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Patient
Group Direction for primary treatment of middle ear disease
1.
Clinical condition
Patients
presenting with what at first appears to be a chronic otitis
externa but following thorough aural toilet, signs of cholesteatoma
can be seen either in the pars flaccida area or covering a
marginal tympanic membrane perforation. A recurrent history
(may be for many years) with scanty foul smelling discharge
and may now complain of deafness and vertigo. There may only
be a history of long term E.T.dysfunction, discomfort and
deafness.
Objective
Speedier
identification, and referral of patients with dangerous ear
disease. To offer
maintenance care prior to hospital consultation and post operatively
in conjunction
with the ENT consultant, thus improving the quality of the
referral and providing
"joined-up" care.
Guidelines
Based
on ENT text book instructions and ENT consultant advice.
2.
Patients
Inclusion
criteria
Patient
presenting with clinical condition as explained above. On
examination the foul
smelling discharge, hearing loss and discomfort together with
complaints of tinnitus,
vertigo and unsteady gait in those who have a long history
of symptoms are indicators
of disease. Usually unilateral presentation.
Exclusion
criteria
Any
patients who do not meet the inclusion criteria for this patient
group.
Excluded
patients and those refusing treatment
Refer
to general practitioner or treat other presenting problems
according to the patient group direction for the relevant
ear problem.
3.
Treatment
Name,
Dose, Method and route
Treat
as chronic otitis externa initially. Once identification of
disease and referral
for secondary care appointment has been achieved, weekly maintenance
by aural toilet
and any necessary treatment (determined through clinical judgement
of individual
condition) is continued until out patient appointment date.
Following this, continue
until surgery and there after post operatively at the consultant's
request. Treatments
used are the same medication and dose as with treatments for
chronic otitis externa
except once the mastoid cavity has been formed a much larger
dressing will be required
See Patient Group Directions for care of mastoid cavities.
Patient
advice
Gain
informed consent before examination or treatment. Advise that
infection may need hospital consultant advice. Advise about
need for future regular care to prevent worsening of symptoms.
Follow
up care
Regular
6 monthly mastoid cavity toilet following hospital discharge.
Maintenance care
before surgery.
Reporting
procedure
Record
findings in patient's notes according to national directions.
Contact GP for
decision regarding hospital referral. Report any adverse problems
to the ENT
consultant while carrying out post operative dressings between
appointments.
Information
recorded
Presenting
problem, previous history, present findings, treatment given
and
reasons for any changes in this. Follow up dates.
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