Otitis media with effusion (OME, glue ear) - commonest cause of hearing loss in children. Suspected unilateral sensorineural hearing loss is usually referred routinely to otology/ENT. If patients are struggling, refer (usually direct to audiology) for hearing aids. Examination will be normal an audiogram is essential for diagnosis. Presents initially with difficulty with speech comprehension, especially in noise. Presbycusis - commonest cause of hearing loss in adults. If not settling, refer to ENT emergency clinic. Gentisone HC or Sofradex) and water precautions. Give a two-week course of antibiotic-steroid eardrops (e.g. Examination reveals a red, oedematous ear canal with thick, coated exudate. Mainly presents with pain/itching/blockage. All other patients can be referred routinely. Ear canal debris can usually be cleared with sodium bicarbonate drops. Haemotympanum can be left to resolve and reassessed later. Check facial nerve function: patients with facial palsy should be referred on the same day. Traumatic hearing loss can be due to blood in the canal or middle ear, ossicular disruption or direct fracture of the inner ear. Refer to ENT emergency clinic for audiometry and further treatment (e.g. Patients suspected of having SSNHL should be started on 1 mg/kg of prednisolone (max 60 mg) for a week, with a PPI. First exclude other causes with otoscopy (should be normal), and check the hearing loss is sensorineural with Rinne/Weber tests. Usually presumed to be viral, but could be a vascular event or related to some medications. Sudden sensorineural hearing loss - sudden unilateral decrease in hearing, +/- tinnitus. If still present after that, refer to a microsuction service. Get patients to use sodium bicarbonate eardrops regularly for a week or two. Syringing is slowly falling out of favour due to the risk of infection. Wax impaction - otoscopy confirms the diagnosis. It can help to conceptualise them into acute and chronic causes. Hearing loss can be divided into conductive, sensorineural or mixed patterns. Otoscopy: often normal, but check for perforation, scarring, discharge, retraction/middle ear fluid, cholesteatoma in atticĭifferential diagnosis and primary care management Inspect pinna and post-auricular area for microtia, swellings, erythema, surgical scar or hearing aids Occupation and history of loud noise exposure Other otological symptoms (pain, discharge, tinnitus, vertigo, facial weakness)Īny ear problems/surgery previously or in childhood? Out-of-proportion pain +/- granulation tissue in the ear canal in an immunocompromised individual (suspected lateral skull base osteomyelitis) Suspected mastoiditis - red fluctuant swelling behind ear, unwell patient with otitis media
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Make the polar residues red (Right mouse button.Make the whole protein cyan (Right mouse button.Render as spacefilling (Right mouse button >.select the protein (Right mouse button >.Render the protein as space filling with the polar.Make the cartoon violet (Right mouse button >.Render as cartoon (Right mouse button > Style.select DNA (Right mouse button > Select.Some things to try with the model in Figure 5: (Right mouse button > Style > Scheme or Structure > Use the pop-up menu (Right mouse button, control-click on oneīutton mice, > Select > choose among the options.) The part of the structure you want to work with. The plane defined by atoms 1, 2 & 3 and the plane defined by atoms Generally the angle between two planes defined by four selected atoms)Ĭursor will convert to a "+". (the angle between two bonds on atoms separated by one bond, or more The angle made by these three atoms will be displayed. Move to the third atom and double click on it. The command is: " measure allconnected (*)(*)" You can also displayīond lengths at once using the command line. Of nm, angstroms and pm (Right mouse button, control-click on one button Using the pop-up menu you can choose between units The distance between the atoms willīe shown. The Bond submenu. You can try this in an open Jmolĭouble click on the first atom. Wireframe is also available in the pull-down display menu in The options are: CPK spacefill Ball and Stick Sticks Wireframe. (Right mouse button > Style > Scheme > XXX). Some common combinations of atom size and bond from the pop-up menu Pop-up menu (Right mouse button, controlĬlick on one button mice, > Style > Atoms > XXXĪpplication or by clicking the link in figure 3 to convert it to a liveĪpplication and the applet. Use the pull-down menus of the application or the pop-up menu in theĪpplication and the applet. The axes are screen axes: Y is up-down, X is The default Y rate is 30 and 0 for X and Z rates. Mouse button > Spin > Set X (Y or Z) Rate > XX). > Spin > Off). You can try this in an open JmolĪpplication or by clicking the link in figure 2 to convert it to a liveĪbout axes other than Y select the rate (degrees per step)įor rotation about the X or Z axis. The spinning of the molecule use the pop-up menuĪgain (Right mouse button, control-click on one button mice, Using the default spin settings use the pop-up menu in both theĪpplication and the applet (Right mouse button, control-click on oneīutton mice, > Spin > On). 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