STANDARD TREATMENT PROTOCOLS FOR E.N.T. DISEASES (FOR RURAL HOSPITALS, BPHC & PHC)
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1 STANDARD TREATMENT PROTOCOLS FOR E.N.T. DISEASES (FOR RURAL HOSPITALS, BPHC & PHC)
2 DEAFNESS-EARLY DETECTION IN CHILDREN AT BIRTH- AUROPALPEBRAL REFLEX & STARTLE REFLEX AT 3 MONTHS- BLINKING & FROWNING IN RESPONSE TO SOUND AT 5 MONTHS- EYE TURNING TO SOUND SOURCE AT 6 MONTHS- HEAD TURNING TO SOUND SOURCE AT MONTHS- SOUND IDENTIFICATION AT ANY PLANE & TRIES TO SAY 1 OR 2 WORDS OVER 2 YEARS- CAN COMPLY TO REQUESTS & DEMANDS BETWEEN 2-5 YEARS- CAN PERFORM SOMETHING/ COMPREHEND
3 ACUTE SUPPURATIVE OTITIS MEDIA: C/F EXCESSIVE CRYING AT NIGHT SEVERE THROBBING EAR PAIN PYREXIA OF UNKNOWN ORIGIN WITH NAUSEA/ VOMITING DEAFNESS OR RARELY AUTOPHONY BLOOD STAINED MUCOID DISCHARGE CONGESTED/ BULGED T.M. WITH/ WITHOUT PERFORATION COUGH & COLD WITH FEVER (ASSOCIATED/ WITHIN A WK)
4 ACUTE SUPPURATIVE OTITIS MEDIA: TREATMENT ANY EAR DROP IS CONTRA-INDICATED WHEN THERE IS NO PERFORATION OR OTOMYCOSIS DRY HOT FOMENTATION/ DRY MOPPING OF DISCHARGE IF PRESENT STEAM INHALATION IN URTI PARACETAMOL FOR FEVER/ IBUPROFEN FOR PAIN (15-20 mg/kg) AMOXYCILLIN OR CEPHALEXIN (20-40 mg/kg IN DIVIDED DOSES) XYLOMETAZOLINE (0.1 %-ADULTS & 0.05 %-CHILDREN)
5 OTOTOXIC DRUGS AMINOGLYCOSIDES (STREPTOMYCIN & GENTAMICIN-VERTIGO, REST-DEAFNESS/ TINNITUS) DIURETICS QUININE & CHLOROQUINE SALICYLATES ANTI-CANCER DRUGS
6 OTOTOXIC DRUGS (CONT.) PARENTERAL ADMINISTRATION IS MORE VULNERABLE IN PREGNANCY THESE DRUGS MAY PASS THE PLACENTAL BARRIER TO AFFECT THE FOETUS. SO EITHER AVOID OR IF NO OTHER OPTION THEN DISCONTINUE WHEN OTOTOXICITY OCCURS
7 BLEEDING PER EAR EAR CANAL INJURY T.M. RUPTURE HEAD INJURY WITH/ WITHOUT TEMPORAL BONE FRACTURE AURAL GRANULATION OR GROWTH TREATMENT: DO NOT PACK THE EAR AVOID EAR DROPS & OIL/ WATER ENTRY PARACETAMOL/ IBUPROFEN AMOXYCILLIN/ CEPHALEXIN
8 NASAL POLYPS INFLAMMATORY POLYP: ANTROCHOANAL & ETHMOIDAL FUNGAL POLYP: RHINOSPORIDIOSIS OTHER SWELLINGS APPEARING AS POLYPS: HYPERTROPHIED INFERIOR TURBINATE, NASAL ANGIOMA, ANGIOFIBROMA, INVERTED PAPILLOMA, CARCINOMA, MENINGOCELE, ENCEPHALOCELE, MENINGO-ENCEPHALOCELE
9 NASAL POLYPS (CONT.) NASAL OBSTRUCTION SNEEZING NASAL DISCHARGE HYPOSMIA/ ANOSMIA HEADACHE/ FACIAL PAIN OCC. EPISTAXIS TREATMENT: MOSTLY SURGICAL (FUNCTIONAL ENDOSCOPIC SINUS SURGERY)
