Ent in General Practice

ENT IN GENERAL PRACTICE A QUICK GUIDE TO MANAGING COMMON CONDITIONS LT COL KABIR BAKSHI CLASSIFIED SPECIALIST (ENT)

THE DILEMMA ENT IS A NICHE SPECIALITY YET MANY ENT CONDITONS ARE NOT UNCOMMON ! HOW TO DIAGNOSE? HOW TO TREAT? IS THIS CONDITION SERIOUS? WHEN TO REFER? WHEN TO WAIT?

ESSENTIAL EQUIPMENT OTOSCOPE TORCH TONGUE DEPRESSOR THUDICUM NASAL SPECULUM ARTERY FORCEPS JOBSON HORNE PROBE OR EUSTACHIAN CATHETER

DISORDERS OF THE PINNA BAT EAR MICROTIA PREAURICUAR TAGS PREAURICULAR SINUS DIAGNOSIS : SPOT! TREATMENT: SURGERY

DISORDERS OF THE PINNA AURICULAR HEMATOMA KELOID DUE TO MINOR TRAUMA COMMON IN WRESTLERS TREATMENT : I & D PRONE TO RECURRENCE FOLLOWS TRAUMA/ PIERCING TREATMENT : EXCISION PRONE TO RECURRENCE REQUIRES POSTOP INTRALESIONAL STEROID INJECTION

DISORDERS OF EAR CANAL FURUNCULOSIS OF EAR CANAL (OTITIS EXTERNA) CAUSE : STREPTOCOCCAL / STAPHYLOCOCCAL INFECTION OF SKIN OF EAC TREATMENT : ANTIBIOTICS, ANALGESICS MAY BE ASSOCIATED WITH UNTREATED MIDDLE EAR INFECTION

DISORDERS OF EAR CANAL WAX EAR (RT) OTOMYCOSIS (LT) TREATMENT : WAX SOFTENING DROPS FOLLOWED BY SYRINGING AFTER ONE WEEK TREATMENT : ANTIFUNGAL EAR DROPS CAUTION : ALL EAR DROPS ARE NOT EQUIVALENT!!!

DISORDERS OF MIDDLE EAR TRAUMATIC PERFORATION DIAGNOSIS HISTORY OF TRAUMA RAGGED EDGES OF PERFORATION FRESH BLEEDING TREATMENT NO EAR DROPS KEEP EAR DRY ORAL ANTIBIOTICS, ANTIHISTAMINICS REVIEW AFTER ONE MONTH IF DUE TO NOISE OF MIL WEAPONS… IT IS IMPULSE NOISE TRAUMA… INNER EAR NEEDS EVALUATION FOR NIHL!

DISORDERS OF MIDDLE EAR ACUTE SUPPURATIVE OTITIS MEDIA STAGES TUBAL OCCLUSION PRESUPPURATION SUPPURATION DISCHARGE/RESOLUTION/ COMPLICATIONS TREATMENT ORAL ANTIBIOTICS ANALGESICS ANTIHISTAMINICS NASAL DECONGESTANTS FOLLOWUP SPECIAL CONSIDERATIONS ROLE OF EAR DROPS MYRINGOTOMY

DISORDERS OF MIDDLE EAR SEROUS OTITIS MEDIA (GLUE EAR/ OME) SYMPTOMS INSIDIOUS ONSET, LONG STANDING CONDITON (3 MONTHS) HEARING LOSS OCCASSIONAL OTALGIA BUBBLING SOUNDS, ECHO OF OWN VOICE TREATMENT CORTICOSTEROID / ANTIHISTAMINIC NASAL SPRAYS ORAL DECONGESTANTS / ANTIHISTAMINICS CHEWING GUM, BLOWING BALLOONS MYRINGOTOMY AND GROMMET INSERTION SPECIAL CONSIDERATIONS ROLE OF ADENOTONSILLECTOMY ROLE OF TEMPORARY HEARING AID DIFFERENTIATION FROM AOM WITH EFFUSION

