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