STANDARD TREATMENT PROTOCOLS FOR E.N.T. DISEASES

(FOR RURAL HOSPITALS, BPHC & PHC)

DEAFNESS-EARLY DETECTION IN CHILDRENAT BIRTH- AUROPALPEBRAL REFLEX & STARTLE REFLEX

AT 3 MONTHS- BLINKING & FROWNING IN RESPONSE TO SOUND

AT 5 MONTHS- EYE TURNING TO SOUND SOURCE

AT 6 MONTHS- HEAD TURNING TO SOUND SOURCE

AT 10-12 MONTHS- SOUND IDENTIFICATION AT ANY PLANE & TRIES TO SAY 1 OR 2 WORDS

OVER 2 YEARS- CAN COMPLY TO REQUESTS & DEMANDS

BETWEEN 2-5 YEARS- CAN PERFORM SOMETHING/ COMPREHEND

ACUTE SUPPURATIVE OTITIS MEDIA: C/F

EXCESSIVE CRYING AT NIGHT

SEVERE THROBBING EAR PAIN

PYREXIA OF UNKNOWN ORIGIN WITH NAUSEA/ VOMITING

DEAFNESS OR RARELY AUTOPHONY

BLOOD STAINED MUCOID DISCHARGE

CONGESTED/ BULGED T.M. WITH/ WITHOUT PERFORATION

COUGH & COLD WITH FEVER (ASSOCIATED/ WITHIN A WK)

ACUTE SUPPURATIVE OTITIS MEDIA: TREATMENT

ANY EAR DROP IS CONTRA-INDICATED WHEN THERE IS NO PERFORATION OR OTOMYCOSIS

DRY HOT FOMENTATION/ DRY MOPPING OF DISCHARGE IF PRESENT

STEAM INHALATION IN URTI

PARACETAMOL FOR FEVER/ IBUPROFEN FOR PAIN (15-20 mg/kg)

AMOXYCILLIN OR CEPHALEXIN (20-40 mg/kg IN DIVIDED DOSES)

XYLOMETAZOLINE (0.1 %-ADULTS & 0.05 %-CHILDREN)

OTOTOXIC DRUGS

AMINOGLYCOSIDES (STREPTOMYCIN & GENTAMICIN-VERTIGO, REST-DEAFNESS/ TINNITUS)

DIURETICS

QUININE & CHLOROQUINE

SALICYLATES

ANTI-CANCER DRUGS

OTOTOXIC DRUGS (CONT.)

PARENTERAL ADMINISTRATION IS MORE VULNERABLE

IN PREGNANCY THESE DRUGS MAY PASS THE PLACENTAL BARRIER TO AFFECT

THE FOETUS. SO EITHER AVOID OR IF NO OTHER OPTION THEN DISCONTINUE

WHEN OTOTOXICITY OCCURS

BLEEDING PER EAR

EAR CANAL INJURY

T.M. RUPTURE

HEAD INJURY WITH/ WITHOUT TEMPORAL BONE FRACTURE

AURAL GRANULATION OR GROWTH

TREATMENT: DO NOT PACK THE EAR

AVOID EAR DROPS & OIL/ WATER ENTRY

PARACETAMOL/ IBUPROFEN

AMOXYCILLIN/ CEPHALEXIN

NASAL POLYPS

INFLAMMATORY POLYP: ANTROCHOANAL & ETHMOIDAL

FUNGAL POLYP: RHINOSPORIDIOSIS

OTHER SWELLINGS APPEARING AS POLYPS: HYPERTROPHIED INFERIOR TURBINATE,

NASAL ANGIOMA, ANGIOFIBROMA, INVERTED PAPILLOMA, CARCINOMA,

MENINGOCELE, ENCEPHALOCELE, MENINGO-ENCEPHALOCELE

NASAL POLYPS (CONT.)NASAL OBSTRUCTION

SNEEZING

NASAL DISCHARGE

HYPOSMIA/ ANOSMIA

HEADACHE/ FACIAL PAIN

OCC. EPISTAXIS

TREATMENT: MOSTLY SURGICAL (FUNCTIONAL ENDOSCOPIC SINUS SURGERY)

