history ears otorrhoea otalgia itch hearing tinnitus balance noses nasal obstruction rhinorrhoea facial pain smell epistaxis post nasal drip throats dysphagia dysphonia odynophagia pain neck lumps weight loss

common nose mistakes

Case

rhinitis vs polyps rhinitis with inflamed turbinates vs nasal polyps polyps more likely with asthma and anosmia

audiograms

normal audiogram

normal audiogram Normal hearing

tinnitus

case

tinnitus 67 year old woman tinnitus for 6 months, getting worse anxious hearing not problem

audiometry

tinnitus hearing loss compatible with aging

tinnitus treatment?

tinnitus treatment? distraction hearing aids tinntius therapy CBT

tinnitus treatment? distraction hearing aids tinntius therapy CBT the truth is there is no treatment which can cure tinnitus

tinntius MRC, 2000 (Davis 2000) longitudinal study of 48,313 people; 10.1% described tinnitus arising spontaneously and lasting for five or more minutes at a time and 5% described it as moderately or severely annoying However, only 0.5% reported tinnitus having a severe effect on their life

tinntius tinnitus which severely affects people, such people will often have other life stress events or psychological issues

nasal polyps

nasal examination

nasal polyps - treatment medical steroids surgical polypectomy

case – ear not getting better

41 year old male right otorrhoea 6 weeks itch foul smelling reduced hearing treated with several courses of gentisone

Diagnosis? fungal otitis externa

Otitis externa itch otorrhoea previous or recurrent symptoms

Otitis externa treatment?

Otitis externa treatment? nothing medical aural toilet antifungal medication needs to be used for at least 14 days

new techniques

Balloon sinuplasty can be used for frontal sinus where access would otherwise be difficult

sudden hearing loss emergencies

64 year old woman presents 2 day history of hearing loss in the right ear Most experts would define sudden sensorineural hearing loss as an inner ear loss of at least 30dB, over 3 contiguous frequencies, occurring over a period of anything up to a few days.

64 year old woman presents 2 day history of hearing loss in the right ear what do you ask? Most experts would define sudden sensorineural hearing loss as an inner ear loss of at least 30dB, over 3 contiguous frequencies, occurring over a period of anything up to a few days.

But, in the catastrophic situation, both ears can be affected..

sudden sensorineural loss definition at least 30dB hearing loss over 3 contiguous frequencies a period of a few hours to 3 days Most experts would define sudden sensorineural hearing loss as an inner ear loss of at least 30dB, over 3 contiguous frequencies, occurring over a period of anything up to a few days.

sudden sensorineural loss incidence 5 – 20 per 100 000 people per year 1 in 10 000 people per year 0.01% people per year Most experts would define sudden sensorineural hearing loss as an inner ear loss of at least 30dB, over 3 contiguous frequencies, occurring over a period of anything up to a few days.

sudden sensorineural loss typical patient 40 – 50 years M=F 30% have balance symptoms Most experts would define sudden sensorineural hearing loss as an inner ear loss of at least 30dB, over 3 contiguous frequencies, occurring over a period of anything up to a few days.

sudden sensorineural loss aetiology? There are many potential causes for sensorineural hearing loss of sudden onset. The treatment of hearing loss due to a cerebello-pontine angle tumour is clearly very different to treatment of an auto-immune hearing loss (if such an entity actually exists).

sudden sensorineural loss Infection Bacterial postmeningitis, bacterial labyrinthitis, syphilis Viral mumps, cytomegalovirus Inflammation Autoimmune Cogan’s syndrome, systemic lupus erythematosus Multiple sclerosis Trauma Temporal bone fracture Acoustic trauma Perilymph fistula Tumor CPA tumour Temporal bone metastasis Carcinomatosis meningitis Toxins Aminoglycosides Aspirin Vascular Thromboembolism Macroglobulinemia, sickle cell disease, post-CABG, vasculitides There are many potential causes for sensorineural hearing loss of sudden onset. The treatment of hearing loss due to a cerebello-pontine angle tumour is clearly very different to treatment of an auto-immune hearing loss (if such an entity actually exists).

sudden sensorineural loss Infection Bacterial postmeningitis, bacterial labyrinthitis, syphilis Viral mumps, cytomegalovirus Inflammation Autoimmune Cogan’s syndrome, systemic lupus erythematosus Multiple sclerosis Trauma Temporal bone fracture Acoustic trauma Perilymph fistula Tumor CPA tumour Temporal bone metastasis Carcinomatosis meningitis Toxins Aminoglycosides Aspirin Vascular Thromboembolism Macroglobulinemia, sickle cell disease, post-CABG, vasculitides Here I am going to confine myself to the treatment of sudden sensorineural hearing loss

sudden sensorineural loss Infection Bacterial postmeningitis, bacterial labyrinthitis, syphilis Viral mumps, cytomegalovirus Inflammation Autoimmune Cogan’s syndrome, systemic lupus erythematosus Multiple sclerosis Trauma Temporal bone fracture Acoustic trauma Perilymph fistula Tumor CPA tumour Temporal bone metastasis Carcinomatosis meningitis Toxins Aminoglycosides Aspirin Vascular Thromboembolism Macroglobulinemia, sickle cell disease, post-CABG, vasculitides where the aetiology is uncertain. There have been many hypotheses advanced to explain the aetiology of sensorineural hearing loss of sudden onset: viral, vascular, allergic, rupture of intralabyrinthine membranes, local histamine production and autoimmune disease are just some theories, but in about three quarters of cases the cause of this condition is unknown and no clear diagnosis is ever made.

topical papers where the aetiology is uncertain. There have been many hypotheses advanced to explain the aetiology of sensorineural hearing loss of sudden onset: viral, vascular, allergic, rupture of intralabyrinthine membranes, local histamine production and autoimmune disease are just some theories, but in about three quarters of cases the cause of this condition is unknown and no clear diagnosis is ever made.

stroke and SSNHL Stroke. 2008 Oct;39(10):2744-8. Epub 2008 Jun 26. Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Lin HC, Chao PZ and Lee HC CONCLUSIONS: Our findings suggest that SSNHL can be an early warning sign of impending stroke. We suggest that SSNHL patients should undergo a comprehensive hematologic and neurological examination to help clinicians identify those potentially at risk for stroke developing in the near future. Carbogen, a mixture of carbon dioxide and oxygen. If I was being sceptical about any of these, equally good contenders for treatment, I would ask where was the evidence for treatment?

otitis externa and mastoiditis emergencies

otitis externa & mastoiditis how to tell the difference? history examination

otitis externa & mastoiditis how to tell the difference? URTI unwell Pyrexia (or history) discharge

how to tell the difference? mastoiditis otitis externa URTI unwell pyrexia (or history) discharge position of pain swelling mastoid swelling in ear canal ear drum longer history past history not systemically unwell itch position of pain discharge both ears swelling in ear canal ear drum