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13.03.11 ENT clinic

History
  • Snoring
  • Trouble breathing at night
  • Sleep apnoea
  • Effects
    • Daytime somnolence
    • Morning headache
  • Seasonality
  • Triggers
  • Occupation
  • Able to eat with mouth closed?
    • Drooling?
  • Able to breathe with mouth closed?
  • Hearing change
  • Number of infections/ Abx in last year


Indications for tonsilectomy

  • Absolute
    • Obstructive sleep apnoea
    • Suspected malignancy
  • Relative: Episodes of tonsilitis:
    • 7 or more in last year
    • 5 or more per year for last 2 years
    • 3 or more per year for last 3 years
  • 2 or more episodes of quinsy in the last year
  • Tonsilitis is defined as sore throat plus one of:
    • Temp >38.5
    • Cervical adenopathy
    • Tonsillar exudate
    • Evidence of group B haemolytic Strep.

Drugs
  • Betnesol drops
    • Betamethasone
    • Can't use for too long (2 months)
  • Mometasone furoate spray
    • Glucocorticosteroid
  • Mupirocin ointment
    • Monoxycarbolic acid antibiotic
    • Good vs Gram +ves incl. MRSA


Management of Ménière's disease
  • Low salt diet
  • Diuretics
    • Hydrochlorothiazide/triamterene or acetazolamide
  • Vestibular suppressants, anti-emetics, or corticosteroids
    • Used for symptomatic treatment of vertigo and its associated nausea or vomiting during acute attacks
    • Act centrally on the vestibular nucleus
    • Meclozine, dimenhydrinate, promethazine, diazepam, prochlorperazine, prednisolone, betahistine
  • Intratympanic corticosteroids
  • Meniett device
    • Handheld device that delivers intermittent pressure pulses through the ear canal and is self-administered 3 times per day
  • Vestibular and balance rehabilitation therapy
  • Tinnitus maskers (white noise generators)
  • Neuromonics
    • Uses a customised neural stimulus combined with specific music, delivered through a coordinated program to interact with, interrupt, and desensitise tinnitus disturbance for long-term benefit
  • Antidepressants or benzodiazepines
  • Endolymphatic sac surgery
  • Vestibular nerve section
    • Prevents the vestibular afferent stimuli from reaching the brain
  • Labyrinthectomy
    • Hearing loss inevitable


Cholesteatoma
  • Destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process


Alzheimer's diagnosis
  • Presence of cognitive impairment, and a suspected dementia syndrome, confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD
    • Memory
    • Language
    • Perceptual skills
    • Attention
    • Constructive abilities
    • Orientation
    • Problem solving
    • Functional abilities
  • Histopathologic confirmation including a microscopic examination of brain tissue is required for a definitive diagnosis

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