Transcript ENT - Welcome to the BHBT Directory
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 Osteomata canal painful tender tragus smooth hard tender lump in Malignancy intractable pain, blood stained discharge, spreads to facial nerve tm joint, cervical glands.
Tympanic membrane injury Symptoms Pain, 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 Organisms H Influenzae, B strep, Pneumococcus, staph Symptoms Persitent pain, discharge, temp, deafness,red ear drum Treatment Mild painkillers Severe 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 Causes Follows URTI Symptoms Deafness, discomfort , pain.
Signs Blue drum, conductive deafness.
Treatment Wait 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 Causes Furuncle Otits externa Otitis media Mastoiditis Wax malignancy
Referred pain Dental abscess Tonsillitis Impacted wisdom teeth Tm joint pain Cancer Post third of tongue Throat temporal arteries
Tinnitus Buzzing hissing noise in ears Causes Any ear disease, loud noises Management explanation White sound from radio Underpilow microphone Worse if depressed treat that
Vertigo Chronic Benign positional vertigo Chronic middle ear disease Meniere’s disease Vertebro basilar ischaemia Acoustic neuroma Posterior fossa tumour Multiple 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 antrum Cheek swelling Swelling/ulceration buccal alveolar sulcus Swelling ulceration palate Epiphora Proptosis, diplopia pain
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 Referral 6-8 episodes/year Lasting 2/52 Loosing time from school/job Failure to gain weight Difficulty 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 Croup Lower temp Slow onset Less il Management Steam Oral dexamethasone admit
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 Symptoms Pain Weight loss Hoarseness Lump in neck refer
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