Peripheral vestibular disorders
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The document discusses peripheral vestibular disorders. It describes the anatomy of the peripheral vestibular system including the vestibular end organs containing the semicircular canals and otoliths. Common peripheral vestibular disorders are then outlined, including Meniere's disease, BPPV, vestibular neuronitis, and labyrinthitis. Vestibular neuronitis and labyrinthitis are discussed in more detail regarding their causes, symptoms, and treatment options. Other causes of peripheral vestibular disorders mentioned include vestibulotoxic drugs, head trauma, perilymph fistula, syphilis, and acoustic neuroma.
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This document discusses vocal cord paralysis, including its causes, evaluation, and treatment. It begins by defining vocal cord paralysis and describing the anatomy and nerve supply of the larynx. Common causes of vocal cord paralysis include trauma, surgery, malignancy, and neurological disorders. Evaluation involves laryngoscopy, stroboscopy, imaging, and biopsy if needed. Treatment depends on the type and severity of paralysis, and may include speech therapy, vocal cord injections, medialization procedures, and reinnervation surgery. Bilateral vocal cord paralysis presents additional challenges and may require procedures like tracheostomy or laryngeal framework surgery.
Vocal cord paralysis and evaluation of hoarseness
Vocal cord paralysis and evaluation of hoarseness
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
Otalgia
Otalgia, or ear pain, can originate from inside or outside the ear. Referred otalgia comes from sources outside the ear, with the most common being dental issues, sinusitis, and neck problems. The trigeminal, facial, and vagus nerves innervate both the ear and distant sites that can refer pain. Evaluation includes examination of the ear, head, neck, and sinuses as well as imaging studies and testing for conditions like thyroid disease.
meniers ppt final 6m 8am.pptx
Meniere's disease is a disorder of the inner ear that causes severe dizziness, hearing loss, and ringing in the ears. It occurs when fluid buildup in the inner ear disrupts balance and hearing. Symptoms include vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Diagnosis involves hearing tests and imaging. Treatment focuses on controlling vertigo and preserving hearing, and may include medications, injections, diet changes, hearing aids, and surgery. Managing stress and lifestyle factors can also help control symptoms.
meniere's disease (Vertigo) and labyrinthitis
This document discusses Meniere's disease and labyrinthitis. Meniere's disease is caused by abnormal fluid balance in the inner ear and causes fluctuating hearing loss, tinnitus, vertigo, and a feeling of fullness or pressure in the ear. Labyrinthitis is an inflammation of the inner ear that can be caused by viral or bacterial infections and causes sudden vertigo, nausea, vomiting, and possible hearing loss or tinnitus. Both conditions are treated medically or surgically, with options including low sodium diets, medications to reduce vertigo and nausea, or procedures to drain fluid from the inner ear or decrease vestibular function.
ENT Care for MO- Management of Common Ear Disorders.pdf
This document provides guidance on managing common ear disorders in primary care settings with limited resources. It covers the anatomy and physiology of the ear, diseases of the external, middle and inner ear, as well as signs, symptoms, diagnosis and management of common conditions like ear wax impaction, otitis externa, acute otitis media, chronic suppurative otitis media, serous otitis media, facial nerve palsy, vertigo, hearing loss, foreign bodies, and trauma. Referral criteria and pathways are also outlined for conditions requiring specialist care. The objective is to equip primary care providers to diagnose and treat ear issues or determine when a patient needs to be referred to an ENT specialist.
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More from Tess Jose
Anesthesia implication in Dextrocardia and situs inversus
This document presents a case report of a 45-year-old man with dextrocardia and situs inversus who presented with a right inguinal hernia. Key points discussed include:
1. The patient's history of dextrocardia diagnosed in childhood and current presentation of a irreducible right inguinal hernia.
2. Anesthesia management considerations for the laparoscopic hernia repair including placement of monitors in reverse positions and intubation occurring on the left side.
3. The intraoperative and postoperative periods were uneventful with pain management including a right-sided TAP block.
4. Challenges of situs inversus include proper
Neuromuscular monitoring
This document discusses neuromuscular transmission monitoring during anesthesia using muscle relaxants. It describes how neuromuscular block depth is monitored using a nerve stimulator to deliver electrical stimuli and evaluate the evoked muscular response. Different patterns of nerve stimulation are used, including single twitch, train-of-four, tetanic and double-burst stimulation to assess the degree of block. Factors like stimulus current, frequency and waveform are discussed in monitoring neuromuscular transmission.
