Ear talk may2010

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Management of middle ear disease

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Ear talk may2010

  1. 1. ENT for GPs: the ear <ul><li>Kevin Green </li></ul><ul><li>Consultant Otolaryngologist </li></ul><ul><li>Manchester Royal Infirmary </li></ul><ul><li>Hope Hospital </li></ul>
  2. 2. Topics <ul><li>Hearing loss </li></ul><ul><li>Dizziness </li></ul><ul><li>Ear infections </li></ul>
  3. 3. Hearing loss <ul><li>Congenital / acquired </li></ul><ul><li>Unilateral / bilateral </li></ul><ul><li>Sensorineural </li></ul><ul><li>Conductive </li></ul><ul><li>Mixed </li></ul>
  4. 4. History <ul><li>Duration- acute / chronic </li></ul><ul><li>Communication difficulties encountered </li></ul><ul><li>Associated symptoms- vertigo, tinnitus, ear pain, ear discharge </li></ul>
  5. 5. History <ul><li>Drug history- particularly antibiotics </li></ul><ul><li>Noise exposure </li></ul><ul><li>Head injury / trauma to ear </li></ul><ul><li>Previous medical history </li></ul><ul><li>Family history </li></ul><ul><li>Previous ear problems </li></ul><ul><li>Previous ear surgery </li></ul>
  6. 6. Examination <ul><li>Ears </li></ul><ul><li>signs of acute / chronic otitis media </li></ul><ul><li>glue ear </li></ul><ul><li>wax </li></ul><ul><li>foreign body </li></ul><ul><li>history dependent </li></ul>
  7. 7. Investigation <ul><li>Pure tone audiogram </li></ul><ul><li>Whisper tests </li></ul><ul><li>Role of tuning forks </li></ul>
  8. 8. Referral? <ul><li>GPSI </li></ul><ul><li>ENT </li></ul><ul><li>Audiology / audiological physician </li></ul>
  9. 9. Management <ul><li>conservative </li></ul><ul><li>hearing aid </li></ul><ul><li>medical </li></ul><ul><li>surgical- including implantable devices </li></ul><ul><li>Dependent on cause </li></ul>
  10. 10. Dizziness <ul><li>affects at least 20% of population at some stage </li></ul><ul><li>75% of cases do not require further investigation </li></ul><ul><li>history is crucial </li></ul>
  11. 11. 10 key dizziness questions <ul><li>Does the room spin? </li></ul><ul><li>types of dizziness- </li></ul><ul><li>vertigo </li></ul><ul><li>presyncope </li></ul><ul><li>dysequilibrium </li></ul><ul><li>lightheadedness </li></ul>
  12. 12. 10 key dizziness questions <ul><li>Is the spinning horizontal or vertical? </li></ul><ul><li>Is it better with eyes open or closed? </li></ul><ul><li>How long does the vertigo last? </li></ul>
  13. 13. 10 key dizziness questions <ul><li>Is there a positional trigger? </li></ul><ul><li>Are deafness and tinnitus associated? </li></ul><ul><li>Are there any other symptoms? </li></ul>
  14. 14. 10 key dizziness questions <ul><li>Has there been a recent viral illness? </li></ul><ul><li>Is there a history of migraine? </li></ul><ul><li>Is there an associated aura? </li></ul>
  15. 15. Examination <ul><li>Examine the ears </li></ul><ul><li>Assess nystagmus </li></ul><ul><li>Examine cranial nerves </li></ul><ul><li>Assess cerebellar function </li></ul>
  16. 16. Dix-Hallpike test
  17. 17. Epley Manouvre
  18. 18. Investigations <ul><li>Pure tone audiogram </li></ul><ul><li>Blood tests- only if indicated by history and examination </li></ul><ul><li>Imaging? </li></ul>
  19. 19. Management <ul><li>Reassurance and explanation </li></ul><ul><li>Vestibular rehabilitation </li></ul><ul><li>Psychological support </li></ul><ul><li>Specific treatment if diagnosis clear </li></ul>
  20. 20. Management <ul><li>BPPV </li></ul><ul><li>Acute vestibular failure / labyrinthitis / vestibular neuronitis </li></ul><ul><li>Vestibular migraine </li></ul>
  21. 21. Ear infections <ul><li>Acute otitis media </li></ul><ul><li>Chronic otitis media </li></ul>
  22. 22. Management <ul><li>History </li></ul><ul><li>Examination </li></ul><ul><li>Medical </li></ul><ul><li>Surgical </li></ul>
  23. 23. Acute otitis media 1
  24. 24. Acute otitis media 2
  25. 25. Acute otitis media 3
  26. 26. Chronic otitis media <ul><li>perforation </li></ul><ul><li>retraction pocket </li></ul><ul><li>cholesteatoma </li></ul><ul><li>no such thing as ‘safe’ and ‘unsafe’ disease </li></ul>
  27. 27. Complications of otitis media <ul><li>Hearing loss </li></ul><ul><li>Vertigo </li></ul><ul><li>Facial palsy </li></ul><ul><li>Meningitis </li></ul><ul><li>Brain abscess </li></ul><ul><li>Hydrocephalous </li></ul>
  28. 28. Perforation
  29. 29. Cholesteatoma
  30. 30. Retraction
  31. 31. Ear infections- which to always refer? <ul><li>Persistent infections / otalgia </li></ul><ul><li>Suspected cholesteatoma </li></ul><ul><li>With any complications of otitis media </li></ul>
  32. 33. Case 1
  33. 34. Case 2
  34. 35. Case 3
  35. 36. Case 4
  36. 37. Case 5
  37. 38. Case 6
  38. 39. Case 7
  39. 40. Case 8
  40. 41. Case 9
  41. 42. Case 10
  42. 43. <ul><li>Thank you for your attention </li></ul><ul><li>[email_address] </li></ul>
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