Common ENT Problems and Managements

Lt Dhirendra Kumar Tiwari

ENT

• Ear• Nose• Throat

• All 3 are releated to each other.

• How?

Otologic Anatomy

• Auricle • Ear canal• Tympanic

membrane• Middle ear &

mastoid• Inner Ear

Nasal Septum

Lateral Wall

ESSENTIAL EQUIPMENT

• OTOSCOPE• TORCH• TONGUE DEPRESSOR• THUDICUM NASAL

SPECULUM• ARTERY FORCEPS• JOBSON HORNE PROBE

OR EUSTACHIAN CATHETER

THE NORMAL EAR

Common problems in Ear

• Pain – Wax – Furuncle– Foreign body

• Ear discharge

DISORDERS OF EAR CANAL

FURUNCULOSIS OF EAR CANAL (OTITIS EXTERNA)• CAUSE : STREPTOCOCCAL / STAPHYLOCOCCAL INFECTION OF SKIN OF EAC• TREATMENT : ANTIBIOTICS, ANALGESICS• MAY BE ASSOCIATED WITH UNTREATED MIDDLE EAR INFECTION

DISORDERS OF EAR CANAL

WAX EAR (RT) OTOMYCOSIS (LT)TREATMENT : WAX SOFTENING DROPSFOLLOWED BY SYRINGING AFTER ONE WEEK

TREATMENT : ANTIFUNGAL EAR DROPS

CAUTION : ALL EAR DROPS ARE NOT EQUIVALENT!!!

DISORDERS OF MIDDLE EAR

TRAUMATIC PERFORATION•DIAGNOSIS

– HISTORY OF TRAUMA– RAGGED EDGES OF PERFORATION– FRESH BLEEDING

•TREATMENT– NO EAR DROPS– KEEP EAR DRY– ORAL ANTIBIOTICS,

ANTIHISTAMINICS– REVIEW AFTER ONE MONTH

•IF DUE TO NOISE OF MIL WEAPONS… IT IS IMPULSE NOISE TRAUMA… INNER EAR NEEDS EVALUATION FOR NIHL!

DISORDERS OF MIDDLE EARACUTE SUPPURATIVE OTITIS MEDIA

•STAGES– TUBAL OCCLUSION– PRESUPPURATION– SUPPURATION– DISCHARGE/RESOLUTION/ COMPLICATIONS

•TREATMENT– ORAL ANTIBIOTICS– ANALGESICS– ANTIHISTAMINICS– NASAL DECONGESTANTS– FOLLOWUP

•SPECIAL CONSIDERATIONS– ROLE OF EAR DROPS– MYRINGOTOMY

DISORDERS OF MIDDLE EARSEROUS OTITIS MEDIA (GLUE EAR/

OME)•SYMPTOMS

– INSIDIOUS ONSET, LONG STANDING CONDITON (3 MONTHS)

