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ent in gp.ppt
- 1. ENT IN GENERAL PRACTICE A QUICK GUIDE TO MANAGING COMMON CONDITIONS V d prasanna kumar CLASSIFIED SPECIALIST (ENT)
- 2. THE DILEMMA ENT IS A NICHE SPECIALITY YET MANY ENT CONDITONS ARE NOT UNCOMMON ! – HOW TO DIAGNOSE? – HOW TO TREAT? – IS THIS CONDITION SERIOUS? – WHEN TO REFER? – WHEN TO WAIT?
- 3. ESSENTIAL EQUIPMENT • OTOSCOPE • TORCH • TONGUE DEPRESSOR • THUDICUM NASAL SPECULUM • ARTERY FORCEPS • JOBSON HORNE PROBE OR EUSTACHIAN CATHETER
- 5. DISORDERS OF THE PINNA BAT EAR MICROTIA PREAURICUAR TAGS PREAURICULAR SINUS DIAGNOSIS : SPOT! TREATMENT: SURGERY
- 6. DISORDERS OF THE PINNA AURICULAR HEMATOMA KELOID • DUE TO MINOR TRAUMA • COMMON IN WRESTLERS • TREATMENT : I & D • PRONE TO RECURRENCE • FOLLOWS TRAUMA/ PIERCING • TREATMENT : EXCISION • PRONE TO RECURRENCE • REQUIRES POSTOP INTRALESIONAL STEROID INJECTION
- 7. DISORDERS OF EAR CANAL FURUNCULOSIS OF EAR CANAL (OTITIS EXTERNA) • CAUSE : STREPTOCOCCAL / STAPHYLOCOCCAL INFECTION OF SKIN OF EAC • TREATMENT : ANTIBIOTICS, ANALGESICS • MAY BE ASSOCIATED WITH UNTREATED MIDDLE EAR INFECTION
- 8. DISORDERS OF EAR CANAL WAX EAR (RT) OTOMYCOSIS (LT) TREATMENT : WAX SOFTENING DROPS FOLLOWED BY SYRINGING AFTER ONE WEEK TREATMENT : ANTIFUNGAL EAR DROPS CAUTION : ALL EAR DROPS ARE NOT EQUIVALENT!!!
- 9. DISORDERS OF MIDDLE EAR TRAUMATIC PERFORATION • DIAGNOSIS – HISTORY OF TRAUMA – RAGGED EDGES OF PERFORATION – FRESH BLEEDING • TREATMENT – NO EAR DROPS – KEEP EAR DRY – ORAL ANTIBIOTICS, ANTIHISTAMINICS – REVIEW AFTER ONE MONTH • IF DUE TO NOISE OF MIL WEAPONS… IT IS IMPULSE NOISE TRAUMA… INNER EAR NEEDS EVALUATION FOR NIHL!
- 10. DISORDERS OF MIDDLE EAR ACUTE SUPPURATIVE OTITIS MEDIA • STAGES – TUBAL OCCLUSION – PRESUPPURATION – SUPPURATION – DISCHARGE/RESOLUTION/ COMPLICATIONS • TREATMENT – ORAL ANTIBIOTICS – ANALGESICS – ANTIHISTAMINICS – NASAL DECONGESTANTS – FOLLOWUP • SPECIAL CONSIDERATIONS – ROLE OF EAR DROPS – MYRINGOTOMY
- 11. DISORDERS OF MIDDLE EAR SEROUS OTITIS MEDIA (GLUE EAR/ OME) • SYMPTOMS – INSIDIOUS ONSET, LONG STANDING CONDITON (3 MONTHS) – HEARING LOSS – OCCASSIONAL OTALGIA – BUBBLING SOUNDS, ECHO OF OWN VOICE • TREATMENT – CORTICOSTEROID / ANTIHISTAMINIC NASAL SPRAYS – ORAL DECONGESTANTS / ANTIHISTAMINICS – CHEWING GUM, BLOWING BALLOONS – MYRINGOTOMY AND GROMMET INSERTION • SPECIAL CONSIDERATIONS – ROLE OF ADENOTONSILLECTOMY – ROLE OF TEMPORARY HEARING AID – DIFFERENTIATION FROM AOM WITH EFFUSION
