Acoustic Trauma and Hyperbaric Oxygen Treatment
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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 -
Temporo-Mandibular Joint (Tmj) Dysfunction
Office: (310) 423-1220 BeverlyHillsENT.com Fax: (310) 423-1230 TEMPORO-MANDIBULAR JOINT (TMJ) DYSFUNCTION You may not have heard of it, but you use it hundreds of times every day. It is the Temporo- Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. You move the joint every time you chew or swallow. You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal. These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and physicians use these maneuvers with patients for diagnosis. TMJ Dysfunction can cause the following symptoms: Ear pain Sore jaw muscles Temple/cheek pain Jaw popping/clicking Locking of the jaw Difficulty in opening the mouth fully Frequent head/neck aches The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth. -
Investigation of the Incidence of Eustachian Tube Dysfunction in Patients with Sinonasal Disease*
ORIGINAL CONTRIBUTION Investigation of the incidence of Eustachian tube dysfunction in patients with sinonasal disease* 1 2 1 1 C.E. Rennie , M. Gutierrez , Y. Darby , V.J. Lund Rhinology Online, Vol 1: 85 - 89, 2018 http://doi.org/10.4193/RHINOL/18.050 1 Royal National Throat Nose and Ear Hospital, ENT, London, United Kingdom 2 University of North Carolina, Medical student, North Carolina, USA *Received for publication: August 12, 2018 Accepted: August 14, 2018 Abstract Background: Rhinosinusitis is characterised by inflammation affecting the respiratory mucosa of the nose and sinuses. Since the Eustachian tube and the middle ear cavity are also lined by the same mucosa, it is likely that the pathophysiological processes that give rise to rhinosinusitis will also affect these areas. Eustachian tube dysfunction (ETD) is a common condition, but it is often dismissed as a "minor" symptom in rhinology patients. Objective: The aim of this study was to determine the frequency of otologic symptoms in patients attending the rhinology clinic. The seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), a validated disease-specific instrument was used to assess symptoms with respect to ETD7. Study design: 119 patients attending the rhinology outpatient clinic completed ETDQ-7, a SNOT 22 and had their PNIF measured. Results: The results showed a significantly higher rate of ETD (p<0.01 paired t-test) in the rhinology patients (mean score 3.1, SD 1.64) as compared to a control population (mean 1.3, SD 0.3). Conclusion: Eustachian tube dysfunction is more common in rhinology patients then the general population, and within the rhinology population. -
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 -
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. -
MASTOIDECTOMY (With Or Without Tympanoplasty)
MASTOIDECTOMY (with or without tympanoplasty) Informed Surgical Consent A mastoidectomy is a surgical procedure that removes diseased mastoid air cells. These cells sit behind your ear in a hollow space in your skull. Typically, a mastoidectomy (with or without tympanoplasty) is recommended for patients that have a cholesteatoma and/or a chronically infected ear that has failed medical management (chronic otitis media). Your doctor at Suburban Ear, Nose, and Throat is uniquely trained to perform mastoidectomy surgery. A cholesteatoma is a benign skin cyst that grows inside the ear. Most cholesteatomas occupy the middle ear space behind the tympanic membrane (eardrum). Occasionally, cholesteatomas arise from the external ear canal, and then are referred to as canal cholesteatomas. Canal cholesteatomas can usually be managed conservatively with routine ear cleaning in the office, but rarely they will require surgical intervention. Middle ear cholesteatomas, on the other hand, almost always require surgery. They typically occur in children and adults who have chronic eustachian tube dysfunction (ETD), a problem with ventilation or "popping" the ears. When ETD is present for many years, it can lead to development of a cholesteatoma. Although most cholesteatomas are acquired, some patients are actually born with the cholesteatoma; this is called a congenital cholesteatoma. Cholesteatomas grow very slowly, but they can cause significant damage to any structure in the ear that they come in contact with. Commonly, the cholesteatoma erodes into the tiny bones (ossicles) in the middle ear that allow for hearing. Untreated, cholesteatomas can lead to hearing loss, infection, chronic ear discharge, ear pain, dizziness, facial paralysis, or in rare cases, infection that spreads to the brain. -
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. -
TMJ (Temporo-Mandibular Joint) Syndrome
TMJ (Temporo-Mandibular Joint) Syndrome What is the TMJ? You may not have heard of it, but you use it hundreds of times every day. It is the Temporo- Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of the head. Each time you chew you move it. But you also move it every time you talk and every time you swallow (every 3 minutes or so). It is, therefore, one of the most frequently used of all the joints of the body. You can locate that joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal. These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and doctors use these maneuvers with patients for diagnosis. How does the TMJ work? When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square inch) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the joint was designed to be a sliding joint, rather than the usual ball-and-socket type joint (such as the hip and shoulder, for example). -
Ear Infections in Children
