Patients with vestibular neuronitis experience recurrent episodes of vertigo lasting for hours to days, often accompanied by nausea. Unlike other causes of vertigo, there is no hearing loss, tinnitus, or neurological symptoms. Meniere’s disease, on the other hand, presents with vertigo, hearing loss, and tinnitus. Benign paroxysmal positional vertigo is characterized by brief episodes of vertigo triggered by head movement, while acoustic neuromas typically present with hearing loss, tinnitus, and facial nerve palsy. Vertebrobasilar insufficiency, which occurs in elderly patients, is associated with neck pain and symptoms triggered by head movement.

Understanding Vestibular Neuronitis

Vestibular neuronitis is a type of vertigo that typically occurs after a viral infection. It is characterized by recurrent episodes of vertigo that can last for hours or days, accompanied by nausea and vomiting. Horizontal nystagmus, or involuntary eye movements, is a common symptom, but there is usually no hearing loss or tinnitus.

It is important to distinguish vestibular neuronitis from other conditions that can cause similar symptoms, such as viral labyrinthitis or posterior circulation stroke. The HiNTs exam can be used to differentiate between vestibular neuronitis and stroke.

Treatment for vestibular neuronitis may involve medications such as prochlorperazine or antihistamines to alleviate symptoms. However, vestibular rehabilitation exercises are often the preferred treatment for patients with chronic symptoms. These exercises can help to retrain the brain and improve balance and coordination. With proper management, most people with vestibular neuronitis can recover fully and resume their normal activities.

Nasal tumors can cause symptoms such as nosebleeds, a persistent blocked nose, blood-stained mucus draining from the nose, and a decreased sense of smell. A chronic cough in smokers, known as a smoker’s cough, is caused by damage and destruction of the protective cilia in the respiratory tract. Nasal polyps can result in symptoms such as nasal obstruction, sneezing, rhinorrhea, and a poor sense of taste and smell. If symptoms are unilateral or accompanied by bleeding, it may be a sign of a more serious condition. Nasal foreign bodies, which are commonly found in children, can include items such as peas, beads, buttons, seeds, and sweets.

Understanding Post-Nasal Drip

Post-nasal drip is a condition that arises when the nasal mucosa produces an excessive amount of mucus. This excess mucus then accumulates in the back of the nose or throat, leading to a chronic cough and unpleasant breath. Essentially, post-nasal drip occurs when the body produces more mucus than it can handle, resulting in a buildup that can cause discomfort and irritation. This condition can be caused by a variety of factors, including allergies, sinus infections, and even certain medications. Understanding the causes and symptoms of post-nasal drip can help individuals seek appropriate treatment and alleviate their discomfort.

If a patient has an uncomplicated tympanic membrane perforation that is dry, they can be managed with watchful waiting for a month without needing to see an ENT specialist. These perforations can occur due to various reasons such as blunt trauma, penetrating injuries, or barotrauma. Typically, the perforation will heal on its own within 4-8 weeks. However, patients should schedule a follow-up appointment after 4 weeks to ensure that the perforation is healing properly. If the patient experiences increasing ear pain, discharge, or worsening hearing loss, they should see their GP. During the examination, the patient should undergo a full examination, including otoscopy, cranial nerve examination, and Rinne/Weber tests. If there are any cranial nerve deficits, the patient should discuss them with an ENT specialist. Patients should keep their ears clean and dry, and topical antibiotics are not recommended for clean, dry perforations. If there are any signs of infection or contamination, topical antibiotics may be given. In cases where the patient has more complex issues such as temporal bone fractures or slowly healing perforations, they may need to be reviewed by an ENT specialist in an emergency clinic. If the perforation does not heal, surgical intervention may be necessary.

Perforated Tympanic Membrane: Causes and Management

A perforated tympanic membrane, also known as a ruptured eardrum, is a condition where there is a tear or hole in the thin tissue that separates the ear canal from the middle ear. The most common cause of this condition is an infection, but it can also be caused by barotrauma or direct trauma. When left untreated, a perforated tympanic membrane can lead to hearing loss and increase the risk of otitis media.

In most cases, no treatment is needed as the tympanic membrane will usually heal on its own within 6-8 weeks. During this time, it is important to avoid getting water in the ear. However, if the perforation occurs following an episode of acute otitis media, antibiotics may be prescribed. This approach is supported by the 2008 Respiratory tract infection guidelines from the National Institute for Health and Care Excellence (NICE).

If the tympanic membrane does not heal by itself, myringoplasty may be performed. This is a surgical procedure where a graft is used to repair the hole in the eardrum.

