1
Q
prebycusis cause
A
loss of air cells at the organ of corti
loss of cochlear neurons
stria vasculairs degenerates and shrinks and ossicles and tympanic membrane become more rigid leading
2
Q
prebycusis SX
A
loss of high frequencies
3
Q
prebycusis RF
A
advance age
male
white race
family history
service/blue-collar occupation
exposure to loud noises
lower education level
cognitive impairment
smoking
high serum homocysteine levels
low folic acid intake
hypertension
diabetes
4
Q
nutrients to treat dizziness and hearing loss
A
zinc
magnesium
glutathione
myeres cocktail
B6
Vit A
Vit D
bioflavonoids
Vit B12
folic acid
iron
Vit C, E, and alpha lipoic acid
5
Q
what dose zinc treat
A
prebycusis
SN hearing loss
SSNHL
6
Q
what dose magnesium treat
A
aminoglycoside antibiotics
7
Q
what dose glutathione treat
A
- gentamicin toxicity
- sensorineural hearing loss
8
Q
vit a treats
A
sensorineural hearing loss
9
Q
Vit D treats
A
- sensorineural hearing loss
- BPPV
- ostosclerosis
10
Q
bioflavonoids treats
A
- allergies
- vascular insufficiency
11
Q
Vit b12 treats
A
- tinnitus and noise induced hearing loss
- presbycusis
12
Q
folic acid
A
slow decline of hearing
13
Q
iron
A
sensorineural hearing loss
14
Q
Vit C, E, and alpha lipoic acid
A
presbycusis
15
Q
meniere’s tx
A
- low salt
- test for food allergies
- B6
- botanical diuretics
- constitutional homeopathy
- pyridocine 1-2 mg
- vestibular rehabilitation and hearing aids
- vestibular suppressant
- diuretics
- betahistine
- antihistamines
- steroids
16
Q
platinum based chemotherapeutics toxicity
A
- rosemarius
- curcumin
- Vitamin E
17
Q
aminoglycoside toxicity tx
A
urtica
18
Q
Botanicals for dizziness and hearing loss
A
ginkgo
vaccinum
vinca minor
vinpocetine
pycnogenol
capsicum
ginger
hypericum
cimicifuga
curcuma
19
Q
pharmacology to treat dizziness
A
scopolamine transdermal patches
20
Q
homeopathy for dizziness and hearing loss
A
Nat sulph, Arn, Nat sal
21
Q
physical medicine
A
- cervical manipulation
- TMJ assessment
- Epley procedures
- posterior canal BPPV
- supine roll test to assess for lateral semicircular canal BPPV
- Brandt-Daroff exercise
- Half Somersault technique
- Gufoni maneuver
22
Q
otosclerosis TX
A
- vit D
- calcium citrate or gluconate
- osteoprime
- nettles, raspberry leaf, alfalfa, avena
- calc phos 6x cell salts
23
Q
Labyrinthitis and Vestibular Neuronitis TX
A
Treat underlying infection
Eustachian tube massage
Steroids
Acupuncture
Homeopathy, anticholinergics I.e. Scopolamine patch, histamine antagonists i.e. Meclizine.
Benzodiazepinesare GABA modulators,
Vestibular Rehabilitation Exercises
24
Q
tinnitus TX
A
Address treatable underlying causes
Employ noise protection
Correct nutritional deficiencies,
Co enzyme C 10
homeopathy, acupuncture, qi gong
If cerebral vascular insufficiency: use ginkgo and vinpocetine, centella and pychnogenol
Cognitive therapy and/or biofeedback
Acoustic therapy
Transcranial Magnetic Stimulation
25
Sudden Sensorineural Hearing Loss TX
Ginkgo biloba
Vit E, Alpha lipoic acid
High dose intravenous Vitamin C
Magnesium: Oral or in IV Myers Cocktail
Oral Zinc 30 MG
Multiple B vitamins
Coenzyme Q10 100 mg BID
Caloric restriction, fasting, increase water, Mediterranean diet to decrease blood viscosity
Hyperbaric Oxygen therapy
Ozone therapy
Acupuncture
26
Benign Positional Vertigo TX
- Perform Epley maneuvers for P SCC BPPV
- Anterior SCC BPPV treat with Variants of the Dix-Hallpike
- Horizontal SCC BPPV treat with Gufoni Maneuver.
