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Common Urgent ENT Problems APRIL 4, 2019 GERARD MACDONALD MD FRCS
3/21/2019 Common Urgent ENT Problems APRIL 4, 2019 GERARD MACDONALD MD FRCS 1 Course Objectives A review of common Urgent ENT problems presenting to office and ER Clinical Pearls to help you manage in a timely fashion Knowing when to refer 2 1 3/21/2019 I do not have any Conflicts of Interest 3 Top Ten List Of Urgent Calls 1.Acute Otitis Externa 2. Sudden Hearing Loss 3.Facial Palsy 4.Salivary Gland Stone /Infection 5.Peritonsillar Abscess 6.Neck Abscess 7.Nosebleeds 8.Hoarseness 9.Foreign Bodies Ear/Nose 10. Acute Vertigo 4 2 3/21/2019 Acute Otitis Externa Commonly associated with swimming ( swimmer’s ear) Common in diabetics and habitual Q-tip Users Usual presenting symptoms are itching, discharge, pain and swelling. More severe symptoms can include severe pain, parotid swelling,trismus and cellulitiis Most common organism is Pseudomonas Aeruginosa May go on to develop secondary otomycosis if frequent use of topical antibiotics. Malignant External Otitis rare but serious 5 Acute Otitis Externa 6 3 3/21/2019 Acute Otitis Externa - Treatment Debridement/Suctioning ? Culture Avoid syringing Ototopicals : Tobradex, Sofracort, Ciprodex Otowick if canal swollen shut Oral Antibiotic ( Cipro ) and single dose Steroid if severe When to refer : Unrelenting pain and swelling, facial nerve weakness,dysphagia , fever 7 Sudden hearing Loss UNEXPLAINED sudden sensorineural hearing loss occurring over 3 days Not AOM, trauma, acoustic trauma , ototoxicity Often confused with ETD , “fluid” Poorer outcome if not recognized -
NOISE and MILITARY SERVICE Implications for Hearing Loss and Tinnitus
NOISE AND MILITARY SERVICE Implications for Hearing Loss and Tinnitus Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present Medical Follow-up Agency Larry E. Humes, Lois M. Joellenbeck, and Jane S. Durch, Editors THE NATIONAL ACADEMIES PRESS Washington, DC www.nap.edu THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Insti- tute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. V101(93)P-1637 #29 between the Na- tional Academy of Sciences and the Department of Veterans Affairs. Any opinions, find- ings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Noise and military service : implications for hearing loss and tinnitus / Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present, Medical Follow- up Agency ; Larry E. Humes, Lois M. Joellenbeck, and Jane S. Durch, editors. p. ; cm. Includes bibliographical references. ISBN 0-309-09949-8 — ISBN 0-309-65307-X 1. Deafness—Etiology. -
Deafness and Hearing Loss Caroline’S Story
Deafness and Hearing Loss Caroline’s Story Caroline is six years old, A publication of NICHCY with bright brown eyes and, at Disability Fact Sheet #3 June 2010 the moment, no front teeth, like so many other first graders. She also wears a hearing aid in each ear—and has done so since she was three, when she Caroline was immediately Hearing Loss was diagnosed with a moderate fitted with hearing aids. She in Children hearing loss. also began receiving special education and related services Hearing is one of our five For Caroline’s parents, there through the public school senses. Hearing gives us access were many clues along the way. system. Now in the first grade, to sounds in the world around Caroline often didn’t respond she regularly gets speech us—people’s voices, their to her name if her back was therapy and other services, and words, a car horn blown in turned. She didn’t startle at her speech has improved warning or as hello! noises that made other people dramatically. So has her vocabu- jump. She liked the TV on loud. lary and her attentiveness. She When a child has a hearing But it was the preschool she sits in the front row in class, an loss, it is cause for immediate started attending when she was accommodation that helps her attention. That’s because three that first put the clues hear the teacher clearly. She’s language and communication together and suggested to back on track, soaking up new skills develop most rapidly in Caroline’s parents that they information like a sponge, and childhood, especially before the have her hearing checked. -
Acoustic Trauma and Hyperbaric Oxygen Treatment