DISORDERS OF MIDDLE EAR CHRONIC OTITIS MEDIA CLASSIFICATION MUCOSAL ACTIVE INACTIVE SQUAMOUS TREATMENT DRY THE EAR TOPICAL ANTIBIOTIC/ STEROID EAR DROPS ORAL ANTIHISTAMINICS OPERATE THE EAR SAFE,DRY,FUNCTIONING EAR SPECIAL CONSIDERATIONS COMPLICATIONS OF COM RESULTS OF SURGERY RESTORATION OF HEARING

DISORDERS OF MIDDLE EAR TYMPANOSCLEROSIS Vs OTOSCLEROSIS

DISORDERS OF INNER EAR SENSORINEURAL HEARING LOSS SUDDEN NOISE INDUCED PRESBYACUSIS UNILATERAL EMERGENCY Mx OF SUDDEN SNHL TAB PREDNISOLONE 60 mg/day TAB ACYCLOVIR 400 mg 4 hrly LOW MOLECULAR WEIGHT DEXTRAN (LOMODEX) 250 ml 12 hrly TAB BETAHISTINE (VERTIN) 16 mg 8 hrly ALL KINDS OF HEARING AIDS- ANALOGUE / DIGITAL, BODY WORN/ BTE/ CIC ARE AVAILABLE FREE OF COST TO SERVING PERS/DEPENDENTS AS WELL AS ECHS MEMBERS/ DEPENDENTS UPTO A COST OF RS 10,000/20,000/60,000 ONCE EVERY 5 YEARS ON PRESCRIPTION BY A SERVICE ENT SURGEON THROUGH CENTRALLY EMPANELLED SERVICE PROVIDERS MRI OTOLOGICAL EMERGENCY!

SYRINGING THE EAR USEFUL FOR WAX REMOVAL, FOREIGN BODY REMOVAL USE 50 ml SYRINGE, LARGE BORE IV CANNULA WATER AT BODY TEMPERATURE TO AVOID CALORIC EFFECT COUNSEL PATIENT BEFOREHAND AVOID OVERINSERTION DIRECT FLOW TOWARDS OCCIPUT USE A KIDNEY TRAY TO COLLECT WASTE WATER

THE NOSE AND PARANASAL SINUSES

DEVIATIONS OF NASAL FRAMEWORK DIFFERENTIATE BETWEEN EXTERNAL NASAL DEVIATIONS SEPTAL DEVIATIONS COMBINED DEVIATIONS IS THE DEVIATION RESPONSIBLE FOR THE SYMPTOMS? DIFFERENTIATE BETWEEN CONSTANT BLOCKAGE DUE TO DNS Vs SEASONAL OR INTERMITTENT BLOCKAGE DUE TO ALLERGY Vs ACUTE ONSET BLOCKAGE, HEADACHE AND FEVER DUE TO AC RHINOSINUSITIS TREATMENT RHINOPLASTY, SEPTOPLASTY OR SEPTORHINOPLASTY

NASAL BONE FRACTURE DOCUMENT NATURE OF TRAUMA LOOK FOR ASSOCIATED MAXILLOFACIAL INJURIES AND INJURIES TO SKULL/SPINE/ CHEST/ EXTREMITIES NEVER FORGET ABC OF TRAUMA MANAGEMENT! RAISE AN MLC! MANAGE NASAL BLEEDING … IF ACTIVE! DISPLACED NASAL BONE FRACTURES LEAD TO COSMETIC DEFORMITY… THEY ARE REDUCED IN INITIAL 12 HRS OR AFTER 3 DAYS (UPTO 10 DAYS LATER) IF LEFT UNTREATED, DISPLACED NASAL BONE FRACTURES HEAL IN 2-3 WEEKS LEADING TO COSMETIC DEFORMITY AND REQUIRING SEPTORHINOPLASTY AFTER 3 MONTHS

