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Acute Otitis Media
Otitis Media Terms: Otitis Media (OM): Refers to all forms of inflammation and infection of the middle ear.Active inflammation or infection is nearly alwaysassociated with a middle ear effusion (fluid in themiddle ear space). Acute Otitis Media (AOM): General term for both acute otitis media with and without perforation. It is…
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Acute Otitis Media with Perforation (AOMwiP)
non-pharm: pharm: Review weekly until the signs of AOM have resolved. Also review within 4 weeks after resolutionfor children at high risk of CSOM Education for AOM with perforation tragal pumping When to Refer TM Perforation
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Adenoid hypertrophy
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Angular Cheilitis
Risk Factors Diagnosis Treatment General Measures Specific Measures
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Audiological Assessment and Management
Listening behaviours and warning signs to ask parents about When to refer Diagnostic audiology Hearing assessment is recommended for the following reasons: Speech Path
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Barotrauma
Characteristic features differentiating inner ear barotrauma and inner ear decompression sickness Inner ear barotrauma Inner ear decompression sickness Conductive or mixed hearing loss Sensorineural hearing loss Descent or ascent Ascent Cochlear symptoms (ie hearing loss predominates) Vestibular symptoms predominant; right sided History of forced or difficult Valsalva manoeuvre Not associated with…
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Benign Paroxysmal Positional Vertigo (BPPV)
Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment/Management Repositioning Maneuvers Surgical Treatment Differential Diagnosis Prognosis Complications Deterrence and Patient Education Enhancing Healthcare Team Outcomes
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Cholesteatoma
Definition: Clinical Presentation: Examination: Pathogenesis: Congenital Cholesteatoma: Acquired Cholesteatoma: Differential Diagnosis: Investigations: Management:
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Chronic suppurative otitis media
Management
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Dental
Gingivitis Dry socket Trauma Loose or displaced teeth (periodontal displacement injuries) Injury Examination findings Management Concussion = An injury to tooth-supporting structures without abnormalloosening or displacement but with marked reaction to percussion. Tender but firm Review by community dentistUsually heal without intervention Subluxation = Slight increase in mobility but without clinically…
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Dustmite, Pet dander, Mould, Pollen Minimisation
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Ear wax management
Anatomy Ear Wax (Cerumen) Causes of Ear Wax Accumulation Indications for Treatment Treatment Options Safe Syringing Procedure Contraindications for Ear Syringing Side Effects and Complications Alternative Mechanical Removal Methods Referral to ENT Specialist Key Patient Education Points Mechanical jet ear irrigation system
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Epistaxis
Classification Causes Hypertension: Red Flags History Management Acute bleed Followup
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Eustachian tube dysfunction
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External auditory exostosis (Exostoses)
Clinical differential diagnoses of EAE include EAE can be classified into four grades of severity based on the percentage of obstruction of the EAC, as assessed by otoscopy Preventive Measures Surgical Treatment Risks and Considerations Alternative Treatments
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Facial pain
may not be identified by clinical assessment. Maxillary sinusitis Trigeminal neuralgia Glossopharyngeal neuralgia Facial migraine Elongated styloid process (Eagle’s syndrome) Symptoms Diagnosis Treatment Cranial (temporal) arteritis Temporomandibular joint dysfunction aetiology clinical features DDx Investigations management
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Glandular fever (EBV)
clinical features of acute EBV infection Adolescent infectious mononucleosis Clinical Status IgM VCA(<36)* IgG VCA(<18)* Anti-EA(<9)* Anti-EBNA(<18)* Susceptible Negative Negative Negative Negative Acute Primary Infection Positive Positive Positive Neg/Wk Pos Recent Primary Infection Neg/Wk Pos Positive Positive Positive Past Infection Negative Positive Negative Positive Reactivation in Immunosuppressed orImmunocompromised Individuals Negative…
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Glossitis
