Primary care
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Rhinitis affects a significant portion of the world population and increases the cost of health care by billions of dollars in treatment costs and missed days of work. Allergic rhinitis is the most common cause. ⋯ Initial treatment includes using topical agents like intranasal corticosteroids and inhaled antihistamines as the first-line therapies for both allergic rhinitis and chronic rhinitis. Therapy can evolve in a stepwise manner depending on the primary symptom complaint prior to referral for advanced therapies such as allergen immunotherapy.
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Acute tonsillitis is a common illness that affects patients of all ages but the risk of complication increases with the young. Tonsillitis commonly presents with a sore throat and difficulty swallowing and will often have swelling of the tonsils with exudate on physical examination. Although acute tonsillitis secondary to group A beta-hemolytic Streptococcus should be considered so that antibiotic therapy can be initiated in a timely fashion to prevent complications such as a retropharyngeal abscess or acute rheumatic fever, the most common etiology of tonsillitis is viral. The treatment of viral tonsillitis is supportive with analgesia and hydration.
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Temporomandibular junction disorders (TMD) are a common problem for patients presenting to the primary care office. Symptoms may be acute or chronic. ⋯ Physical examination findings vary and may include palpable tenderness or spasm of the pterygoid muscles, palpable or audible clicking at the joint, wear and tear of tooth enamel, or dental malocclusion. Most TMDs respond well to conservative therapy, but some patients may benefit from more invasive treatments.
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The term vestibular disorder (VD) means the condition is related to vestibular structure (peripheral and central) or its mechanism. On the other hand, vestibular symptoms or dysfunctions are broader terminologies and include symptoms not related or partially related to vestibular apparatus or mechanism.
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Bell's palsy is acute weakness of the facial muscles associated with compression of cranial nerve VII. The annual incidence is 20 to 30 per 100,000. Diagnosis is based on a thorough history and physical examination, with careful attention to exclude other causes of facial weakness, such as stroke or Lyme disease. ⋯ Physical therapy and Botox injections can help patients with persistent symptoms. The roles of surgery and acupuncture remain unclear. Close follow-up is warranted and patients without improvement should be referred to a specialist.