Ear nose and throat diseases becker quimica,what stops ear ringing,tinnitus traditional chinese medicine cursos - New On 2016

Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Each chapter in this new edition includes key learning points, up-to-date references, and suggestions for further reading.
The book is essential reading for the practicing otolaryngologist, ENT specialists in training and those undertaking specialty examinations. Overview Earwax blockage can occur when your body produces too much earwax or when the existing wax is pushed too far into your ear canal. Use of the copyright symbol on this website does not limit or abridge the rights of Veterans, the general public, or the Government from non-commercial access to, and use of, the information displayed on this website. Even adults find life very difficult and depressing if they were to lose the sense of hearing, for example following an accident or infection. Otologists (the E of the ENT), audiologists and engineers have endeavored to remedy this problem throughout the times. Recently Mr Brett Lee – world renowned cricketer visited Sri Lanka to create an awareness of this technology.
With the Sri Lankan government’s commitment to support these patients, we hope the totally deaf community in Sri Lanka will be able to get great benefit from cochlear implantation. Due to its close proximity and intricate anatomical relationship to the thyroid gland, the recurrent laryngeal nerve is at risk during thyroid surgery.
On one hand we have diverse and vibrant medical specialty of Otorhinolaryngology and Head and Neck surgery – more simply known as ENT, on the other, commonest metabolic disorder DM. At the end if this talk I hope you will appreciate the relationship, however seems improbable, between two.
Considering the time available, let me enlighten you on three important conditions one from the EAR, one from the NOSE and one from the THROAT.
An 65 year old male presented to us with excruciating right sided otalgia and ipsilateral lower motor neurone facial nerve palsy.
If I say more than 90% of patients are elderly diabetics, you will agree diabetes is a strong risk factor. Morbidity figure is even greater as the condition is associated with lower cranial nerve palsies.
First described in 1959 Meltzer and Keleman in a poorly controlled diabetic who died despite a protracted course of antibiotics and repeated surgical debridement. If I say that this condition has a high mortality figure, varying from 10-50%, you will agree diabetes is a potentially fatal risk factor. Biopsy oeosinophilic granulomas non caseating, no fungal filaments, no features suggestive of malignancy.
Immunocompromised with severe neutropenia (chemotherapy patients, BMT, organ transplants, AIDS) – Aspergillus accounts for 80% of infection in this group. I consider it a great privilege to be delivering this talk about thyroid surgery which i simply love. As the luck would have it, two sets of guidelines have come up from either side of Atlantic. Before that, to gain some credibility to my talk, let us examine some statistics about the thyroid surgeries done at our unit.
BTA guidelines recommends a surgeon must perform minimum of 20 thyroid surgeries for a year to be a part of the team managing thyroid cancers. Here is a diagram showing my way of looking at management of a patient with thyroid cancer. Risk factors for malignancy extremes of age, male gender, recent rapid enlargement, hoarseness and associated lymphadenopathy. Another important aspect is not to miss preoperative laryngoscopy as up to 2% will have a vocal cord palsy.
Although there are many other modalities like CT, MRI radio nuclide scans, the most important imaging modality is Ultrasound.
Rather I’d like to address a few areas related to the surgery according to the guidelines. It a such a peculiar situation where a seemingly innocent symptom, can in fact kill the sufferer. In the limited time allocated to me I want to give you some practice tips, useful hints and relevant know how. Second, when talking about OSA one can go on and on about the defintions, minor details about clinical features and exotic details of surgical steps. Evidence, recommendations and guidelines are derived from three main bodies on either side of Atlantic. Scottish intercollegiate guideline network came up with first set of guidelines in 2003 and more recent and more accepted from American College of Physicians and American Academy of Sleep Medicine in 2014. So let me concentrate of couple of highlights in three main areas of , well in any condition, clinical assessment, investigations and treatment. Remember the 3 S of OSA – Snoring, Sleepiness (excessive, unexplained), and Significant other noticing stopping breathing. The problem with ESS is that some situations doesn’t apply to local setting and also some recent evidence questions the validity. Low- quality evidence from 18 studies (72, 115, 116, 118–133) showed that the Berlin Questionnaire may be helpful in predicting risk for OSA.
That’s the third practice point use easy to remember questionnaires or at least remember to use 3s s. General examination, nasal examination, oro-pharyngeal examination, facial skeletal assessment when combined with fibre optic naso pharyngo laryngosvpy gives fairly complete examination.
Type 1 is the best with all the channels in a facility, type two being all the channels but portable, third is more practical with essential channels at least 4 in portable, type 4 is anything else.
There is also another principal Bernoulli – when there is narrowing the pressure exerted becomes less and the collapse is likely to be more. Two basic principles of fluid flow, the Bernoulli principle and the Venturi effect, can be applied to give additional insight to the effects of airway narrowing. Bernoulli’s Principle states that as the speed of a moving fluid increases, the pressure within the fluid decreases.
I hope I was able to give be you an overview of the condition and some useful practice points to add to your clinical assessment. As the name implies, Rhinolith means a stone in the nose.Although rare, we see quite a few patients with this condition.
Presentation is generally a middle aged female presenting with foul smelling discharge or halitosis.


