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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.

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  1. 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

  2. common nose mistakes

  3. Case

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

  5. audiograms

  6. normal audiogram

  7. normal audiogram Normal hearing

  8. tinnitus

  9. case

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

  11. audiometry

  12. tinnitus • hearing loss compatible with aging

  13. tinnitus • treatment?

  14. tinnitus • treatment? • distraction • hearing aids • tinntius therapy • CBT

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

  16. 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

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

  18. nasal polyps

  19. nasal examination

  20. nasal polyps - treatment medical steroids surgical polypectomy

  21. case – ear not getting better

  22. 41 year old male • right otorrhoea 6 weeks • itch • foul smelling • reduced hearing • treated with several courses of gentisone

  23. Diagnosis? • fungal otitis externa

  24. Otitis externa • itch • otorrhoea • previous or recurrent symptoms

  25. Otitis externa • treatment?

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

  27. new techniques

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

  29. sudden hearing lossemergencies

  30. 64 year old woman presents 2 day history of hearing loss in the right ear

  31. 64 year old woman presents 2 day history of hearing loss in the right ear what do you ask?

  32. sudden sensorineural loss definition at least 30dB hearing loss over 3 contiguous frequencies a period of a few hours to 3 days

  33. sudden sensorineural loss incidence 5 – 20 per 100 000 people per year 1 in 10 000 people per year 0.01% people per year

  34. sudden sensorineural loss typical patient 40 – 50 years M=F 30% have balance symptoms

  35. sudden sensorineural loss • aetiology?

  36. 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

  37. 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

  38. sudden sensorineural loss • Infection • Bacterial postmeningitis, bacterial • labyrinthitis, syphilis • Viralmumps, 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

  39. topical papers

  40. 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. stroke and SSNHL

  41. otitis externa and mastoiditisemergencies

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