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