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Richard Isaacs MD
- 1. Dr. Richard Isaacs, MD COMMON PROBLEMS IN ENT
- 2. OUTLINE Nose − Epistaxis − Chronic Rhinosinusitis Throat − Peritonsillar Abscess − Tonsillitis Ear − Hearing Loss − Vertigo Head & Neck Dr. Richard Isaacs, MD
- 3. ACUTE EPISTAXIS Nasal mucosa: rich blood supply, anastomoses between internal and external carotid supply Causes − Trauma − Chronic irritation e.g. sinusitis, steroid spray abuse − Coagulopathies − Anatomical abnormalities − Vascular malformation − Tumour 90% anterior (capillary, venous in origin) 10% posterior (arterial in origin) – may present as haemoptysis, melaena, haematemesis etc. Dr. Richard Isaacs, MD
- 4. MANAGEMENT D R S A B C D Anterior vs Posterior Achieve Haemostasis − Pressure − Ice − Co-Phenylcaine/Cocaine − Cauteurisation − Packing − Balloon − Embolisation − Antibiotics (Flucloxacillin) Complications Dr. Richard Isaacs, MD
- 5. CHRONIC RHINOSINUSITIS Inflammation involving nasal mucosa and paranasal sinuses lasting longer than 12 weeks Criteria − Anterior and/or posterior mucopurulent drainage − Nasal obstruction − Facial pain, pressure and/or fullness − Decreased sense of smell Subtypes − With nasal polyposis − Without nasal polyposis − Allergic fungal rhinosinusitis Dr. Richard Isaacs, MD
- 6. MANAGEMENT Medical Therapy − Nasal lavage – Normal Saline − Nasal glucocorticoid sprays − Oral glucocorticoid − Antibiotics (Augmentin, Doxycycline) − Antihistamines Surgical Therapy − Functional Endoscopic Sinus Surgery (Category of Operation) Complications − Recurrence − Epistaxis − (Very Rare) Blindness (Retrobulbar Haemorrhage) Dr. Richard Isaacs, MD
- 7. WITHOUT POLYP WITH POLYP ALLERGIC FUNGAL Untreated Oral Steroids Oral Steroids Surgery Oral Antibiotics Maintenance Topical Steroids Topical Steroids Oral Steroids Steroid Instillation Steroid Instillation Steroid Instillation +/- Antihistamine +/- Antihistamine +/- Oral Antifungals +/- Antileukotriene
- 8. TONSILLITIS/TONSILLECTOMY Indications – controversial in adult population Management − Analgaesia − +/- Antibiotics (GAS coverage) Tonsillectomy − Contraindications – Velopharyngeal, Acute Tonsillitis − Knife vs Unipolar vs Bipolar − Complications: Haemorrhage, Haemorrhage, Haemorrhage, Pain (Otalgia) − Post tonsillectomy haemorrhage requires representation − Management involves vasoconstriction, pressure Dr. Richard Isaacs, MD
- 9. PERITONSILLAR ABSCESS Risk factors − Tonsillitis − Smoking Symptoms − Trismus − Dysphagia − Systemically Unwell Management − Drainage (Needle Aspiration vs Surgery) − Antibiotics (Not amoxicillin) − Analgaesia − Tonsillectomy (Acute vs Chronic) − +/- Glucocorticoids Complications – Recurrence (10-15%) Dr. Richard Isaacs, MD
- 10. HEARING LOSS Sensorineural vs Conductive vs Mixed Dr. Richard Isaacs, MD
- 11. CAUSES CONDUCTIVE SENSIRONEURAL External Ear Congenital Bilateral Noise Induced Foreign Body Presbycusis Tumour Autoimmune Infection Drug Mediated Middle Ear Trauma Unilateral Trauma Infection Perilymphatic Fistula Cholesteatoma Acoustic Neuroma Otosclerosis Meniere’s Disease Glomus Tumour Idiopathic
- 12. HISTORY/EXAMINATION History − Onset/Time Course – Acute vs Chronic, Bilateral vs Unilateral − Aggravating/Relieving Factors – − Associated Symptoms – Tinnitus, Vertigo, Pain, Discharge − Trauma – Physical, Barotrauma, Noise Induced − Medications − Past History – Stroke Risk Factors Examination − Otoscopy − Whispered Voice − Renee & Weber Tests − Pneumoscopy/Tympanoscopy Dr. Richard Isaacs, MD
- 13. INVESTIGATION Special Tests − Pure tone audiogram − Speech audiometry − Tympanogram Imaging − CT Temporal Bone − +/- MRI Auditory Canal Dr. Richard Isaacs, MD
- 14. CHOLESTEATOMA Acquired vs Congential Locally invasive overgrowth of epithelial cells – not cholesterol Sx: Unilateral Conductive Hearing Loss, Discharge (often discoloured and malodorous) Cx: Local invasion, CN VII palsy, Mastoiditis, Meningitis Management: − Antibiotics − CT Temporal Bone − Surgery – Canal Wall Up vs Down Follow Up – Local recurrence, Ossiculoplasty Dr. Richard Isaacs, MD
- 15. VERTIGO CAUSES Seconds BPPV Perilymphatic Fistula Migrainous Hours Meniere’s Vertebrobasilar TIA Days Vestibular Neuritis Cerebellar Stroke Multiple Sclerosis PERIPHERAL CENTRAL Unidirectional Nystagmus Nystagmus can reverse direction Horizontal +/- Torsional Any direction Suppressed with visual fixation Not suppressed with fixation Hearing Loss/Tinnitus Neurological Signs Gait preserved Severe postural instability
- 16. HISTORY/EXAMINATION Vertigo vs Dizziness Peripheral vs Central History − Onset/Time Course – Seconds, Hours, Days − Aggravating/Relieving Factors – Movement, Tullio’s Phenomenon − Associated symptoms – Neurology, Nystagmus Examination − Assess as per hearing loss − Neurological examination − Dix-Hallpike Test Investigations − CTB
- 18. MANAGEMENT Non-pharmacological − Vestibular Rehabilitation Pharmacological − Antiemetics – Prochlorperazine (Stemetil), Metoclopramide (Maxolon), Promethazine (Phenergan) − Vestibular Suppressants – Clonazepam (Rivotril), Amitriptyline (Endep) Specific − BPPV – Epley’s Manoeuvre − Vestibular Neuritis – Vestibular Suppressants − Meniere’s Disease – Na restrict, Diuretics (HCT), Surgical − Migraine – Pizotifen, Amitriptyline, Aspirin − Stroke – As per Stroke
- 19. HEAD & NECK TUMOURS Fifth most common cancer worldwide Most common histology squamous cell carcinoma “Field Cancerization” − multiple primary and secondary tumours in upper aerodigestive tract − tobacco (smoked or smokeless) +/- alcohol – synergistic − HPV − betel nut chewing − previous radiation exposure − periodontal disease − occupational exposure e.g. wood-dust Dr. Richard Isaacs, MD
- 20. Thank You Dr. Richard Isaacs, MD