- 12. DISORDERS OF MIDDLE EAR CHRONIC OTITIS MEDIA • CLASSIFICATION – MUCOSAL • ACTIVE • INACTIVE – SQUAMOUS • TREATMENT – DRY THE EAR • TOPICAL ANTIBIOTIC/ STEROID EAR DROPS • ORAL ANTIHISTAMINICS – OPERATE THE EAR • SAFE,DRY,FUNCTIONING EAR • SPECIAL CONSIDERATIONS – COMPLICATIONS OF COM – RESULTS OF SURGERY – RESTORATION OF HEARING
- 13. DISORDERS OF MIDDLE EAR TYMPANOSCLEROSIS Vs OTOSCLEROSIS
- 14. DISORDERS OF INNER EAR • SENSORINEURAL HEARING LOSS – SUDDEN – NOISE INDUCED – PRESBYACUSIS – UNILATERAL • EMERGENCY Mx OF SUDDEN SNHL – TAB PREDNISOLONE 60 mg/day – TAB ACYCLOVIR 400 mg 4 hrly – LOW MOLECULAR WEIGHT DEXTRAN (LOMODEX) 250 ml 12 hrly – TAB BETAHISTINE (VERTIN) 16 mg 8 hrly ALL KINDS OF HEARING AIDS- ANALOGUE / DIGITAL, BODY WORN/ BTE/ CIC ARE AVAILABLE FREE OF COST TO SERVING PERS/DEPENDENTS AS WELL AS ECHS MEMBERS/ DEPENDENTS UPTO A COST OF RS 10,000/20,000/60,000 ONCE EVERY 5 YEARS ON PRESCRIPTION BY A SERVICE ENT SURGEON THROUGH CENTRALLY EMPANELLED SERVICE PROVIDERS MRI OTOLOGICAL EMERGENCY!
- 15. SYRINGING THE EAR • USEFUL FOR WAX REMOVAL, FOREIGN BODY REMOVAL • USE 50 ml SYRINGE, LARGE BORE IV CANNULA • WATER AT BODY TEMPERATURE TO AVOID CALORIC EFFECT • COUNSEL PATIENT BEFOREHAND • AVOID OVERINSERTION • DIRECT FLOW TOWARDS OCCIPUT • USE A KIDNEY TRAY TO COLLECT WASTE WATER
- 16. THE NOSE AND PARANASAL SINUSES
- 17. DEVIATIONS OF NASAL FRAMEWORK • DIFFERENTIATE BETWEEN – EXTERNAL NASAL DEVIATIONS – SEPTAL DEVIATIONS – COMBINED DEVIATIONS • IS THE DEVIATION RESPONSIBLE FOR THE SYMPTOMS? – DIFFERENTIATE BETWEEN CONSTANT BLOCKAGE DUE TO DNS Vs SEASONAL OR INTERMITTENT BLOCKAGE DUE TO ALLERGY Vs ACUTE ONSET BLOCKAGE, HEADACHE AND FEVER DUE TO AC RHINOSINUSITIS • TREATMENT – RHINOPLASTY, SEPTOPLASTY OR SEPTORHINOPLASTY
- 18. NASAL BONE FRACTURE • DOCUMENT NATURE OF TRAUMA • LOOK FOR ASSOCIATED MAXILLOFACIAL INJURIES AND INJURIES TO SKULL/SPINE/ CHEST/ EXTREMITIES • NEVER FORGET ABC OF TRAUMA MANAGEMENT! • RAISE AN MLC! • MANAGE NASAL BLEEDING … IF ACTIVE! • DISPLACED NASAL BONE FRACTURES LEAD TO COSMETIC DEFORMITY… THEY ARE REDUCED IN INITIAL 12 HRS OR AFTER 3 DAYS (UPTO 10 DAYS LATER) • IF LEFT UNTREATED, DISPLACED NASAL BONE FRACTURES HEAL IN 2-3 WEEKS LEADING TO COSMETIC DEFORMITY AND REQUIRING SEPTORHINOPLASTY AFTER 3 MONTHS
