Azgher M Karjieker all appts. Cape Town Rondebosch Constantiaberg
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1 Azgher M Karjieker all appts Cape Town Rondebosch Constantiaberg 2012
2 OBJECTIVES RECOGNISE AND TREAT MAXIMUM MEDICAL THERAPY REFER ON WHEN NECESSARY
3 ENT PROBLEMS The ENT TEN BASIC AUDIOLOGY
4
5 Post Nasal Drip Water Intake (esp excessive talkers) Tea/Coffee intake (diuretic effect) NO response in 2 weeks add Nasal steroid?scan - NOT XRAY
6 Polyp vs Turbinate
7 Topical vs Oral decongestant Blocked nose topical - like Vibrocil Rhinorrhea oral like Demazin NS
8 WHICH Nasal Steroid Beclate Budesonide (Inflanaze) Fluticasone (Flomist,Flixonase, Avamys) Mometasone (Nexomist, Nasonex) Triamcinolone (Nasacor T) Steroid Absorption Chronic Medication Med Aid Cover limited unless asthma as well (J45.0 PMB)
9 Eustachean Tube Dysfunction Unable to Valsalva Blocked ear after URTI Increase water intake Mucolytic Oral Steroids
10 Tired voice Reliant on thin runny mucus Affected by Dryness Thick mucus Acid irritation Cig smoke
11 Persistent cough Or poorly controlled asthma Consider sinusitis, ACE Inhibitor Ct scan NOT XRAY
12 Snoring ~ when to worry OSA symptoms: awakes dry mouth, feeling unrefreshed, nocturnal micturition Suspect with young male hpt, poorly controlled hpt
13 Primary health measures Start Nasal Steroid early Weightloss diet + exercise review 3 months until goal achieved Thyroid functions
14 Surgery for obvious blockages
15 Conservative options Nasal Steroid Splint Sleep Study CPAP
16 KIDS AT CRECHE Saline spray + Dimetap at 1 st hint of runny nose Freq URTI regular saline spray Mon to Fri after creche Adenoids central cause
17 UPPER AIRWAY OBSTRUCTION IN CHILDREN MOUTH BREATHING NEGATIVE IMPACT ON HEALTH
18 Adenoiditis - J35.2 Recurrent URTI Mouth breathing Rec Ear Infections Bug trap Betnesol N 2 drops bd for 5 days Regular Nasal Saline Feeding position
19 Middle Ear Otitis media Treat adenoiditis + ear infection
20 Middle Ear Otitis media If recurrent same principle Grommets +Adenoidectomy
21 Tonsillitis vs QUINSY 4 or more infections per year Quinsy Asymmetry?sinister pathology (lymphoma) Upper airway obstruction (snoring-osa) Prophylaxis Pen VK daily for 3 months <20kg 250mg >20kg 500mg
22 Tonsillitis vs Quinsy
23 Acid Reflux K21.9 Sore throat / discomfort Normal pharynx Ask about: Late nibbling Morning discomfort Excessive clearing of throat Recurrent hoarseness Dyspepsia only in 40%
24 Treatment Increase water intake Last 2 hours before sleeping water only PPI BD before meals for 2-6 months Gaviscon if eats late for any reason
25 Outer ear WAX Encourage water in ears Avoid cotton buds Syringing
26 Otitis Externa Start ear drops early NOT oral Antibiotic Sofradex / Ciloxan / Cilodex -? Pope wick Recurrent Keep dry 2 months NSAID Swollen tight - Refer
27 Sudden onset deafness Wax Mid Ear effusion post URTI +- airtravel Viral inner Ear infection Oral Steroids Antiviral Disprin MRI or Neuroma
28 Vertigo It s all in the history Rotatory Vertigo Postural Hypotension
29 Vertigo H81.3 Few seconds = BPPV Worse to one side Loose crystals in Inner Ear Epley Manouvre
30 Vertigo H81.3 Few minutes to hours, episodic with hearing loss/aural fullness and tinnitus = Meniere s Disease Low salt diet, HCTZ 12.5mg daily? Longterm anti emetic
31 Vertigo Few days at a time with no hearing loss = Vestibular neuronitis 1 st few days severe then abates IMI Stemetil Serc 24mg BD 5 days then wean
32 Vertigo Few days at a time with hearing loss = Labyrinthitis IMI Stemetil Serc 24mg BD Oral Steroids
33 OTHER Anaemia, Thyroid Dysfxn, CVA Other symptoms/signs Blood tests Refer any atypical features Tannin,tea and kids
34 Tinnitus Bilateral - degeneration Unilateral - acoustic neuroma Audiogram Advantage of hearing aid
35 Some unusual pathology
36 Nasal Fracture - S02.2 Xray not necessary
37 TMJ Disorder Earache sharp, shooting H92.0 Eardrum normal Jaw clicks Celebrex + Refer physio & Max Fac
38 THE ENT 10 If a mother says her child can t hear it is almost always true unilateral nasal discharge foreign body inflamed swollen cheek dental abscess Look at ear in cases of facial palsy refer if hoarse voice >1 month
39 THE ENT 10 sun should never set on a foreign body in nose beware of the old man with sore throat and cottonwool in his ear adult with Mid Ear Effusion Post Nasal Space growth/ HIV unilateral neck swelling only thing you can put in your ear is your elbow?????
40 AUDIOLOGY Just the basics
41 Transmission of Sound Air Conduction Bone Conduction
42 Tympanogram types Normal Effusion Negative Pressure
43 Pure tone testing
44 Normal Hearing Thresholds
45 Conductive Hearing Loss Bone conduction > Air conduction
46 Sensorineural Hearing Loss Bone and air conduction equally affected
47 Mixed Hearing Loss
48 Hearing on the audiogram
49 Otoacoustic emissions (OAE s)
50 Auditory Brainstem Response (ABR)
51 TEST ALL NEWBORNS
52 NIHL NIHL
53
54 Sensorineural Hearing Loss (Noise Induced Hearing Loss) Personal Music Players Work Dip at 4000hz diagnostic
55 Amplification
56
57 Contact Details Azgher Karjieker F Dhansay Audiology Chris Barnard Hospital Rondebosch Med Centre Chris Barnard Hospital Rondebosch Med Centre Tokai Medicross Constantiaberg Mediclinic
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