- supplemental Vit D
27
Acoustic Neuroma TX
surgery
radiosurgery
gamma knife radiosurgery
28
Bilateral Nasal Specific Technique
A simple intranasal procedure in which a balloon is inserted into each nasal passage in three different positions. The balloon is briefly inflated in each position, then removed.
29
Bilateral Nasal Specific Technique use
- chronic recurrent sinusitis
- Snoring if due to nasal passage and not tongue position
- Headaches
- History of facial trauma leading to pain or dysfunction
- Difficulty breathing through the nose
- Seizure disorders
- Nasal polyps
- Sphenoid malposition
- Pituitary hypofunction
- TMJ dysfunction
30
Bilateral Nasal Specific Technique CI
- Implanted hardware
- Severe epistaxis
- Thrombocytopenia
- Patient taking blood thinning medications
- Recent nasal surgery
- Status post cleft palate surgery or other surgeries that might leave the area fragile in light of dilation caused by the procedure
- Foreign body in the nose
- Latex allergy
31
Bilateral Nasal Specific Technique caution
- Osteoporosis
- Elderly patients
- Infants and children
- Nervous, hesitant, or reticent patients
32
Bilateral Nasal Specific Technique problems
aspiration
tissue damage
33
Bilateral Nasal Specific Technique supplies
- Bulb (quick release is nice)
- Medium latex finger cots
- 1-layer soft pressure
- 2
- 3
- 4 lot of pressure, more firm
- Floss (waxed) or rubber grommets
- Lubricant
- Round or flat toothpicks or 2mm ear curette
- Exam gloves
- Facial tissues
34
Bilateral Nasal Specific Technique steps
- Inspect the nose and nasal cavity
- Look for foreign objects
- Note asymmetry and places of narrowing
- Insert the deflated balloon into the first meatus
- Have the patient inhale through their mouth and hold their breath
- Secure and seal the balloon in the nostril
- Give two pumps of air and then quickly release the pressure
- Repeat for the remaining meatuses
35
Hepar Sulphuris
very sensitive to pain and stimuli
impatient and cranky
violent impulses
discouraged or even suicidal over their suffering
dream of fires and tend towards pyromania
fear violent accidents, injury
very cold and intolerant to it
painful swelling and ulceration
offensive odors from discharges
stitching, sharp, or splinter-like pains
36
Mercurius solubilis
closed, suspicious, emotionally intense, putrid, dribbly, smelly
paranoia
irritability, anxious, restless,
urge to kill, or be killed
suicidal
frequent infections
offensive greenish discharges, abscess, suppressed ones aggravates
worse at night, heat, and cold
tremor
37
Natrum Muriaticum
reserved/private
responsible, dependable, put together
mature beyond their years
holding an old betrayal close to the chest but will not openly share or complain unless directly asked
affected by grief and ailments from it
sad but can't cry
easily offended or wounded
desire to be alone
periodicity to complaints
38
Pulsatilla
changeable, emotional, weepy, clingily
thick/greenish yellow discharges
dogmatic about their beliefs
strong attachments to few individuals
desires consolation, manipulative to get affection
worse warm
39
common cold pathophysiology
- Rhinovirus (i.e., respiratory syncytial virus)
- Adenovirus
- Parainfluenza virus
- Coronaviruses
40
common cold SX
- Nasal congestion
- Rhinorrhea - watery thick
- Mild sore throat and cough
- Headache and malaise
- Fever - unusual in adults; low grade in children
41
common cold PE
Nasal mucosa is erythematous, swollen, and congested with discharge
42
common cold tx
-hydrotherapy: constitutional, hot fomentation, colonics, enema, 42s, carrot/ginger therapy, fever therapy
-rest
-stress reduction
-increase water intake
-fasting not more than 48
-chicken soup or miso
First sign of sx
- HP: ocillococcinum
- Yin chiao
- echinacea
- esberitox
- Zinc lozenges
- mycosheild
Sicker patients
- bioflavonids
- vit C
- Carrot juice
43
common cold botanicals
- sambucus
- ginger
- achillea
- salvia
- foeniculum
- Eriodictyon
- Stillingia
- Verbascum
- Glycyrrhiza
- Usnea
- Ligusticum
44
aconite
to be taken at the first sign of cold, especially after exposure to dry, cold wind. Sneezing, burning throat, thirst, restlessness at night, buzzing in ears. Clear, hot discharge < stuffy atmosphere. * Useful only during onset
45
allium cepa
sneezing, with streaming nose & eyes. Nasal discharge makes nose and upper lip sore. Hot, thirsty, headachy. < warm room. > open air. Cough hurts larynx
46
arsenicum album
gets cold with every change of weather. Sneezing frequent and painful. Thin, watery, burning nasal discharge, irritates nostrils. Intense tickle inside nose, one spot. Tends to move to chest. < after midnight, > warm drinks, burning pains relieved by heat. Sensation of "ice cold water or boiling water coursing through veins". Thirst for small amounts.