Inhalational agent.pptx
1. Several gases were discovered to have anesthetic properties throughout the 19th century, including nitrous oxide, diethyl ether, and chloroform.
2. Between 1920-1940, newer inhaled anesthetics like ethylene, cyclopropane, and divinyl ether were introduced with faster induction and recovery times but also serious drawbacks like flammability and toxicity.
3. Modern inhaled anesthetics developed through fluorination have greater stability and lesser toxicity compared to earlier agents. Their uptake and distribution involves transfer between the anesthesia machine, breathing circuit, alveoli, and pulmonary blood based on partial pressures and solubility properties.
Patient positioning and associated risk
This document discusses various patient positions used during surgery and their associated risks. It describes positions such as supine, lateral, prone, lithotomy, and variations like Trendelenburg. For each position, it details anatomical support, physiological impacts, and potential complications. Positioning-related nerve injuries, pressure points, vascular complications, and retinal ischemia are addressed. Proper padding, stabilization, and frequent reassessment are emphasized to prevent issues from sustained pressures.
Local anaesthetics.pptx
Local anaesthetics are weak bases that are prepared as water soluble salts for commercial use. They consist of an aromatic part linked to a tertiary amine via an intermediate chain containing an ester or amide linkage. Local anaesthetics act by blocking sodium channels, and their potency, onset, and duration of action depend on properties like lipid solubility, pKa, and protein binding. Adverse effects include both central nervous system and cardiovascular toxicity.
Opioids drugs
This document provides information on opioids including their classification, mechanism of action, receptors, and effects. It discusses specific opioids like morphine, fentanyl, and sufentanil. Morphine is naturally occurring and has a duration of action of 3-4 hours. Fentanyl is 75-125 times more potent than morphine. Sufentanil has an analgesic potency 5-10 times that of fentanyl. All three opioids can cause respiratory depression, the most serious adverse effect. Their use requires monitoring to prevent this.
Epidural Anaesthesia.pptx
This document provides an overview of epidural anesthesia. It discusses the anatomy of the spine and structures in the epidural space, including the dura mater, spinal cord, nerve roots, fat, and blood vessels. It describes how epidural blocks are performed in different regions of the spine and the physiology of how local anesthetics spread within the epidural space to produce analgesia. Indications, complications, and the history of epidural anesthesia are also summarized.
Techniques of mask ventilation
This document discusses techniques of mask ventilation. It begins by introducing mask ventilation as a noninvasive airway management technique used for short anesthetics or as a bridge to a more definitive airway. It then describes the types of face masks, including open masks for oxygen delivery and closed masks for ventilation. It discusses the parts of masks including the connector and harness. The document outlines techniques for mask application, including one-handed and two-handed techniques. It describes signs of inadequate mask ventilation and complications of mask ventilation such as skin allergy, nerve injury, gastric inflation, and eye or skin injuries. Throughout, it provides details on positioning, types of masks, application techniques, and complications to summarize techniques of mask ventilation.
Cirrhosis
This document discusses alcoholic liver disease and cirrhosis. It covers the pathology and symptoms of alcoholic hepatitis and cirrhosis, including jaundice, hepatomegaly, portal hypertension, and fibrosis. It also mentions common lab abnormalities seen in alcoholic liver disease such as anemia, increased bilirubin, AST>ALT. Potential treatments discussed include pentoxyfilline, steroids, and acamprosate to aid abstinence from alcohol. The Lille score is mentioned as a method to assess treatment response to steroids in alcoholic hepatitis using 6 variables.
Viral hepatitis
This document summarizes different types of viral hepatitis. It discusses the transmission routes and at-risk groups for Hepatitis A, B, C, D, E, and G. It also provides recommendations for immunization against Hepatitis B and post-exposure prophylaxis. Additionally, it briefly describes the pathological findings seen in acute viral hepatitis, including panlobular infiltration, hepatic cell necrosis, and ballooning of cells.
Antisocial personality disorder
Antisocial personality disorder is characterized by a disregard for social norms and the rights of others since age 15, as demonstrated by behaviors such as failure to conform to social norms, deceitfulness, impulsivity, irritability and aggression, recklessness, irresponsibility, and lack of remorse. The disorder typically follows a chronic unremitting course, with symptoms peaking in late adolescence. Common comorbid conditions include substance abuse disorders and depressive disorders. Treatment may involve psychotherapy, though patients often respond better in peer settings rather than isolation. Pharmacotherapy can also be used to treat comorbid conditions like anxiety, rage, and depression.
