SWALLOWING COMPLAINTS• ALLERGY AND IMMUNOTHERAPY• AMPLIFICATION IN THE CLASSROOM• EVALUATION OF EAR PAIN
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HEARING SCREENING
• INTERVENTION IN THE PAST RELIED UPON THE HIGH RISK REGISTER AND “LATE SCREENING”
• SOPHISTICATED TESTING AT BIRTH AND GENETIC TESTING HAS TAKEN THE BURDEN OFF OF PRESCHOOL TESTING FOR THE PROFOUNDLY DEAF
• SCREENING AT 5, 1 AND 2K HELPFUL TO IDENTIFY MOSTLY CONDUCTIVE LOSSES
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Hearing Screening/Roundup
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Screening for Hearing Loss
• Designed to produce false positives and few false negatives
• Easy to administer• Thresholds significant for speech development• 5,1,2• 1,2,4• Easily understood referral criteria• RESA
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The Audiogram and Frequency Responses
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History of Hearing Screening
• 1990 High risk register• OAE looking for cochlear emissions• Fast ABR establishing intact pathway from
canal to brain• Follow up established by hospital where birth
ocurred• Dictated by law
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Hearing Screening
• Fewer students seen with delayed identification of profound loss
• Role of School Nurse changes to screen for persistent middle ear effusion and subsequent hearing loss
• Referral to qualified medical professional
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Bob’s Referral Criteria
• Hearing Thresholds >25 db• Subjective Hearing Loss• Abnormal Tympanometry with no prior tube
insertion• Speech and Language issues without reason• Chronic Otorrhea
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Special Topics
• Amplification in the classroom• Cochlear implants• Child placement • Auditory trainer
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Chronic mucoid effusionBest fit for tube insertionImmediate correction of conductive hearing loss
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Tubes/audiometry
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Impact of Tubes on Screening
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Acute otitis mediaBULGING TYMPANIC MEMBRANE
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Tube granulomaManaged best with ciprodex
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atelectasisLoss of the air containing space behind the tympanic membraneLikely eventual loss of ossicular chair
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Otitis Externa
• Eczema • Fungus• Swimming• Hearing aids
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Bacterial Externa
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Otitis Externa Contact Dermatitis
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Ear Foreign Bodies
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Complications of Piercings
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Tonsillitis
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Peritonsillar Abscess
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Tonsillitis
• Exudative• Strep• Mono• Bleeding• Peritonsillar abscess• Asymmetry• Establish protocols for intervention/treatment
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Post Tonsillectomy
• When to return to school• Normal activities at 3 weeks• Would not release to full contact until 3 wks• Risk of bleeding greatest between 7-12 d
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Post Tonsillectomy
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Allergy and Immunotherapy
• Immunotherapy increasing used to chronically sick children with multiple allergies
• Serum is prepared from known concentrations of antigens to which the individual is allergic
• “immunity” is conveyed by the development of “blocking” antibodies when antigen is placed in the subdermal tissues away from the target organ (nose, mouth and lung)
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Allergy and Immunotherapy
• Progressively higher concentrations are given over a schedule of 3-6 months until the individual achieves maintenance
• Definition of Maintenance• Weekly maintenance injections for several
years• 10 min wait time after injection• Auto injector to manage reactions (rare)
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Nose Bleeds
• Most commonly associated with allergy and sinusitis
• Ice pack, compression and elevation • Refer quickly if not improving• Packing is very rarely needed for children• Cautery is used for persistent bleeding or
recurrences
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HPV RELATED CANCERS
• Relationship between virus and cervical cancers known for many years
• Vaccine available for about 10 years commercially
• Tremendous growth in the amount of oral, tonsil, tongue base cancers make this a growing public health issue