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  <head>
    <title>056-02 Auditory localisation, vestibular syndromes, deep-neck danger, and airway protection</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Localisation, vestibular syndromes, deep neck, airway">
      <outline text="Time-dependent syndromes">
        <outline text="Stridor, drooling, enlarging neck swelling"/>
        <outline text="Deep-neck sepsis, severe epistaxis"/>
        <outline text="Sudden hearing loss, vertigo with central signs"/>
        <outline text="Compact anatomy speeds progression">
          <outline text="Airway obstruction, intracranial spread, aspiration"/>
        </outline>
      </outline>
      <outline text="Hearing pathway and testing">
        <outline text="Conductive loss attenuates before the cochlea"/>
        <outline text="Sensorineural: hair cells, nerve, central"/>
        <outline text="Air conduction includes both pathways">
          <outline text="Bone conduction bypasses external and middle ear"/>
          <outline text="Air-bone gap supports conductive loss"/>
        </outline>
        <outline text="Poor speech discrimination suggests neural cause"/>
        <outline text="Tuning forks modify probability">
          <outline text="Conductive: Weber toward, bone exceeds air"/>
          <outline text="Sensorineural: Weber away, air exceeds bone"/>
          <outline text="Technique and bilateral disease mislead"/>
        </outline>
      </outline>
      <outline text="Sudden loss and ear infection">
        <outline text="Sudden loss mistaken for wax or congestion">
          <outline text="Steroid benefit is time-sensitive"/>
          <outline text="Normal otoscopy is not reassuring"/>
        </outline>
        <outline text="Otitis externa confined to canal skin">
          <outline text="Wick or cleaning when canal closed"/>
          <outline text="Aminoglycoside drops injure inner ear if perforated"/>
        </outline>
        <outline text="Nocturnal pain, cranial neuropathy: skull-base osteomyelitis"/>
        <outline text="Bulging membrane, not redness, for otitis media"/>
        <outline text="Adult unilateral effusion: examine nasopharynx"/>
        <outline text="Cholesteatoma erodes bone despite modest pain"/>
      </outline>
      <outline text="Tinnitus and hearing function">
        <outline text="Pulsatile or not, unilateral or bilateral"/>
        <outline text="Pulse-synchronous suggests vascular mechanisms"/>
        <outline text="Unilateral with asymmetric loss: retrocochlear"/>
        <outline text="Rehabilitation reduces distress, percept persists"/>
        <outline text="Function not set by pure-tone thresholds"/>
        <outline text="Aids adjust frequency and binaural input"/>
        <outline text="Implant delivers electrical nerve stimulation"/>
      </outline>
      <outline text="Vestibular mechanisms and syndromes">
        <outline text="Paired labyrinths give balanced resting signal">
          <outline text="Unilateral loss read as rotation"/>
        </outline>
        <outline text="Reflex moves eyes opposite the head">
          <outline text="Catch-up saccade: peripheral deficit"/>
          <outline text="Central lesions may preserve the reflex"/>
        </outline>
        <outline text="Classify by timing and triggers">
          <outline text="Seconds, positional: benign positional vertigo"/>
          <outline text="Minutes to hours: migraine, Meniere, ischaemia"/>
          <outline text="Days, continuous: neuritis or stroke"/>
          <outline text="Worse with movement is nonspecific"/>
        </outline>
        <outline text="Otoconia in canal, repositioning manoeuvre"/>
        <outline text="Non-fatigable vertical nystagmus: central"/>
        <outline text="Impulse-nystagmus-skew valid only when continuous">
          <outline text="Early posterior-fossa MRI can be negative"/>
        </outline>
      </outline>
      <outline text="Nose, sinuses, and foreign bodies">
        <outline text="Allergic rhinitis is IgE-mediated"/>
        <outline text="Steroid spray regular, aimed off septum"/>
        <outline text="Unilateral obstruction, blood: tumour concern"/>
        <outline text="Thin orbital walls, valveless veins permit spread">
          <outline text="Emergency imaging, antibiotics, drainage"/>
        </outline>
        <outline text="Compress soft nose, not nasal bones">
          <outline text="Bilateral septal cautery risks perforation"/>
          <outline text="Posterior bleed threatens airway, circulation"/>
        </outline>
        <outline text="Button battery causes rapid necrosis">
          <outline text="Blind attempts push objects deeper"/>
        </outline>
      </outline>
      <outline text="Deep-neck infection and airway crisis">
        <outline text="Infection spreads along fascial planes"/>
        <outline text="Peritonsillar abscess: trismus, palatal bulge"/>
        <outline text="Ludwig angina elevates the tongue">
          <outline text="Sedation removes compensatory tone"/>
        </outline>
        <outline text="Stridor phase localises obstruction"/>
        <outline text="Severity from work and fatigue, not loudness">
          <outline text="Quieter stridor can mean exhaustion"/>
        </outline>
        <outline text="Normal saturation is not reassuring">
          <outline text="Oxygenation falls abruptly before obstruction"/>
        </outline>
        <outline text="Prepare expert, equipment, surgical airway"/>
      </outline>
      <outline text="Voice and vocal-fold paralysis">
        <outline text="Persistent hoarseness needs fold visualisation"/>
        <outline text="Recurrent laryngeal nerve, skull base to chest">
          <outline text="Thyroid, lung, aortic, mediastinal disease"/>
        </outline>
        <outline text="Bilateral paralysis threatens airway"/>
      </outline>
      <outline text="Swallowing safety and aspiration">
        <outline text="Alertness, closure, sensation, cough needed"/>
        <outline text="Aspiration silent when sensation impaired"/>
        <outline text="Endoscopy views pharynx, residue"/>
        <outline text="Videofluoroscopy shows mechanics across strategies"/>
        <outline text="Safety measures can cost hydration, pleasure"/>
        <outline text="Aspiration pneumonia is multifactorial">
          <outline text="Saliva aspirated despite nil by mouth"/>
          <outline text="Mouth care, upright posture, bolus size"/>
        </outline>
        <outline text="Share texture as real consistency"/>
      </outline>
    </outline>
  </body>
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