Resultados de Búsqueda
Don’t use oral antibiotics as a first line treatment for patients with painless ear drainage associated with a tympanic membrane perforation or tympanostomy tube unless there is evidence of ...
Choosing Wisely Canada
Canadian Society of Otolaryngology-Head & Neck Surgery
First line therapy constitutes a short course of topical antibiotic/steroid drops. The potential ototoxicity of any topical medication entering the middle ear space should be considered in selecting an appropriate agent. Where available, fluoroquinolone combination preparations (e.g., ciprofloxacin and dexamethasone) should be used as a first choice and caution should be exercised in using topical aminoglycosides. Microdebridement and further assessment should be considered in the following ...
ver más ... 2016Don’t perform auditory brainstem responses (ABR) in patients with asymmetrical hearing loss.
Choosing Wisely Canada
Canadian Society of Otolaryngology-Head & Neck Surgery
Asymmetrical hearing loss is defined as bone conduction threshold difference of: - 20 dB threshold difference at a single frequency - 15 dB threshold difference at 2 frequencies - 10 db threshold difference at 3 frequencies If there is no obvious cause of the asymmetry such as unilateral trauma or unilateral noise exposure like gun blasts, a MRI should be ordered. MRI scans are superior in sensitivity for detecting retrocochlear pathologies such as vestibular schwannoma when compared to ABR ...
ver más ... 2016Don’t perform computed tomography or blood work in the evaluation of a patient with sudden sensorineural hearing loss (SSNHL) given its presumed viral etiology.
Choosing Wisely Canada
Canadian Society of Otolaryngology-Head & Neck Surgery
Blood work which typically would consist of a CBC, differential and electrolytes along with an autoimmune panel are often normal and would not change initial clinical management if abnormal. The CT scan which is done to rule out central causes is not sensitive enough to pick up most cases of retrocochlear pathology. MRI scans should be considered instead. If verified to be sensorineural with audiometric testing, urgent treatment with steroid therapy can be initiated. There is no role for ...
ver más ... 2016Don’t order specialized audiometric and vestibular neurodiagnostic tests in an attempt to screen for peripheral vestibular disease.
Choosing Wisely Canada
Canadian Society of Otolaryngology-Head & Neck Surgery
The diagnosis of the dizzy patient should be guided by the presenting symptoms and office examination. Tests such as ABR (auditory brainstem response), ECOG (electrocochleography), ENG/VNG (electronystagmography/ videonystagmography), VEMP (vestibular evoked myogenic potential), vHIT (video head impulse test), CDP (computerized dynamic posturography) and RCT (rotational chair testing) should only be ordered if clinically indicated. In general, advanced balance tests should be ordered and ...
ver más ... 2016Don’t use antibiotics in adults and children with uncomplicated acute otitis media.
Choosing Wisely Canada
The Canadian Association of Emergency Physicians
Both adults and children commonly present to the emergency department with symptoms of a middle ear infection, or acute otitis media (AOM). The symptoms of AOM include fever, earache, discharge from ear, and/or decreased hearing. Evidence suggests that adults and children with uncomplicated AOM do not need antibiotics. Treatment should focus on analgesia and the use of antibiotics should be limited to complicated or severe cases. A watch and wait approach (analgesia and observation for 48 to 72 ...
ver más ... 2016