ABSTRACT
The usefulness of tympanotomy tubes in children with otitis media with effusion who also have speech and language retardation is doubtful in view of the natural development. The second revision of the practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners is still not in complete agreement with this. The indications for performing an adenoidectomy are now more limited. Pneumatic otoscopy and tympanometry are diagnostic aids that may deserve a permanent place in the general practitioner's medical practice in the future.
Subject(s)
Family Practice/standards , Otitis Media with Effusion/diagnosis , Otitis Media with Effusion/therapy , Practice Guidelines as Topic , Practice Patterns, Physicians' , Acoustic Impedance Tests/methods , Adenoidectomy , Humans , Netherlands , Otoscopy/methodsABSTRACT
In the revised practice guideline on hypertension from the Dutch College of General Practitioners, some changes have been made in the areas of diagnosis and therapy in comparison to the previous edition. Finding people with hypertension is a major goal for the prevention of cardiovascular disease. A systolic blood pressure > 140 mmHg (> 160 mmHg in patients > 60 years) necessitates non-pharmaceutical advice and antihypertensive therapy with diuretics, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or calcium antagonists, either as monotherapy or in combination. In view of the ever-increasing importance of ACE inhibitors in antihypertensive therapy, we expect that the next revision of the practice guideline will soon be necessary.
Subject(s)
Antihypertensive Agents/therapeutic use , Family Practice , Hypertension/diagnosis , Hypertension/drug therapy , Practice Guidelines as Topic , Age Factors , Humans , NetherlandsABSTRACT
In four patients with hoarseness, men aged 53 and 67 years, and women aged 8 and 37 years, indirect laryngoscopy revealed, respectively, a squamous cell carcinoma of the vocal cord, recurrent nerve paralysis due to pulmonary carcinoma, irritative noduli due to forced use of the voice, and psychic stress as the cause. In a patient with existing hoarseness over a period of 3 to 6 weeks, the vocal cords will have to be examined with indirect laryngoscopy. Where the general practitioner is not equipped to handle this procedure, he can make a referral to an ear, nose and throat specialist. It would, however, be to the benefit of the patient and the general practitioner if the latter were to master the technique of indirect laryngoscopy. This would enable the patient to be treated without further delay, and it might also make selective referral possible.
Subject(s)
Hoarseness/etiology , Laryngeal Neoplasms/diagnosis , Laryngoscopy , Vocal Cord Paralysis/etiology , Vocal Cords/pathology , Adult , Aged , Carcinoma, Squamous Cell/diagnosis , Child , Diagnosis, Differential , Family Practice , Female , Humans , Laryngeal Neoplasms/complications , Laryngoscopy/methods , Male , Middle Aged , Netherlands , Recurrent Laryngeal Nerve/pathology , Referral and Consultation , Stress, Psychological/complications , Stress, Psychological/diagnosis , Vocal Cord Paralysis/psychologyABSTRACT
The 61st guideline of the Dutch College of General Practitioners titled 'Slechthorendheid' gives clear instructions regarding anamnesis, examination, supplementary examination and management. It might be added that audiometry in general is well feasible from the age of 4 years, while the guideline gives 6 years as the lower limit. The instruction in the guideline to observe a period of watchful waiting of 3 months in adults with otitis media will give rise to problems in practice.