– HEARING LOSS– OCCASSIONAL OTALGIA– BUBBLING SOUNDS, ECHO OF OWN VOICE

•TREATMENT– CORTICOSTEROID / ANTIHISTAMINIC NASAL

SPRAYS– ORAL DECONGESTANTS / ANTIHISTAMINICS– CHEWING GUM, BLOWING BALLOONS– MYRINGOTOMY AND GROMMET INSERTION

•SPECIAL CONSIDERATIONS– ROLE OF ADENOTONSILLECTOMY– ROLE OF TEMPORARY HEARING AID – DIFFERENTIATION FROM AOM WITH

EFFUSION

DISORDERS OF MIDDLE EARCHRONIC OTITIS MEDIA

•CLASSIFICATION– MUCOSAL

• ACTIVE • INACTIVE

– SQUAMOUS

•TREATMENT– DRY THE EAR

• TOPICAL ANTIBIOTIC/ STEROID EAR DROPS• ORAL ANTIHISTAMINICS

– OPERATE THE EAR• SAFE,DRY,FUNCTIONING EAR

•SPECIAL CONSIDERATIONS– COMPLICATIONS OF COM– RESULTS OF SURGERY– RESTORATION OF HEARING

SYRINGING THE EAR

• USEFUL FOR WAX REMOVAL, FOREIGN BODY REMOVAL

• USE 50 ml SYRINGE, LARGE BORE IV CANNULA

• WATER AT BODY TEMPERATURE TO AVOID CALORIC EFFECT

• COUNSEL PATIENT BEFOREHAND• AVOID OVERINSERTION• DIRECT FLOW TOWARDS OCCIPUT• USE A KIDNEY TRAY TO COLLECT

WASTE WATER

THE NOSE AND PARANASAL SINUSES

Common problems in Nose

• Furuncle• Epistaxis(bleeding)• Cold(running nose)• Sneezing(allergic rhinitis)• Sinusitis • Foreign body

NASAL VESTIBULITIS

• STAPHYLOCOCCAL INFECTION OF NASAL HAIR FOLLICLES

• INVOLVES DANGER AREA OF FACE

• EXQUISITELY PAINFUL• TREATMENT

– INJECTABLE ANTIBIOTICS– ANALGESICS– TOPICAL ANTIBIOTIC CREAM

INTRANASAL POLYPS

• DIFFERENTIATE HYPERTROPHIED INFERIOR TURBINATE FROM INTRANASAL POLYPS

• ALLERGIC POLYPS ARE USUALLY BILATERAL, MULTIPLE, AND PALE

• MEDICAL POLYPECTOMY– SHORT COURSE ORAL STEROID– INTRANASAL CORTICOSTEROID

SPRAY– ORAL ANTIHISTAMINICS

• SURGICAL MANAGEMENT : FESS

ALLERGIC RHINITIS• DIAGNOSIS

– PAROXYSMAL SNEEZING, WATERY RHINORRHOEA,NASAL ITCHING AND STUFFINESS

– SEASONAL OR PERENNIAL– GENETIC PREDISPOSITION– OFTEN ASSOC WITH OTHER ATOPIC MANIFESTATIONS

IN EYE, EAR AND THROAT ,ALLERGIC POLYPS OR BRONCHIAL ASTHMA

– MAY PROGRESS TO SINUSITIS IF UNTREATED

• TREATMENT– AVOIDANCE OF ALLERGEN– INTRANASAL CORTICOSTEROID/ ANTIHISTAMINE

SPRAYS (FLUTICASONE / AZELASTINE)– ORAL ANTIHISTAMINICS (CETRIZINE/ FEXOFENADINE)– ORAL ANTI LEUKOTRIENE (MONTELEUKAST)

• SPECIAL CONSIDERATIONS– AVOID USE OF TOPICAL DECONGESTANTS LIKE NASIVION/

OTRIVIN … RHINITIS MEDICAMENTOSA!– LIFELONG TREATMENT MAY BE REQUIRED!

ACUTE SINUSITIS

• PRESENTATION– ACUTE INFLAMMATION OF SINUS

MUCOSA DUE TO INFECTION– FEVER, HEADACHE, PURULENT NASAL

DISCHARGE, ERYTHEMA AND TENDERNESS OVER AFFECTED SINUSES

• TREATMENT– ANTIBIOTICS– ANALGESICS– TOPICAL DECONGESTANTS– ANTIHISTAMINICS– STEAM INHALATION

EMERGENCY MANAGEMENT OF EPISTAXIS

• FIRST AID– SIT THE PATIENT UPRIGHT AND PINCH THE NOSE

(TROTTER’S METHOD)

• IF BLEEDING PERSISTS– FOR POSTERIOR NASAL BLEEDING INFLATE A

FOLEY’S CATHETER IN NASOPHARYNX– FOR ANTERIOR NASAL BLEEDING DO ANTERIOR

NASAL PACKING WITH RIBBON GAUZE OR GELFOAM STRIPS

• IF BLEEDING STOPS SPONTANEOUSLY / MINOR BLEEDING– DECONGESTANT DROPS, ANTIHISTAMINICS,

ANTIBIOTICS

• IF ELDERLY PATIENT WITH HYPERTENSION – CHECK BLOOD PRESSURE– ELICIT MEDICATION HISTORY– RESTART ANTIHYPERTENSIVES

REMOVAL OF NASAL FOREIGN BODIES

• REMOVE UNDER VISION USING AN EUSTACHIAN CATHETER OR JOBSON HORNE PROBE

• DO NOT PUSH THE FOREIGN BODY FURTHER INTO THE NASOPHARYNX

• CONSIDER SEDATING OR RESTRAINING THE CHILD

THE THROAT

Common problems of Throat

• Cough• Throat pain– Tonsilitis– Peritonsilar abscess– Pharangitis

• Mouth ulcers

Cough

Pharyngitis Antihistaminics

Mouth ulcers

Also known as aphthus ulcers.