On examination we can see unilateral (one sided) purulent (yellowish, pus like) discharge in a otherwise normal patient.
It is thought that rhinoliths form by deposition of Calcium and Magnesium salts around a nidus. We need to take them out (usually) under General Anaesthesia. Once removed this does not recur. When the patient is educated about the problem and that there is no major or dangerous condition, patients are able to tolerate the symptoms. I recently presented at North Colombo Teaching Hospital, Ragama, Sri Lanka about using Information Technology to become a better medical professional. Good afternoon, I am delighted to be here with you today and thank you very much for inviting me over. Today I intend to talk about using information technology to develop as a medical professional. Not only that you have to use it unconventionally and as they say “thinking out of the box”. With those examples, you can see the use of IT in action, you can learn from it and adopt it to your particular needs.
Intersection between IT and Medicine is vast and I don’t wish even to attempt to cover even the very broadest outline of it.
What follows is my own deliberations and therefore will take full responsibility of the ideas and hence if there are any commissions and commissions please excuse me. Multimedia capable, you can easily upload photos and videos right from the phone or computer if you want.
You can submit this for assessment – once downloaded you can format it however you may like and submit to relevant authorities. At present, MDT for head and neck cancer does not exist in Southern province (similar to most of the parts of the country). One of the most important reasons for this is the fact that relevant consultants work in geographically different parts of the district. First MDT was held on 30 October 2013 close to one and half years we have had monthly sessions.
So I have shown you three specific IT usages in medical professionalism and hopefully you can implement some of that in your own professional life.
Lastly I like to show you three useful mobile applications as I don’t have time to delve in to all the medical apps today. So before I wind up I would like to highlight that no amount of technology can replace the healing touch of medicine.
They say the when a patient with a rare condition presents to the ward, there usually be another soon! Enter your email address to subscribe to this blog and receive notifications of new posts by email. This classic textbook has been completely updated and expanded to reflect the increasing sophistication of diagnostic and management skills.
The contributors are leaders in their respective fields – a virtual list of ‘who’s who’ of British otolaryngology head & neck surgery. General practitioners, doctors considering ENT as a career, and medical students will also find the book a valuable resource.
In some cases, you may not be able to hear out of the affected ear, but this typically lasts only until you can have the excess wax removed. Hence, tor the sake of the former, nomenclature and classification have been made, it is hoped, much less complex than is the case in the ordinary text-book; while for the sake of the latter, those diseases of the eye for which the general practitioner is expected to prescribe are fully dwelt upon, especially those the proper diagnosis of which will lead to recognition of general diseases. In this short presentation I discuss relevant aspects of the relationship between the thyroid gland and the recurrent nerve. A search in the published medical literature for DM and ENT provided evidence for some associations. We know that quinolones inhibit DNA gyrase and topo isomerase and mutations in the respective – responsible genes can lead to resistance. Histology again multiple non-caseating granuloma, no evidence of malignancy, Fungal studies missing.
This is a very serious condition needing emergent interventions in the form of surgery and intravenous anti fungals. Through this restricted region travels components of every major system of body except genito urinary system.
Ludwig’s angina lateral neck abscess para pharyngeal space accesses, parotid abcesses all these are commoner in diabetics. Its a daunting task talk about a common operation like thyroid to the community of head and surgeons. Traditional anatomy, physiology, pathology, clinical features, investigations and treatment method is what widely utilized.
What I intend to do is to analyze our own practice in the light of current guidelines and learn and improve through the comparison.
2014 British thyroid association guidelines, and 2015 American thyroid association guidelines. All recommendations without exception suggests MDT – The team comprises of surgeon, pathologists, radiologists, oncologists, nurses etc Can I by show of hands know how many of you actually practice it? By reducing cognitive skills and excessive day time sleepiness causing road traffic accidents. Rather I would like to concentrate on salient points, practice tips and evidence based recommendations. So that’s the first practice point try and diagnose more patients with this killer condition. Combine that with the Muller’s manoeuvre then you can be even surer where the obstruction is or are. We need to educate them about their condition, findings of the study, severity, risks, options patients role and about driving.
Studies have shown over and over again that this is useful not only in severe OSA but moderate category as well. COBLATION Plasma Technology creates a controlled, stable plasma field to precisely remove tissue at a low relative temperature, resulting in minimal thermal damage to surrounding soft tissues. Some have only a minor nuisance while some others a severe distress at times even prompting suicidal ideation. Using it as a tool rather than being a slave and frustrated in ever increasing flow of information.