- 19. NASAL VESTIBULITIS • STAPHYLOCOCCAL INFECTION OF NASAL HAIR FOLLICLES • INVOLVES DANGER AREA OF FACE • EXQUISITELY PAINFUL • TREATMENT – INJECTABLE ANTIBIOTICS – ANALGESICS – TOPICAL ANTIBIOTIC CREAM
- 20. INTRANASAL POLYPS • DIFFERENTIATE HYPERTROPHIED INFERIOR TURBINATE FROM INTRANASAL POLYPS • ALLERGIC POLYPS ARE USUALLY BILATERAL, MULTIPLE, AND PALE • MEDICAL POLYPECTOMY – SHORT COURSE ORAL STEROID – INTRANASAL CORTICOSTEROID SPRAY – ORAL ANTIHISTAMINICS • SURGICAL MANAGEMENT : FESS
- 21. ALLERGIC RHINITIS • DIAGNOSIS – PAROXYSMAL SNEEZING, WATERY RHINORRHOEA,NASAL ITCHING AND STUFFINESS – SEASONAL OR PERENNIAL – GENETIC PREDISPOSITION – OFTEN ASSOC WITH OTHER ATOPIC MANIFESTATIONS IN EYE, EAR AND THROAT ,ALLERGIC POLYPS OR BRONCHIAL ASTHMA – MAY PROGRESS TO SINUSITIS IF UNTREATED • TREATMENT – AVOIDANCE OF ALLERGEN – INTRANASAL CORTICOSTEROID/ ANTIHISTAMINE SPRAYS (FLUTICASONE / AZELASTINE) – ORAL ANTIHISTAMINICS (CETRIZINE/ FEXOFENADINE) – ORAL ANTI LEUKOTRIENE (MONTELEUKAST) • SPECIAL CONSIDERATIONS – AVOID USE OF TOPICAL DECONGESTANTS LIKE NASIVION/ OTRIVIN … RHINITIS MEDICAMENTOSA! – LIFELONG TREATMENT MAY BE REQUIRED!
- 22. ACUTE SINUSITIS • PRESENTATION – ACUTE INFLAMMATION OF SINUS MUCOSA DUE TO INFECTION – FEVER, HEADACHE, PURULENT NASAL DISCHARGE, ERYTHEMA AND TENDERNESS OVER AFFECTED SINUSES • TREATMENT – ANTIBIOTICS – ANALGESICS – TOPICAL DECONGESTANTS – ANTIHISTAMINICS – STEAM INHALATION
- 23. CHRONIC SINUSITIS AND FESS • PRESENTATION – CHRONICALLY IMPAIRED DRAINAGE OF SINUSES DUE TO INTERACTION OF BACTERIAL OR FUNGAL INFECTION, ALLERGY, ANATOMICAL ABNORMALITIES AND CILIARY DYSFUNCTION – HEADACHE, PURULENT NASAL DISCHARGE, NASAL STUFFINESS, ANOSMIA • INVESTIGATIONS MUST INCLUDE SINUS CT SCAN • TREATMENT – ONE MONTH TRIAL OF MEDICAL MANAGEMENT – FUNCTIONAL ENDOSCOPIC SINUS SURGERY
- 24. EMERGENCY MANAGEMENT OF EPISTAXIS • FIRST AID – SIT THE PATIENT UPRIGHT AND PINCH THE NOSE (TROTTER’S METHOD) • IF BLEEDING PERSISTS – FOR POSTERIOR NASAL BLEEDING INFLATE A FOLEY’S CATHETER IN NASOPHARYNX – FOR ANTERIOR NASAL BLEEDING DO ANTERIOR NASAL PACKING WITH RIBBON GAUZE OR GELFOAM STRIPS • IF BLEEDING STOPS SPONTANEOUSLY / MINOR BLEEDING – DECONGESTANT DROPS, ANTIHISTAMINICS, ANTIBIOTICS • IF ELDERLY PATIENT WITH HYPERTENSION – CHECK BLOOD PRESSURE – ELICIT MEDICATION HISTORY – RESTART ANTIHYPERTENSIVES
