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Ears:
#1.
Ear Pain. Only 50% of ear
pain comes from the ears. If
treated with multiple antibiotics and the eardrum is normal, look for other
causes such as TMJ pain or maxillary sinusitis.
#2.
Swimmer's ear or external otitis is often caused by pseudomonas. In the child, open the canal with a pope ear wick and use
ear drops. Do the same in the adult
but you may also want to use Cipro.
#3.
Itching ears are often caused by a fungus.
Lotrimin or Tinactin solution can be of help.
I prescribe it four drops four times a day for two weeks.
#4.
Ear pressure may be referred from the sinuses or nose much like an ice
cream headache. Ear fluid is
seldom present if the patient does not complain of hearing loss.
#5.
If pus is draining out of the external canal, always treat with oral
antibiotics AND ear drops. If an
ear tube is present 33% of these infections are pseudomonas, thus, ear drops are
needed.
#6.
Dizziness from the
inner ear
is
vertigo.
Vertigois the sensation of motion, sometimes spinning.
Light-headedness is usually not from
inner ear
disease.
#7.
Ear fluid rarely causes dizziness.
#8.
New advances in digital hearing aids are helping many patients with
sensorineural hearing loss.
Nose:
#1.
If a patient has chronic nasal and facial complaints, obtain sinus films
they may show a sinusitis.
#2.
Severe and chronic headaches are usually not caused by sinusitis, a sinus
CT scan can rule out sinusitis as a cause.
#3.
Maxillary mucus retention cysts are common and most do not need
treatment.
#4.
Do not use decongestants in patients with high blood pressure, especially
if on Beta Blockers.
#5.
Follow patients on nasal steroids to diagnosis mucosal atrophy early and
prevent a septal perforation.
Throat:
#1.
The most common cause of hoarseness in the non-smoker is gastroesophageal
reflux, even if no heartburn symptoms are present.
#2.
The most common cause of food sticking in the lower throat is
gastroesophageal reflux, even if no heartburn symptoms are present
#3.
Persistent hoarseness needs a laryngeal exam to rule out a throat cancer
and other disorders.
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