Acoustic Trauma and Hyperbaric Oxygen Treatment Mesut MUTLUOGLU Department of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Haydarpasa Teaching Hospital 34668, Uskudar, Istanbul TURKEY [email protected] ABSTRACT As stated in the conclusions of the HFM-192 report on hyperbaric oxygen therapy (HBOT) in military medical setting, acoustic trauma is a frequent consequence of military activity in operation. Acoustic trauma refers to an acute hearing loss following a single sudden and very intense noise exposure. It differs from chronic noise induced hearing (NIHL) loss in that it is usually unilateral and causes sudden profound hearing loss. Acoustic trauma is a type of sensorineural hearing loss affecting inner ear structures; particularly the inner and outer hair cells of the organ of Corti within the cochlea. Exposure to noise levels above 85 decibel (dB) may cause hearing loss. While long-term exposure to repetitive or continuous noise above 85 dB may cause chronic NIHL, a single exposure above 130-140 dB, as observed in acoustic trauma, may cause acute NIHL. The loudest sound a human ear may tolerate without pain varies individually, but is usually around 120dB. Military personnel are especially at increased risk for acoustic trauma due to fire arm use in the battle zone. While a machine gun generates around 145dB sound, a rifle generates 157- 163dB, a 105 mm towed howitzer 183dB and an improvised explosive device around 180dB sound. Acoustic trauma displays a gradually down-slopping pattern in the audiogram, particularly after 3000Hz and is therefore described as high-frequency hearing loss. Tinnitus is almost always associated with acoustic trauma. -
ICD-9 Diseases of the Ear and Mastoid Process 380-389
DISEASES OF THE EAR AND MASTOID PROCESS (380-389) 380 Disorders of external ear 380.0 Perichondritis of pinna Perichondritis of auricle 380.00 Perichondritis of pinna, unspecified 380.01 Acute perichondritis of pinna 380.02 Chronic perichondritis of pinna 380.1 Infective otitis externa 380.10 Infective otitis externa, unspecified Otitis externa (acute): NOS circumscribed diffuse hemorrhagica infective NOS 380.11 Acute infection of pinna Excludes: furuncular otitis externa (680.0) 380.12 Acute swimmers' ear Beach ear Tank ear 380.13 Other acute infections of external ear Code first underlying disease, as: erysipelas (035) impetigo (684) seborrheic dermatitis (690.10-690.18) Excludes: herpes simplex (054.73) herpes zoster (053.71) 380.14 Malignant otitis externa 380.15 Chronic mycotic otitis externa Code first underlying disease, as: aspergillosis (117.3) otomycosis NOS (111.9) Excludes: candidal otitis externa (112.82) 380.16 Other chronic infective otitis externa Chronic infective otitis externa NOS 380.2 Other otitis externa 380.21 Cholesteatoma of external ear Keratosis obturans of external ear (canal) Excludes: cholesteatoma NOS (385.30-385.35) postmastoidectomy (383.32) 380.22 Other acute otitis externa Excerpted from “Dtab04.RTF” downloaded from website regarding ICD-9-CM 1 of 11 Acute otitis externa: actinic chemical contact eczematoid reactive 380.23 Other chronic otitis externa Chronic otitis externa NOS 380.3 Noninfectious disorders of pinna 380.30 Disorder of pinna, unspecified 380.31 Hematoma of auricle or pinna 380.32 Acquired -
Hearing Impairment Sheet
Oklahoma State Department of Education Special Education Services • 405-521-3351 • www.ok.gov/sde/special-education FACT HEARING IMPAIRMENT SHEET ■ Definition of Intellectual POSSIBLE CAUSES Disabilities under IDEA • Acquired, meaning that the loss occurred after birth, Hearing impairment means an impairment in hearing, due to illness or injury; or whether permanent or fluctuating, that adversely affects • Congenital, meaning that the hearing loss or deafness a child’s educational performance. 34 CFR 300.8(c)(5) was present at birth The most common cause of acquired hearing loss is TYPES exposure to noise (Merck Manual’s Online Medical Conductive hearing losses are caused by diseases or Library, 2007). Other causes can include: obstructions in the outer or middle ear (the pathways • Build up of fluid behind the eardrum for sound to reach the inner ear). Conductive hearing • Ear infections (known as otitis media) losses usually affect all frequencies of hearing evenly • Childhood diseases, such as mumps, measles, or and do not result in severe losses. A person with a con- chicken pox; and ductive hearing loss usually is able to use a hearing aid • Head trauma well or can be helped medically or surgically. Congenital causes of hearing loss and Sensorineural hearing losses result from damage to the deafness include: delicate sensory hair cells of the inner ear or the nerves • A family history of hearing loss or deafness that supply it. These hearing losses can range from • Infections during pregnancy (such as rubella) mild to profound. They often affect the person’s abil- • Complications during pregnancy (such as the Rh ity to hear certain frequencies more than others. -
EXAMINATION of PATIENTS with ACUTE ACOUSTIC TRAUMA Umar B