And at the end of the presentation, I will give you the access to all the resources I describe in this presentation. In the software aspects similarly there is a shift from fully fledged versions to mobile friendly applications. However I would like to illustrate ways how the information technology may be utilised for the said task by taking specific case scenarios. They need surgery, radiotherapy, imaging (CT and MRI), pathology and speech and language therapy services for optimal care. I devised a solid workflow for patients with head and neck cancer and utilised google’s hangout on air. Clinic book is give a separate MDT number and patient details are enter to the online database.
In most cases, home treatment works well, but a doctor can also help eliminate the earwax blockage. This is rather unfortunate considering the long term consequences like poor communication (both receptive and expressive), poor learning outcomes and poor employability. Add this to prolong duration of treatment, sometimes months, a sure recipe for antibiotic resistance. If I say that this condition has a high mortality figure, varying from 50-80%, you will agree diabetes is a potentially fatal risk factor. Trained under the tutelage of European greats like Theodore Bilroth etc, he pioneered many forms of modern surgery from mastectomy to inguinal hernia repair. Clinical features, Imaging (particularly ultrasound), FNAC, MDT meeting, Surgery, Radioactive remnant ablation, Follow up and Recurrences (if any). When we first assess a patient with a goiter, we look for evidence, by way of history taking and examination, in the 4 categories .
Also, some recent phenomenon is when you do thyroidectomy for toxicity you encounter malignant histologies. One of the problems for a surgeon practicing far away from the onco center is the distance. For the therapeutic neck dissection in the central compartment levels v and vi and for the lateral neck levels 11 A to VB had to be taken out.
There is a relationship between critical pressure, upstream pressure and downstream pressure. Therefore data loss due to physical damage, lost or broken computer or accidental or non-accidental deletion of files is no more a major problem.
After a while you get used to it and change the workflow to suite the gadgets and software you have. Multidisciplinary team meetings are, therefore essential for management of head and neck cancer patients. Regional cancer centre is located at Karapitiya 128 km away from local district general (Hambantota) and with poor availability of public transport system, the patients find it very difficult to visit these hospitals multiple times. Causes of Earwax Blockage The presence of some earwax is normal; earwax protects your inner ear from debris, such as bacteria and dust. Diabetes cause micro vascular disease, diabetes cause macro vascular disease and diabetes impairs host immunity. Eccentric man, much more than the usual of surgeons in general, he is credited for many principles of modern surgeries including aseptic technique, meticulous haemostasis, tension free tissue approximation, obliteration of dead space and preservation of vascular supply also known as Halsted principles.
The Venturi effect describes the acceleration of airflow that occurs as a current of air enters a narrow passageway. And also your files are available to you from wherever you are – as long as internet connection is there. Online data collection system is capable of holding pathology slides, CT scans etc and the team members get an email notification once the patient details are entered. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. The water spraying out of a hose that is partially occluded by the thumb is an example of this effect. However, you may develop a blockage if you push the wax deep into your ear or naturally produce an excess amount of earwax. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. Once he has operated on his own mother on the kitchen table at 2 am and performed one of the first gall stones surgeries in the history and on another instance transfused his own blood to his sister who was dying on post partum hemorrhage and operated on her to save her life. I did a rough calculation based on available statistics – 16 Million adults roughly 5 million has it. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.
He invented rubber gloves out of love for his scrubbed nurse who developed contact dermatitis for antiseptic solution.
Other common symptoms include: a feeling of fullness in your ear an earache ringing, buzzing, or other odd noises in your ear Most patients only notice these symptoms in one ear, since it is unlikely that both ears will be blocked at the same time.
If you are experiencing these symptoms in both ears, you should see a doctor to rule out any other medical conditions.
Your doctor will likely ask about your symptoms before diagnosing you with a wax blockage. Your doctor will also use a lighted instrument called an otoscope to look into your ear and see if wax may be causing your symptoms.
Home Care You can use several substances to soften and remove earwax at home, including: mineral oil glycerin baby oil Use an eyedropper to insert a few drops into your ear canal twice a day for four to five days to soften the wax. If this does not work, you can try putting a little hydrogen peroxide in your ear to remove the wax. Fill a rubber ball syringe with warm water, tilt your head, and pull your earlobe up a bit so that you can direct the water into your ear canal. Another way to prevent earwax blockage is to avoid sticking anything in your ear, including the cotton swabs that many people regularly use to clean out wax. In many cases, this tactic can actually push wax further into your ear, causing an obstruction.



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06.04.2014 admin



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