Otolaryngology | The National EM Board (MyEMCert) Review Course

Otolaryngology by Ken Milne, MD
Learn more and register at www.emboards.com.
The National EM Board Review is the highly regarded course which has helped tens of thousands of emergency medicine physicians pass their qualifying and concert™ exams.
Ace Your ABEM/AOBEM Certifying and Recertifying Exams the First Time. Guaranteed.
Here’s What You’ll Receive When You Attend the Course
- Instruction by a small, select cadre of full-time emergency medicine educators/clinicians.
- A focus on material likely to be covered in the exams
- A detailed session on strategies to help you optimize your test-taking skills
- Three comprehensive “tag-team” evening review sessions
- A full color atlas containing 224 “need to know” clinical images
- A comprehensive course manual
- Up to 34.75 AMA PRA Category 1 Credits™ and ACEP Category I credit
- Live & self-study participants receive the third edition of the Aldeen and Rosenbaum’s 1,200 EM question book and access to the digital version PLUS up to 40 additional CME credit hours (A $350 Value!)
- Free access to the EMsono ultrasound tutorial program
- Our unique 100% Money Back - No Pass, No Pay Guarantee!

[@divyamarkande35]

I just love this channel

[@silvinlito609]

Doctor, your presentation rocks! ❤

[@zaidikmc]

thank you sir for such a nice talk.

[@ansabjalil]

Beautifully delievered lecture

[@dailydoseofmedicinee]

Wonderful presentation 💯

[@dipaknadkarni62]

Thank you.

[@rumit9946]

So useful 🙏

[@abioserocks]

blood fantastic video!

[@xDomglmao]

Excellent review, highly recommended if in ENT rotation

[@mahmoudchibani2697]

thanks !

[@Drenoxian]

Top notch 👌🏼

[@petertao1747]

very help

[@pingkanpermataputri1741]

very helpful lecture thank you sir

[@PeterJohns]