Anatomy of the Tongue Etiology of Glossitis Epidemiology Pathophysiology History and Physical Examination Types of Glossitis Evaluation Treatment/Management Differential Diagnosis Prognosis Complications Patient Education and Deterrence
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Halitosis
Halitosis, or oral malodour, is a common complaint among the general population. If severe or longstanding, it may decrease self-confidence and social interactions. Classification of Halitosis Causes of Halitosis Oral Causes: Non-Oral Causes: Examination Management
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Hand, foot, and mouth disease
Age Group Affected: Transmission: Causative Agents: Modes of Transmission: Signs and Symptoms: Duration: Complications: Complications in Pregnancy: Complications in Newborns: Rare Complication: Reye Syndrome Management Pain Relief for HFMD Simple Analgesia: Oral Ulcers: Aspirin: Hydration Prevention of Dehydration: Blister Care Management of Blisters: Staying Home and Preventing Spread Home Care:…
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Hoarse Voice
General rule: consider referral in the following circumstances Causes: Primary Intralaryngeal Causes: Secondary Intralaryngeal Causes: Laryngeal Nerve Damage (left recurrent laryngeal nerve) Causes: Functional Hoarseness (no organic cause) Management Laryngitis Structural lesions Age-related voice change
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Idiopathic Sensorineural Hearing Loss
Definition: Epidemiology: Symptoms: Diagnosis: Prognosis: Treatment:
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Labyrinthitis
Anatomy Etiology Epidemiology History and Physical Examination Evaluation Treatment/Management Differential Diagnosis Complications Prognosis Deterrence and Patient Education Enhancing Healthcare Team Outcomes
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Mastoiditis
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Meniere Disease
from: MedicineToday 2014; 15(3): 18-26 Hallmark of Acute Attack: Vertigo Characteristics: Early Stage: Middle Stage: Late Stage: Natural History: Variants: Epidemiology: Pathophysiology – Current Understanding: Differential Diagnosis Diagnosis Diagnosis Criteria (Barany Society): Clinical Examination: Between Attacks: During Acute Attack: Investigations: Differential Diagnosis Common Causes of Disturbed Balance: Conditions Mimicking Ménière’s…
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Nasal Bone Fractures
Anatomy History and Physical Examination Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Postoperative and Rehabilitation Care
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NECK MASSES in ADULTS
Ancillary investigations for adult neck massesintended to assist clinicians when malignancy is unlikely or when initial investigations do notyield a diagnosis. If these tests are undertaken, they should be based on clinical suspicion for specific diseases and should be obtained simultaneously to the malignancy work-up to prevent a delayed diagnosis. Ancillary…
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Neck MASSES in KIDS
divided into the broad categories of congenital, inflammatory/infective and neoplastic Paediatric cervical masses according to anatomical location Location Aetiology Congenital Inflammatory/infective Neoplastic Submental Thyroglossal cystDermoid cyst SialadenitisLymphadenitisReactive lymphadenopathy Malignant lymphadenopathyBenign connective tissue tumour Submandibular Vascular or lymphatic malformationBranchial cleft cyst SialadenitisLymphadenitisReactive lymphadenopathy Malignant lymphadenopathySalivary gland tumourBenign connective tissue tumour Carotid…
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Noise-induced deafness
Noise trauma is a primary preventable cause of sensorineural hearing loss, which occurs due to damage to the hair cells in the inner ear. It can result from various sources: Types of Occupational Noise Damage Characteristics of Occupational Noise-Induced Hearing Loss Diagnosis Treatment Prevention
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Nonallergic Rhinitis
Vasomotor rhinitis
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Oral candidiasis
3 forms SSx
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Oral disease
may present as Ulcerated lesions Traumatic ulcers Aphthous ulcers Oral SCC Ulcer on lip White, red and mixed lesions Geographic tongue Black Tongue Median Rhomboid Glossitis Frictional keratoses Oral submucous fibrosis Leukoplakia (diagnosis of exclusion) Erythroplakia (diagnosis of exclusion) oral cavity Submucosal swelling Palate exostoses and tori Cysts of the…
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Oral lichen planus
Multiple subtypes may be observed in a single patient.
