Alcohol consumption is linked to 30% of cases in the UK.

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 doesn’t 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.

The Rinne and Weber tests are utilized to differentiate between conductive and sensorineural hearing loss.

In the case of this individual, there is an obstruction of wax in the right ear canal, which would result in a conductive hearing loss on the right side.

During the Weber test, the patient should be able to locate the sound to the side of a conductive hearing loss, as bone conduction is enhanced. The sound will be located away from a sensorineural hearing loss.

If there is a conductive hearing loss, the Rinne test will be negative, as bone conduction is better than air conduction. It will be positive if air conduction is better than bone conduction, which may be the case for mild-moderate sensorineural hearing loss or if there is normal hearing.

In this instance, the wax blockage causes a conductive hearing loss on the right side. Therefore, during the Weber test, the sound should be localized to the right, and Rinne should be negative on the right side and positive on the left.

Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

Rinne’s and Weber’s tests are used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test indicates that BC is better than AC, suggesting conductive deafness.

Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking the patient which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

The table below summarizes the interpretation of Rinne and Weber tests. A normal result indicates that AC is greater than BC bilaterally and the sound is midline. Conductive hearing loss is indicated by BC being greater than AC in the affected ear and AC being greater than BC in the unaffected ear, with the sound lateralizing to the affected ear. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, with the sound lateralizing to the unaffected ear.

Overall, Rinne’s and Weber’s tests are useful tools for differentiating between conductive and sensorineural deafness, allowing for appropriate management and treatment.

Understanding Otitis Externa: Causes, Features, and Management

Otitis externa is a prevalent condition that often prompts primary care visits in the UK. It is characterized by ear pain, itch, and discharge, and can be caused by bacterial or fungal infections, seborrhoeic dermatitis, or contact dermatitis. Swimming is also a common trigger for otitis externa. Upon examination, the ear canal may appear red, swollen, or eczematous.

The recommended initial management for otitis externa is the use of topical antibiotics or a combination of topical antibiotics with a steroid. However, if the tympanic membrane is perforated, aminoglycosides are traditionally not used. If there is canal debris, removal may be necessary, and if the canal is extensively swollen, an ear wick may be inserted. Second-line options include taking a swab inside the ear canal, considering contact dermatitis secondary to neomycin, or using oral antibiotics such as flucloxacillin if the infection is spreading. Empirical use of an antifungal agent may also be considered.

It is important to note that if a patient fails to respond to topical antibiotics, they should be referred to an ENT specialist. Malignant otitis externa is a more severe form of the condition that is more common in elderly diabetics. It involves the extension of infection into the bony ear canal and the soft tissues deep to the bony canal, and may require intravenous antibiotics. While some ENT doctors disagree, concerns about ototoxicity may arise with the use of aminoglycosides in patients with perforated tympanic membranes.

Tuning Fork Tests for Hearing Loss

Tuning fork tests are commonly used to differentiate between conductive and sensorineural hearing loss. Two tests are usually performed: the Rinne test and the Weber test. The Rinne test compares air conduction to bone conduction by placing the tuning fork against the mastoid and adjacent to the ear canal on both sides. Normally, sound is heard better by air conduction than bone conduction, resulting in a Rinne-positive outcome. However, conductive hearing loss can reverse this result, causing a Rinne-negative pattern where bone conduction is better than air conduction. On the other hand, sensorineural hearing loss and normal hearing both result in a Rinne-positive outcome, requiring the Weber test for further information.

The Weber test involves placing the tuning fork on the forehead and checking if sound waves are transmitted equally to both ears. If the sound is heard equally in both ears, the result is normal. However, conductive hearing loss in one ear causes the sound to be heard on the same side as the conductive loss. In contrast, sensorineural hearing loss causes sound to be heard on the opposite side.

In this particular case, the Rinne test resulted in a negative outcome on the right side, indicating right-sided conductive hearing loss. The Weber test confirmed this by lateralizing to the affected side. Tuning fork tests are a quick and non-invasive way to determine the type and location of hearing loss, allowing for appropriate treatment to be initiated.

Nasal Foreign Bodies: Risks, Complications, and Removal Techniques

Nasal foreign bodies are a common occurrence, but they should not be taken lightly. Bleeding is the most common complication, but inflammation, mucosal damage, extension into adjacent structures, and infection can also occur. In severe cases, a foreign body can accidentally be aspirated, leading to acute respiratory obstruction. Additionally, foreign bodies in the nose can carry causative organisms of infectious diseases. Therefore, spontaneous expulsion should not be anticipated, and urgent ENT referral may be necessary.

Successful removal of a nasal foreign body requires a cooperative patient and a doctor experienced and confident in the removal technique. Several methods are available, including blowing positive pressure through the nose, using forceps or suction, and passing a balloon catheter. The choice of method depends on the type of foreign body and the doctor’s comfort level.