Oh Ken, When I saw that central vs. peripheral chart come up at 14:30, I thought “surely he is going to lambaste the heck out of that chart!” Well, you didn’t so I will. Onset-vestibular neuritis, a fairly common cause of persistent dizziness can come on over a number of hours. Cerebellar stroke usually has a sudden onset. Severity-although it is true that some central causes of vertigo can be relatively mild, stroke can present with horrible ongoing vertigo. Pattern- both central and peripheral causes can be constant or intermittent. Eg. BPPV and TIA, vs vestibular neuritis and cerebellar stroke Worse on movement-all vertigo gets worse on movement! If it doesn’t get worse with movement, it probably isn’t vertigo. The degree of nausea/vomiting is not a way to discriminate central vs peripheral vertigo. Both can be either mild or severe. Nystagmus-vertical common seen in positive DHT. And horizontal can be seen in central. Fatigues-not recommended to test for it anymore. And you confuse it with duration. Hearing loss can occur in AICA (anterior inferior cerebellar artery) strokes. That’s why there is HINTS plus, with a bedside test of new hearing loss. Abnormal TM is exceeding rare finding in both central and peripheral causes of vertigo. CNS symptoms-yes!! This is actually quite helpful. And you didn’t talk about diplopia or dysarthria or the other D’s (dysphagia, dysphonia or dysmetria). As well as new significant headach or neck pain (cerebellar hemorrhage or vertebral artery dissection) and new sensory or motor complaints or inability to walk unaided. So the table is useless and should be abandoned. End of story there. In addition, to talk about tumours as a cause of dizziness is very misleading. It is quite rare to have a tumour present as isolated dizziness to the emergency department. Progressive headache and dizziness, sure. History of lung or breast cancer and headache, sure. But totally out of the blue isolated dizziness being a brain tumour? Quite rare. For some reason you seem to think that most patients with BPPV have horizontal nystagmus, when in fact the most common variant, posterior canal BPPV, has vertical upward/rotatory nystagmus. Horizontal canal BPPV can have horizontal nystagmus, but you have to make the distinction. BPPV is the most common cause of dizziness, but it’s probably more like 30 or 40%, not 90% of vertigo seen in the ED as you suggest. You confuse duration of the nystagmus with fatigueability. Duration is how long you see the nystagmus for. Fatigueability is if repeating the Dix-Hallpike test over and over again, the nystagmus would lessen or stop happening. This was recommended when we didn’t know how to cure it with the Epley maneuver. It’s no longer recommended to test for fatigueability. Just do the Epley maneuver and cure them. The illustration of the Dix-Hallpike test is from Furman’s NEJM article from 1999. And in that article, it clearly states that the nystagmus is “torsional and vertical nystagmus”. Why you keep saying horizontal is not clear to me. You must have happened upon a lot of horizontal canal BPPV. Watch this video to clear things up for you. kzbin.info/www/bejne/jIPNg4ekftxsj6c Quoting 50% success of the Epley maneuver is incorrect. If done on the right patient, the right way, it is more like 80% effective after 1, and 90% effective after two. Given that the sheets you give out likely only show a left or right Epley, home treatment by the patient will likely be much less successful than that. Not treating them in the ED is therapeutic abandonment in my opinion. The reason why you are getting a 50% cure is likely that when you see the horizontal nystagmus which occurs in the less common horizontal canal BPPV, you attempt an Epley, which does not work. Horizontal canal BPPV is probably about 30% of the BPPV that presents to the ED. It should be treated with another maneuver, such as the Gufoni maneuver. Posterior canal is about 70%. Anterior canal BPPV fairly rare, about 2%. I’ve seen a handful of those. So if you take 100 cases of BPPV, apply Epley to all of them, only 70% are going to benefit, because roughly 30% are horizontal canal BPPV, and Epley doesn’t work for it. And since Epley works in about 80% of patients with posterior canal BPPV, you get a cure rate of 80% of 70% which is 56%, which is around the cure rate you state you are seeing. Vestibular neuritis is still commonly called vestibular neuritis. Some dizzy experts preferred UPV, unilateral peripheral vestibulopathy. But let’s keep it simple. Vestibular neuritis. So much hate for the HINTS exam. Turning even an old lady’s relaxed neck from 20 off midline back to midline will not hurt them. You are not in grade 9 science anymore Ken. You will not “pith” a patient doing the head impulse test. Look at my video at this time stamp. kzbin.info/www/bejne/jqHKmZ-so9eFe6s You can do better if you try. Also the text on the slide is wrong about the side the abnormal HIT is on. With vestibular neuritis, the fast component of the horizontal/rotational nystagmus is towards the normal side. And the abnormal head impulse test occurs when from a starting position 20 off midline (starting position towards the normal ear) rapidly back to the midline. (moving towards the affected ear.). The catch up saccade is in the same direction as the spontaneous nystagmus, but of greater magnitude. Also, skew means vertical or diagonal movement of the eyes, horizontal movement does not count as skew. Ken I realized you were likely given this slide set to talk about, but almost 5000 people have looked at this video already, and they need to have accurate information, and well, you did not score too well at the vertigo section. If you give this talk again, please make sure you are have the facts straight.

[@PeterJohns]

kzbin.info/www/bejne/ZnevZGptpbp8oqM This gave me the impetus to finally made a video on why these sorts of tables are wrong.

[@dragon888193ftw]

you sound like a pain in the ass

[@PeterJohns]

@@dragon888193ftw and.....?

[@dragon888193ftw]

@@PeterJohns I was kidding. Thank you for your helpful comment, you are clearly very knowledgeable on this topic, but you should be more humble!

[@PeterJohns]

@@dragon888193ftw Gentle nudging people away from the old myths of vertigo has not been successful. I have decided to call out HARD this decades old misinformation whenever I see it. It was just presented at one of their educational sessions less than a month ago. See here. kzbin.info/www/bejne/f3iqanmhid2Ems0

[@Noah-ln2ph]

♡