Rx Note

Introduction Vertigo is an illusion of rotational, liner or tilting movement of self or environment. It could be produced by peripheral (inner ear) or central (brainstem-cerebellum) stimulation. The most common motion illusion is a spinning sensation. Nausea and vomiting are typical with acute vertigo, unless it is mild or very brief, as with benign paroxysmal positional vertigo (BPPV). Vomiting can be severe, causing dehydration and electrolyte imbalance. Postural stability can be affected in patients with vertigo. NOTE: It is important to distinguish vertigo from other potential causes of "dizziness". Evaluation The clinical features of the most common disorders are summarized in the table below. NOTE: The time course of symptoms provides one the best clues to the underlying pathophysiology of vertigo. Symptomatic Treatment Medications to suppress vestibular symptoms are best used for alleviating acute episodes of vertigo that last at least a few hours or days. These dr...

Introduction Ear preparations are usually placed in the ear canal by drops in small amounts for Removal of excessive cerumen (earwax) Treatment of ear infections, inflammation or preparation. Advantages Ability to achieve a local drug concentration much higher than what could be achieved via systemic administration. Also minimizing off-target systemic exposure. Proper Administration Wash your hands thoroughly with soap and water. If the ear drops are a cloudy suspension, shake the bottle well for 10 seconds. For convenience, it is probably easier to have someone other than the patient to administer the drops. When instilled into the ear, to allow the drops to run in deeper, the earlobe should be held up and back. For a child younger than 3 years of age, the earlobe should be held gently down and back to open the ear canal. Also, remain in position for several minutes and gently press on the small skin flap over the ear to help the drops to run into the ear canal. When eardrops are pre...

Introduction Acute otitis media is a self-limiting middle ear infection that mainly affects children. A viral cold , especially in children, can lead to blockage of the Eustachian tube and fluid formation within the middle ear. This causes symptoms of pressure and pain (otalgia). Sometimes, the fluid can then secondarily infected by a bacterial infection. Symptoms Acute otitis media is most common in children up to the age of 4 years old. In young children, it is often manifested as irritability or crying, with characteristic ear tugging/rubbing. In older children, ear pain (earache) is the predominant feature and tends to be throbbing. Systemic symptoms, such as fever and loss of appetite , can also be present. An examination of the ear should reveal a red-yellow and bulging tympanic membrane, with a loss of normal land-marks. Management Over three-quarters of episodes resolve within 3 days (but it can last up to 1 week) without treatment; current guidelines do not advocate the rout...

Introduction Otitis externa (Swimmer's Ear) involves inflammation and infection of the skin in the ear canal and is generally caused by bacterial infection . Otitis externa is 5 times more common in swimmers than non-swimmers. Otitis externa can be precipitated by Ear trauma, e.g. scratching, foreign body and use of cotton buds Swimming, especially in dirty or polluted water Chemicals, e.g. hairspray, hair dyes, shampoo and drops of earwax Skin conditions, e.g. eczema, seborrheic dermatitis and psoriasis Clinical Features Otitis externa is characterised by itching and irritation , which, depending on the severity, can become intense. This provokes the patient to scratch the skin of the EAM (external auditory meatus), resulting in trauma and pain. Chewing and manipulation of the tragus and pinna can exacerbate pain. Otorrhoea (ear discharges) follows, and the skin of the EAM can become oedematous, leading to conductive hearing loss. Otitis media (middle ear infection) is the most c...