Otosclerosis is a primary disease of the bony otic capsule characterized by abnormal bone resorption and replacement with thicker woven bone. It commonly causes progressive conductive hearing loss. Diagnosis involves history of gradual hearing loss, physical exam finding of Schwartze's sign or positive Rinne test, and audiometry showing conductive loss. Treatment options include hearing aids, medication to slow progression, or stapedotomy/stapedectomy surgery for severe cases. The goal of surgery is to create a new connection between the middle and inner ear by placing a prosthesis between the incus and stapes footplate.
otosclerosis....
stapedectomy vs stapedotomy
complication of otosclerotic surgery
management of otosclerotic surgery complications
techniques
latest trends
otosclerosis....
stapedectomy vs stapedotomy
complication of otosclerotic surgery
management of otosclerotic surgery complications
techniques
latest trends
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Otosclerosis is defined as hereditary localized disease of bone derived from the otic capsule characterized by alternating phases of bone formation and resorption
The mature lamellar bone is resorbed and replaced by an immature woven bone of greater thickness, cellularity and vascularity
First described by Politzer in 1893
Types of Otosclerosis
Stapedial
Cochlear: Round window and Promontory
Mixed: Stapedial + cochlear
Malignant: Rapidly progressing cochlear lesion with severe sensori-neural deafness
Types of Stapedial otosclerosis
1. Anterior focus (commonest): 2 mm anterior to oval
window , fissula ante fenestrum, more unstable
2. Posterior focus: 2 mm behind oval window
3. Circumferential: involves footplate margin only
4. Biscuit type: footplate involved, margin is free
5. Obliterative : Obliterates the oval window completely
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. • Otic capsule
▫ The embryonic cartilage capsule that surrounds
the inner ear mechanism and develops into bony
tissue.
• Otic labyrinth
▫ The endolymphatic labyrinth. Consists of utricle,
saccule, cochlea, Semicircular canals,
endolymphatic duct and sac.
• Periotic labyrinth
▫ The perilymphatic labyrinth. Consists of vestibule,
scala vestibula, scala tympani and perilymphatic
space around semicircular canals.
2
5. Otosclerosis
A primary disease of the bony otic capsule
characterized by abnormal removal of
mature bone by osteoclasts and replacement
with woven bone of greater thickness,
cellularity and vascularity.
5
6. • Autosomal-dominant hereditary disease
• Leads to progressive conducting hearing loss
• Most common cause of CHL in adults
• Bilateral hearing loss in 70% cases
• Male:Female is 1:2
• Most commonly effected age group is 15-45 years
old with hearing loss manifesting typically in the
third decade
• Cochlear otosclerosis manifests with sensorineural
hearing loss
6
7. Etiology
• The exact cause is unknown but many factors
have been proposed such as:
▫ Hereditary
▫ Endocrine (pregnancy)
▫ Trauma
▫ Infectious (eg: measles)
▫ Vascular
▫ Autoimmune
7
9. • Divided in two phases:
▫ Early spongiotic phase (otospongiosis)
Osteocytes, histiocytes, osteoclasts
Active reabsorption of bone
Stains blue (blue mantles) on using H&E stain
Dilated vessels (Schwartze’s sign)
▫ Late or Sclerotic phase
Formation of new bone in resorption areas
New bone is dense and sclerotic
Stains red on using H&E stain
Starts in endochondral bone then involves endosteal
& periosteal layers and membranous labyrinth as
disease progress
9
10. Histopathology
10
Histologic otosclerosis with small focus in
the anterior oval window (arrow).
Clinical otosclerosis. The lesion has
spread across the annular ligament and
fixed the stapes.
11. Types of Stapedial fixation
• Anterior Focus
▫ Most common, at fissula ante fenestram
• Posterior Focus
▫ Lesion spreading from posterior oval window to annular ligament
• Circumferential
▫ Lesion flows across the ligament totally obliterating the annular
ligament
• Biscuit type
▫ Lesion replacing entire footplate, but no involvement of annular
ligament leading to a solid footplate
• Obliterative
▫ Completely obliterates the oval window
11
16. History
• Gradual onset of hearing loss progressing slowly
• In 70% cases hearing loss is bilateral
• Usually becomes apparent around the age of 30
• Loss noticeable when it reaches 25 to 30 dB
• Paracusis of Willis (characteristic of CHL)
• Unilateral loss noticed even later, problem with
localization of sound
• Tinnitus
• Positive family history
16
17. Physical Examination
• Otoscopy
Schwartze sign; red blush occasionally seen over
promontory or anterior to oval window
• Pneumo-otoscopy used to rule out other causes of
CHL such as middle ear serous fluid or small perforation
• Tuning Fork Test
▫ Weber Test
▫ Rinne Test
17
19. • Weber test
▫ Performed with 512 Hz tuning fork
▫ Lateralizes to ear with conductive or greater
conductive loss
▫ Lateralizes with 5 dB of conductive hearing loss
19
20. • Rinne test
▫ Performed with 512 or 1024 Hz tuning forks
▫ Compares patient perception of loudness of air
conduction versus bone conduction
▫ If BC > AC on 512 Hz fork
Loss is 15 – 20 dB
▫ If BC > AC on 1024 Hz fork
Loss is at least 30 db
20
21. Audiometry
• Pure Tone Audiometry
▫ Loss of air conduction at
lower frequencies
▫ Bone conduction normal,
sometimes shows a dip at
2000 Hz (Cahart’s notch)
which disappears after
successful surgery.
