ENT UPDATE FOR PRIMARY CARE
WEST CUMBERLAND HOSPITAL
05/06/2013
Mohamed Ouda ST1
WHY ENT?
• very common
• comprising 20% of presenting complaints to a
primary care provider
• limited training in undergraduate and
postgraduate medical education for primary
care
• What are the most common conditions ?
Sore throat tonsillitis ear ache Otitis
media Dysphagia lump in the throat
dizziness tinnitus deafness neck lump
hoarseness anosmia ear discharge
Facial palsy Facial swelling thyroid
disease F.B EAR F.B nose
F.B throat ,Nose bleeding ,wax
nasal blockage Snoring Stridor Otitis
externa nasal polyps sinusitis Rhinitis
Anatomy
External Ear
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Cellulitis
Erysiplas
Perichondritis,chondritis
Eczema ,Psoriais
Trauma (heamatoma)
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Exostosis
Malignancy (BCC , SCC,Melanoma)
Bat ear
Preauricular sinus
Otitis externa
Bat ears
1
Preauricular sinus
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Otitis externa
• Ask about :swimming, D.M,
Eczema, Psoriasis.
• Causative organism?
• Treatment:
Aural toilet
Ear drops
Ear wick
Oral antibiotics
?IV antibiotics
*Analgesia
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Necrotizing otitis externa =Malignant
O. E
• NON Neoplastic
• Osteomyelitis (canalskull base)
• DM
• Severe pain, granulations.
• Diagnosis :history +C/P+ CT SCAN
• Treatment
 Admit
 DM control
 Systemic Abx(Oral or IV)
FOR 6-12 WEEKS
 Aural toilet
 Surgery
 Topical anti psudomonal
 Death
SOFRADEX
GENTISONE HC
`
Otitis media
• Inflammation of the middle ear caused by
infective organism.
• <3 weeKs =Acute Otitis Media
• > or = 3 episodes in 6 months =Recurrent AOM.
• INFECTION> 3 MONTHS =CSOM.
Self limiting . Oral antibiotics(controversial)
Acute OM
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COMMON
Pain relief with perforation
80% resolve in 4/7 days without treatment
Antibiotics (Amoxycillin):no improvement in 4 days, B/L
OM,OM with otorrhoea, systemically unwell.
• Delayed approach
• ENT Referral :
-Recurrent( >4 episodes in 6 months),
-poerforation has not healed after
1 month.
Acute mastoiditis
Urgent ENT Referral
Otitis media with effusion (OME)
Serous OM=Secretory OM=Glue ear
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NO infection
Fluid in the middle ear
E T dysfunction
Most common cause of
hearing loss in children.
• Down syndrome, cleft
palate.
• Adults :post URTI ,Resolve in
6/52 if not Refer?PNS tumour
(NICE GUIDELINES) 2008
Children who will benefit from surgical intervention
 Children with persistent bilateral OME documented
over a period of
3 months with a hearing level in the better ear of 25–
30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz .
 Adjuvant adenoidectomy is not recommended in the absence of
persistent and/or frequent upper respiratory tract symptoms
Active monitoring
(watchful waiting)*
• Essential
• 50% will recover
with no treatment
in the first three
months.
The following treatments are not
recommended for the management of
OME:
− antibiotics
− topical or systemic antihistamines
− topical or systemic decongestants
− topical or systemic steroids
Browning GG. Watchful waiting in childhood otitis media with effusion.Editorial.Clin
Otolaryngology 2001;26:417-424
Otitis media with effusion (OME)
Serous OM=Secretory OM=Glue ear
Investigations
– PTA ...Conductive deafness
– Tympanometry....Type B curve(Flat)
Treatment
Watchful waiting (Valsalva maneovre)
Hearing aid
Ventilation tubes
CSOM
without cholestatoma
• Chronic otorroea (mucopurulent) +
perforation (can be dry in inactive disease).
• Pseudomonas aeruginosa,staph aureus
• Otalgia is uncommon .
• Peforation (safe versus unsafe)
• Treatment: aural toilet, topical antibiotics
,surgical repair
CSOM with cholestatoma
• Skin in the wrong place.
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Sudden
SNHL
IF UNILATERAL OR ONLY GOOD EAR...Refer
SAME day referral if within 24 hours
Acoustic neuroma=Vestibular schwanoma
Benign ,slow growing tumour.
80% CPA tumour
B/L in NF2
MRI
ACOUSTIC NEUROMA
• Acoustic neuromas (more correctly called vestibular schwannomas)
account for approximately five percent of intracranial tumours and
90 percent of cerebellopontine angle
Features can be predicted by the affected cranial nerves
cranial nerve VIII: hearing loss, vertigo, tinnitus
• cranial nerve V: absent corneal reflex
• cranial nerve VII: facial palsy
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Bilateral acoustic neuromas are seen in neurofibromatosis type 2
MRI of the cerebellopontine angle is the investigation of choice
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