47
belladonna
sudden onset of cold, perhaps even violent. After exposure, especially chilling of head. Face flushed, skin feels hot and dry to touch. Fever may strike quickly, restlessness. Sensitivity to light. Sore throat, bright red, < right side. Very little nasal discharge. thirstless.
48
bryonia
Symptoms slow in developing, onset delayed. Much sneezing, eyes red and watery. Nasal discharge watery. Lips & mouth dry, great thirst for large quantities. Tendency to spread to chest, painful cough. Severe headache. < slightest movement, warm room.
49
dulcamara
old follows exposure to cold, wet or chilling after being over-heated. Profuse watery discharge from nose and eyes. Nose runs more in warm room. Sneezing severe, eyes red and sore. Wants to keep nose warm, neck stiff, throat sore, pains in back and limbs. < cold room.
50
ferrum phos
Recommended for early stages of cold with no marked indications, except fever
51
euphrasia
Profuse watery discharge from nose and eyes. Makes eyes, but not nose, sore. Discharge < at night when lying down. Cough < by day, > lying down.
52
gelsemium
Influenza type of cold. Brought on by warm, moist weather, slow onset. Sluggish feeling, chilly, dull headache with heavy feeling in eyes and limbs. Much sneezing and watery discharge. Wants to be left alone. Little thirst. Discharge makes nose sore. Tickling cough, > by fire.
53
nux vomica
From exposure to dry cold. Much sneezing, nose alternately blocked, running, streams in warm room and daytime. > outdoors. Extremely chilly. Shudders drinking water or least movement.
54
phosphorus
Begins in chest or throat. Sneezing causes pain in throat or head. Nose alternately blocked or running and red, shiny, sore. Throat sore, voice hoarse. Tight feeling in chest.
55
preventing common cold
healthy diet
good hygiene and preventing transmission
lactobacillus
breastfeeding
low stress
active lifestyle
echinacea and vit C:
Vit D
Fish oil
DHA:
hydrotherapy: sauna
56
Allergic rhinitis cause
low dose antigen diffuses across mucous membranes → Th2 response → allergen specific Th2 clls produce IL-4 and IL-13 and B cells produce IgE → IgE bind to mast cell and activated eosinophils → mast cells release histamine, leukotrienes, kinins, TNFa → contraction of SM, capillary dilation which increases permeability of capillary cells, and glandular hypersecretion.
57
allergic rhinitis types
seasonal
- associated with arrival of trees, grass, weeds
perennial
- dust, mold, dust mites, animal dnader
- associated with sleep disorders, sinusitis, serous otitis media and anosmia
- dust mite allergy appear to be mediated by IL 22
58
allergic rhinitis SX
- Episodic nasal obstruction
- Rhinorrhea
- Sneezing (uncommon with URI)
- Lacrimation and pruritus of nose, eye & throat
- Sore throat - secondary to mouth breathing
- Nasal voice
- Allergic salute - itch nose → crease above the bridge
- Itchy eyes→ redness, puffiness
59
allergic rhinitis PE
- Internal nose - red; if perennial can be pale, bluish; discharge usually clear and watery
- Mouth breathing may cause adenoidal facies- sunken cheeks with high palatine arch.
