ent presentation

1. ENT within
Primary Care
– Ears
“Can you hear
me!!”

2. Agenda

3. What's
important

4. Objectives –
Ears

5. Primary care ear
presentations
(typical) Otitis externa Otitis media
Blocked
ear/Wax foreign
body and pain
Chronic
condition
Sinus problems
Other ear
disorders

8. Prescribing

9. Referrals

10. 36-year-old
male

11. History of presenting complaint: Symptoms have presented for 3-4 weeks
Medical history: Recurrent ear infection. Type I diabetes (controlled well)
Drug history: Insulin; aspirin; paracetamol for earache as required
Family history: Nil relevant
Social history: Happily married, works in IT, smokes 5 cigarettes a day, no alcohol, is a keen
runner/swimmer
Basic observations: Temperature 37.2, Pulse 78 BPM, Tender and swollen auricular & cervical
lymph nodes on right side, Mouth and throat (NAD). All else is normal
TEST yourself: Answers on next slide
1.You notice an offensive odour from the ear. When you examine the right ear there is some
debris and inflammation in the ear canal. Consider and explain the history and the need for doing
an ear swab?
2. Despite the debris you are able to visualise the TM. There is a perforation in the attic area
(pars flaccida). What type of perforation is this?
3. What are the differential diagnoses?
4. Which other procedures could be done as part of the examination?
5. Which factors in the history may predispose to recurrent ear infections?
C

12. Case study answers

13. Summary

14. Sharma A, Machen K, Clarke B, Howard, D et al. (2006) Is undergraduate
otolaryngology teaching relevant to junior doctors working in accident and
emergency departments? J Laryngol Otol 120(110: 949-51
Otitis externa | Health topics A to Z | CKS | NICE
Scenario: Recurrent acute otitis media | Management | Otitis media - acute |
CKS | NICE
Antimicrobial prescribing table (bnf.org)

15. Thank You
r.atherton@cumbria.ac.uk