NASAL VESTIBULITIS STAPHYLOCOCCAL INFECTION OF NASAL HAIR FOLLICLES INVOLVES DANGER AREA OF FACE EXQUISITELY PAINFUL TREATMENT INJECTABLE ANTIBIOTICS ANALGESICS TOPICAL ANTIBIOTIC CREAM

INTRANASAL POLYPS DIFFERENTIATE HYPERTROPHIED INFERIOR TURBINATE FROM INTRANASAL POLYPS ALLERGIC POLYPS ARE USUALLY BILATERAL, MULTIPLE, AND PALE MEDICAL POLYPECTOMY SHORT COURSE ORAL STEROID INTRANASAL CORTICOSTEROID SPRAY ORAL ANTIHISTAMINICS SURGICAL MANAGEMENT : FESS

ALLERGIC RHINITIS DIAGNOSIS PAROXYSMAL SNEEZING, WATERY RHINORRHOEA,NASAL ITCHING AND STUFFINESS SEASONAL OR PERENNIAL GENETIC PREDISPOSITION OFTEN ASSOC WITH OTHER ATOPIC MANIFESTATIONS IN EYE, EAR AND THROAT ,ALLERGIC POLYPS OR BRONCHIAL ASTHMA MAY PROGRESS TO SINUSITIS IF UNTREATED TREATMENT AVOIDANCE OF ALLERGEN INTRANASAL CORTICOSTEROID/ ANTIHISTAMINE SPRAYS (FLUTICASONE / AZELASTINE) ORAL ANTIHISTAMINICS (CETRIZINE/ FEXOFENADINE) ORAL ANTI LEUKOTRIENE (MONTELEUKAST) SPECIAL CONSIDERATIONS AVOID USE OF TOPICAL DECONGESTANTS LIKE NASIVION/ OTRIVIN … RHINITIS MEDICAMENTOSA! LIFELONG TREATMENT MAY BE REQUIRED!

ACUTE SINUSITIS PRESENTATION ACUTE INFLAMMATION OF SINUS MUCOSA DUE TO INFECTION FEVER, HEADACHE, PURULENT NASAL DISCHARGE, ERYTHEMA AND TENDERNESS OVER AFFECTED SINUSES TREATMENT ANTIBIOTICS ANALGESICS TOPICAL DECONGESTANTS ANTIHISTAMINICS STEAM INHALATION

CHRONIC SINUSITIS AND FESS PRESENTATION CHRONICALLY IMPAIRED DRAINAGE OF SINUSES DUE TO INTERACTION OF BACTERIAL OR FUNGAL INFECTION, ALLERGY, ANATOMICAL ABNORMALITIES AND CILIARY DYSFUNCTION HEADACHE, PURULENT NASAL DISCHARGE, NASAL STUFFINESS, ANOSMIA INVESTIGATIONS MUST INCLUDE SINUS CT SCAN TREATMENT ONE MONTH TRIAL OF MEDICAL MANAGEMENT FUNCTIONAL ENDOSCOPIC SINUS SURGERY

EMERGENCY MANAGEMENT OF EPISTAXIS FIRST AID SIT THE PATIENT UPRIGHT AND PINCH THE NOSE (TROTTER’S METHOD) IF BLEEDING PERSISTS FOR POSTERIOR NASAL BLEEDING INFLATE A FOLEY’S CATHETER IN NASOPHARYNX FOR ANTERIOR NASAL BLEEDING DO ANTERIOR NASAL PACKING WITH RIBBON GAUZE OR GELFOAM STRIPS IF BLEEDING STOPS SPONTANEOUSLY / MINOR BLEEDING DECONGESTANT DROPS, ANTIHISTAMINICS, ANTIBIOTICS IF ELDERLY PATIENT WITH HYPERTENSION CHECK BLOOD PRESSURE ELICIT MEDICATION HISTORY RESTART ANTIHYPERTENSIVES