- Airflow obstruction may be objectively quantified with peak nasal inspiratory flow (PNIF)
- Allergic shiners may be present - bluish discoloration secondary to obstruction of venous drainage because of nasal and sinus congestion.
- May have gingival hypertrophy.
- Halitosis - often from mouth breathing
- Enlarged adenoidal tonsils
- Asthma, atopic dermatitis and urticaria may get worse in individuals with these conditions
60
allergic rhinitis labs
- CBC - show eosinophilia may
- Nasal cytology demonstrates eosinophils
- Scratch tests
- RAST/ELISA tests; in vitro serum test
- Total serum Ige:
61
allergic rhinitis tx
- elimination diet, food allergens, anti-inflammatory diet, Mediterranean diet
- avoid trans fatty acid
- avoid indoor air pollution and smoking
Supplements
- antioxidants
- vitamin C
- Selenium
- Vitamin E
- Vitamin A
- N-Acetyl Cysteine
- Quercetin
- Catechin
- Pycnogenol
- Essential Fatty Acids
- Vitamin D
- Fish oils
- Calcium and magnesium
- Quail egg
- Adrenal support: Consider cortisol and DHEA testing.
- probiotics: fermented foods
Herbs
- urtica:
- butterbur
- scutellaria biacalensis
- green tea
- elder flower
- astragalus
- zingiber
- Cromolyn sodium nasal spray: amnii visnaga potent mast cell stabilizer
- Hydrastis, Achillea, Euphrasia, Armoracia.
- honey
biofeedback
stress reduction
exercise
environmental
- air filters
- HEPA vacuum cleaners
- change pillowcase daily, sheets every 2 days
Hydrotherapy
- sauna
- nasal irrigation
Homeopathy
- arundo
- ambrosia
- sabadilla
- wyethia
- euphrasia
Sublingual immunotherapy/allergy shots
Acupuncture
62
Non-Allergic Rhinitis with Eosinophil Syndrome pop
adults
63
Non-Allergic Rhinitis with Eosinophil Syndrome cause
is unclear; believed to be due to same chemical mediators as all rhinitis but activated by non-immune events. Characterized by absence of atopy, T H2 lymphocyte, immunoglobulin E (Ige)-mediated mechanisms
64
Non-Allergic Rhinitis with Eosinophil Syndrome sx
- Sneezing paroxysms
- Nasal itching
- Runny nose- serous or seromucous hypersecretion
65
Non-Allergic Rhinitis with Eosinophil Syndrome PE
dry atrophic appearance, pallor
66
Non-Allergic Rhinitis with Eosinophil Syndrome labs
- Positive nasal cytology for eosinophils
- Negative skin scratch test and normal serum Ige
67
Non-Allergic Rhinitis with Eosinophil Syndrome comorbidity
fibromyalgia, Chronic fatigue syndrome, IBS,
68
cholinergic rhinitis cause
thought to be secondary to imbalance between the sympathetic and parasympathetic nervous systems. The parasympathetics =>increase in cholinergic (ACH) leads to vasodilation, nasal congestion and increased mucous secretion. This condition is more common in women. One theory is estrogens inhibits acetylcholinesterase → inc acetylcholine (parasympathetic neurotransmitter)
69
cholinergic rhinitis sx
Obstruction with or without rhinorrhea, will complain of chronic sinus problems
chronic, not seasonally or geographically associated
Bilateral or unilateral
May alternate sides
69
cholinergic rhinitis sx
Obstruction with or without rhinorrhea, will complain of chronic sinus problems
chronic, not seasonally or geographically associated
Bilateral or unilateral
May alternate sides
70
cholinergic rhinitis PE
Swollen inferior nasal turbinates, Color - dark red to blue. Significantly increased mucus production.
