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Ear talk may2010

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Management of middle ear disease

Management of middle ear disease

Published in: Health & Medicine, Business

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Transcript

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