Ahmed Qashou

Topics covered

Ear
Wax
Otitis media/externa Labyrinthitis/ vestibular

Nose
Epistaxis
Rhinitis Sinusitis

neuronitis BPPV Menieres disease Acoustic neuroma Deafness

Throat
Acute tonsillitis

Wax!

NaHCO3 or olive oil drops Syringing / microsuction Throw away cotton buds

ENT

Case 1

A 35 y.o man complains of a 3/7 hx of an itchy/ painful ear Diagnosis?

Case 1

A 35 y.o man complains of a 3/7 hx of an itchy/ painful ear Diagnosis?

Otitis externa

Key features and management

Symptoms
Pain Swelling Debris and discharge

Causative organisms
Pseudomonas

(chronic)

Predisposing
Water (swimmers

aeruginosa Staphs/Streps Fungal

Management
Analgesia Abx If Sx persist Microsuction Swab

ear) Trauma Eczema/psoriasis

Case 2

5 year old girl attends c/o a 24 hour history of fever and pulling at her ear What is the diagnosis?

Case 2

5 year old girl attends c/o a 24 hour history of fever and pulling at her ear What is the diagnosis?
Acute otitis media

Key features and Managment

Symptoms
Pain
Fever Hearing loss

Management
Analgesia
Abx controversial
Withold unless Sx for

Causative organisms
Bacterial
S.pneumoniae Haemophilus Barnhamella

3/7 Amoxicillin TDS for 5/7

Complications
Perforation Mastoiditis

cattarhalis
Viral

Meningitis
Intracranial abscess Facial palsy

Mastoiditis

Key features and Managment

Symptoms
Pain
Fever Hearing loss

Management
Analgesia
Abx controversial
Withold unless Sx for

Causative organisms
Bacterial
S.pneumoniae Haemophilus Barnhamella

3/7 Amoxicillin TDS for 5/7

Complications
Perforation Mastoiditis

cattarhalis
Viral

Meningitis
Intracranial abscess Facial palsy

Case 3

A 25 y.o man comes into A&E c/o 2 day history of feeling as if the room is spinning

Differentials?
Benign paroxysmal positional vertigo Menieres disease Labyrinthitis/ Vestibular neuronitis Acoustic neuroma Stroke/ TIA

Pathology

Duration of vertigo

Associated Sx Other feature

Treatment

BPPV

Seconds

No N & V

Positional Dix Hallpikediagnostic Viral Assoc URTI Gradual recovery Viral Assoc URTI Gradual recovery MRI- diagnostic

Epleys maneuver

Menieres disease

Hours

Nausea Vomiting Tinnitus Nausea Vomiting Tinnitus Hearing loss Nausea Vomiting Tinnitus Sensorineural hearing loss Balance

Betahistine Low salt diet Surgery Prochlorperazine

Labyrinthitis

Days

Acoustic neuroma

Varies

Observation Radiotherapy Surgery

Disorders of hearing

Ear canal
Otitis externa
Wax Foreign bodies

Middle ear Perforation 2 otitis media Cholesteatoma

Inner ear Congenital hearing loss Presbycusis Sudden sensorineural hearing loss

Cholesteatoma
Secondary to inward migration of skin from canal erodes into bone Clinically

Painless discharge and hearing loss

Complications

Complete deafness Meningitis Intracranial abscess Facial palsy

Treatment- surgical

Case 4

An 25 year old man attends A&E with a persistent nose bleed lasting > 30 minutes. There is no history of trauma.

How would you manage the patient?

ABC Ix: FBC, clotting, G&S First aid measures Nasal packing If fails to settle, refer to ENT for cautery

Case 5

A 15 year old boy attends c/o of a 2/7 history of a runny nose, sneezing and itchy eyes Diagnosis?

Case 5

A 15 year old boy attends c/o of a 2/7 history of a runny nose, sneezing and itchy eyes Diagnosis?
Allergic rhinitis

Allergic rhinitis

Management:
Avoid allergen: keep windows closed in

pollen season Oral antihistamines: citerizine Eye drops: Sodium cromoglycate, antihitamines Leukotriene receptor antagonists: Monteleukast RAST test if allergen in doubt

Case 6

A 25 year old man with a 2/52 history of fevers, facial pain and tenderness and nasal congestion Diagnosis?

Sinustitis

Acute
Inflammation of 1 nasal sinuses lasting for 2 weeks Resolves spontaneously with no complications Tx: analgesia/ Abx/ decongestants

Recurrent acute
4 episodes of sinustitis in 1 year

Chronic
Inflammation of 1 nasal sinuses for 8 weeks with

metaplasia of nasal mucosa Tx: As for acute + steroids, surgery

Complications

Eyes:
Periorbital cellulitis

Subperiosteal abscess Ophthalmoplegia Intraorbital abscess Blindness

Brain
Meningitis

Estra/subdural abscess Intracranial abscess

Case 7
A 20 year old patient complains of a sore throat. Differential diagnoses:

Acute: Viral: adeno/ coxsachie/ rhino/ EBV Bacterial: BHS Candidiasis Chronic Poor inhaler technique GORD Smoking

Further questions?

Duration of symptoms
Associated fever Coryzal symptoms Any OTC medications

The patient says he has had Sx for 2 days, has had a fever but no cough or coryzal symptoms

Centor criteria
Tonsillar exhudate Tender anterior cervical lymph nodes Absence of cough History of fever

If patient has 3 of above then likely bacterial infection that will benefit from Abx
Phenoxymethyl penicillin 500mg QDS for 10 days

What is the name of this complication of bacterial tonsilitis? How do you treat it?

The END