Breaking bad news
This document discusses how to effectively deliver bad news to patients. It notes that bad news includes diagnoses of serious illnesses, discussing prognoses, do-not-resuscitate orders, death pronouncements, and organ donation talks. Doctors are worried about damaging their reputation, facing questions from relatives, and dealing with legal and compensation issues when delivering bad news. The document recommends following the Kübler-Ross model of how people process bad news, which involves denial, anger, bargaining, depression, and acceptance. It emphasizes that breaking bad news requires a tactful approach and is a sensitive task that benefits from practice and guidelines.
urinary tract infection
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Ryles tube insertion and its care
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This document discusses the history, indications, types, equipment, and procedure for inserting a Ryles tube. It notes that enteral feeding has been practiced for thousands of years using enemas. There are short tubes like Levin tubes that are inserted through the nose into the stomach for decompression and washing. Longer tubes can reach the duodenum or jejunum. The procedure involves lubricating the tube, inserting it through the nose while the patient swallows, checking placement is in the stomach, and monitoring for complications. Common complications include clogged tubes, aspiration, and electrolyte imbalances.
Supraglottic airway devices
The document discusses different types of supraglottic airway devices. It describes laryngeal mask airways (LMAs) like the Classic LMA, ProSeal LMA, LMA Supreme, and Intubating LMA. It also discusses pharyngeal sealers like the Laryngeal Tube and Combitube. Cuffless preshaped sealers like the i-gel and SLIPA are also outlined. Key features of different devices are highlighted, along with their indications, proper usage, advantages, and complications. Supraglottic airways provide an alternative to endotracheal intubation and help with ventilation in difficult airway scenarios.
E fast
The document discusses the eFAST (extended focused assessment with sonography in trauma) protocol, which was developed in the mid-1990s and expanded in 2004 to include pneumothorax detection. It describes the 7 areas to scan in an eFAST exam, including the right and left upper quadrants, subxiphoid/subcostal, and suprapubic and intercostal areas. Signs of a pneumothorax on ultrasound include absent lung sliding, irregularly spaced A-lines, and no B-lines. The eFAST protocol plays an important role in diagnosing blunt abdominal injuries as physical exams and CT scans are not always possible or optimal in trauma settings.
Ca stomach
This document summarizes carcinoma of the stomach, including its anatomy, blood supply, classification, risk factors, common sites, spread, and surgical management. It notes that stomach cancer can be classified as intestinal, diffuse, or unclassified based on histological features. Risk factors include conditions like HNPCC or pernicious anemia. Surgical options include partial or total gastrectomy depending on the location and extent of the cancer, often with removal of nearby organs.
Developmental dysplasia of hip
This document discusses congenital dislocation of the hip. It defines developmental dysplasia of the hip as partial or complete displacement of the femoral head from the acetabulum present since birth. Risk factors include being female, a first born, having a family history, or experiencing faulty intrauterine positioning such as breech presentation. Diagnosis involves physical exam findings like leg length discrepancy and a positive Ortolani or Barlow maneuver. Treatment depends on age and may involve closed or open reduction along with hip spica casting or surgical procedures like femoral and pelvic osteotomies.
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This document summarizes different types of vasculitis, including:
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- Giant cell arteritis, which occurs in the elderly and involves cranial vessels.
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- ANCA associated vasculitis, which can involve various organ systems.
The document provides details on symptoms, presentations, diagnostic criteria and treatments for each type.
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The trochlear nerve emerges from the dorsal aspect of the brainstem and is the only cranial nerve that decussates. It innervates the superior oblique muscle. The superior oblique muscle functions to depress, abduct, and intort the eye. Damage to the trochlear nerve results in limitations in depression, especially in adduction, which can cause diplopia that is worse on downward gaze. Compensatory head positioning such as tilting the head contralaterally may help alleviate diplopia.