A typical scenario for viral labyrinthitis involves a person who has recently had a respiratory infection and suddenly experiences vertigo, vomiting, and hearing loss. The symptoms are usually severe and persistent, and rest may not provide relief. This is likely caused by a viral infection in the inner ear, which is known as labyrinthitis. Given the patient’s history, this is the most probable diagnosis.

Understanding Vertigo and Its Causes

Vertigo is a condition characterized by a false sensation of movement in the body or environment. It can be caused by various factors, including viral infections, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, and acoustic neuroma.

Viral labyrinthitis and vestibular neuronitis are often associated with recent viral infections and can cause sudden onset vertigo, nausea, and vomiting. While hearing may be affected in viral labyrinthitis, vestibular neuronitis does not cause hearing loss. Benign paroxysmal positional vertigo, on the other hand, has a gradual onset and is triggered by changes in head position. Each episode typically lasts for 10-20 seconds.

Meniere’s disease is characterized by vertigo, hearing loss, tinnitus, and a sensation of fullness or pressure in one or both ears. Vertebrobasilar ischaemia, which is more common in elderly patients, can cause dizziness when the neck is extended. Acoustic neuroma, which is associated with neurofibromatosis type 2, can cause hearing loss, vertigo, and tinnitus. An absent corneal reflex is an important sign of this condition.

Other causes of vertigo include posterior circulation stroke, trauma, multiple sclerosis, and ototoxicity from medications like gentamicin. Understanding the different causes of vertigo can help in the diagnosis and management of this condition.

If a patient has had persistent oral ulceration for more than three weeks, it is recommended that they be referred to oral surgery under the two week wait. This is especially important for smokers, as it raises suspicion for malignancy. Referring the patient to oral surgery under the two week wait is more appropriate than routine referral, as it allows for a quicker diagnosis. Following up with a community dentist is not recommended, as it may cause delays in diagnosis if the patient does not attend. While chlorhexidine may provide symptom relief, it does not address the underlying diagnosis, and reassurance alone is also not sufficient. Medical practitioners should refer patients with this presentation to oral surgery.

When to Refer Patients with Mouth Lesions for Oral Surgery

Mouth lesions can be a cause for concern, especially if they persist for an extended period of time. In cases where there is unexplained oral ulceration or mass that lasts for more than three weeks, or red and white patches that are painful, swollen, or bleeding, a referral to oral surgery should be made within two weeks. Additionally, if a patient experiences one-sided pain in the head and neck area for more than four weeks, which is associated with earache but does not result in any abnormal findings on otoscopy, or has an unexplained recent neck lump or a previously undiagnosed lump that has changed over a period of three to six weeks, a referral should be made.

Patients who have persistent sore or painful throats or signs and symptoms in the oral cavity that last for more than six weeks and cannot be definitively diagnosed as a benign lesion should also be referred. It is important to note that the level of suspicion should be higher in patients who are over 40, smokers, heavy drinkers, and those who chew tobacco or betel nut (areca nut). By following these guidelines, healthcare professionals can ensure that patients with mouth lesions receive timely and appropriate care. For more information on this topic, please refer to the link provided.

This woman is experiencing sialadenitis, which is inflammation of the salivary gland. It is likely caused by a stone blocking the duct. The submandibular gland is located below the jawline and its duct drains into the floor of the mouth. When there is a discharge from this duct, it can cause a bad taste in the mouth. There are three main salivary glands: the parotid glands, which are located in front of and below each ear, the submandibular glands, which are located below the jawline, and the sublingual glands, which are located beneath the tongue. Disorders of these glands can be caused by infection, inflammation, obstruction, or malignancy. Swelling of the submandibular gland can be caused by a stone or a tumor, which can be either benign or malignant.

Salivary Glands and Their Pathologies

Salivary glands are responsible for producing saliva, which aids in digestion and protects the mouth from harmful bacteria. There are three pairs of salivary glands: parotid, submandibular, and sublingual. The parotid gland is the most common site for tumors, while the submandibular gland is most commonly affected by stones.

Tumors in the salivary glands are rare, but when they do occur, 80% of them are found in the parotid gland. Of these, 80% are pleomorphic adenomas, which are benign. These tumors typically grow slowly and are painless, but surgical removal carries a risk of damage to the facial nerve (CN VII). Warthin’s tumor is another benign tumor that affects the salivary glands, but it is less common than pleomorphic adenomas.

