43
ENT for GPs: the ear Kevin Green Consultant Otolaryngologist Manchester Royal Infirmary Hope Hospital

Ear talk may2010

Embed Size (px)

DESCRIPTION

Management of middle ear disease

Citation preview

Page 1: Ear talk may2010

ENT for GPs: the ear

Kevin Green

Consultant OtolaryngologistManchester Royal Infirmary

Hope Hospital

Page 2: Ear talk may2010

Topics

• Hearing loss• Dizziness• Ear infections

Page 3: Ear talk may2010

Hearing loss

• Congenital / acquired• Unilateral / bilateral

• Sensorineural• Conductive• Mixed

Page 4: Ear talk may2010

History

• Duration- acute / chronic• Communication difficulties encountered

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

Page 5: Ear talk may2010

History

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

Page 6: Ear talk may2010

Examination

• Earssigns of acute / chronic otitis mediaglue earwaxforeign body

history dependent

Page 7: Ear talk may2010

Investigation

• Pure tone audiogram

• Whisper tests• Role of tuning forks

Page 8: Ear talk may2010

Referral?

• GPSI

• ENT

• Audiology / audiological physician

Page 9: Ear talk may2010

Management

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

Dependent on cause

Page 10: Ear talk may2010

Dizziness

• affects at least 20% of population at some stage

• 75% of cases do not require further investigation

• history is crucial

Page 11: Ear talk may2010

10 key dizziness questions

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

Page 12: Ear talk may2010

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?

Page 13: Ear talk may2010

10 key dizziness questions

1. Is there a positional trigger?

2. Are deafness and tinnitus associated?

3. Are there any other symptoms?

Page 14: Ear talk may2010

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?

Page 15: Ear talk may2010

Examination

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

Page 16: Ear talk may2010

Dix-Hallpike test

Page 17: Ear talk may2010

Epley Manouvre

Page 18: Ear talk may2010

Investigations

• Pure tone audiogram

• Blood tests- only if indicated by history and examination

• Imaging?

Page 19: Ear talk may2010

Management

• Reassurance and explanation• Vestibular rehabilitation• Psychological support

• Specific treatment if diagnosis clear

Page 20: Ear talk may2010

Management

• BPPV• Acute vestibular failure / labyrinthitis /

vestibular neuronitis• Vestibular migraine

Page 21: Ear talk may2010

Ear infections

• Acute otitis media• Chronic otitis media

Page 22: Ear talk may2010

Management

• History• Examination

• Medical • Surgical

Page 23: Ear talk may2010

Acute otitis media 1

Page 24: Ear talk may2010

Acute otitis media 2

Page 25: Ear talk may2010

Acute otitis media 3

Page 26: Ear talk may2010

Chronic otitis media

• perforation• retraction pocket• cholesteatoma

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

Page 27: Ear talk may2010

Complications of otitis media

• Hearing loss• Vertigo• Facial palsy

• Meningitis• Brain abscess• Hydrocephalous

Page 28: Ear talk may2010

Perforation

Page 29: Ear talk may2010

Cholesteatoma

Page 30: Ear talk may2010

Retraction

Page 31: Ear talk may2010

Ear infections- which to always refer?

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

Page 32: Ear talk may2010
Page 33: Ear talk may2010

Case 1

Page 34: Ear talk may2010

Case 2

Page 35: Ear talk may2010

Case 3

Page 36: Ear talk may2010

Case 4

Page 37: Ear talk may2010

Case 5

Page 38: Ear talk may2010

Case 6

Page 39: Ear talk may2010

Case 7

Page 40: Ear talk may2010

Case 8

Page 41: Ear talk may2010

Case 9

Page 42: Ear talk may2010

Case 10

Page 43: Ear talk may2010

Thank you for your attention

[email protected]