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About HeadNeckPA

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  1. HaHaHa! That is actually one of the main reasons we wanted to go down this road. Some sources estimate the 35-50% of all primary care medicine is from the neck up...yet primary care physicians and ER trainees, by my experience, spend less than 2 weeks doing ENT and maybe a month if they are overly aggressive....
  2. Wanted to let everyone know about the ENT for the PA-C conference coming up April 24th - 27th in Pittsburgh. For the first time we have geared the conference towards PA's and NPs working in Emergency medicine and primary care, as well as to those working in ENT. We have a full day of procedure work-shops that would be highly beneficial to anyone in the above disciplines or looking to get into ENT. There are two separate tracks of lectures to choose from as well. Some workshop highlights include: Draining of peritonsillar abscess Management of anterior and posterior epistaxis foreign body removal cricothyroidotomy and tracheostomy management I&D of auricular hematoma Lecture highlights include: Head and Neck trauma Common ENT emergencies Dental Emergencies Bells Palsy guidelines Evaluating stridor in infants airway foreign body management Otologic emergencies Common ear complaints and many more Here is the link for the conference web-site and the pdf form is attached. www.entpa.org/ent_for_the_pac This would be a very worth-while conference regardless of your area of expertise.
  3. Head and Neck PA;


    Why did you stop doing the ENT cases of the week??? keep 'em coming please :)

  4. It's reasonable to do a myringotomy and aspiration with the understanding that their may not be any diving in May. I would also be sure to have this in writing and ensure follow-up to protect yourself. Most myringotomies heal extremely fast, but on occasion the patient can have a persistant perf. ETD in patients who dive can be a real challenge.
  5. The big difference here is the treatment! If the person plans to continue diving, then they absolutely can not have a tube placed. there have been cases of divers drowning because water went down the tube and caused severe vertigo resulting in disorientation and subsequent death......if this person had a hemotympanum from a single dive I would say their days of diving are numbered........
  6. Incorrect.....this patient requires multiple treatments in the hyperbaric chamber. Standard of care is myringotomy with placement of a tube. In select cases of barotrauma ( ie single flight ) you may be able to observe but not in this case. This patient can not return to the chamber without a tube.
  7. What is the significance of this patient's palate lesion?
  8. Yea, well you should see what part of the world I practice in....this is nothin!
  9. You are correct.......the probe is in the patient's right submandibular duct. If you look close, you can actually see the small stone just under the surface (whitish-yellow) and about 3 mm to the left of the probe tip in the picture. This is a classic case of sialolithiasis. Intermittent swelling of the jaw (neck is probably a better description) that is usually associated with eating (very important question to ask)....... Treatment is removal of the stone if accessible. We use increasing diameter lacrimal probes to enter the duct orifice. If resistance is met the SOP is to use local anesthesia and incise the duct. Frequently a small incision is all that it takes to extrude the stone and release a heavy flow of saliva, owing to the narrowing of the duct as it enters the oral cavity (think sphincter). If the saliva runs clear then no antibiotics are required. If the stone can not be located and removed then anti-staph meds are indicated. I use dicloxicillin in patient's without a PCN sensitivity....it's very cheap and works well. The downside is it is QID, as compared to say cephalexin which is TID. Treatment of any infection or the inability to locate a stone should also include warm compresses and massage of the affected land at a minimum of 3x per day. Some also recommend sour candies such as lemonheads to stimulate saliva production... Below is the stone immediately after incising the duct and massaging the gland.
  10. 44 yr-old white female who presents with a one week history of intermittent right jaw pain and swelling. Otherwise healthy with no medical problems and takes no meds. NKDA Anything else you want to know? What is the probe pointing to? Presumed Diagnosis? Treatment?
  11. Ok, so maybe this one was a little tough. The kicker here is to pick up on the hyperbaric treatments for his diabetic leg wounds. This patient has suffered from barotrauma secondary to the hyperbaric chamber. He now has blood in the middle ear space, or hemotympanum (reddish hue in bottom right of picture). Anytime you have fluid behind the TM you have a conductive hearing loss to some degree, as in this case. The patient's history of high frequency sensorineural loss is attributed to his age and has nothing to do with the barotrauma. On to the next case............
  12. 95 views and only one comment..........anyone......anyone.....Beuhler......Beuhler. :-)
  13. High frequency SNHL is essentially consistent with age-related hearing loss or presbycusis..... The air-bone gap in this setting is basically indicative of a conductive hearing loss......so this patient has a mixed hearing loss. Assume the SNHL is age related. What you want to focus on then is a history of abrupt onset of pain in conjunction with a conductive loss. Weber test lateralizes to this affected side........now with the picture shown, what do you think may be the source/ cause of these symptoms
  14. For any students interested in a career in primary care, ER / urgent care or ENT I would encourage you to visit the Otolaryngology page for the "ENT Pic of the Day." I have been trying to put up a case a day of common ENT entities that you are likely to encounter. Disorders from the neck up account for anywhere from 30-50% of primary care. Family medicine residents (MDs, DOs) will generally spend 2 weeks doing ENT during their entire residencies. If you anticipate any of the above careers then I encourage you to look into an ENT elective during your training. You can find the Otolaryngology page here: http://www.physicianassistantforum.com/forums/forumdisplay.php/462-Otolaryngology
  15. The picture below (albeit not a great one) is from the middle ear of a 67 yr-old male with a complicted past medical history including CAD, HTN and uncontrolled type II DM that is further complicated by diabetic neuropathy, prior amputation of the left forefoot and ongoing hyperbaric therapy for a chronic right heel ulcer. His medication list is extensive as one might imagine. He presents to you with a one day history of severe ear pain and associated hearing loss on the same side. You look in the ear and see the image below.......audiogram reveals a 30 dB air-bone gap on the affected side in the setting of high frequency sensori-neural loss . What are your thoughts? What treatment would you suggest?
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