Common ent problems and managements

Common ent problems and managements at primary healthcare centers

1. Common ENT Problems and
Managements
Lt Dhirendra Kumar Tiwari

2. ENT
•Ear
•Nose
•Throat
•All 3 are releated to each
other.
•How?

3. Otologic Anatomy
•Auricle
•Ear canal
•Tympanic
membrane
•Middle ear &
mastoid
•Inner Ear

5. Nasal Septum

6. Lateral Wall

12. ESSENTIAL EQUIPMENT
•OTOSCOPE
•TORCH
•TONGUE DEPRESSOR
•THUDICUM NASAL
SPECULUM
•ARTERY FORCEPS
•JOBSON HORNE PROBE
OR EUSTACHIAN
CATHETER

13. THE NORMAL EAR

14. Common problems in Ear
•Pain
–Wax
–Furuncle
–Foreign body
•Ear discharge

15. 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

16. DISORDERS OF EAR CANAL
WAX EAR (RT) OTOMYCOSIS (LT)
TREATMENT : WAX SOFTENING DROPS
FOLLOWED BY SYRINGING AFTER ONE WEEK
TREATMENT : ANTIFUNGAL EAR DROPS
CAUTION : ALL EAR DROPS ARE NOT EQUIVALENT!!!

17. 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!

18. DISORDERS OF MIDDLE EAR
ACUTE 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

19. DISORDERS OF MIDDLE EAR
SEROUS 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

20. DISORDERS OF MIDDLE EAR
CHRONIC 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

21. 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

22. THE NOSE AND PARANASAL SINUSES

23. Common problems in Nose
•Furuncle
•Epistaxis(bleeding)
•Cold(running nose)
•Sneezing(allergic rhinitis)
•Sinusitis
•Foreign body

24. NASAL VESTIBULITIS
•STAPHYLOCOCCAL INFECTION OF
NASAL HAIR FOLLICLES
•INVOLVES DANGER AREA OF
FACE
•EXQUISITELY PAINFUL
•TREATMENT
–INJECTABLE ANTIBIOTICS
–ANALGESICS
–TOPICAL ANTIBIOTIC CREAM

25. 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

26. 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!

27. 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

28. 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

29. 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

30. THE THROAT

31. Common problems of Throat
•Cough
•Throat pain
–Tonsilitis
–Peritonsilar abscess
–Pharangitis
•Mouth ulcers

32. Cough
Pharyngitis
Antihistaminics
Mouth ulcers
Also known as aphthus ulcers.
Mouth ulcer gel
MultiVit

33. ACUTE TONSILLITIS
•PRESENTATION
–PAINFUL SORE THROAT
–FEVER
–ODYNOPHAGIA
–TONSILLAR SWELLING
–LYMPHADENOPATHY
•MANAGEMENT
–ANTIBIOTICS
–ANALGESICS
–SALT WATER GARGLES

34. 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

35. CHRONIC TONSILLITIS
•PRESENTATION
–RECURRENT ATTACKS OF ACUTE
TONSILLITIS
–ERYTHEMA OF ANTERIOR PILLARS
–TONSILS MAY SHOW VARYING
DEGREE OF ENLARGEMENT
–JUGULODIGASTRIC
LYMPHADENOPATHY
•MANAGEMENT
–TONSILLECTOMY

36. 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!

37. Summary

38. 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)

39. 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*

40. 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*

41. 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*

42. 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*

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