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ∙ National Institutes of Health NIDCD Fact Sheet | Hearing and Balance Ear Infections in Children What is an ear infection? How can I tell if my child has an ear infection? An ear infection is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds Most ear infections happen to children before they’ve up behind the eardrum. Anyone can get an ear infection, learned how to talk. If your child isn’t old enough to say but children get them more often than adults. Five out of “My ear hurts,” here are a few things to look for: six children will have at least one ear infection by their third } Tugging or pulling at the ear(s) birthday. In fact, ear infections are the most common reason parents bring their child to a doctor. The scientific name for } Fussiness and crying an ear infection is otitis media (OM). } Trouble sleeping What are the symptoms of an } Fever (especially in infants and younger children) ear infection? } Fluid draining from the ear } Clumsiness or problems with balance There are three main types of ear infections. Each has a different combination of symptoms. } Trouble hearing or responding to quiet sounds. } Acute otitis media (AOM) is the most common ear What causes an ear infection? infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This An ear infection usually is caused by bacteria and often causes pain in the ear—commonly called an earache. -
DEVELOPMENT of a SCREENING TOOL for IDENTIFYING YOUNG PEOPLE at RISK for NOISE-INDUCED HEARING LOSS by Copyright 2010 Susan C. M
DEVELOPMENT OF A SCREENING TOOL FOR IDENTIFYING YOUNG PEOPLE AT RISK FOR NOISE-INDUCED HEARING LOSS BY Copyright 2010 Susan C. Megerson Submitted to the graduate degree program in Audiology and the Graduate Faculty of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Chairperson: Judith E. Widen, Ph.D. Committee members: Mark E. Chertoff, Ph.D. Won S. Choi, Ph.D., M.P.H. Byron J. Gajewski, Ph.D. Tiffany A. Johnson, Ph.D. Date defended: July 15, 2010 The Dissertation Committee for Susan C. Megerson certifies that this is the approved version of the following dissertation: DEVELOPMENT OF A SCREENING TOOL FOR IDENTIFYING YOUNG PEOPLE AT RISK FOR NOISE-INDUCED HEARING LOSS Judith E. Widen, Ph.D. Chairperson Date approved: July 15, 2010 2 ABSTRACT This study surveyed common noise activities of young adults, quantified their annual equivalent noise exposures, and examined the effectiveness of a self- assessment screening tool for identifying risk of noise-induced hearing loss. One hundred fourteen college freshmen self-reported any exposure to loud noise and occurrence of ear symptoms over the previous year. Annual equivalent exposures for the group ranged from 64 to 88 L Aeq8760h , with an overall group mean of 75 LAeq8760h (mean of 78 L Aeq8760h for men and 73 LAeq8760h for women). Thirty-one percent of subjects reported exposure to gunfire (43% of men and 22% of women). Regression analyses revealed three screening questions to be statistically significant predictors of high risk noise exposures. Evaluation of ROC curves indicated that a self-assessment screening tool based on these three screening items yields moderate to high discriminatory power for detecting risk. -
Differential Diagnosis and Treatment of Hearing Loss JON E
Differential Diagnosis and Treatment of Hearing Loss JON E. ISAACSON, M.D., and NEIL M. VORA, M.D., Milton S. Hershey Medical Center, Hershey, Pennsylvania Hearing loss is a common problem that can occur at any age and makes verbal communication difficult. The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing loss may strike one or more sections. Hearing loss can be cat- egorized as conductive, sensorineural, or both. Leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis. Leading causes of sensorineural hear- ing loss include inherited disorders, noise exposure, and presbycusis. An understanding of the indications for medical management, surgical treatment, and amplification can help the family physician provide more effective care for these patients. (Am Fam Physician 2003;68:1125-32. Copyright© 2003 American Academy of Family Physicians) ore than 28 million Amer- tive, the sound will be heard best in the icans have some degree of affected ear. If the loss is sensorineural, the hearing impairment. The sound will be heard best in the normal ear. differential diagnosis of The sound remains midline in patients with hearing loss can be sim- normal hearing. Mplified by considering the three major cate- The Rinne test compares air conduction gories of loss. Conductive hearing loss occurs with bone conduction. The tuning fork is when sound conduction is impeded through struck softly and placed on the mastoid bone the external ear, the middle ear, or both. Sen- (bone conduction). When the patient no sorineural hearing loss occurs when there is a longer can hear the sound, the tuning fork is problem within the cochlea or the neural placed adjacent to the ear canal (air conduc- pathway to the auditory cortex. -
Relationship Between Otological Symptoms And
ORIGINAL PAPER DOI: 10.5935/0946-5448.20180005 International Tinnitus Journal. 2018;22(1):30-34. Relationship between Otological Symptoms and TMD Pamela Maria Kusdra1 Jose Stechman-Neto1 Bianca Lopes Cavalcante de Leão1 Paulo Francisco Arant Martins1 Adriana Bender Moreira de Lacerda1 Bianca Simone Zeigelboim1 Abstract Background: Patients with any type of temporomandibular disorder (TMD) may have several symptoms in their temporomandibular joints, masticatory muscles and associated structures, and may have otological symptoms such as tinnitus, ear fullness, ear pain, hearing loss, hyperacusis, and vertigo, which may be due to the anatomical proximity between the temporomandibular joint, muscles innervated by the trigeminal nerve, and ear structures. Objective: This study found a prevalence of ear complaints described in the medical records of patients (n = 485) at the Center for Diagnosis and Treatment of the Temporomandibular Joint and Dental-Facial Functional Alterations at Tuiuti University of Paraná (CDATM/UTP), with TMD evaluated by the Research Diagnostic Criteria/Temporomandibular Disorders (RDC/ TMD). Method: After approval by the ethics committee were examined 485 medical records of patients of the CDATM/UTP, of both sexes a period of 2 years. The data analyzed were gender, age and the presence of reported otologic symptoms. The data were organized and subjected to statistical analysis using SPSS (IBM Statistic 20.0). Results: The results showed a higher number of female patients between 41 and 50 years old. There was a prevalence of otological symptoms (tinnitus, deafness, dizziness, imbalance, and ear fullness) in 87% of TMD cases, regardless of sex and age. Tinnitus was the symptom with the highest prevalence (42%), followed by the ear fullness (39%).