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