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ENT Problem and its management techniques.pdf
- 1. Common ENT Problemsand Managements Lt Dhirendra Kumar Tiwari
- 2. ENT • Ear • Nose •Throat • All 3 are releated to each other. • How?
- 3. Otologic Anatomy • Auricle •Ear canal • Tympanic membrane • Middle ear & mastoid • Inner Ear
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- 12. ESSENTIAL EQUIPMENT • OTOSCOPE •TORCH • TONGUE DEPRESSOR • THUDICUM NASAL SPECULUM • ARTERY FORCEPS • JOBSON HORNE PROBE OR EUSTACHIAN CATHETER
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- 14. Common problems inEar • Pain – Wax – Furuncle – Foreign body • Ear discharge
- 15. DISORDERS OF EARCANAL 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
- 16. DISORDERS OF EARCANAL 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!!!
- 17. DISORDERS OF MIDDLEEAR 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!
- 18. DISORDERS OF MIDDLEEAR 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
- 19. DISORDERS OF MIDDLEEAR 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
- 20. DISORDERS OF MIDDLEEAR 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
- 21. 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
- 22. THE NOSE ANDPARANASAL SINUSES
- 23. Common problems inNose • Furuncle • Epistaxis(bleeding) • Cold(running nose) • Sneezing(allergic rhinitis) • Sinusitis • Foreign body
- 24. NASAL VESTIBULITIS • STAPHYLOCOCCALINFECTION OF NASAL HAIR FOLLICLES • INVOLVES DANGER AREA OF FACE • EXQUISITELY PAINFUL • TREATMENT – INJECTABLE ANTIBIOTICS – ANALGESICS – TOPICAL ANTIBIOTIC CREAM
- 25. INTRANASAL POLYPS • DIFFERENTIATEHYPERTROPHIED 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
- 26. 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!
- 27. 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
- 28. 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
- 29. REMOVAL OF NASALFOREIGN 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
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- 31. Common problems ofThroat • Cough • Throat pain – Tonsilitis – Peritonsilar abscess – Pharangitis • Mouth ulcers
- 32. Cough Pharyngitis Antihistaminics Mouth ulcers Also knownas aphthus ulcers. Mouth ulcer gel MultiVit
- 33. ACUTE TONSILLITIS • PRESENTATION –PAINFUL SORE THROAT – FEVER – ODYNOPHAGIA – TONSILLAR SWELLING – LYMPHADENOPATHY • MANAGEMENT – ANTIBIOTICS – ANALGESICS – SALT WATER GARGLES
- 34. 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
- 35. CHRONIC TONSILLITIS • PRESENTATION –RECURRENT ATTACKS OF ACUTE TONSILLITIS – ERYTHEMA OF ANTERIOR PILLARS – TONSILS MAY SHOW VARYING DEGREE OF ENLARGEMENT – JUGULODIGASTRIC LYMPHADENOPATHY • MANAGEMENT – TONSILLECTOMY
- 36. 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!
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- 38. Important part • Cetrizineor Levocetrizine 5mg tabs • 6 month to 2 yrs – 2.5 mg od • 2 to 6 yrs – 2.5 mg bd • > 6 yrs 5 mg bd • (syr 5mg per 5 ml)
- 39. Augmentin • Amoxycilline withclavulanic acid. • Dose in adults- 625 mg tds or 1 gm bd • Dose in childrens – 20-40 mg/kg/day in 2 divided doses – Syr each 5 ml contains 200mg…so, – ½ of body wt.of baby in ml bd*
- 40. For cough • Adults–syr cough 2TSF tds • Childrens upto wt 20 to 3o kgs – TSF tds • Pediatrics -Syr Tixylix – each 5 ml contains • 1.5 mg promethazine • 1.5 mg pholcodine • ½ of body wt.of baby in ml- tds*
- 41. For Ear Pain •Adults –voveron or combiflam • Pediatrics – Syr Ibugesic(ibuprofen) – Dose 10-15 mg/kg/dose 6 hrly – Each 5 ml contains 100mg,so – ½ of body wt.of baby in ml- tds*
- 42. Fever • PCM – Adults500mg sos or tds – Pediatrics • 15 mg/kg/day in 3 divided dose • Syr each 5 ml contains 125 mg,so… – ½ of body wt.of baby in ml- tds*
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