ent - ear nose and throat head and neck page




ENT and Head & Neck Referrals Amer Amen, FRCS(Eng), DLO Consultant ENT & Head and Neck Surgeon PAH Health Trust General referral guide to ENT department Referral according to urgency Very urgent direct to ENT ward Urgent referral to the clinic Very soon Soon Routine Very urgent directly to the ENT ward in your local hospital Better if the SHO on call is informed Stridor or any severe upper respiratory tract obstruction. Severe dysphagia ( Foreign body) Severe infection Periorbital or orbital inflammatory swelling Cervical abscess Quinsy( peritonsillar abscess Very severe tonsillitis? Glandular fever Mastoiditis Severe Otitis Externa or furunculosis. Perichondritis of the pinna Parotitis or abscess Sudden facial palsy Trauma Haematoma of the pinna Severe nasal bleeding not responding to simple measures. Severe uncontrolled vertigo with dehydration Urgent Referral to the clinic *Throat* Stridor Dysphagia Hoarseness of voice for more that 4 week Smoking patient Any mass or persistent ulcer Tongue Oral cavity Pharynx Asymmetrical tonsils Stone in Salivary gland duct. Large Palatal swelling Neck Persistent cervical swelling Solid -- Lymph nodes Cystic Branchial cyst Thyroglossal cyst Cystic hygroma Dermoid cyst Laryngocele Salivary gland swelling parotid Submandibular Minor salivary gland Thyroid goitre for general surgery Other cervical swelling for ENT Lymph node in the neck management Need to exclude Malignant pathology Nasal and post nasal space sinuses Pharynx Larynx The Ears External Perichondritis of the pinna Furunculosis use wick of glycerin and triadcortyl wick Diclofenic tab (NSAID) Antibiotic Persistent ulcer or mass Middle Mastoiditis Severe otitis media with no response to treatment Serous otitis media in adult with no response to treatment Post nasal tumour to be excluded Facial palsy Suppurative otitis media with complication Facial palsy Sudden Deafness Severe vertigo Sinuses & nasal cavity Suspicious Swelling or ulcer Severe sinusitis with no response to treatment Complicated Sinusitis Periorbital or orbital swelling Very severe headache Empyema of the sinus Fronto ethmoidal Maxillary Swelling of the maxilla Urgent referral to the clinic Consideration by GP The problem of lump in the throat Urgent if any real dysphagia very soon if no real dysphagia Consider FBC Barium Swallow Globus pharyngeus is very common We still have to exclude malignancy Very soon referral Tonsillitis with severe adenoids symptom in child Continuous noisy breathing at rest. Very mark mouth breathing Failure to thrive Severe otitis media with no response to treatment Very soon referral Nasal and sinuses Severe nasal blockage Mark nasal polypi Severe sinusitis with no response Unilateral nasal bleeding in old age Arrange urgent sinuses x ray If opaque sinuses refer urgently If with epiphora refer urgently Suspicious neoplasm Very soon referral Ears Persistent ear’s discharge with no response Ear discharge with vertigo Aural polyp Attic or posterior marginal perforation of T M With headache Recurrent perichondritis of pinna Infected pre-auricular sinuses Soon or Routine most other Referral What can be done before referral Recurrent tonsillitis with or without adenoids May be we open a direct access to waiting list Confirmed Recurrent tonsillitis One peri tonsillar abscess Streptococcus carrier Tonsillitis and snoring X ray of post nasal space show large adenoids Otitis media with effusion (Glue ears) Before referral Try long course of antibiotic Seven day full dose then after 4-6 prophylactic dose Trimethoprim Amoxil Erythromycin Others A wait for 3 to 6 months may clear the ears Refer Otitis media with effusion sooner if there is mark retraction pocket. Recurrent severe acute otitis media I have seen very severe throat thrush from antibiotic any marked hyperaemia of tonsils and palate after 7 days Thrush Blood test for glandular fever For Chronic rhinitis Try steroid nasal drop for 4 to six weeks exclude sinusitis by x ray Antihistamine in allergic rhinitis Systemic decongestant with antihistamine if vaso motor If you suspect allergic Try from history to find what is the allergen Sinusitis Try antibiotic with nasal decongestant and steam inhalation for 7 days Some time sinusitis may need longer antibiotic course Sinuses x ray after the treatment If shows signs of sinusitis opacity or fluid level Refer to ENT department Feeling of lump in the throat with no difficulty on swallowing and patient is non smoker usually stress related Try frequent sip of water if 10 minuet to stop the continuous swallowing on empty throat Steam inhalation at bed time Avoid irritant drink or food spicy food spirit smoking should be stopped avoid very hot or very cold Refer very soon if no clearance of symptoms Feeling lump in the throat Heavy smoking or with hoarseness Difficulty on swallowing Refer urgently Otitis externa Before referral patient should not self clean the ear Swab for bacteriology Try glycerine & triadcortyl oto wick In severe pain give NSAID Earache with no sign of ear disease referral for dental check up and exclude tempro mandibular joint problem then refer to ENT Referral for Hearing aid direct to Hearing aid centre . Try to train nurses from your surgery to learn audiogram scanning Audiogram and Tympanogram in your surgery will markedly reduce the referral.