ACUTE SINUSITIS (< 6 WKS)NASAL OBSTRUCTION WITH DISCHARGE

SEVERE HEADACHE/ FACIAL PAIN

FEVER

UNPLEASANT TASTE/ POST-NASAL DRIP

OCC. EPISTAXIS

TREATMENT: AMOXYCILLIN/ CIPROFLOXACIN

PARACETAMOL

CETIRIZINE/ LEVOCETIRIZINE

XYLOMETAZOLINE NASAL DROPS

CHRONIC SINUSITIS (> 6 WKS)NASAL OBSTRUCTION

DULL HEADACHE/ FACIAL PAIN

REPEATED HAWKING/ CLEARING OF THROAT

BLOCKING SENSATION OF THE EARS

INTERMITTENT HOARSENESS

TREATMENT: ORAL HYGIENE

NORMAL SALINE SPRAYS/ DROPS

ANTIBIOTICS

IF PERSISTING- SURGERY (FESS)

PATCH OVER TONSILS

ACUTE FOLLICULAR TONSILLITIS

FAUCEAL DIPHTHERIA (GREYISH WHITE PATCH, PSEUDO-MEMBRANE, TOXIC PATIENT & CERVICAL

LYMPHADENOPATHY. ALBERT STAINING. ANTI-DIPHTHERITIC SERUM 20,000-1,00,000 IU)

AGRANULOCYTOSIS (RELATIVE LYMPHOCYTOSIS)

INFECTIOUS MONONUCLEOSIS (EBV)

LEUKAEMIA/ SQUAMOUS CELL CA

VINCENT’S/ RARELY LUDWIG’S ANGINA

TRACHEOSTOMY

TRAUMA TO NECK & CHEST

CUT THROAT INJURY

LARYNGEAL GROWTH

SEVERE LARYNGEAL INFECTION

DIPHTHERIA

ACUTE LARYNGO-TRACHEO-BRONCHITIS IN CHILDREN

TRACHEOSTOMY (CONT.)WHENEVER YOU THINK OF TRACHEOSTOMY, DO IT

NEEDS 3 D CONSENT (DEATH BEFORE, DURING OR AFTER SURGERY)

VERTICAL MIDLINE INCISION FROM CRICOID TO SUPRASTERNAL NOTCH IN EXTENDED NECK POSITION

USUALLY DONE UNDER LOCAL ANAESTHESIA

THYROID ISTHMUS IS RETRACTED UPWARDS

OPENING DONE OVER 3RD & 4TH TRACHEAL RINGS

MOSTLY METALLIC TUBES ARE USED

TUBE IS FIXED TO THE NECK WITH TAPES

FOREIGN BODY THROAT

FISH BONE- COMMONEST F.B. BUT FOUND IN 60 % OF CASES ONLY (MANUAL PALPATION NEEDED)

TONSILS- MOST COMMON SITE

MOST OF THE FISH BONES, ARTIFICIAL DENTURES & PLASTIC MATERIALS ARE RADIO-LUCENT

RECENT SKIAGRAMS ARE NECESSARY

LATERAL VIEW IS MORE INFORMATIVE

MAY NEED I/L, D/L OR FOL FOR REMOVAL

MAY NEED BRONCHOSCOPY

MESSAGE CONGENITAL DEAFNESS SUSPICION INTRACTABLE VERTIGO- LABYRINTHITIS, CSOM,RTA, BPPV CSOM WITH INTRACRANIAL COMPLICATION, FACIAL PALSY BLEEDING EAR WITH FACIAL PALSY IN CHILD/ADULT UNILATERAL SNHL IN ADULTS INTRACTABLE EPISTAXIS ADULTS/ YOUNG, (JNA) IMPACTED OLD/RARE FB, LEECH & MAGGOT IN NOSE & NASOPHARYNX, TRACHEA RTA WITH CSF LEAK UNEXPLAINED HEADACHE & FACIAL PAIN, HEMIFACIAL SPASM HEAD NECK TUMORS, SUSPECTED LYMPHOMAS ORBITAL CELLULITIS & TUMORS UNEXPLAINED DYSPHAGIA, HOARSENESS, TRISMUS, STRIDOR IN CHILD CHRONIC DACRYOCYSTITIS, LACRIMAL CYSTS & ABSCESS NECK SPACE INFECTON MISCELLANEOUS

AWARENESS IN INDISCRIMINATE USE OF STEROID, ND