Stones in the salivary glands can cause recurrent pain and swelling, especially when eating. They are most commonly found in the submandibular gland and can lead to infection if left untreated. Other causes of salivary gland enlargement include viral or bacterial infections, as well as autoimmune disorders like Sjogren’s syndrome. Proper diagnosis and treatment are important for managing these conditions and preventing complications.

Nasal Septal Haematoma: A Complication of Nasal Trauma

Nasal septal haematoma is a serious complication that can occur after even minor nasal trauma. It is characterized by the accumulation of blood between the septal cartilage and the surrounding perichondrium. The most common symptom is nasal obstruction, but pain and rhinorrhoea may also be present. On examination, a bilateral, red swelling arising from the nasal septum is typically seen. It is important to differentiate this from a deviated septum, which will be firm to the touch.

If left untreated, nasal septal haematoma can lead to irreversible septal necrosis within just a few days. This occurs due to pressure-related ischaemia of the cartilage, which can result in necrosis and a saddle-nose deformity. To prevent this, surgical drainage and intravenous antibiotics are necessary. It is important to be vigilant for this complication after any nasal trauma, no matter how minor.

Management of Otitis Externa: Recommended Actions and Guidelines

Otitis externa is a common condition that affects the outer ear canal. The management of this condition depends on the severity of the inflammation and the presence of other symptoms. Here are some recommended actions and guidelines for managing otitis externa:

1. Start topical antibiotic and steroid: This is recommended for patients with acute otitis externa who present with more severe inflammation. The treatment should last for seven days.

2. Start topical acetic acid 2% spray: This is recommended for patients with mild otitis externa who do not have hearing loss or discharge.

3. Refer to ENT urgently: This is not part of initial management but should be considered for patients with chronic diffuse otitis externa when treatment is prolonged beyond two to three months.

4. Start oral amoxicillin: Oral antibiotics are rarely indicated for otitis externa. They should only be considered for patients with severe infection or at high risk of severe infection.

5. Take an ear swab and start topical antibiotic: Ear swab is not recommended as first-line management. It should only be done if there is no response to initial treatment or in recurrent infections.

In summary, the management of otitis externa depends on the severity of the inflammation and the presence of other symptoms. Following these recommended actions and guidelines can help improve patient outcomes.

Common Causes of Hearing Loss and Their Characteristics

Hearing loss can be caused by various factors, including genetic factors, abnormal bone formation, and tumors. Here are some common causes of hearing loss and their characteristics:

1. Otosclerosis: This condition affects young adults and causes conductive deafness. It is caused by abnormal bone formation around the base of the stapes, which eventually fuses with the bone of the cochlea, reducing normal sound transmission.

2. Glue ear: This is a type of conductive hearing loss that is more common in children. There is no evidence of ear examination, but it can cause hearing difficulties.

3. Meniere’s disease: This is a sensorineural type of hearing loss that is usually accompanied by vertigo and a sensation of fullness or pressure in the ear.

4. Presbycusis: This is a sensorineural hearing loss that is associated with aging. Audiometry should show a bilateral high-frequency hearing loss.

5. Vestibular schwannomas: This is a benign primary intracranial tumor that affects the vestibulocochlear nerve. It commonly presents with unilateral hearing loss and can affect the facial nerve causing facial palsy as well.

Understanding the characteristics of these common causes of hearing loss can help in early detection and management of the condition.

Differentiating Causes of Hearing Loss: A Brief Overview

Hearing loss can be caused by a variety of factors, including age-related changes, tumors, infections, and genetic conditions. Here are some key features to help differentiate between some of the most common causes of hearing loss:

Presbycusis: This is age-related hearing loss that affects high-frequency sounds and is irreversible. Management includes reassurance and discussion of hearing aid options.

Acoustic Neuroma: This is a benign tumor of the vestibulocochlear nerve that can cause unilateral tinnitus and hearing loss, as well as facial numbness and balance problems. Bilateral hearing loss without other symptoms makes this diagnosis unlikely.

Cholesteatoma: This condition is characterized by recurrent or persistent ear discharge, conductive hearing loss, and ear discomfort. Otoscopy may reveal a deep retraction pocket or pearly white mass behind the intact tympanic membrane. This patient has sensorineural rather than conductive hearing loss.

Ménière’s Disease: This condition typically presents with fluctuating hearing loss, vertigo, and tinnitus. Aural fullness may also be present. This patient does not have all the symptoms to meet the criteria for this diagnosis.

Otosclerosis: This is a form of conductive hearing loss that typically occurs in early adulthood and may be accompanied by tinnitus and transient vertigo. Sensorineural hearing loss in an older patient makes this diagnosis unlikely.