71
cholinergic rhinitis labs
All IgE allergy tests negative
Negative nasal smear
72
cholinergic rhinitis TX
nervine herbs
food sensitivities
massage
spinal manipulation
stress management
15 micrograms *capsaicin* (from capsicum) suspended in 100 microliters solution
acupuncture
73
Drugs Induced Rhinitis cause
Reserpine, Methyl Dopa, Beta-blockers, BCP (birth control pills)
Abuse of sympathomimetic nose drops and sprays
cocaine
74
Drugs Induced Rhinitis PE
Redness, edema, friability of mucosa
75
Drugs Induced Rhinitis Tx
Patient education, allopathic treatment is to switch to steroid sprays and wean off.
Naturopathic: slowly wean off substituting sympathomimetics with saline spray
76
Sick Building Syndrome
Inhalation exposures can produce asthma and rhinitis by several mechanisms. Respiratory irritants can lead to asthma and rhinitis through interaction with chemical irritant receptors in the airway
77
Adenoidal Hyperplasia pop
children
78
Adenoidal Hyperplasia cause
- Associated with allergies
- Tonsils enlarge =>-nasal obstruction
79
Tumors pop
adults
80
tumors cause
occupational exposure to chemicals, such as nickel, wood or leather dusts, chromate, formaldehyde, and chlorophenol,
81
tumors sx
With persistent unilateral nasal discharge, discharge is bloody.
82
tumors management
referred to an otolaryngologist
83
Foreign Bodies cause
crayons, peas, stones, erasers, gum Causes airway obstruction and secondary bacterial infection
84
Foreign Bodies sx
Unilateral discharge, foul smelling, snoring
85
Foreign Bodie tx
0.5% phenylephrine (Neo-Synephrine)
topical lidocaine
direct visualization using forceps, curved hooks, cerumen loops, or suction catheters
blowing their nose
Refer EENT
86
Foreign Bodies complication
bronchial foreign body
87
Cerebrospinal Fluid Rhinorrhea cause
secondary to head trauma, sinus surgery, weightlifting
88
Cerebrospinal Fluid Rhinorrhea sx
history of prominent unilateral nasal drainage
clear profuse discharge
89
Cerebrospinal Fluid Rhinorrhea PE
increased discharge with Valsalva, jugular vein compression, and lowering head
negative swelling, redness,
normal mucosa
90
Cerebrospinal Fluid Rhinorrhea dx
check for glucose
CT with CSF dye
91
Cerebrospinal Fluid Rhinorrhea tx
interventional neuroradiologist
92
Nasal Polyps cause
Chronic rhinitis predisposes due to traction effect of nose blowing and forced breathing
93
Nasal Polyps sx
Pale grape-like swellings that project into the nasal lumen from the turbinates
opalescent appearance, soft consistency, ethmoid origin, and tissue eosinophilia
94
Nasal Polyps dx
small polypoid swellings along the lateral middle turbinate and ethmoid region may require rhinoscopy for identification
- ***Grade 1***: smallest size polyps within the middle meatus not reaching the inferior edge of the middle turbinate).
- ***Grade 2***: polyps within the middle meatus reaching the inferior border of the middle turbinate.
- ***Grade 3:*** polyps extending into the nasal cavity below the edge of the middle turbinate but not below the inferior edge of the inferior turbinate
- ***Grade 4:*** polyps filling up the nasal cavity
95
Nasal Polyps tx
Surgically remove, medical polypectomy with steroids
HP: Calc., Sang., Teucr., Thuj.
low salicylate diet
high omega-3
96
Rhinosinusitis cause
Viral rhinitis => blocked ostia => O2 absorbed => negative pressure (pain at this stage = vacuum sinusitis) => transudate => bacteria invade => inflammation => Ciliary dyskinesis=> positive pressure => pain
Haemophilus *influenza*
Streptococcus *pneumonia (more severe)*
Anaerobes
Gram-negative bacteria
Staphylococcus *aureus*
Moraxella *catarrhalalis*
Streptococcus *species*
97
Acute Rhinosinusitis
symptoms for less than four weeks
98
Subacute rhinosinusitis
symptoms for four to twelve weeks
99
Chronic rhinosinusitis
persists greater than twelve weeks.