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Learning objectives:
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2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
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Peripheral vestibular disorders
- 1. PERIPHERAL VESTIBULAR DISORDERS Dr Tess Jose Intern
- 2. • . The peripheral vestibular system includes Vestibular end organs First order neuron VIII CN
- 3. • VESTIBULAR END ORGAN INCLUDE 3 semicircular canal(sensitive head rotation) 2 otoloth (sensitive to linear acceleration)
- 4. Semi-circular canal 3 in number-lateral post, superior Respond to angular acceleration and deceleration Right angle to each other Stimulation of canal produce nystagmus Horizontal nystagmus –horizontal canal Rotatory- superior Vertical -posterior
- 5. Peripheral vestibular disorders 1. Meniere disease 2. BPPV 3. Vestibular neuronitis 4. Labrynthits 5. Vestibulotoxic drugs 6. Head trauma 7. Perilymph fistula 8. Syphilis 9. Acoustic neuroma
- 6. 1.Vestibular neuronitis • Inflammation of vestibular branch of VIIIth cranial nerve • Affects balance >> hearing • Infection often associated with systemic viral infection such as influenza , EBV, herpes, measles, hepatitis • Symptoms severe vertigo sudden onset with no cochlear symptoms • Last for few days to 2 to 3 weeks. • Tx –antihistaminics , anticholinergics, anti dopaminergic • Self limiting
- 7. 2.Labyrinthitis • Infection of labyrinth • There are 3 stages Fistula formation Serous labryrinthitis diffuse suppurative labryrinthitis
- 8. Fistula formation • Causes –csom ,neoplasm,trauma • Dx FISTULA TEST 1. pressure on tragus 2. siegle’s speculum • Mx – antibiotics , mastoid exploration False negative: cholesteatoma False positive :congential syphilis,Meniere’s d/s(25%) Sudden inward pressure is applied on tragus Increases pressure in ear canal stimulates labyrinth Vertigo , nystagmus
- 9. Diffuse serous labyrinthitis • Causes – pre existing fistula formation ,acute infection of middle ear ,following stapedectomy • Cf –vertigo, vomiting , SNHL • TX- antibiotics, labyrinthine sedative myringotomy mastoidectomy
- 10. • Diffuse suppurative labyrinthitis • Follows serous labyrinthitis • Cf- severe vertigo , nausea , vomiting Total loss of hearing Tx-same as above
- 11. 3.Vestibulo toxic drugs • Aminoglycosides (irreversible) Streptomycin Gentamycin Kanamycin Amikacin • Cisplatin • Furosemide • Quinine • NSAIDS(Naproxin,Ibuprofen) • Macrolides (erythomicin) Affects hair cell of crista ampuillaris
- 12. 4.Head trauma • Can be due to: concussion of labyrinth Disrupt bony labyrinth VIII th CN Disturb vestibular end organ
- 13. 5.Perilymph fistula • A perilymph fistula (PLF) is an abnormal connection in one or both of the oval window and the round window) that separate the air filled middle ear and the fluid filled perilymphatic space of the inner ear. • This small opening allows perilymph (fluid) to leak into the middle ear. • Causes : 1.stapectomy complication 2. barotrauma 3. raised ICT
- 14. 6.Syphillis • Can be seen In patients with any stage . 1. hearing loss ,vertigo, tinnitus 2. Aural pressure 3. Loudness in tolerance 4. Displacusis(inter aural pitch difference – single auditory stimulus as different pitch in 2 ears ) 5. Neurosyphilis – central type of vestibular dysfunction )
- 15. 7.Acoustic neuroma • Benign encapsulated tumor of VIII th nerve • Clinical features • Earliest symptoms 1. Cochleovestibular symptoms(deafness,tinnitus)as tumour arises from IAC) 2. Tinnitus, Vertigo (COCHLEAR SYMPTOMS) 3. Progressive unilateral SNHL
- 16. FEATURES DUE TO INVOLVEMENT OF OTHER STRUCTURES • CN VII Hitzelberger’s sign :hypothesia in posterior meatal wall. Loss of taste in ant 2/3of tongue Schirmer’s test : reduced lacrimation Delayed blink reflex • CN V Reduced corneal sensitivity Numbness and parathesia of face
- 17. • CN IX &X Dysphagia , hoarseness of face • Brainstem involvement Ataxia weakness, numbness of arms and legs • Cerebellar involvement • Raised IC T Features
- 18. MANAGEMENT • SURGERY • RADIOTHERAPY • Conventional radiotherapy • Gamma knife surgery {source of radiation Cobalt 60 ) • Cyber knife (robotic sx –done by computer controlled robots )
- 20. References • Diseases of ear , nose, throat 5 th edition –PL dingra • Self assessment and review ENT – Sakshi arora