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Diabetes and ENT Ruhunu Clinical Society Lecture 2015 learnent.net

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Dr. M.T.D. Lakshan MBBS MS(Oto) DOHNS(Eng) FEB ORL-HNS (Europe) FRCSEd ORL-HNS (UK) Consultant ENT and Head and Neck Surgeon
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Page 1: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Dr. M.T.D. LakshanMBBS MS(Oto) DOHNS(Eng) FEB ORL-HNS (Europe)

FRCSEd ORL-HNS (UK) Consultant ENT and Head and Neck Surgeon

Page 2: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

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Hearing Loss

Sensorineural deafness in patients of type 2 diabetes mellitus in Uttar Pradesh: a pilot study

Vilas Misra, C G Agarwal, N Bhatia, G K Shukla Indian Journal of Otolaryngology and Head and Neck Surgery 2013, 65:

DM & ENT Hearing Loss

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Otitis Externa: Review and Clinical Update

J David Osguthorpe, David R Nielsen American Family Physician 2006 November 1, 74 (9): 1510-6

DM & ENT Fungal Otitis Externa

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DM & ENT Deep Neck Space Infections

Predisposing Factors of Complicated Deep Neck Infection: An Analysis of 158 Cases.

Lee J-K, Kim H-D, Lim S-C. Yonsei Medical Journal. 2007;48(1):55-62. doi:10.3349/ymj.2007.48.1.55.

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DM & ENT Fungal Sinusitis

Neuro-ophthalmology of invasive fungal sinusitis: 14 consecutive patients and a review of the literature

Matthew J Thurtell, et al Clinical & Experimental Ophthalmology 2013, 41 (6): 567-76

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DM & ENTVestibular Function

Characterization of Vestibulopathy in Individuals with Type 2 Diabetes Mellitus

Bryan K Ward et al Otolaryngology—Head and Neck Surgery 2015, 153 (1): 112-8

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DM & ENT Malignant Otitis Externa

Malignant otitis externa

Matthew J Carfrae, Bradley W Kesser Otolaryngologic Clinics of North America 2008, 41 (3): 537-49, viii-ix

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Hearing Loss

Fungal Otitis Externa

Malignant Otitis Externa

Fungal Sinusitis

Deep Neck Space Infections

Vestibular Function

DM & ENTlearnent.NET

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Malignant Otitis Externa

Fungal Sinusitis Deep Neck Space Infections

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Malignant Otitis Externa

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Malignant Otitis Externa

Necrotizing Otitis Externa

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InvestigationsSwab

PTA CT

Bone Scans EUA + Biopsy

Treatment

Quinolone 4 - 6W Surgery - limited role Hyperbaric Oxygen

Elderly Patient Excruciating Otalgia Lower cranial Nerve Palsies Granulations in the ear DM

Clinical Features

Necrotizing Otitis Externa

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Page 19: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

InvestigationsSwab

PTA CT

Bone Scans EUA + Biopsy

Treatment

Quinolone 4 - 6W Surgery - limited role Hyperbaric Oxygen

Elderly Patient Excruciating Otalgia Lower cranial Nerve Palsies Granulations in the ear DM

Clinical Features

Necrotizing Otitis Externa

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Page 20: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

InvestigationsSwab

PTA CT

Bone Scans EUA + Biopsy

Treatment

Quinolone 4 - 6W Surgery - limited role Hyperbaric Oxygen

Elderly Patient Excruciating Otalgia Lower cranial Nerve Palsies Granulations in the ear DM

Clinical Features

Necrotizing Otitis Externa

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Page 21: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Necrotizing Otitis Externa

90% Diabetics

Mortality 10 - 50%

Malignant Otitis Externa

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Malignant Otitis Externa

Fungal Sinusitis Deep Neck Space Infections

3

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Fungal Sinusitis

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Fungal Ball / Mycetoma Allergic Fungal Sinusitis

Chronic invasive non granulomatous

Chronic invasive granulomatous

Acute invasive

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Co-morbidity No Percentage

Diabetes 11 100%

Hypertension 3 27.2%

Hyperlipidemia 2 18.2%

Metabolic Acidosis 2 18.2%

IHD 1 11.1%

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Page 36: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Nasal Mass Orbital / Palatal

Intracranial DM

Other Immunodeficiency

Investigations

CT

EUA + Biopsy

Treatment

Systemic Anti-fungals Surgery

Clinical Features

Fungal Sinusitis

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Page 37: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Nasal Mass Orbital / Palatal

Intracranial DM

Other Immunodeficiency

Investigations

CT

EUA + Biopsy

Treatment

Systemic Anti-fungals Surgery

Clinical Features

Fungal Sinusitis

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Page 38: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Nasal Mass Orbital / Palatal

Intracranial DM

Other Immunodeficiency

Investigations

CT

EUA + Biopsy

Treatment

Systemic Anti-fungals Surgery

Clinical Features

Fungal Sinusitis

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~100% Diabetics

50-80% Mortality

Invasive Fungal Sinusitis

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Malignant Otitis Externa

Fungal Sinusitis Deep Neck Space Infections

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Deep Neck Space Infections

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1. Straight Spine

2. Wide RPS

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Complications

Airway Obstruction

Airway Soiling

Septic Thrombosis

Carotid Artery

RuptureMediastinitis

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Neck Lump Fever

Odynophagia Stridor

DM Other

Immunodeficiency

Investigations

FBC, ESR/CRP CT

Culture ABST

Treatment

Systemic Antibiotics Surgery

Clinical Features

DNSI

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Page 50: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Neck Lump Fever

Odynophagia Stridor

DM Other

Immunodeficiency

Investigations

FBC, ESR/CRP CT

Culture ABST

Treatment

Systemic Antibiotics Surgery

Clinical Features

DNSI

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Page 51: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Neck Lump Fever

Odynophagia Stridor

DM Other

Immunodeficiency

Investigations

FBC, ESR/CRP CT

Culture ABST

Treatment

Systemic Antibiotics Surgery

Clinical Features

DNSI

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Page 52: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

DMCommonest

Systemic Disease

Complicated ICU/

Hospital Stay Risk

DNSI

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Page 53: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Hearing Loss

Fungal Otitis Externa

Malignant Otitis Externa

Fungal Sinusitis

Deep Neck Space Infections

Vestibular Function

DM & ENTlearnent.NET

Page 54: Diabetes and ENT  Ruhunu Clinical Society Lecture 2015  learnent.net

Malignant Otitis Externa

DNSIFungal Sinusitis

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MTD Lakshan learnent.net

@mtdlakshan [email protected]


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