It is important to note that small button batteries should be removed immediately as they can cause local necrosis if they leak. Topical anaesthetic and vasoconstrictor may be helpful in the removal process. In cases where the patient is uncooperative or the foreign body is in a posterior position, urgent ENT referral is appropriate.

Management of Unilateral Sensorineural Hearing Loss

Unilateral sensorineural hearing loss can be a sign of an acoustic neuroma, a tumour of the vestibulocochlear nerve. Therefore, any patient presenting with this symptom should undergo an MRI scan of the head to investigate the cause. Betahistine is not appropriate for this condition, but may be used in patients with Ménière’s disease. Hearing aid provision may be considered if the MRI is normal and the diagnosis is presbyacusis. High-dose oral steroids are not indicated for gradual-onset hearing loss. Grommet insertion is not a suitable treatment for sensorineural hearing loss.

Facial Paralysis: Understanding the Causes and Symptoms

Facial paralysis can be caused by a variety of factors, including stroke, brain tumours, and viral infections. The most common type of facial paralysis is Bell’s palsy, which is often idiopathic in nature. In Bell’s palsy, the brow is paralyzed due to a lower motor neuron facial nerve palsy. While the underlying cause is often unknown, viruses such as herpes simplex type 1 have been implicated. Other potential causes include mononeuropathy in diabetes or sarcoid, Lyme disease, and posterior fossa tumours.

Fortunately, the majority of patients with Bell’s palsy recover significantly within six weeks to three months, with around 70% making a full recovery. Treatment typically involves prednisolone and vigilant eye care.

It’s important to differentiate Bell’s palsy from other potential causes of facial paralysis, such as stroke or brain tumours. In a stroke, the brow would not be paralyzed due to an upper motor neuron lesion. While a posterior fossa tumour can cause facial palsy, it is less common than Bell’s palsy. Paralysis is a nonspecific diagnosis and not the best answer, while Ramsay Hunt syndrome is associated with the varicella-zoster virus and typically presents with concomitant shingles, which is not present in this patient.

Management of Acute Otitis Media in Children: Treatment Options

Acute otitis media is a common childhood infection that can cause pain, fever, and hearing loss. When managing this condition, healthcare providers have several treatment options to consider. Here are some possible approaches:

Immediate Oral Antibiotics: If the child has otorrhoea or bilateral infection, or is under two years old, immediate oral antibiotics are recommended. Parents should be informed that the typical duration of acute otitis media is around three days, but it can last up to one week.

Delayed Antibiotics: In cases where otorrhoea and tympanic perforation are absent, or the child presents at an earlier stage, a prescription for delayed antibiotics may be appropriate. Parents should be advised on when to start the antibiotics, such as if the child experiences persistent fevers or worsening pain.

Oral Decongestants: According to guidance from the National Institute for Health and Care Excellence (NICE), decongestants are not recommended for the management of acute otitis media.

Referral to Ear, Nose and Throat: Immediate referral to an Ear, Nose and Throat specialist is necessary if the child is younger than three months and has tympanic perforation, shows signs of systemic sepsis, or has complicated otitis media (e.g., venous sinus thrombosis, meningitis, or mastoiditis). If none of these features are present, starting with oral antibiotics is reasonable.

Analgesia Only: While analgesia can help alleviate pain, it should not be the only treatment offered if the child has a perforation and otorrhoea. Antibiotics should also be prescribed in this case.

Treatment Options for Acute Otitis Media in Children

Suspected Nasopharyngeal Carcinoma

The suspicion is that the patient may have an underlying nasopharyngeal carcinoma, likely related to smoking, which is causing a blocked left nostril and bloody, serous discharge. It is important not to delay referral to an ear, nose, and throat (ENT) specialist by performing investigations through the GP outpatient radiology service. Imaging of the sinuses may be appropriate to determine the extent of any tumor, but this would be done as part of the pre-surgery workup rather than as outpatient GP investigations. A trial of intranasal steroids is not appropriate as a diagnosis of allergic rhinitis is unlikely, and this would waste valuable time in addressing any underlying tumor. Nasopharyngeal cancers are more common in people from southern China, including Hong Kong, Singapore, Vietnam, Malaysia, and the Philippines.

Mumps: Symptoms and Complications

Mumps is a viral infection that has an incubation period of 14-21 days. It can affect any of the salivary glands, but sometimes only one gland is affected. In rare cases, mumps can cause meningoencephalitis, which is inflammation of the brain and its surrounding tissues.

One of the common complications of mumps is orchitis, which is inflammation of the testicles. This occurs in around 25% of cases and can cause pain, swelling, and fever. However, sterility is a relatively uncommon complication following orchitis.