Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi guys, there's anybody there at the moment. So, can you guys hear me? Perfect. So, we'll wait a little bit longer, then we'll make a start. Um, I've got a few slides to go through with you and some SBA S basically throughout. So it's probably quite good prep for your exams. Um, just sort of let me know in the chat if you're P year, f year, t year and just interested and I'll try and gauge it appropriately. Ok. So p uh, one of your exams? Ok, mid June. So you got a while. Um, Ent doesn't make up a huge part of your exams, but it's easy marks. So it's good to know it. Um, and in my pe Os there was an Ent station so it was probably worth paying attention. Fine. So I think we'll make a start. Um, if people join they'll no join halfway through. But, ok, uh, hang on just trying to work out how I can see the chat and this at the same time. Ok. Can you guys see the slides? At least when I share it like this, I can't see the chat but I'll stop sort of every now and then to, to make sure you can see the slides. Just let me know in the chat. If you can see this, I'll try and open it on my phone as well. Ok. So you can't see them at the moment. How about now? Can you see a slide now? Yes, we can see them now. Yeah. Great. Perfect. So, I'm Will, I'm one of the SF PF ones at Norfolk and Norwich. Um I'm doing my academic blocking E ENT next year, but at the moment I'm doing quite a bit of research with the team. Um My email address is here if you have any questions and I'll get a surgical. So to send out the slides, if you've got any questions at any point, I've got the chat open on my phone as well. So just let me know um as we go. So this session's on ears, we're gonna look at dizziness and vertigo to start with. Um, we're gonna look at hearing loss and audiograms to some extent. I'm saving more about the audiograms for the AUS prep at the end the last session. Um We'll look at otalgia, what can cause it and types of ears in ear infections and we'll look at foreign bodies in the ear as well. So all of this is taken from um all this is taken from stuff from the NLA syllabus. So dizziness and vertigo is the first topic to look at dizziness is a really broad term, it encompasses lightheadedness, unsteadiness, and to some extent of vertigo, vertigo. On the other hand, is the sensation that the room is spinning around you. So when you're asking questions in your history, make sure you're always asking if you feel dizzy, what are you actually experiencing? Are you lightheaded or does it feel like the room is moving around you? So that leads us on to a question. So this is the first question if you wanna pop your answers in the chat. Um And once I've got a few answers coming through, I'll move on to the next slide. So you got a 39 year old female who presents to the GP with constant dizziness since waking this morning, her hearing is unaffected. She has a one week history of an anti cries or symptoms. What's the most likely diagnosis? Ok. So we've got one person going to see anyone else brave enough to pop an answer in the chat for this one. So you've got an E, I'll give you a couple more seconds and then we'll go through the answer and why it's why it is what it is. Ok. So the answer to this one is vestibular neuronitis. Now, there's a few things in this question that are important. So it's acute dizziness, first of all. So it's unlikely to be an acoustic neuroma. Her hearing is unaffected, which rules out labyrinthitis in men. E BPPV is a possible and vestibular neuronitis is a possible. However, given the fact that she's had recent cold like symptoms, vestibular neuronitis is more likely. So the way that you can approach questions like this and the way that I approach them is first of all, to ask myself, is there hearing loss? Yes or no? If there is hearing loss, you then ask yourself whether it's hearing loss and associated with episodic dizziness or vertigo or constant dizziness and vertigo, you then ask yourself the same question. If it's no, if you have hearing loss and you've got episodic dizziness and ver episodic dizziness or vertigo, it's likely to be many air and we'll go through it in a second as to why if it's constant dizziness and vertigo associated with hearing loss, it's labyrinthitis or an acoustic neuroma. In most cases, if there's no hearing loss and the dizziness will that to go is episodic. It's likely BPPV. And if you have constant dizziness and vertigo that's associated with hearing l with no hearing loss. And then it's vestibular neuronitis like it was in that question. OK. So I'll make sure the slides get sent out. So you can have a look at this properly. We're gonna go through each of those pathologies one by one. Now. So, acoustic neuroma is the first one and it's a benign tumor that's arising from Craner eight of the vestibular cochlear nerve. The tumors tend to be at the cerebellopontine angle and there's a lot of other structures that run within that area. And it explains some of the symptoms that you get. So you get uh you can get compression of cranial nerve five, the trigeminal nerve. So you get weakness, um you know, the masticatory muscles potentially, but it's more often than not the sensory division that's affected. So you'll get loss of sensation over the face and cranial nerve seven can be compressed leading to facial nerve weakness on that side. The investigation of choice for an acoustic neuroma is an MRI of the internal acoustic meatus. And management can be either observation if it's small radiotherapy or surgery if it's causing problems. And this is just showing you where the tumor arises. So the cere, the cerebellopontine angle sits around here, you'll have the tumor growing from the vestibular cochlear nerve down here.