ENT WORKSHOP

DR NICHOLAS STOW

ENT SURGEON

AIMS

vertigo tips

epistaxis tips

quinsy drainage

foreign body

ear pain & otowick

VERTIGO - TIPS

EAR DIZZINESS

45% of dizziness = peripheral vestibulopathy

characterised by:

• vertigo = illusion of rotatory movement

• nausea & vomiting

• prostration

ALL exacerbated by head movement

DIZZY HISTORY

1.single or multiple episodes or constant?

2.EAR: hearing loss, tinnitus, ear pressure?

3. lasts seconds S, minutes M, hours H, days D?

does it happen in bed?

NEURO: headache, cranial nerve signs?

SINGLE EPISODE

VERTIGO

EAR SYMPTOMS?

YES NO

Meniere’s disease (M-H) BPPV (S)

Labyrinthitis (H-D) Vestibular neuronitis (H-D)

(Perilymph fistula) Brainstem CVA (H-D)

MULTIPLE EPISODE

VERTIGO

EAR SYMPTOMS?

YES NO

Meniere’s disease (M-H) BPPV (S)

(Superior SCC Dehisence) Migraine (M-H)

CONSTANT

IMBALANCE

EAR SYMPTOMS?

YES NO

Acoustic neuroma Non-vestibular

Burnt-out Meniere’s Vestibular failure

Superior SCC Dehisence - recovering unilateral

Perilymph fistula - bilateral

BPPV

3 semicircular canals

commonest BPPV

= posterior canal

DIAGNOSTIC:

• Dix-Hallpike manoeuvre

THERAPEUTIC:

• Modified Epley manoeuvre

• Semont manoeuvre

Modified Epley

Dix-

Hallpike

Semont

EPISTAXIS

FIRST AID

Rest

Ice to forehead or neck

Compression of nasal tip for 15 minutes

Elevation of head

HISTORY

right or left?

anterior or posterior?

recent nasal surgery?

NOSE: blockage, rhinorrhoea, postnasal drip

SYSTEMIC: medications, blood, liver, alcohol?

TREATMENT

ANTERIOR

cophenylcaine-soaked cotton ball to nostril

compression of nasal tip for 15 minutes

Bleeding stopped Bleeding ongoing

• Suction & cautery Anterior pack

CAUTERY

cophenylcaine spray to septum

roll silver nitrate stick

start peripheral and finish on central vessel

one side of septum only (risk of perforation if

both sides done at once)

TREATMENT

POSTERIOR

posterior and anterior pack

antibiotics while pack is in

POST DISCHARGE

CARE

no nose-blowing or straining for 2 weeks

saline sprays bd to both nostrils

vaseline ointment bd to both nostrils

medication management

nasendoscopy in 2 weeks

QUINSY

QUINSY DRAINAGE

cophenylcaine spray - 15 sprays = maximal

2 wooden tongue depressors

21 G needle on 10ml syringe

puncture above tonsil in soft palate

aspirate as you insert in posterior direction

(carotid artery lies 2cm lateral)

FOREIGN BODIES -

TIPS

FOREIGN BODY

REMOVAL

1) LOCATE - LIGHT & ACCESS

head light

ear or nasal speculum / tongue depressor

cophenylcaine spray in nose / mouth

mouth - tonsils, base of tongue,

nasendoscopic view of pharynx

FOREIGN BODY

REMOVAL

2) REMOVE - INSTRUMENT SELECTION

micro ear hook - spherical FB in small space

wax curette / Jobson Horne probe - general

micro ear forceps (Alligator) - flat FB

Magill’s forceps - oral FB

EAR PAIN & OTOWICK

EAR PAIN

OUTER EAR

otitis externa (edematous canal, tender tragus)

- non-occlusive or occlusive

cellulitis of pinna (entire ear inflamed)

perichondritis (inflammation spares ear lobule)

Herpes Zoster (vesicles on ear)

EAR PAIN

MIDDLE EAR

acute otitis media (red TM)

bullous myringitis (blisters on TM)

OTOWICK INSERTION

for occlusive otitis externa

lubricate otowick with chlorsig

pull ear back and up +/- ear speculum

insert otowick with micro ear (Alligator) forceps

& headlight

add antibiotic drops

QUESTIONS