Dr David VokesOtolaryngologist

Head & Neck Surgeon

Director

ENT Associates, Auckland

17:00 - 17:30 Red Flags in ENT: Symptoms and Signs of Serious

Disease

David Vokes, FRACSAuckland City Hospital

ENT Associateswww.entassociates.co.nz

Life threatening

▪ Neoplasm (esp. Cancer)

▪ Airway

▪ Infection

Functional sequelae

▪ Facial weakness

▪ Hearing loss

▪ Blindness

Pain Unilateral hearing loss Sudden hearing loss Unilateral or pulsatile tinnitus Facial palsy

Normal ear exam Referred otalgia (5 T’s)

▪ Throat

▪ Tongue

▪ Tonsils

▪ TMJ

▪ Teeth

Malignant Otitis Externa, aka. Skull Base Osteomyelitis

OME: possible nasopharyngealcancer (Chinese, Maori &Pasifika)

SNHL: possible vestibularschwannoma

Usually unilateral Normal ear exam

Sudden SNHL, usu Idiopathic

Ramsay-Hunt Syndrome Possible CPA lesion

Unilateral tinnitus: exclude CPA lesion

Pulsatile tinnitus: exclude vascular lesion

Weakness of half of face (upper & lower)

Bell’s Palsy: dx of exclusion

Warning signs for cancer:▪ Gradual onset

▪ If associated▪ AOM, TM perforation, OE

▪ Parotid/neck mass

▪ Other CN palsies

Epistaxis Orbital signs Anosmia Facial pain, facial

anaesthesia

With history of trauma (fracture ose): brief large volume bleed = AEA injuiry

Recurrent or persistent small volume, esp. unilateral: considermalignancy

Periorbital inflammation Chemosis Visual acuity decrease Proptosis Diplopia

Loss of sense of smell

Conductive vs sensorineural

DDX

▪ Post viral or post head injury

▪ Anterior cranial fossa lesion

Unilateral

Sinus, Pharyngeal malignancy

Cutaneous SCC with perineuralinvasion

Invasive sinusitis (immunocompromised, DM)

Voice change Dysphagia Aspiration Stridor Pain Neck lump

>3/52 duration

Neoplasm: SCCa Paralysis/paresis Benign but needs

help!

>3/52 duration

Neoplasm: SCCa Paralysis/paresis Benign but needs

help!

>3/52 duration

Neoplasm: SCCa Paralysis/paresis Benign but needs

help!

Malignancy until proven otherwise

▪ SCC

▪ Adennocarcinoma

DDx:

▪ Cricopharyngeal achalasia or pouch

▪ Stricture

Aspiration (choking/coughing with eating)

DDx:▪ Cancer

▪ Neurological disease (Central or Peripheral)

▪ Cricopharyngeal dysfunction

Concerns/Risks:▪ Malnutrition

▪ Aspiration pneumonia

Urgent if not emergent

Stridor vs Wheeze(Beware dx of

difficult to treatasthma)

Aetiology▪ Neoplasm: Cancer▪ Benign mass lesion▪ Bilateral VF immobility

0-15 y inflammatory > congential >neoplastic

15-40 y ”

>40 y NEOPLASTICie. METASTATIC CANCER

Evaluation▪ FNA (not open biopsy)

▪ UADT Exam

ENT symptoms very common Majority underlying cause benign Many sites in H&N inaccessible to primary care exam Beware symptoms:

▪ Neoplasm (cancer)

▪ Airway compromise

▪ Severe infection

David.Vokes@entassociates.co.nzDVokes@adhb.govt.nz

www.entassociates.co.nz

FIN