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  <head>
    <title>056-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Ear, nose, throat, hearing, balance, voice, and swallowing">
      <outline text="Orientation and red flags">
        <outline text="Many functions concentrated in a small region">
          <outline text="Minor swelling obstructs airflow"/>
          <outline text="Infection spreads to orbit, skull base, neck, brain"/>
        </outline>
        <outline text="Recognise stridor, drooling, respiratory effort"/>
        <outline text="Expanding neck swelling, severe haemorrhage"/>
        <outline text="Sudden sensorineural loss, central vertigo"/>
      </outline>
      <outline text="Hearing physiology and assessment">
        <outline text="Ossicles transmit and amplify to cochlear fluid"/>
        <outline text="Basilar membrane bends hair-cell stereocilia">
          <outline text="Mechanical energy becomes auditory nerve signals"/>
        </outline>
        <outline text="High frequencies at base, low at apex"/>
        <outline text="Bilateral brainstem input supports localisation"/>
        <outline text="Conductive: external or middle-ear transmission"/>
        <outline text="Sensorineural: cochlea, nerve, central pathways"/>
        <outline text="Sudden sensorineural loss is an emergency">
          <outline text="Time-sensitive corticosteroid treatment"/>
        </outline>
        <outline text="Audiometry quantifies air, bone, speech">
          <outline text="Tuning forks do not replace it"/>
        </outline>
      </outline>
      <outline text="External and middle-ear disease">
        <outline text="Otitis externa after moisture or trauma">
          <outline text="Tragal tenderness, itch, discharge"/>
          <outline text="Clean canal, topical antimicrobial"/>
        </outline>
        <outline text="Invasive skull-base infection in diabetes">
          <outline text="Urgent imaging, systemic antipseudomonal therapy"/>
        </outline>
        <outline text="Acute otitis media follows Eustachian dysfunction">
          <outline text="Bulging inflamed membrane with effusion"/>
          <outline text="Analgesia central, antibiotics selective"/>
        </outline>
        <outline text="Persistent effusion affects speech development"/>
        <outline text="Cholesteatoma: expanding keratinising epithelium">
          <outline text="Bone erosion, facial palsy, intracranial infection"/>
          <outline text="Definitive management usually surgical"/>
        </outline>
        <outline text="Perforation: avoid water and ototoxic drops"/>
      </outline>
      <outline text="Tinnitus and hearing rehabilitation">
        <outline text="Sound without an external source"/>
        <outline text="Unilateral, asymmetric, pulsatile need investigation">
          <outline text="Pulsatile: vascular flow or raised pressure"/>
        </outline>
        <outline text="Non-pulsatile usually accompanies hearing loss">
          <outline text="Hearing aids, sound strategies, CBT"/>
          <outline text="Do not promise a universal cure"/>
        </outline>
        <outline text="Age and noise loss hit high frequencies"/>
        <outline text="Cochlear implant stimulates nerve in severe loss"/>
      </outline>
      <outline text="Vestibular physiology and vertigo">
        <outline text="Canals detect angular acceleration"/>
        <outline text="Utricle and saccule: linear acceleration, gravity"/>
        <outline text="Vertigo is an illusion of movement">
          <outline text="Dizziness may mean presyncope or disequilibrium"/>
        </outline>
        <outline text="BPPV from displaced otoconia">
          <outline text="Delayed fatigable positional nystagmus"/>
          <outline text="Canalith repositioning treats"/>
        </outline>
        <outline text="Neuritis spares hearing, labyrinthitis does not"/>
        <outline text="Meniere: episodic vertigo, fluctuating hearing"/>
        <outline text="Stroke can mimic peripheral disease">
          <outline text="Expert head impulse, nystagmus, skew"/>
          <outline text="Severe headache, cannot stand, vertical nystagmus"/>
        </outline>
        <outline text="Suppressants brief, early mobilisation"/>
      </outline>
      <outline text="Nose and sinuses">
        <outline text="Nose warms, humidifies, filters air"/>
        <outline text="Allergy: itch, sneeze, watery discharge">
          <outline text="Saline, intranasal corticosteroids"/>
        </outline>
        <outline text="Topical decongestants cause rebound congestion"/>
        <outline text="Acute rhinosinusitis usually viral">
          <outline text="Orbital or intracranial spread is an emergency"/>
        </outline>
        <outline text="Anterior epistaxis: sit forward, pinch soft nose">
          <outline text="Posterior bleeding needs specialist control"/>
        </outline>
        <outline text="Unilateral symptoms may signal malignancy"/>
      </outline>
      <outline text="Throat, tonsils, and deep-neck infection">
        <outline text="Pharyngitis mostly viral, test selectively"/>
        <outline text="Mononucleosis: protect the vulnerable spleen">
          <outline text="Aminopenicillin rash without true allergy"/>
        </outline>
        <outline text="Peritonsillar abscess: trismus, uvular deviation"/>
        <outline text="Retropharyngeal infection threatens airway"/>
        <outline text="Ludwig angina elevates the tongue">
          <outline text="Early airway, antibiotics, drainage"/>
        </outline>
      </outline>
      <outline text="Voice, larynx, and airway">
        <outline text="Hoarseness from laryngitis to cancer">
          <outline text="Persistent or red flags need laryngoscopy"/>
        </outline>
        <outline text="Stridor is an emergency sign">
          <outline text="Inspiratory: extrathoracic obstruction"/>
          <outline text="Biphasic: glottic or subglottic narrowing"/>
        </outline>
        <outline text="Calm, oxygen, airway expertise"/>
        <outline text="Adrenaline, foreign-body removal, surgical airway"/>
      </outline>
      <outline text="Swallowing">
        <outline text="Oral, pharyngeal, sphincter, oesophageal phases"/>
        <outline text="Dysfunction: cough, wet voice, pneumonia"/>
        <outline text="Bedside screen only estimates risk">
          <outline text="Silent aspiration needs instrumental study"/>
        </outline>
        <outline text="Posture, texture, rehabilitation, mouth care"/>
        <outline text="Thickened fluid may impair hydration"/>
      </outline>
    </outline>
  </body>
</opml>
