ENT Lecture - Ears
Summary
This on-demand teaching session led by Dr. Sayan Biswas, a specialized foundation doctor, delves into key ear, nose, and throat (ENT) topics and conditions relevant to medical professionals. It covers Acoustic Neuroma/Vestibular Schwannoma, Benign paroxysmal positional vertigo (BPPV), Hearing Loss, Meniere's Disease, and different types of Otitis. It also includes a quiz to test your knowledge and understanding. Attendees will learn about the classic history, associated cranial nerve dysfunctions, and differential diagnoses along with clinical investigations and management options. The knowledge shared in this session will be beneficial in daily clinical practice, making it a must-attend.
Learning objectives
- By the end of the session, participants should be able to describe the differential diagnoses for Acoustic Neuroma, and discuss the application of various investigative tools such as MRI Brain scan and Audiometry.
- Learners should be able to identify the common symptoms associated with Benign Paroxysmal Positional Vertigo (BPPV) and suggest appropriate treatments, such as the Epley manouver or surgery.
- Participants should be able to recognise the symptoms and manage the presentation of Meniere’s disease, using tests like Weber and Rinne’s test and treatments such as surgery or intratympanic steroid injections.
- Learners should be able to explain the causes and treatments for both acute and chronic otitis externa, highlighting the differences between the two.
- By the end of the session, participants should be able to navigate various clinical scenarios and suggest appropriate diagnostic tests and management steps for conditions such as hearing loss and otitis media. They should also be capable of correctly answering quiz questions based on these case studies.
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ENT - EARS Sayan Biswas Specialized Foundation DoctorCONTENT 1. Acoustic Neuroma / Vestibular Schwannoma 2. BPPV 3. Hearing Loss 4. Meniere’s disease 5. Otitis externa 6. Otitis media 7. QuizACOUSTIC NEUROMA/VESTIBULAR SCHWANNOMAACOUSTIC NEUROMA/VESTIBULAR SCHWANNOMA 1. Classic history: sensori-neural hearing loss, tinnitus, vertigo, cranial nerve dysfunction 2. Associated cranial nerve dysfunction: i. CN V: absent corneal reflex ii. CN VII: facial nerve palsy iii. CN VIII 3. DDX: Schwannoma, Aneurysm, Meningioma, Ependymoma 4. Ix: MRI Brain, Audiometry 5. Mx: Observe, Surgery, RadiotherapyBPPVBPPV 1. Sudden onset of dizziness and vertigo triggered by changes in head position (e.g. rolling over in bed or gazing upwards) 2. Associated with nausea 3. Each episode typically lasts 10-20 seconds 4. Relapses are common, so a history of recurrent vertiginous spells suggests BPPV. 5. Ix: Positive Dix-Hallpike manoeuvre - pathognomonic sign = rotatory nystagmus, which has fatiguability and short duration 6. Tx: Epley manouver, Anti-histamines, Anti-emetics, SurgeryHEARING LOSSMENIERE’S DISEASE 1. Excessive pressure and progressive dilation of the endolymphatic system 2. More common in middle-aged adults 3. Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss (low frequency, unilateral) 4. >2 spontaneous episodes of vertigo with each lasting 20 minutes to 12 hours 5. Sensation of aural fullness or pressure 6. Ix: Weber and Rinne’s test 7. Tx: ENT referral, inform DVLA, acute attacks: buccal or intramuscular prochlorperazine, prevention: betahistine and vestibular rehabilitation exercises, surgery, intratympanic steroid injectionsOTITIS EXTERNA 1. Acute otitis externa: <6 weeks duration; Pseudomonas aeruginosa or Staphylococcus aureus 2. Chronic otitis externa: >3 months; Aspergillus species (black balls) or Candida albicans (white strands) 3. Malignant otitis externa: DM + immunocompromised 4. Hx: Ear pain, discharge, itchy, swelling, redness, hearing loss, fever, risk factors 5. DDx: Contact dermatitis, Eczema, Seborrheic dermatitis 6. Tx: Ear hygiene, Topical Abx + steroid for 1 to 2 weeks, Remove debris, Topical anti-fungal drops 7. If the canal is extensively swollen, then an ear wick (Pope) is sometimes insertedOTITIS MEDIAOTITIS MEDIA 1. AOM, Persistent AOM, Recurrent AOM, ASOM, CSOM, OME 2. Causes: Viral, Bacterial, Congenital abnormalities, Immunodeficiences 3. Hx: Ear ache, hearing loss, discharge 4. Ix: Otoscopy +/- Tympanometry 5. Mx: Anti-biotics, Analgesia, Ear hygiene, ENT referral, SurgeryQUIZ – Q1 A 55-year-old woman presents with recurrent episodes of vertigo that are often triggered by a change in head position. Each episode lasts around 10-20 seconds and is associated with nausea is a stereotypical history of: 1. Meniere’s Disease 2. Viral labyrinthitis 3. Vestibular neuritis 4. BPPV 5. Basilar IschemiaQUIZ – Q2 For a patient with hearing loss, what do the following results suggest? (Air conduction = AC, Bone conduction = BC) Rinne result: BC > AC in left ear, AC > BC in right ear; Weber result: Lateralises to left 1. Left conductive HL 2. Normal hearing 3. Right conductive HL 4. Right SN HL 5. Left SN HLQUIZ – Q3 Elderly patient dizzy on extending neck in a question is most likely to indicate: 1. BPPV 2. Vertebro-basilar ischemia 3. VS 4. Viral labyrinthitis 5. Multiple SclerosisQUIZ – Q4 Mother brings in 5 year old child to GP saying that her son no longer responds to people saying his name. He is having to watch TV at a louder volume. Otoscopy shows fluid behind normal TM. How would you treat this? 1. Antibiotics 2. Antihistamines 3. Reassurance 4. ENT referral 5. SurgeryQUIZ – Q5 A 4 year old child comes to the GP practice with his mother, as she is concerned that he has been crying more than normal, tugging his ear and has a sniffly nose. Given conservative treatment haven’t worked, what is the most likely diagnosis and how will you treat it? 1. Flu → Tamiflu 2. Hissy fit → Consoling and reassurance 3. Acute otitis media → Antivirals 4. Acute otitis media → Anti-biotics 5. Malignant otitis externa → Hospital admissionTHANK YOU sayan.biswas@lthtr.nhs.uk