EXAMINATION OF PATIENTS WITH ACUTE ACOUSTIC TRAUMA Umar B. Bobodzhanov, Jamol I. Kholmatov, Ravshan U. Bobodzhonov Department of Otorhinolaryngology of the Tajik Medical University of the name Abuali ibni Sino Corresponding author: Jamal I. Kholmatov, Department of Otorhinolaryngology of the Tajik Medical University of the name Abuali ibni Sino, e-mail: [email protected] Abstract The acute acoustic trauma leads to further injuries of various structures of the middle and inner ear. Complex audiological examination of hearing in order to reveal posttraumatic sensorineural hearing loss and timely rehabilitation is required to re- veal injuries. It is especially necessary in case of suspicion of integrity damage of labyrinthine windows. In order to evaluate posttraumatic hearing loss, we consider complete audiological examination, including audiomentry in the expanded range of frequencies of air-conduction and bone-conduction, and also urgent rehabilitation actions necessary. Background All patients with ear trauma reported decrease of hear- ing and tinnitus in the ears which was perceptible from According to different authors ear traumas make 32–70% the moment of trauma. The majority of patients suffered of all injuries both in war and a peace times. Decrease of from abrupt hearing loss. the tinnitus was of various in- their number is hard to estimate in the near future be- tensity and character. cause of constant development of manufacture, increase of speed, instability of living standards and growth of house- Other implications of diseases were noted, such as pain hold violence [1,3,6–8]. and feeling of heaviness in the injured ear. 98 (32.7%) pa- tients noted a short-term loss of consciousness immediate- Occurring diagnostic difficulties, especially in cases of ly after trauma, later on they experienced dizziness, nausea polytrauma of various ear structures and posttraumat- and vomiting. -
Tinnitus What Is Tinnitus? Tinnitus Is Defined As the Perception of Sound When No External Sound Is Present
Tinnitus What is tinnitus? Tinnitus is defined as the perception of sound when no external sound is present. The common vernacular is "ringing in the ears"; however, the quality of the tinnitus can range from roaring to hissing and chirping to clicking. Tinnitus can pulsate or be constant. It can be a single tone or multiple tones, and it's amplitude can vary from background noise to an excruciating experience. What causes tinnitus? Tinnitus has a variety of causes. The most common causes include wax in the ear canal, noise trauma or temporomandibular joint (TMJ) dysfunction. It can also be caused by Meniere's disease, endolymphatic hydrops, allergies, destruction of the middle ear bones, infection, nutritional deficiency, cardiovascular disease, thyroid disorders, certain medications, head injury and cervical disorders. Recently, migraine disorders have also been listed as a culprit. Regardless of the inciting etiology, it has been shown that the it is within the brain that the sound resides, persists, evolves and propagates. Tinnitus may begin with damage to the peripheral auditory system (the cochlea and auditory nerve), but its persistence is a function of the attention that it receives parietal cortex and frontal cortex), the importance that it is given (cingulate cortex, anterior insula) and it maintaining residence in the limbic system (the amygdala, hippocampus and thalamus). Ongoing research is being aggressively pursued to stop this feed-forward cycle in its tracks. Medications that may exacerbate tinnitus (adapted from Bailey's Otolaryngology - Head and Neck Surgery 4th ed.) include aspirin and aspirin-containing compounds, aminoglycoside antibiotics, nonsteroidal antiinflammatory drugs and heterocycline antidepressants. -
The Role of Potassium Recirculation in Cochlear Amplification
The role of potassium recirculation in cochlear amplification Pavel Mistrika and Jonathan Ashmorea,b aUCL Ear Institute and bDepartment of Neuroscience, Purpose of review Physiology and Pharmacology, UCL, London, UK Normal cochlear function depends on maintaining the correct ionic environment for the Correspondence to Jonathan Ashmore, Department of sensory hair cells. Here we review recent literature on the cellular distribution of Neuroscience, Physiology and Pharmacology, UCL, Gower Street, London WC1E 6BT, UK potassium transport-related molecules in the cochlea. Tel: +44 20 7679 8937; fax: +44 20 7679 8990; Recent findings e-mail: [email protected] Transgenic animal models have identified novel molecules essential for normal hearing Current Opinion in Otolaryngology & Head and and support the idea that potassium is recycled in the cochlea. The findings indicate that Neck Surgery 2009, 17:394–399 extracellular potassium released by outer hair cells into the space of Nuel is taken up by supporting cells, that the gap junction system in the organ of Corti is involved in potassium handling in the cochlea, that the gap junction system in stria vascularis is essential for the generation of the endocochlear potential, and that computational models can assist in the interpretation of the systems biology of hearing and integrate the molecular, electrical, and mechanical networks of the cochlear partition. Such models suggest that outer hair cell electromotility can amplify over a much broader frequency range than expected from isolated cell studies. Summary These new findings clarify the role of endolymphatic potassium in normal cochlear function. They also help current understanding of the mechanisms of certain forms of hereditary hearing loss. -
