GEM - ENT problems including vertigo and urgent cancer referral

Dizziness and Vertigo:

• dizziness is a non-specific term used to describe a sensation of altered orientation in space
• vertigo is the hallucination of rotation or movement of one's self or one's surroundings.
• dizziness is of little diagnostic value without trying to elaborate further information. However, when vertigo, postural hypotension or other types of unsteadiness are less severe or chronic, it may be impossible to describe the sensation more accurately than "dizziness". If there is loss of consciousness then this defines the term syncopeWhat are some important elements of the history when managing the "dizzy" patient?What are some important elements of the examination of the "dizzy" patient?If the patient has provided a good history of "vertigo" then
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  • what are some examples of peripheral causes of vertigo?
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  • what are some examples of central causes of vertigo?
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  • what inherited condition is associated with bilateral acoustic neuromas?
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  • if tinnitus was also present, what other features would suggest a diagnosis of Meniere's disease rather than a central cause such as a acoustic neuroma?
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  • can you suggest some instances when a patient with vertigo should be referred for specialist review?
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  • if vertigo is associated with unilateral sensioroneural hearing loss then should this be a routine or urgent outpatient review?
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The patient with tinnitus

• can you suggest important elements of the history and examination?
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• in what circumstances is referral for specialist review indicated?
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Urgent referral for suspected head and neck cancer

When managing patients in primary care, which of these cases should be urgently referred (i.e. seen within a two week period)?

• unilateral unexplained pain in the head and neck area for more than 2 weeks, associated with otalgia (ear ache) but a normal otoscopy
• unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks
• it is important for GP registrars to make themselves familiar with the urgent referral guidance for possible head and neck cancer GPN reference

Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.4 ENT and facial problems.