ent p feldman. the external ear bat ears chondrodermatitis chronica helicis basal cell carcinoma
TRANSCRIPT
ENT
P Feldman
The External Ear
Bat ears
Chondrodermatitis
chronica helicis
Basal cell carcinoma
External auditory meatus
Congenital stenosis
Foreign bodies
wax
Otitis externa
Otitis externa
Tragus tender Ear canal swollen, red, weeping Staph pyogenes, pseudomonas, e coli, candida. Swabs unhelpful Gentisone hc, if severe add augmentin If recurrent moisturising cream + hydrocrtiosne
External ear
Furuncle painful tender tragus
Osteomata smooth hard tender lump in
canal
Malignancy intractable pain, blood
stained discharge, spreads to facial nerve
tm joint, cervical glands.
Tympanic membrane injury
SymptomsPain, vertigo, deafness, bleeding from ear,
blood clot in meatus DO NOT CLEAN OUT EAR OR INSERT
DROPs Watch tear shouls heal gradually, if
infection present give antibiotics
Perforated Tympanic Membrane
Middle Ear
Otitis Media
Otitis Media
OrganismsH Influenzae, B strep, Pneumococcus, staph
SymptomsPersitent pain, discharge, temp, deafness,red ear
drum Treatment
Mild painkillersSevere antibiotics
Complications
Acute mastoiditis Meningitis Facial palsy Labyrinthitis Lateral sinus thrombosis Brain abscess Temporal lobe abscess Cerebellar abscess
Secretory Otitis Media
Secretory Otits Media
Secretory Otitis Media
CausesFollows URTI
SymptomsDeafness, discomfort , pain.
SignsBlue drum, conductive deafness.
TreatmentWait for improvement if not refer
Chlosteatoma
Cholosteatoma
Cholosteatoma
Keratotic material that forms in a retraction pocket in the attic.
Gradually enlarges and erodes the surrounding tissues, destroying the auricles.
Creates a large cavity allowing infection to spread into middle ear and post cranial fossa
Cholosteatoma
Signs
Chronic discharging ear
Awful smell - cats pee
Management
Refer urgently
Earache
CausesFuruncleOtits externa Otitis mediaMastoiditisWaxmalignancy
Referred pain
Dental abscess Tonsillitis Impacted wisdom teeth Tm joint pain Cancer
Post third of tongueThroat temporal arteries
Tinnitus
Buzzing hissing noise in ears Causes
Any ear disease, loud noises Management
explanationWhite sound from radioUnderpilow microphoneWorse if depressed treat that
Vertigo
ChronicBenign positional vertigoChronic middle ear diseaseMeniere’s diseaseVertebro basilar ischaemiaAcoustic neuromaPosterior fossa tumourMultiple sclerosis
Vertigo
Acute
Labyrinthitis
Head injury
Drugs/Alcohol
Vascular
Infection
Examination
BP Nystagmus Pupils Fundi Cr nerves Neck movements Ear drums
Management
Prochlorperazine 5mg tds
Cinnarizine 15-30mg tds
Prochlorperazine supp 25mg
If persists for 4-8 weeks refer
Deafness
Acute onset
? Vascular spasm
Refer immediately
Deafness
Chronic
Wax
Age
Congenital
Familial
Drugs
Deafness
Barotrauma
Injury to TM
Infection
Acoustic neuroma
If > 60 no wax or apparent cause refer hearing
aid clinic special forms
Rareties
Otosclerosis
Famial
New bone formation at stapes
Conductive loss
Aggravated by COC, pregnancy, HRT
Treatment stapedectomy
Facial palsy
Bell’s palsy
Trauma
Tumour
Infection
Multiple sclerosis
Guillain barre syndrome
Bells’palsy
Management controversial
If complete get ENT assesment
If resolving watch
If incomplete ? steroids
The nose
Foreign bodies
Use wax hook
Caution can push into larynx and lung
Refer if unhappy
Fractured nasal bones
Swollen Distorted Tender Increased mobilty To a&e
Deviated nasal septum
Sinusitis
Sinusitis
Follows URTI, dental abscess. Injury, blocked
ostia.
