Referrals to ENT - Croydon University Hospital
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Transcript Referrals to ENT - Croydon University Hospital
Referrals to ENT
Mr Robert Harris
ENT Consultant
Commonest referrals
Adult Hearing Loss / tinnitus
Paediatric Glue Ear
Paediatric snoring/OSA
Adult snoring/OSA
Otitis externa
Otalgia (cause unknown)
Recurrent epistaxis
Hoarseness
Rhinitis
Sinusitis
Ear Wax
Globus / cough
Throat pain
Tonsillitis
Dizziness
Triage options
Secondary Care
Secondary Care outside Croydon
Intermediate Care
Back to Referrer
Different Specialty
Adult Audiology
Paediatric Audiology
Symptoms in acute and chronic
rhinosinusitis
ARS
Nasal obstruction
Anterior or postnasal
discharge
Progressive severe facial
pain (affects teeth if
maxillary)
Reduced smell not
volunteered
Often pyrexia
CRS
Nasal obstruction
Anterior or postnasal discharge
(often discoloured yellow with eosinophils but
green and infected uncommon)
Facial pain uncommon unless
acute exacerbation
Hyposmia common
Late onset asthma common
Case study – 1 week history of itchy ear
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Case study – 1 week history of itchy, painful ear,
decreased hearing
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ENT UK evidence review and consensus
document
The following be adopted as formal ENT-UK guidance: When treating a
patient with a discharging ear, in whom there is a perforation or patent
grommet:
1.
If a topical aminoglycoside is used, this should only be in the
presence of obvious infection
2.
Topical aminoglycosides should be used for no longer than two
weeks
3.
The justification for using topical aminoglycosides should be
explained to the patient
https://entuk.org/docs/prof/position_papers/position_paper_ear_drops
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Case study
65 year old diabetic
3 week history of otalgia
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Otitis Externa Prevention
Keep ears dry
Dry thoroughly after wet
EarCalm
Early intervention with topical steroids / antiobiotics
Case study
45 year old IT manager
woke yesterday with muffled right hearing
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Sudden hearing loss
Tuning fork tests
Consider high dose steroids and urgent referral for intratympanic
steroids
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Paediatric OSA
Paediatric OSA
Nasal symptoms
Snoring
Assessment of severity
History
Video
Clinical examination
Anterior rhinoscopy
Oropharynx
Neck
Silent Laryngopharyngeal Reflux
Excessive throat clearing
Persistent cough
Hoarseness
A "lump" in the throat that doesn't go away with repeated
swallowing
A sensation of post nasal drip
Dry throat
Sore throat
Hallitosis
Furry tongue
Silent Laryngopharyngeal Reflux
Sleep on an empty stomach
Elevate head of bed
Smoking cessation
PPI double dose with evening meal for 1 month
Manage associated anxiety
Thank you
Mr Robert Harris MSc FRCS
NHS
CUH
T: 02084013327
F: 02084013339
[email protected]
k
SGH
T: 02087252054
F: 02087253306
[email protected]
Private
Shirley Oaks Hospital
North Downs Hospital
Parkside Hospital
T: 02086576653
F: 02086576653
[email protected]
Rationale for long-term macrolides
for Chronic Rhinosinusitis
ARS
Stretococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Few anaerobes,
streptococci,
staphylococcus
• CRS
Acute RS vs Chronic
RS
bacteria
– Staph Aureus
– Coag neg staph
– Strep pneum
– anaerobes
Long-term antibiotics
Efficacy of long term treatment in diffuse panbronchiolitis
Asian studies CRS over last decade
Long-term low-dose macrolide
60-80% improvement in CRS refractory to surgery and
steroids
Slow onset, ongoing improvement at 4/12
Macrolides
Increase mucociliary transport
Reduce goblet cell secretion
Accelerated apoptosis of neutrophils
Other anti-inflammatory effects
Inhibit IL expression
Reduce virulence and tissue damage caused
by chronic bacterial colonisation
Increase ciliary beat
Long-term macrolides
Prospective RCT
N=90 CRS =/- NP
3/12 erythromycin
ESS
VAS, SNOT-22, SF36, NO,
rhinometry, saccharine
clearance, endoscopy
No signif difference in outcome
Medical Regimen for Chronic
Rhinosinusitis
Clarithromycin 250mg bd for 6-12 weeks
Xylometazoline bd for 1 week
Nasal douche for 6-12 weeks
Topical nasal steroids for 6-12 weeks
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Medical Regimen for nasal polyps
Maintenance dose of topical nasal steroid long-term
30mg prednisolone for 7 days as required, (but not more
frequently than 3 monthly)
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