Azgher M Karjieker 0861 275 337 all appts Cape Town Rondebosch Constantiaberg 2012
OBJECTIVES RECOGNISE AND TREAT MAXIMUM MEDICAL THERAPY REFER ON WHEN NECESSARY
ENT PROBLEMS The ENT TEN BASIC AUDIOLOGY
Post Nasal Drip Water Intake (esp excessive talkers) Tea/Coffee intake (diuretic effect) NO response in 2 weeks add Nasal steroid?scan - NOT XRAY
Polyp vs Turbinate
Topical vs Oral decongestant Blocked nose topical - like Vibrocil Rhinorrhea oral like Demazin NS
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)
Eustachean Tube Dysfunction Unable to Valsalva Blocked ear after URTI Increase water intake Mucolytic Oral Steroids
Tired voice Reliant on thin runny mucus Affected by Dryness Thick mucus Acid irritation Cig smoke
Persistent cough Or poorly controlled asthma Consider sinusitis, ACE Inhibitor Ct scan NOT XRAY
Snoring ~ when to worry OSA symptoms: awakes dry mouth, feeling unrefreshed, nocturnal micturition Suspect with young male hpt, poorly controlled hpt
Primary health measures Start Nasal Steroid early Weightloss diet + exercise review 3 months until goal achieved Thyroid functions
Surgery for obvious blockages
Conservative options Nasal Steroid Splint Sleep Study CPAP
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
UPPER AIRWAY OBSTRUCTION IN CHILDREN MOUTH BREATHING NEGATIVE IMPACT ON HEALTH
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
Middle Ear Otitis media Treat adenoiditis + ear infection
Middle Ear Otitis media If recurrent same principle Grommets +Adenoidectomy
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
Tonsillitis vs Quinsy
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%
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
Outer ear WAX Encourage water in ears Avoid cotton buds Syringing
Otitis Externa Start ear drops early NOT oral Antibiotic Sofradex / Ciloxan / Cilodex -? Pope wick Recurrent Keep dry 2 months NSAID Swollen tight - Refer
Sudden onset deafness Wax Mid Ear effusion post URTI +- airtravel Viral inner Ear infection Oral Steroids Antiviral Disprin MRI or Neuroma
Vertigo It s all in the history Rotatory Vertigo Postural Hypotension
Vertigo H81.3 Few seconds = BPPV Worse to one side Loose crystals in Inner Ear Epley Manouvre
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
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
Vertigo Few days at a time with hearing loss = Labyrinthitis IMI Stemetil Serc 24mg BD Oral Steroids
OTHER Anaemia, Thyroid Dysfxn, CVA Other symptoms/signs Blood tests Refer any atypical features Tannin,tea and kids
Tinnitus Bilateral - degeneration Unilateral - acoustic neuroma Audiogram Advantage of hearing aid
Some unusual pathology
Nasal Fracture - S02.2 Xray not necessary
TMJ Disorder Earache sharp, shooting H92.0 Eardrum normal Jaw clicks Celebrex + Refer physio & Max Fac
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
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?????
AUDIOLOGY Just the basics
Transmission of Sound Air Conduction Bone Conduction
Tympanogram types Normal Effusion Negative Pressure
Pure tone testing
Normal Hearing Thresholds
Conductive Hearing Loss Bone conduction > Air conduction
Sensorineural Hearing Loss Bone and air conduction equally affected
Mixed Hearing Loss
Hearing on the audiogram
Otoacoustic emissions (OAE s)
Auditory Brainstem Response (ABR)
TEST ALL NEWBORNS
NIHL NIHL
Sensorineural Hearing Loss (Noise Induced Hearing Loss) Personal Music Players Work Dip at 4000hz diagnostic
Amplification
Contact Details Azgher Karjieker 0861 275 337 drk@drkarjieker-ent.co.za F Dhansay Audiology 0800 12 4324 ann@drkarjieker-ent.co.za Chris Barnard Hospital Rondebosch Med Centre Chris Barnard Hospital Rondebosch Med Centre Tokai Medicross Constantiaberg Mediclinic