Mouth ulcer gel

MultiVit

ACUTE TONSILLITIS

• PRESENTATION– PAINFUL SORE THROAT– FEVER– ODYNOPHAGIA– TONSILLAR SWELLING– LYMPHADENOPATHY

• MANAGEMENT– ANTIBIOTICS– ANALGESICS– SALT WATER GARGLES

PERITONSILLAR ABSCESS• PRESENTATION

– VERY PAINFUL SORE THROAT– HIGH FEVER– MARKED ODYNOPHAGIA – INABILITY TO

SWALLOW SALIVA– HOT POTATO VOICE– TRISMUS– SWELLING OF SOFT PALATE, ANTERIOR

PILLARS– TONSIL MAY OR MAY NOT BE ENLARGED– DEVIATION OF UVULA TO OPPOSITE SIDE– TORTICOLLIS– CERVICAL LYMPHADENOPATHY

• MANAGEMENT– I & D– ANTIBIOTICS– ANALGESICS– SALT WATER GARGLES

CHRONIC TONSILLITIS

• PRESENTATION– RECURRENT ATTACKS OF ACUTE

TONSILLITIS – ERYTHEMA OF ANTERIOR PILLARS– TONSILS MAY SHOW VARYING

DEGREE OF ENLARGEMENT– JUGULODIGASTRIC

LYMPHADENOPATHY

• MANAGEMENT– TONSILLECTOMY

FOREIGN BODY OESOPHAGUS• PRESENTATION

– TYPICAL HISTORY OF INGESTION– DYSPHAGIA, DROOLING– BEWARE OF HOARSENESS,

DYSPNOEA, STRIDOR … THESE MAY INDICATE FOREIGN BODY IN AIRWAY

• MANAGEMENT– X RAY NECK, CHEST AP AND LATERAL– ASK FOR TIME OF LAST MEAL, DRINK– KEEP NIL ORALLY IF OPERATIVE

INTERVENTION PLANNED– FISH BONES ARE USUALLY

RADIOLUCENT, SMALL CHICKEN BONES MAY BE OBSCURED

– OESOPHAGOSCOPY IS THE GOLD STANDARD INVESTIGATION

– IF THE FB HAS REACHED THE STOMACH, IT WILL USUALLY PASS OUT WITHOUT DIFFICULTY!

Summary

Important part

• Cetrizine or Levocetrizine 5mg tabs• 6 month to 2 yrs – 2.5 mg od• 2 to 6 yrs – 2.5 mg bd• > 6 yrs 5 mg bd• (syr 5mg per 5 ml)

Augmentin

• Amoxycilline with clavulanic acid.• Dose in adults- 625 mg tds or 1 gm bd• Dose in childrens– 20-40 mg/kg/day in 2 divided doses– Syr each 5 ml contains 200mg…so,– ½ of body wt.of baby in ml bd*

For cough

• Adults –syr cough 2TSF tds• Childrens upto wt 20 to 3o kgs – TSF tds• Pediatrics -Syr Tixylix– each 5 ml contains

• 1.5 mg promethazine• 1.5 mg pholcodine

• ½ of body wt.of baby in ml- tds*

For Ear Pain

• Adults –voveron or combiflam• Pediatrics – Syr Ibugesic(ibuprofen)– Dose 10-15 mg/kg/dose 6 hrly– Each 5 ml contains 100mg,so– ½ of body wt.of baby in ml- tds*

Fever

• PCM– Adults 500mg sos or tds– Pediatrics • 15 mg/kg/day in 3 divided dose• Syr each 5 ml contains 125 mg,so…

– ½ of body wt.of baby in ml- tds*

No Thanks