ENT treatments Flashcards
cholesteatoma
surgery
otosclerosis
1st line - hearing aid
stapedectomy, CO2 laser, cochlear implant
treatment of OME (glue ear) in < 3 year olds
grommets
treatment of OME (glue ear) in > 3 year olds 1st episode
grommets
treatment of OME (glue ear) in > 3 year olds 2nd episode
grommets and adenoidectomy
presbycusis
hearing aid
ix vestibular schwannoma
contrast MRI of cerebellopontine angle
tx vestibular schwannoma
watchful waiting
radiotherapy
surgical excision
ix if persistent unilateral otitis externa
biopsy - may be maligancy
tx mild otitis externa
topical acetic acid (OTC) + topical antibiotic +/- topical steroid
tx moderate otitis externa
topical otomize (dexamethasone + neomycin + acetic acid)
are swabs usually taken in otitis externa
no - only in non-resolving cases
tx otitis externa that is spreading despite treatment
oral flucloxicillin
tx malignant otitis externa
refer urgently to ENT and IV ciprofloxacin
1st line treatment in acute otitis media
rest analgesia and fluids - usually self limiting
when are antibiotics given in acute otitis media
o >4 days or not improving
o Systemically unwell
o Younger than 2 years old with bilateral OM and marked symptoms
o Otitis media with perforation
o Immunocompromise or high risk of complications due to significant heart/lung/kidney/liver/neuromuscular disease
antibiotic of choice in acute otitis media if being given
500mg Amoxicillin TDS 5-7 days
2nd line antibiotic of choice in acute otitis media if being given
500mg Clarithromycin or erythromycin TDS 5 days
tx ruptured tympanic membrane
majority heal on own, review in 6-8 weeks
if fails to heal - myringoplasty
tx mastoiditis
IV tazocin +/- mastoidectomy
tx epiglottitis/supraglottitis
IV ceftriaxone
tx acute attack menieres
buccal or IM prochlorperazine
tx preventing menieres
beta histine and vestibular rehabilitation exercises
life style advice for menieres
reduce salt, alcohol, caffeine and stress
dx BPPV
dix hallpike - rotational nystagmus
tx BPPV
epley
teach patient exercises to do at home
tx vestibular neuronitis
- buccal or IM prochlorperazine for rapid relief
- short course oral prochlorperazine or antihistamine
tx chronic vestibular neuronitis
vestibular rehab exercises
tx labyrinthitis
prochlorperazine or antihistamine may help
what nystagmus is seen in labyrinthitis and vestibular neuronitis
horizontal
1st line nose bleed treatment haemodynamically stable
first aid measures:
sit forward and mouth open
pinch cartilaginous area of nose firmly for 20 mins
breath through mouth
o Avoid blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks
2nd line nose bleed treatment
naseptin cream (chlorhexidine and neomycin)
when is naseptin contraindicated
peanut soy or neomycin allergy
what is an alternative to naseptin cream in peanut allergy
mupirocin