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Otalgia
OTALGIA Local Causes Referred (10 T’s + 2) Primary or Secondary – Primary otalgia is pain coming directly from the ear where secondary otalgia is referred pain by cranial nerves from somewhere outside the ear (Trigeminal, facial, glossopharyngeal, vagus, cervical plexus, Require higher index of suspicion, More common in adults)
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Otitis externa
Acute localised otitis externa Necrotising otitis externa
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Otitis media with effusion (OME)
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Parotitis
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Perforation
Aetiology Symptoms Red flags Signs Management Keep ear dry ENT Consultation indications Acute Traumatic Perforations: Chronic Perforations: Unsafe Perforations: Antibiotics: Surgical Indications Prognosis Key Takeaways
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Peritonsillar abscess (quinsy)
Epidemiology Pathophysiology Symptoms Physical Exam Findings Clinical features associated with airway obstruction or deep neck space infection Conditions associated with airway obstruction or deep neck space infection Initial Management: Abscess drainage Antibiotics OR continue intravenous therapy for 1 to 2 days following successful abscess drainage, then switch oral therapy Antibiotics…
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Pharyngeal Cancers
Painful Swallowing + Ear Pain + Hoarseness = Pharyngeal Cancer Risk Factors: smoking (tobacco, marijuana, cigars), UV lights, EtOH, Betel nut chewing, HPV, EBV Presenting Symptoms Nasopharynx Cancer more common in African and East Asian populations, ay cause paresis of soft palate and nasal regurgitation on swallowing Laryngeal Cancer: stridor
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Post-Tonsillectomy Bleeding
Incidence and Timing Red Flags Assessment Laboratory Tests (if indicated) ABCDE Assessment Management of Active Bleeding Learning bites Post-Tonsillectomy Home Care Advice Eating and Drinking Pain Management Bleeding Risks Other Risks and Management Important Reminders for Parents
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Presbyacusis
Symptoms Risk Factors Diagnosis Treatment
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Rhinitis
Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip. Allergic Rhinitis IgE-mediated hypersensitivity. While this classification is useful for specific treatments such as allergen avoidance and immunotherapy, in practice, nonallergic and…
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Rhinitis Medicamentosa
Physiology of Nasal Congestion Topical Nasal Decongestants Pathophysiology- unknown (Hypotheses) Symptoms: Signs: Treatment / Management Complications
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Rinne’s Test and Weber’s Test
Rinne’s Test Weber’s Test Rinne’s test Weber’s test Normal Air conduction > bone conduction (Positive Rinne’s) Heard in the midline Conductive hearing loss Bone conduction > Air conduction(Negative Rinne’s) Heard in the bad ear Sensorineural hearing loss Air conduction > bone conduction(Positive Rinne’s) Heard in the good ear Causes of Conductive Hearing Loss…
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Sialolithiasisis
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Sinusitis
Overview: Prevalence: Anatomy: Paranasal Sinuses: Mucociliary System: Pathophysiology: Diagnostic criteria (from the European Position Paper on Rhinosinusitis) Adult Acute Rhinosinusitis: Adult Chronic Rhinosinusitis: Paediatric Acute Rhinosinusitis: Paediatric Chronic Rhinosinusitis: Acute rhinosinusitis (ARS) Clinical assessment The signs and symptoms of acute viral and bacterial rhinosinusitis overlap considerably, especially during the first 3…
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Sudden onset hearing loss (SOHL)
Aetiology of SOHL clinical Outer ear (conductive hearing loss) Foreign bodyWaxOtitis externaOther ear canal pathology (eg. exostoses)Trauma (syringing) Non-distorted soundFeatures of external ear pathologyVolume of voice remains normal and hearing improves in noisy environment Middle ear (conductive hearing loss) Otitis media with effusionHaemotympanumOssicular chain discontinuityTraumaBarotraumaIatrogenic (post-operative)Tympanic membrane perforationCholesteatoma Inner…
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Temporomandibular Dysfunction (TMD)
TMD encompasses a group of disorders affecting the masticatory system, including muscular conditions and those affecting the temporomandibular joint (TMJ). Prevalence Common Symptoms Anatomy TMJ Structure Musculature Innervation Aetiology General Factors Myofascial Disorders Intra-articular Causes Other Considerations Causes of Orofacial Pain Dental Conditions Otological Conditions Headache Disorders Neurogenic Conditions Inflammatory…
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Tinnitus
Type of Tinnitus Description Possible Causes/Differentials Subjective Tinnitus Only the affected individual can hear the sound – Noise-induced hearing loss– Presbycusis– Ototoxic medications– Meniere’s disease– Acoustic trauma– Inner ear infections/inflammation– Stress and anxiety Objective Tinnitus The sound can also be heard by the examiner – Vascular abnormalities– Muscular disorders– TMJ…
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tongue-tie (ankyloglossia)
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Vasomotor Rhinitis (VMR)
Definition: Features of Vasomotor Rhinitis: Triggers: Diagnosis: Key Features: Other Non-Allergic Rhinitis Causes: Conditions Confused with Non-Allergic Rhinitis: Treatment: Non-drug, Non-surgical: Drug Therapy: Surgery: Key Takeaways:
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VERTIGO
These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms. Cause Description Peripheral causes Acute labyrinthitis Inflammation of the labyrinthine organs caused by viral or bacterial infection Acute vestibular neuronitis (vestibular neuritis)* Inflammation of the vestibular nerve, usually caused by viral infection Benign positional paroxysmal…
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Vertigo differentials
Meniere’s Disease Vestibular Neuritis Labyrinthitis Benign Paroxysmal Positional Vertigo (BPPV) General Considerations Management Principles
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Vestibular Neuronitis
Introduction Etiology Epidemiology Pathophysiology History and Physical Examination Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Deterrence and Patient Education Enhancing Healthcare Team Outcomes
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Vestibular schwannoma/ acoustic neuroma
Overview: Epidemiology: Symptoms: Imaging: Referral: Additional Notes: