This is ENT/Gerontology Jeopardy!!
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Transcript This is ENT/Gerontology Jeopardy!!
Cristie Roush, DNP,
GNP- BC
VA Ann Arbor
Healthcare System
-Review of ENT anatomy
-Discuss an assortment of
ENT problems related to the
older adult:
Important History
Sign and Symptoms
Physical Findings
Treatment/Work Up
When to Refer to ENT
History
Previous impactions
Hearing aid use
Ear Surgery*
Anticoagulation
therapy*
Diabetes*
Immunocompromised
state*
*Refer to ENT
Symptoms
Hearing loss
Pain, itching
Fullness, tinnitus
Cough, drainage,
odor
Dizziness
Treatment
Cerumenolytic
agents*
Carbamide Peroxide
(Debrox)
Chlorine Salicylate
and Glycerol (Audax,
Earex Plus)
Instill several drops
three times a day for 714 days
*Do not use if the status
of the TM is unknown
Advantages
Easy to use
Effective-not
superior
Disadvantages
Otitis Externa
Pain/Vertigo if
perforation
Allergic reactions
Transient hearing
loss
Treatment
Irrigations
Vinegar/Water
H2O2/H2O
Advantages
Disadvantages
Manual Removal
TM Perforation
Pain/Vertigo
EAC Trauma
Otitis Externa
Failure
Advantages
Effective
Effective
Disadvantages
Special Skills
Pain, EAC trauma
Inappropriate
interventions
Oral Jet irrigators
Cotton-tipped
Swabs
Ear Candles
Limited research
Seely et al-found no
negative pressure
Complications
Referral
Unclear
diagnosis
Hx of ear
surgery/Known
perforation
Anticoagulation
therapy
Diabetes
Immunocompromised
state
History
Hearing aid use, ear surgery, Diabetes
RAPID onset (within 48 hours) in the past 3
weeks AND
Symptoms
of EAC inflammation
Otalgia (often severe), itching/fullness
Tenderness of the tragus/pinna/both or diffuse
canal edema/erythema
MAY have hearing loss or jaw pain
MAY have otorrhea/lymphadenitis/TM
erythema or cellulitis of the pinna and
adjacent skin
Treatment
Pain Management
NSAIDS-Ibuprofen
MAX 800 mg/
3200mg daily
May add opiates
No clinical trial to
assess topical
benzocaine otic
solution
Treatment
Irrigations
Vinegar/Water irrigations
BID – BEFORE instilling
medicated drops
Topical drops
Cortisporin – if no
perforation
Ciprofloxacin/Prednisolone
Regardless of topical agent
used, 65%- 90% of patients
had resolution within 7-10
days.
Inappropriate
interventions
Systemic antimicrobial
therapy
Not indicated unless
there is extension
outside the ear canal or
other modifying factors
–Diabetes
-HIV infection
-Other
immunocompromised
states.
Referral
Failed initial therapy
Extensive debris in
canal
Extensive edema of
canal
Reminder
Keep aids out
Canal open to air
Ear Wick
History
Seasonal allergies
Environmental
allergies
Smoker
Nasal/sinus surgery
Nasal trauma
Epistaxis
Use of nasal sprays
Asthma
Symptoms
Clear rhinorrhea
Nasal congestion
No fever
Worse in Spring/Fall
Worse at meal
times*
Stringy Rhinorrhea
Treatment-
Nasally
Remove allergens if
possible
Nasal saline irrigation
Steroid nasal sprays
Flunisolide -BID
Beclomethasone
dipropionate- Dry
BudesonideFluticasone propinonate
Other Sprays
Azelastine-Antihistamine BID
Cromolyn Sodium-Mast Cell
inhibitor-3-4 x daily
Ipratropium bromideAnticholingergic 2-3x daily
Treatment-
Orally
(Second generation –non-drowsy)
Loratadine 10 mg daily
Fexofenadine
hydrochloride 60 mg
daily twice a day
Cetirizine 5-10 mg daily
*Conditions of rhinitis
do not need CT
imaging.
Referral
Abnormal nasal exam
*May warrant CT
imaging – Non
contrast maxillofacial
CT, axial and coronal
cuts
Failure of initial
therapy
State medications
tried/failed
History
How long? Recent
URI/Pneumonia?
Intubation?
Smoker? How long?
How much?
ETOH abuse? How
long? How much?
Vocal use – hx of
singer, coach, other
vocal overuse
Heartburn History
Symptoms
Dysphagia/Odynophagia
Dyspnea/Hemoptysis
Unexplained wt loss
Unilateral ear pain
Heartburn/Indigestion
Frequency, medicated
Altered voice quality,
pitch, loudness, or
vocal effort that
impairs communication
or reduces voicerelated quality of life.
2
1
1. Reinke’s edema
2. Bilateral vocal cord nodules
3. Vocal Cord Polyp
3
Vocal Cord
Paralysis
Presbylarynx – bowing of vocal cords
Laryngeal Cancer
Referral
For flexible
nasopharyngeal
scope
May consider trial of
H2 blocker
(randitine 150 mg
BID) or PPI
(omeprazole 20 mg
daily) if suspect
GERD
Symptoms which
persist > 3 months
Not
recommended
CT imaging w/o LAD
Oral Corticosteroids
Oral antibiotics
Hope you had fun!
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http://www.ncbi.nlm.nih.gov/pubmed/18707628 (Cerumen)
http://www.ncbi.nlm.nih.gov/pubmed/19729111 (Hoarseness)