- 25. REMOVAL OF NASAL FOREIGN BODIES • REMOVE UNDER VISION USING AN EUSTACHIAN CATHETER OR JOBSON HORNE PROBE • DO NOT PUSH THE FOREIGN BODY FURTHER INTO THE NASOPHARYNX • CONSIDER SEDATING OR RESTRAINING THE CHILD
- 26. THE THROAT
- 27. ACUTE TONSILLITIS • PRESENTATION – PAINFUL SORE THROAT – FEVER – ODYNOPHAGIA – TONSILLAR SWELLING – LYMPHADENOPATHY • MANAGEMENT – ANTIBIOTICS – ANALGESICS – SALT WATER GARGLES
- 28. PERITONSILLAR ABSCESS • PRESENTATION – VERY PAINFUL SORE THROAT – HIGH FEVER – MARKED ODYNOPHAGIA – INABILITY TO SWALLOW SALIVA – HOT POTATO VOICE – TRISMUS – SWELLING OF SOFT PALATE, ANTERIOR PILLARS – TONSIL MAY OR MAY NOT BE ENLARGED – DEVIATION OF UVULA TO OPPOSITE SIDE – TORTICOLLIS – CERVICAL LYMPHADENOPATHY • MANAGEMENT – I & D – ANTIBIOTICS – ANALGESICS – SALT WATER GARGLES
- 29. CHRONIC TONSILLITIS • PRESENTATION – RECURRENT ATTACKS OF ACUTE TONSILLITIS – ERYTHEMA OF ANTERIOR PILLARS – TONSILS MAY SHOW VARYING DEGREE OF ENLARGEMENT – JUGULODIGASTRIC LYMPHADENOPATHY • MANAGEMENT – TONSILLECTOMY
- 30. FOREIGN BODY OESOPHAGUS • PRESENTATION – TYPICAL HISTORY OF INGESTION – DYSPHAGIA, DROOLING – BEWARE OF HOARSENESS, DYSPNOEA, STRIDOR … THESE MAY INDICATE FOREIGN BODY IN AIRWAY • MANAGEMENT – X RAY NECK, CHEST AP AND LATERAL – ASK FOR TIME OF LAST MEAL, DRINK – KEEP NIL ORALLY IF OPERATIVE INTERVENTION PLANNED – FISH BONES ARE USUALLY RADIOLUCENT, SMALL CHICKEN BONES MAY BE OBSCURED – OESOPHAGOSCOPY IS THE GOLD STANDARD INVESTIGATION – IF THE FB HAS REACHED THE STOMACH, IT WILL USUALLY PASS OUT WITHOUT DIFFICULTY!
- 31. EMERGENCY AIRWAY MANAGEMENT • FIRST CONSIDER – JAW THRUST – OROPHARYNGEAL AIRWAY – AMBU BAG – INTUBATION – LARYNGEAL MASK AIRWAY • TRACHEOSTOMY – INVOLVES INCISION OF SKIN, SEPARATION OF STRAP MUSCLES, DIVISION OF THYROID ISTHMUS, OPENING OF TRACHEA AND FIXATION OF TRACHEOSTOMY TUBE – PLANNED PROCEEDURE TAKES MINIMUM 20 MIN – 1 HR • CRICOTHYROTOMY – PROVIDES INSTANT AIRWAY – REQUIRES NO SPECIAL TRAINING OR EQPT – OPENING MADE IN CRICO THYROID MEMBRANE
- 32. RESOURCES • DISEASES OF EAR, NOSE AND THROAT 5TH ED: PL DHINGRA. ELSEVIER INDIA – E VERSION AVAILABLE FROM http://www.filefactory.com/file/cca0cf0/n/Diseas es_of_Ear_Nose_and_Throat_5th_Pg.chm • THIS PRESENTATION IS AVAILABLE FROM www.slideshare.net • CREATED UNDER CREATIVE COMMONS LICENCE FOR NON COMMERCIAL USE • ALL IMAGES DOWNLOADED FROM THE INTERNET AND COPYRIGHT OF ORIGINAL OWNERS!