Anatomy of the Ear ANATOMY & Glossary of Terms
Anatomy of the Ear ANATOMY & Glossary of Terms By Vestibular Disorders Association HEARING & ANATOMY BALANCE The human inner ear contains two divisions: the hearing (auditory) The human ear contains component—the cochlea, and a balance (vestibular) component—the two components: auditory peripheral vestibular system. Peripheral in this context refers to (cochlea) & balance a system that is outside of the central nervous system (brain and (vestibular). brainstem). The peripheral vestibular system sends information to the brain and brainstem. The vestibular system in each ear consists of a complex series of passageways and chambers within the bony skull. Within these ARTICLE passageways are tubes (semicircular canals), and sacs (a utricle and saccule), filled with a fluid called endolymph. Around the outside of the tubes and sacs is a different fluid called perilymph. Both of these fluids are of precise chemical compositions, and they are different. The mechanism that regulates the amount and composition of these fluids is 04 important to the proper functioning of the inner ear. Each of the semicircular canals is located in a different spatial plane. They are located at right angles to each other and to those in the ear on the opposite side of the head. At the base of each canal is a swelling DID THIS ARTICLE (ampulla) and within each ampulla is a sensory receptor (cupula). HELP YOU? MOVEMENT AND BALANCE SUPPORT VEDA @ VESTIBULAR.ORG With head movement in the plane or angle in which a canal is positioned, the endo-lymphatic fluid within that canal, because of inertia, lags behind. When this fluid lags behind, the sensory receptor within the canal is bent. -
Managing Noise and Preventing Hearing Loss at Work Code of Practice 2021 Page 2 of 54
Managing noise and preventing hearing loss at work Code of Practice 2021 PN12640 ISBN Creative Commons This copyright work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses. In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Managing noise and preventing hearing loss at work Code of Practice 2021 Page 2 of 54 Contents Foreword ................................................................................................................................... 4 1. Introduction ........................................................................................................................ 5 1.1 Who has health and safety duties in relation to noise? .......................................... 5 1.2 What is involved in managing noise and preventing hearing loss?........................ 7 1.3 Information, training, instruction and supervision ................................................... 8 2. Noise and its effects on health and safety ..................................................................... 9 2.1 How does hearing loss occur? ................................................................................ 9 2.2 How much noise is too much? ................................................................................ 9 2.3 Other effects of noise............................................................................................ -
The Tectorial Membrane of the Rat'
The Tectorial Membrane of the Rat’ MURIEL D. ROSS Department of Anatomy, The University of Michigan, Ann Arbor, Michigan 48104 ABSTRACT Histochemical, x-ray analytical and scanning and transmission electron microscopical procedures have been utilized to determine the chemical nature, physical appearance and attachments of the tectorial membrane in nor- mal rats and to correlate these results with biochemical data on protein-carbo- hydrate complexes. Additionally, pertinent histochemical and ultrastructural findings in chemically sympathectomized rats are considered. The results indi- cate that the tectorial membrane is a viscous, complex, colloid of glycoprotein( s) possessing some oriented molecules and an ionic composition different from either endolymph or perilymph. It is attached to the reticular laminar surface of the organ of Corti and to the tips of the outer hair cells; it is attached to and encloses the hairs of the inner hair cells. A fluid compartment may exist within the limbs of the “W’formed by the hairs on each outer hair cell surface. Present biochemical concepts of viscous glycoproteins suggest that they are polyelectro- lytes interacting physically to form complex networks. They possess character- istics making them important in fluid and ion transport. Furthermore, the macro- molecular configuration assumed by such polyelectrolytes is unstable and subject to change from stress or shifts in pH or ions. Thus, the attachments of the tec- torial membrane to the hair cells may play an important role in the transduction process at the molecular level. The present investigation is an out- of the tectorial membrane remain matters growth of a prior study of the effects of of dispute.