Ear talk may2010

ENT for GPs: the ear

Kevin Green

Consultant OtolaryngologistManchester Royal Infirmary

Hope Hospital

Topics

• Hearing loss• Dizziness• Ear infections

Hearing loss

• Congenital / acquired• Unilateral / bilateral

• Sensorineural• Conductive• Mixed

History

• Duration- acute / chronic• Communication difficulties encountered

• Associated symptoms- vertigo, tinnitus, ear pain, ear discharge

History

• Drug history- particularly antibiotics• Noise exposure• Head injury / trauma to ear• Previous medical history• Family history• Previous ear problems • Previous ear surgery

Examination

• Earssigns of acute / chronic otitis mediaglue earwaxforeign body

history dependent

Investigation

• Pure tone audiogram

• Whisper tests• Role of tuning forks

Referral?

• GPSI

• ENT

• Audiology / audiological physician

Management

• conservative• hearing aid• medical• surgical- including implantable devices

Dependent on cause

Dizziness

• affects at least 20% of population at some stage

• 75% of cases do not require further investigation

• history is crucial

10 key dizziness questions

1. Does the room spin? types of dizziness-vertigopresyncopedysequilibriumlightheadedness

10 key dizziness questions

1. Is the spinning horizontal or vertical?

2. Is it better with eyes open or closed?

3. How long does the vertigo last?

10 key dizziness questions

1. Is there a positional trigger?

2. Are deafness and tinnitus associated?

3. Are there any other symptoms?

10 key dizziness questions

1. Has there been a recent viral illness?

2. Is there a history of migraine?

3. Is there an associated aura?

Examination

• Examine the ears• Assess nystagmus• Examine cranial nerves• Assess cerebellar function

Dix-Hallpike test

Epley Manouvre

Investigations

• Pure tone audiogram

• Blood tests- only if indicated by history and examination

• Imaging?

Management

• Reassurance and explanation• Vestibular rehabilitation• Psychological support

• Specific treatment if diagnosis clear

Management

• BPPV• Acute vestibular failure / labyrinthitis /

vestibular neuronitis• Vestibular migraine

Ear infections

• Acute otitis media• Chronic otitis media

Management

• History• Examination

• Medical • Surgical

Acute otitis media 1

Acute otitis media 2

Acute otitis media 3

Chronic otitis media

• perforation• retraction pocket• cholesteatoma

• no such thing as ‘safe’ and ‘unsafe’ disease

Complications of otitis media

• Hearing loss• Vertigo• Facial palsy

• Meningitis• Brain abscess• Hydrocephalous

Perforation

Cholesteatoma

Retraction

Ear infections- which to always refer?

• Persistent infections / otalgia• Suspected cholesteatoma• With any complications of otitis media

Case 1

Case 2

Case 3

Case 4

Case 5

Case 6

Case 7

Case 8

Case 9

Case 10

Thank you for your attention

kmjgreen@rcsed.ac.uk