October 1998  Tutorial

Aim: To cover ENT problems with special regard to General Practice and to RCGP exam.


ENT  PROBLEMS


Examination:

                       Tuning fork tests 512 cps
                       Rinne's test
                       Weber's  test
                       Children/Hearing TV/Others in a crowd

                       Conductive deafness/Sensory deafness.
                       Charts

Common GP problems:

                       Neoplasia - Salient features - external ear/sinuses/tonsil
                                 - acoustic neuroma                                                                
                                        
                       Infections etc  In a practice of 2500 patients, each year
                                   300 children 0-10 years consult GP each with
                                   3 / 4 consultations - of which 15% are T's
                                                  - 25% are Otitis Media

                       Tonsillitis : causes/diagnosis/treatment  
                                   ?tonsillectomy
                                   ?swabs
                                   ?bloods for immunodeficiency/IM
                                   Drug & Therapeutics Bull Vol 33 no2 Feb 1995 
                                  
                       Otitis Media: causes/ diagnosis/treatment
                                   Papers/Burke and Baine
                                   When to treat/patient/Dr factors/time factors
                                   Problems with Rx/Expectations
                                   Patient education/Class/Deprivation.
  
                       Acute epiglottitis - H Influenzae
                                   - How to approach (carefully!)

                       Sinusitis - diagnosis/treatment -?sinus XRay 
                                   - recent papers  
                                      
                       Ear syringing


                       Allergy : Acute hay fever and treatment
                               : Chronic Rhinitis and treatment/ when to refer
                                                                       
                       Polypi  : medical /surgical treatment


                       Glue ear: Aetiology
                                 Testing children's hearing
                                 Treatment
                                 Surgery?

                       Education problems - HV's
                                                                          

                       Otitis Externa: Treatment by GP/Hospital
                       Chronic discharge with perforation 
                                         

                       Bell's Palsy and treatment. 

                                        
                       The symptom of vertigo - acute situation
                                              - chronic problem
                                              - drugs NB Parkinsonian side effects



                       Otosclerosis: conductive deafness
                                     younger females
                                     pregnancy/pill/HRT
                                     referal for Rx

                       The symptom of tinnitus and dealing with patients

                       Menieres disease: vertigo/nausea & vomiting/tinnitus

                       Foreign body in nose or ear.

                       Treatment of epistaxis

                       Nasal fractures/deviated septum

                       The symptom of the hoarse voice

                       Surfer's Nodule

                       Cauliflower ear

                       Chondrodermatitis chronicus helicis

                       Croup - aetiology/treatment

                       Aphthous  ulcers and treatment.


Summary: Covered  everything above but needs to research more on . . . .




                                  This tutorial provided by Clive Blake - Redruth 1998