10 ACUTE SINUSITIS (< 6 WKS) NASAL OBSTRUCTION WITH DISCHARGE SEVERE HEADACHE/ FACIAL PAIN FEVER UNPLEASANT TASTE/ POST-NASAL DRIP OCC. EPISTAXIS TREATMENT: AMOXYCILLIN/ CIPROFLOXACIN PARACETAMOL CETIRIZINE/ LEVOCETIRIZINE XYLOMETAZOLINE NASAL DROPS
11 CHRONIC SINUSITIS (> 6 WKS) NASAL OBSTRUCTION DULL HEADACHE/ FACIAL PAIN REPEATED HAWKING/ CLEARING OF THROAT BLOCKING SENSATION OF THE EARS INTERMITTENT HOARSENESS TREATMENT: ORAL HYGIENE NORMAL SALINE SPRAYS/ DROPS ANTIBIOTICS IF PERSISTING- SURGERY (FESS)
12 PATCH OVER TONSILS ACUTE FOLLICULAR TONSILLITIS FAUCEAL DIPHTHERIA (GREYISH WHITE PATCH, PSEUDO-MEMBRANE, TOXIC PATIENT & CERVICAL LYMPHADENOPATHY. ALBERT STAINING. ANTI- DIPHTHERITIC SERUM 20,000-1,00,000 IU) AGRANULOCYTOSIS (RELATIVE LYMPHOCYTOSIS) INFECTIOUS MONONUCLEOSIS (EBV) LEUKAEMIA/ SQUAMOUS CELL CA VINCENT S/ RARELY LUDWIG S ANGINA
13 TRACHEOSTOMY TRAUMA TO NECK & CHEST CUT THROAT INJURY LARYNGEAL GROWTH SEVERE LARYNGEAL INFECTION DIPHTHERIA ACUTE LARYNGO-TRACHEO-BRONCHITIS IN CHILDREN
14 TRACHEOSTOMY (CONT.) WHENEVER YOU THINK OF TRACHEOSTOMY, DO IT NEEDS 3 D CONSENT (DEATH BEFORE, DURING OR AFTER SURGERY) VERTICAL MIDLINE INCISION FROM CRICOID TO SUPRASTERNAL NOTCH IN EXTENDED NECK POSITION USUALLY DONE UNDER LOCAL ANAESTHESIA THYROID ISTHMUS IS RETRACTED UPWARDS OPENING DONE OVER 3 RD & 4 TH TRACHEAL RINGS MOSTLY METALLIC TUBES ARE USED TUBE IS FIXED TO THE NECK WITH TAPES
15 FOREIGN BODY THROAT FISH BONE- COMMONEST F.B. BUT FOUND IN 60 % OF CASES ONLY (MANUAL PALPATION NEEDED) TONSILS- MOST COMMON SITE MOST OF THE FISH BONES, ARTIFICIAL DENTURES & PLASTIC MATERIALS ARE RADIO-LUCENT RECENT SKIAGRAMS ARE NECESSARY LATERAL VIEW IS MORE INFORMATIVE MAY NEED I/L, D/L OR FOL FOR REMOVAL MAY NEED BRONCHOSCOPY
16 MESSAGE CONGENITAL DEAFNESS SUSPICION INTRACTABLE VERTIGO- LABYRINTHITIS, CSOM,RTA, BPPV CSOM WITH INTRACRANIAL COMPLICATION, FACIAL PALSY BLEEDING EAR WITH FACIAL PALSY IN CHILD/ADULT UNILATERAL SNHL IN ADULTS INTRACTABLE EPISTAXIS ADULTS/ YOUNG, (JNA) IMPACTED OLD/RARE FB, LEECH & MAGGOT IN NOSE & NASOPHARYNX, TRACHEA RTA WITH CSF LEAK UNEXPLAINED HEADACHE & FACIAL PAIN, HEMIFACIAL SPASM HEAD NECK TUMORS, SUSPECTED LYMPHOMAS ORBITAL CELLULITIS & TUMORS UNEXPLAINED DYSPHAGIA, HOARSENESS, TRISMUS, STRIDOR IN CHILD CHRONIC DACRYOCYSTITIS, LACRIMAL CYSTS & ABSCESS NECK SPACE INFECTON MISCELLANEOUS AWARENESS IN INDISCRIMINATE USE OF STEROID, ND
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