100
Recurrent acute rhinosinusitis
four or more episodes of ARS per year, with interim symptom resolution.
101
Rhinosinusitis sx
Sudden onset of malaise, fever, nasal congestion, purulent rhinorrhea, post-nasal drainage with throat clearing, facial or head pain, mucopurulent discharge low-grade fever
102
Rhinosinusitis PE
diffuse mucosal edema, narrowing of the middle meatus, inferior turbinate hypertrophy, and copious rhinorrhea or purulent discharge
Pain localized to the sinuses
Sinus transillumination is negative
103
Acute Bacterial Rhinosinusitis sx
Purulent nasal discharge
Maxillary tooth or facial pain
Unilateral maxillary sinus tenderness
Worsening symptoms after initial improvement
104
Acute Bacterial Rhinosinusitis labs
C-reactive protein
CT only for recurrent symptoms
Sinus tap: puncture into maxillary sinuses
105
Acute Bacterial Rhinosinusitis dx
1. Persistent symptoms or signs of ARS lasting 10 or more days without evidence of clinical improvement.
2. Onset of severe symptoms or signs of high fever (>39°C or 102°F) and purulent nasal discharge or facial pain for at least three to four consecutive days at the beginning of illness.
3. Onset with worsening symptoms or signs (new onset fever, headache, nasal discharge) following a typical viral upper respiratory infection that lasted five to six days and were initially improving.
106
Primary Ciliary Dyskinesia cause
Kartagener syndrome genetic disorder
secondary: Smoking, asthma and allergic rhinitis, chronic rhinitis and sinusitis, chronic bronchitis, Sick building syndrome, air pollution, cystic fibrosis, and lung carcinoma
Asthma and sinusitis
107
Primary Ciliary Dyskinesia sx
situs inversus, chronic sinusitis, and bronchiectasis
108
Rhinosinusitis in Children RF
- viral URI
- daycare
- allergic rhinitis
- dairy and food allergies
- anatomic obstruction
- Mucosal irritants (e.g., dry air, tobacco smoke, chlorinated water)
- Sudden changes in atmospheric pressure (e.g., descent in an airplane)
109
Rhinosinusitis in Children cause
viral URI
110
Rhinosinusitis in Children sx
older children will have fever, facial pain, rhinorrhea. Younger child less obvious. Increased irritability and vomiting occurring in association with gagging on mucus and/or prolonged cough
111
Rhinosinusitis in Children complication
preseptal cellulitis
orbital cellulitis
septic cavernous sinus thrombosis
meningitis
osteomyelitis
epidural abscess
subdural empyema
brain abscess
112
preseptal cellulitis
welling and erythema of the lids and periorbital area; there is no proptosis or limitation of eye
113
orbital cellulitis
Pain with eye movement, conjunctival swelling (chemosis), proptosis, globe displacement, limitation of eye movements (ophthalmoplegia), double vision, vision loss.)
114
septic cavernous sinus thrombosis
Ptosis, proptosis, ophthalmoplegia, periorbital edema, headache, alterations in mental status
115
meningitis sx
Fever, headache, nuchal rigidity, and change in mental status, petechial rash
116
osteomyelitis
Forehead or scalp swelling, headache, photophobia, fever, vomiting, lethargy
117
epidural abscess SX
Papilledema, focal neurologic signs, headache, lethargy, nausea, vomiting.
118
subdural empyema
subdural empyema: Fever, severe headache, meningeal irritation, progressive neurologic deficits, seizures, signs of increased intracranial pressure
119
brain abscess
Unilateral headache, neck stiffness, changes in mental status, vomiting, focal neurologic deficits, seizures, third and sixth cranial nerve deficits, papilledema
120
Fungal sinusitis types
- invasive sinusitis
- fugus ball of the sinus
- allergic
121
Fungal sinusitis cause
Invasive: HIV or chemoherapy
fungus ball: Aspergillus
allergic: mold, preceding sinus surgeries and nasal polyposis,
122
Fungal sinusitis sx
allergic: chronic sinus pain
123
Fungal sinusitis dx
requires histology of nasal secretions or tissues
EENT
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