Conditions, investigations & treatments

Some examples of conditions and how they would be investigated and consequently treatment

CONDITIONS INVESTIGATIONS TREATMENT
NASAL:

Full nasal work-up includes: Nasal Endoscopy, CT Scan of Nose/Sinuses, Allergy Skin Prick Tests, Blood tests including RAST.

 

Allergic Rhinitis Full nasal work-up Inhaled nasal steroid sprays, anti-histamines, ? Ipratropium Bromide, Neil Med Sinus Rinse, Allergy avoidance
Deviated Nasal Septum Nasal Endoscopy +/- CT scan Septoplasty
Nasal Polyps Full nasal work-up Inhaled nasal steroid sprays/drops, Neil Med Sinus Rinse, FESS (Functional Endoscopic Sinus Surgery)/ Nasal Polypectomy
Sinusitis Nasal Endoscopy, CT Scan of Sinuses Inhaled nasal steroid sprays, Neil Med Sinus Rinse, FESS (Functional Endoscopic Sinus Surgery)/ Balloon Sinuplasty Dilatation
Anosmia (Loss of Smell) Nasal Endoscopy and CT Scan of Sinuses and Frontal lobe, ? UPSIT Smell test Inhaled nasal steroid sprays, Neil Med Sinus Rinse, Bio-feedback training
Nasal Deformity Nasal Endoscopy and preoperative nasal photographs Rhinoplasty/Septorhinoplasty
Nose bleeds Nasal Endoscopy, blood tests Antibiotic/antiseptic nasal creams, nasal cautery, FESS- Cautery to nose/Sphenopalatine Artery Ligation
Snoring

Nasal Endoscopy +/- CT scan

Fibre-optic Nasopharyngoscopy under controlled sedation (Adults)

Advice- weight loss, alcohol reduction, cessation of smoking, dietary advice. Treatment of cause of nasal obstruction. CPAP (Continuous Positive Airway Pressure), MAD (Mandibular Advancement Device), UPPP (UvuloPharyngopalatoplasty) +/- Tonsillectomy
Sleep Apnoea Fibre-optic Nasopharyngoscopy +/- under controlled sedation (Adults), Sleep Studies, X-ray of Nasopharynx (Children) Advice- weight loss, alcohol reduction, cessation of smoking, dietary advice. Treatment of cause of nasal obstruction. CPAP (Continuous Positive Airway Pressure), MAD (Mandibular Advancement Device), UPPP (UvuloPharyngopalatoplasty) +/- Tonsillectomy
Foreign body in nose Nasal Endoscopy Removal in clinic or under GA

 

EARS:
Hearing Loss (Adults and Children) PTA (Pure Tone Audiogram, Tympanogram, ? MRI Scan Depends on cause
Glue Ear (Secretory Otitis Media) (Children) PTA, Tympanogram, X-ray of Nasopharynx Medical treatment, Insufflation balloon, Grommets insertion
Glue Ear (Adults) PTA, Tympanogram, Nasopharyngoscopy, ? CT scan Medical treatment, Insufflation balloon, Grommets insertion +/- biopsy of Nasopharynx
Wax Impaction Ear drops, Micro-suction of ears.
Chronic Otitis Media, with or without Cholesteatoma PTA, Tympanogram, Microscope examination+/- suction debridement, CT Scan Micro-suction, Antibiotic Ear drops, Tympanoplasty, Mastoidectomy
Acute Otitis Media Antibiotics (Aural and oral), decongestants.
Foreign Body Micro-examination Microscope-assisted removal
(PTA if necessary)
Vertigo (Meniere’s disease, Benign Positional Paroxysmal vertigo, Migraine-associated vertigo, Vestibular Neuronitis, Acute Labyrinthitis) PTA, Tympanogram, Hallpike manoeuvre, Vestibular tests, ? MRI scan Treatment of diagnosed condition (Epley manoeuvre, Vestibular Rehabilitation Physiotherapy, Vestibular sedatives, Betahistine)
THROAT & NECK:
Laryngo-pharyngeal Reflux FOL (Fibre-optic Laryngoscopy), ? CT scan Advice (dietary/weight loss), Antacids, Proton pumps inhibitors, H2 antagonists, Throat hygiene
Vocal Cord Polyps/nodules, including Change in Voice FOL SALT (Speech and Language Therapy), Advice (dietary, vocal use), Micro-surgery
Lesions on Tongue/in Oral Cavity FOL Excision biopsy, microbiological analysis
Swellings in neck, including Thyroid Blood tests, FOL, Ultra-sound scan with +/- FNA (fine Needle Aspiration for Cytology), ?CT scan Aspiration of Cysts, Excision of swelling, refer to Thyroid surgeon
Swallowing Difficulty FOL, Blood Test, Barium Swallow Study, ? CT scan,? FEES (Fibre-optic Endoscopic Evaluation of Swallowing) Treatment dependent on cause.
Tonsillitis Tonsillectomy (if indicated)
Tonsil Stones (Chronic Tonsillitis) Tonsillectomy (if indicated)
Submandibular Sialadenitis/stones FOL, Ultra-sound scan Dietary advice, antibiotics, removal of stones, excision of gland.