Symptoms – ill, temp, facial pain, sinus
tenderness
Treatment – antibiotics, ephedrine nasal drops,
steam inhalations.
Sinus pain
Symptoms – pain in and over sinuses often
follows urti
Less ill than sinusitis
Causes – blocked ostia
Treatment – ephedrine nasal drops, steam
inhalations
Swollen cheek
Usually due to dental abscess
Advise see dentist
Antibiotics – amoxicillin or metronidazole
Carcinoma
Maxilliary antrumCheek swellingSwelling/ulceration buccal alveolar sulcusSwelling ulceration palateEpiphoraProptosis, diplopiapain
Carcinoma
Nose Nasal obstruction
Blood stained discharge
Epistaxis
Diplopia
Enlarged cervical nodes
Conductive deafness
Rhinitis
Rhinitis
Symptoms
Sneezing
Watery nasal discharge
Causes
Allergy – cats, pollens, perfumes
vasomotor
Non allergic rhinitis
Rhinitis
Treatment Antihistamines
Cetrizine 10mg
Neoclarityn 5mg
Son of trilludan
Steroid spray Beconase 2 puffs bd en
Flixonase 2 pyf od en
Sore throat
Causes 70% viral
30% bacterial
Treatment Mild – paracetamol gargles lozenges
Severe – antibitocs penicillinv 250 qds or
erythromycin
Sore throat
Indications for antibiotics High temp
Enlarged tonsils with exudate
Enlarged cervical galnds
Present >3 days
Very ill ? glandular fever Fbc, paul bunnel, throat swab.
Tonsillitis
Tonsillitis
Referral6-8 episodes/yearLasting 2/52Loosing time from school/jobFailure to gain weightDifficulty breathing/swallowing
Progressive unilateral tonsillar enlargement refer ? ca
Glandular fever
Quinsy
Quinsy
Unilateral peritonsillar swelling
High temp
Very ill
Trismus
Admit
Adenoids
Adenoids
Normally enlarged age 4-7 years
Can’t visualise
Lateral xray of neck but high dose radiation not
indicated
Refer if recurrent otitis media
Mouth ulcers
Apthous ulcer
Vincents angina – tender red swelling and
ulceration of gingiva needs antibiotic
Glandular fever
Agranulocytosis
Mouth ulcers
Herpes
Syphilis
Diptheria
Cancer fails to heal
Apthous ulcers
Diptheria
Syphilis
Larynx
Injuries
May lead to infection causing perichondritis,
necrosis, fibrosis and laryngeal stridor admit
Herpectic stomatitis
Infections
Acute epiglottis Sudden onset high temp
Resp stridor
Distress
Restless
Admit
Cause – h influenzae
Epiglotitis
Infections
CroupLower tempSlow onsetLess il
ManagementSteamOral dexamethasoneadmit
Chronic laryngitis
Misuse of voice Shouting
Talking +++
smoking
Management Voice modulation
Speech therapy
Vocal cords
laryngitis
Stridor
Vocal cord paralysis Ca bronchus
Ca oesophagus
Ca thyroid
Ca pharynx
TB
Aortic aneurysm
Plummer vinson syndrome
Dysphagia
Weight loss
Tiredness
Anaemia
Pharyngeal web
Precursor to ca oesophagus
Pharyngeal pouch
Dysphagia
Regurgitation of undigested food
Gurgling noises in throat
Refer
Ca hypopharynx
Can’t be visualised in pyriform fossa or post cricoid region
SymptomsPain Weight lossHoarsenessLump in neckrefer
Carcinoma larynx
Cancers
Hoarseness > 6/52 Ulceration buccal mucosa > 3/52 Oral swellings . 3/52 All red or white patches of oral mucosa Dysphagia > 3/52 Unlareal nasal obstruction with purulent
discharge
Cancers
Un explained tooth mobility not related to
periodontal disease
Unresolved neck masses > 3/52
Cranial neuropathies
Orbital masses