Australian Family Physician May 2008 - ENT
Vol 37, (5) 289-384
The theme for the May issue of AFP
is ENT. This month's articles include hoarseness, chronic
rhinosinusitis, asymmetrical hearing loss, hearing impairment &
technological advances, when to refer a child to an otolaryngologist,
managing spinal cord
injury in general practice and clinical breast examination of
asymptomatic women.
The way we look at things
Jenni Parsons
There has been a big change in the way I see things. The big picture is fine, but the devil is in the detail. As I grapple with the frustration of putting on glasses to read and write and drag them off again to see the faces that have then become a blur in a frame, I am aware that it is now just a little more difficult to be fully engaged and present in consultations and conversations.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Vertiginous syndrome
Janice Charles, Salma Fahridin, Helena Britt
The 652 occurrences of vertiginous syndrome recorded over
the 2 year period can be divided into benign positional vertigo
(38.7%), labyrinthitis (31.9%), Meniere disease (17.4%) and
vestibular disorders (12.1%).
Hoarseness - What is the voice trying to tell you?
Nicholas J M Agar, Neil A Vallance
Voice disorders typically present with hoarseness or more
subtle symptoms such as loss of vocal range, change in pitch,
tremor, breathiness or pain on phonation. The pathophysiology
of voice change is usually due to oedema, stiffening or a
discrete lesion of the vocal cord(s) interfering with the
mechanics of vocal cord vibration.
Chronic rhinosinusitis - ‘It’s my sinus doc!’
Christopher Brown
Rhinosinusitis is now the preferred term rather than sinusitis as this reflects the underlying pathophysiology. Patients with CRS have symptoms of at least 12 weeks duration with supporting examination and/or computerised tomography findings.
Asymmetrical hearing loss
Jessica Prasad, Vincent C Cousins
General practitioners are usually the first point of contact for
patients with hearing loss. Asymmetrical sensorineural hearing
loss can be a symptom of a wide range of diseases. A correct
diagnosis is essential for appropriate treatment and limitation of
the progression of hearing loss.
Hearing impairment - Technological advances and insights
Stephen O’Leary, Andrew Chang
The treatment of hearing impairment is rapidly evolving. Despite
this, a significant number of adults with hearing impairment
receive inadequate treatment or rehabilitation, resulting in
functional impairment and social isolation.
When to refer a child to an otolaryngologist
Robert G Berkowitz
While children commonly present with acute or chronic upper
respiratory tract disorders in general practice, in the majority
of cases these problems are seasonal, self limiting and/or
unlikely to cause long term disability. However, assessment may
be difficult, and on occasions, surgical referral and treatment
should be considered.
Management of spinal cord injury in general practice – Part 2
James W Middleton, Grace Leong, Linda Mann
People with spinal cord injury (SCI) are at risk of developing complications specific to the condition. As the incidence of SCI is low, general practitioners may not be familiar with these complications.
Lessons from the TAPS study - Reducing the risk of patient harm
Meredith A B Makeham, Simone Stromer, Michael R Kidd
The Threats to Australian Patient Safety (TAPS) Study collected
648 anonymous reports about threats to patient safety from a
representative random sample of Australian general practitioners.
These contained any events the GPs felt should not have happened
and would not want to happen again, regardless of who was at fault
or the outcome of the event.
Vertigo - Part 1 - Assessment in general practice
Chih-Hung Kuo, Leo Pang, Robert Chang
The clinical assessment aims to: establish the presence of true vertigo, differentiate between vertigo of central or peripheral origins, and to evaluate the need for urgent investigations and referrals. Peripheral causes of vertigo are more common, but central causes such as transient ischaemic attack or stroke should always be considered and ruled out appropriately.
Vitamin D and people with intellectual disability
Simon Vanlint, Michael Nugent, Seeta Durvasula
Vitamin D is essential for the normal functioning of a diverse range of
metabolic processes, especially bone health. It is widely appreciated
that the elderly are at increased risk of vitamin D insufficiency, but it
is less well known that people with intellectual disability are also at
increased risk.
Clinical Challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 40 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
Ear syringing: minimising the risks
Sara Bird
The patient, 61 years of age, saw the general practitioner
for a repeat prescription for her blood pressure
medication. During the consultation, the patient
mentioned that she had some discomfort in her left
ear.
New medical graduates - Can general practice help with training?
Tom Brett
Medical student numbers in Australia have increased significantly in
recent years. A resulting increase in medical graduates is inevitable
and desirable.
The medical humanities - A brief introduction
Claire Hooker
The medical humanities is a broad area of study and practice
encompassing all nontechnical or 'human' aspects of medicine.
What do GPs get out of participating in research? - Experience of the LEAP trial
Jane Gunn, Zoë McCallum, Lena Sanci
Maximising the health of our communities requires a strong foundation
of clinical research. Undertaking community based clinical research
requires an understanding of what motivates practitioners to participate
in research and how they experience the process. It has been
suggested that a primary care sector with a strong research culture and
evidence base is crucial to getting evidence into practice, yet general
practice research has been criticised for ignoring clinical research.
Clinical breast examination of asymptomatic women - Attitudes and clinical practice
Jill Thistlethwaite, Rebecca Stewart, Rebecca Evans
Well woman health checks are offered in general practice and may
include breast examination.
Practice based research - Lessons from the field
Clare F Heal, Craig Veitch, Robyn Preston
The authors sought to describe the process of conducting a
successful randomised controlled trial in a primary care setting and
identify enabling factors and barriers.
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