REMOVAL OF NASAL FOREIGN BODIES REMOVE UNDER VISION USING AN EUSTACHIAN CATHETER OR JOBSON HORNE PROBE DO NOT PUSH THE FOREIGN BODY FURTHER INTO THE NASOPHARYNX CONSIDER SEDATING OR RESTRAINING THE CHILD

ACUTE TONSILLITIS PRESENTATION PAINFUL SORE THROAT FEVER ODYNOPHAGIA TONSILLAR SWELLING LYMPHADENOPATHY MANAGEMENT ANTIBIOTICS ANALGESICS SALT WATER GARGLES

PERITONSILLAR ABSCESS PRESENTATION VERY PAINFUL SORE THROAT HIGH FEVER MARKED ODYNOPHAGIA – INABILITY TO SWALLOW SALIVA HOT POTATO VOICE TRISMUS SWELLING OF SOFT PALATE, ANTERIOR PILLARS TONSIL MAY OR MAY NOT BE ENLARGED DEVIATION OF UVULA TO OPPOSITE SIDE TORTICOLLIS CERVICAL LYMPHADENOPATHY MANAGEMENT I & D ANTIBIOTICS ANALGESICS SALT WATER GARGLES

CHRONIC TONSILLITIS PRESENTATION RECURRENT ATTACKS OF ACUTE TONSILLITIS ERYTHEMA OF ANTERIOR PILLARS TONSILS MAY SHOW VARYING DEGREE OF ENLARGEMENT JUGULODIGASTRIC LYMPHADENOPATHY MANAGEMENT TONSILLECTOMY

FOREIGN BODY OESOPHAGUS PRESENTATION TYPICAL HISTORY OF INGESTION DYSPHAGIA, DROOLING BEWARE OF HOARSENESS, DYSPNOEA, STRIDOR … THESE MAY INDICATE FOREIGN BODY IN AIRWAY MANAGEMENT X RAY NECK, CHEST AP AND LATERAL ASK FOR TIME OF LAST MEAL, DRINK KEEP NIL ORALLY IF OPERATIVE INTERVENTION PLANNED FISH BONES ARE USUALLY RADIOLUCENT, SMALL CHICKEN BONES MAY BE OBSCURED OESOPHAGOSCOPY IS THE GOLD STANDARD INVESTIGATION IF THE FB HAS REACHED THE STOMACH, IT WILL USUALLY PASS OUT WITHOUT DIFFICULTY!

EMERGENCY AIRWAY MANAGEMENT FIRST CONSIDER JAW THRUST OROPHARYNGEAL AIRWAY AMBU BAG INTUBATION LARYNGEAL MASK AIRWAY TRACHEOSTOMY INVOLVES INCISION OF SKIN, SEPARATION OF STRAP MUSCLES, DIVISION OF THYROID ISTHMUS, OPENING OF TRACHEA AND FIXATION OF TRACHEOSTOMY TUBE PLANNED PROCEEDURE TAKES MINIMUM 20 MIN – 1 HR CRICOTHYROTOMY PROVIDES INSTANT AIRWAY REQUIRES NO SPECIAL TRAINING OR EQPT OPENING MADE IN CRICO THYROID MEMBRANE

RESOURCES DISEASES OF EAR, NOSE AND THROAT 5 TH ED: PL DHINGRA. ELSEVIER INDIA E VERSION AVAILABLE FROM http://www.filefactory.com/file/cca0cf0/n/Diseases_of_Ear_Nose_and_Throat_5th_Pg.chm THIS PRESENTATION IS AVAILABLE FROM www.slideshare.net CREATED UNDER CREATIVE COMMONS LICENCE FOR NON COMMERCIAL USE ALL IMAGES DOWNLOADED FROM THE INTERNET AND COPYRIGHT OF ORIGINAL OWNERS!

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Ent in General Practice