• Speech Audiometry
▫ Normal except in those with
cochlear involvement.
21
23. • Acoustic reflex
▫ Measure of movement of stapes at stimulus
▫ Reflex is absent in otosclerosis
23
Progressive changes in the
configuration of the acoustic
reflex with stapedial fixation.
A, healthy reflex with a
sustained change in compliance
as long as stimulus is on.
B, diphasic reflex with on-off
pattern. Seen in cases of early
otosclerotic fixation.
C, Absent acoustic reflex
24. Radiological Investigations
• High resolution CT scan
▫ Shows subtle areas of demineralisation
▫ In case of cochlear involvement it shows “double
ring sign”
24
25. Differential diagnosis
• Ossicular chain discontinuity
• Mass effect on TM or ossicular chain
• Conginital stapedial footplate fixation
• Malleus head fixtion : cause infection ,
tympanosclerosis
• Paget Dz (osteitis deformans ) :begin involve
periosteal layer & involve endochondral bone
last
• Osteogenesis imperfecta: autosomal dominant
25
28. Medical management
• Aim is to Stabilize the disease by
reduction of the osteoclastic bone resorption increase
osteoblastic bone formation
Inhibits proteolytic enzymes that are cytotoxic to
cochlea.
• Slows the progression of sensorineural hearing
loss
• Not commonly used
28
29. • Sodium Fluoride therapy
Contraindicated in patients with
Chronic nephritis
Chronic rheumatoid arthritis
Pregnant and lactating women
Children
• Bisphosphonates
29
30. Hearing Aid
• Very effective in early stage of disease
• But can be used in advance stage, if:
Surgery is contraindicated
Patient refuses the surgery
In far-advance cases it is required, even after
stapedotomy
30
31. Surgical Management
• Poorer ear always chosen for surgery
• Done preferably under local anesthesia so
patient can notify surgeon if vertigo occurs
during procedure
• Options are:
Stapedotomy
Stapedectomy
• Lesser complications due to use of Lasers now.
31
32. Surgical management
• Stapedectomy :
indicated the stapes fix (A-B gap at least 30
dB) negative Rinne test at 256 , 512 Hz (
Shambaugh)
• Successful stapedectomy :
1. correct CHL
2. remove Carhart’s notch
3. closure pre-op A-B gap
32
33. Contraindication( Shambaugh)
1. Poor speech discrimination & Hx of vertigo in
recent month (because possibility of
endrolymohatic hydrop labyrinth open)
2. Pt with only hearing ear should be avoid
(relative)
3. Pt with ME infection or effusion (absolute)
33
34. Summary of small fenestra stapedotomy
• Anethesia injected
• Incisions at lateral process of malleus and inferiorly
• Tympanomeatal flap elevated
• Adequate exposure (facial nerve superiorly, pyramidal process inferiorly)
• Distance from incus to footplate measured (usu. 4.5mm)
• Microdrill used to create fenestra
• Prosthesis placed on incus and crimped firmly in place.
• Incudostapedial joint separated and stapedial tendon sectioned
• Stapes superstructure fractured and removed
• Prosthesis checked
• Tympanomeatal flap returned to normal position
34
40. Selection Criteria
• Hearing threshold is 30dB or worse
• AB gap at least 15dB
• Rinne’s negative for 256 Hz and 512 Hz
• Speech Discrimination Score is 60% or more
40
42. Stapedotomy v/s Stapedectomy
• Stapedotomy
oSafer
oLower rate of high frequency sensorineural
hearing loss post op.
• Stapedectomy
oLess chances of recurrence
42
43. Postoperative Care
• Patient’s head elevated to 30o to reduce
perilymph pressure in vestibule
• Bed rest for at least 1 hour
• If no vertigo on getting up then patient can go
home
• Patients can resume air travel after 5 days
• Follow up with audiogram in 3 weeks
43
44. Contraindications
• Only hearing ear
• Meniere’s disease
• Occupation
Experience frequent change in pressure
Works in noisy surrounding
• Otitis externa
• Perforated TM
• Young children
• Poor state of health
44