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 painful tender tragus

Osteomata smooth hard tender lump in

canal

Malignancy intractable pain, blood

stained discharge, spreads to facial nerve

tm joint, cervical glands.

Tympanic membrane injury

SymptomsPain, 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

OrganismsH Influenzae, B strep, Pneumococcus, staph

SymptomsPersitent pain, discharge, temp, deafness,red ear

drum Treatment

Mild painkillersSevere 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

CausesFollows URTI

SymptomsDeafness, discomfort , pain.

SignsBlue drum, conductive deafness.

TreatmentWait 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

CausesFuruncleOtits externa Otitis mediaMastoiditisWaxmalignancy

Referred pain

Dental abscess Tonsillitis Impacted wisdom teeth Tm joint pain Cancer

Post third of tongueThroat temporal arteries

Tinnitus

Buzzing hissing noise in ears Causes

Any ear disease, loud noises Management

explanationWhite sound from radioUnderpilow microphoneWorse if depressed treat that

Vertigo

ChronicBenign positional vertigoChronic middle ear diseaseMeniere’s diseaseVertebro basilar ischaemiaAcoustic neuromaPosterior fossa tumourMultiple 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 antrumCheek swellingSwelling/ulceration buccal alveolar sulcusSwelling ulceration palateEpiphoraProptosis, diplopiapain

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

Referral6-8 episodes/yearLasting 2/52Loosing time from school/jobFailure to gain weightDifficulty 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

CroupLower tempSlow onsetLess il

ManagementSteamOral dexamethasoneadmit

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

SymptomsPain Weight lossHoarsenessLump in neckrefer

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