\documentclass[10pt,a4paper]{article}

% Packages
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\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
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\usepackage{hhline}             % Border under tables
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\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (otology.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Otology Cheat Sheet)
}

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% This two commands together give roughly
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% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
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\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Otology Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/22881/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 17th May, 2020.\\
   Updated 7th May, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.


\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{History}}  \tn
% Row 0
\SetRowColor{LightBackground}
Pain Location, quality, course, \seqsplit{aggrevating/relieving} factors & Discharge (frequency, colour, consistency, odour) \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
Feeling of fullness/pressure & Hearing loss \seqsplit{(uni/bilateral/partial/complete} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Tinnitus & Vertigo \tn 
% Row Count 8 (+ 1)
% Row 3
\SetRowColor{white}
Loud noise exposure & Injury to the ear \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Recent swimming/air travel & Infection \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
Past Ear surgery/treatment & Past serious illness \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Family history of hearing problems/ ear conditions & Cold water sports \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.6991 cm} x{11.5709 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hearing Loss}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Types}} & {\bf{Age}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Congenital & Infant - Young children \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Serous Otitis Media & Infant - Young children \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Postinfective} & Young children - Teenagers/adolescents \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Noise Induced & Teenagers/adolescents - Over 60 \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
Otosclerosis & 20-60yo \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Acoustic Neuroma & 20-60+yo \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
Meniere's Disease & 20-60 yo \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
Early Prebycusis & 40-60 yo \tn 
% Row Count 15 (+ 2)
% Row 9
\SetRowColor{white}
Prebycusis & 60+ \tn 
% Row Count 16 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Tinnitus Classfications}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Subjective}} & {\bf{Objective}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Most common & Can be heard by patient and examiner - Rare \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Sound can only be heard by patient - caused by abnormal activity in inner ear/CNS & Vascular Abnormalities, muscle related \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
{\bf{Primary}} & {\bf{Secondary}} \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Idiopathic + sensorineural Hearing loss & Underlying cause - not sensorineural \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\seqsplit{Constant/intermittent/unilateral/bilateral:} \newline Buzzing, Whistling, Hissing, Ringing, Roaring, Clicking, Pulsing (vascular), Whooshing, Humming}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.4623 cm} x{8.8077 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Causes of Subjective Tinnitus}}  \tn
% Row 0
\SetRowColor{LightBackground}
Infections & Ear wax \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Inner ear noise damage & Meniere's disease \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Otosclerosis & Acoustic Neuroma \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
MS & Ototoxic drugs \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Metabolic disorder & Psychological disorders \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Mechanical disorders} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{If unilateral + sensorineural hearing loss consider:}} \newline Meniere's disease + Acoustic Neuroma \newline  \newline {\bf{If Bilateral consider:}} \newline Age related hearing loss \newline Noise induced hearing loss \newline Drug induced ototoxicity \newline   \newline  \newline {\bf{Subjective tinnitus + conductive hearing loss consider:}} \newline Disorders of middle/outer ear \newline Otosclerosis(family hx)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Examination}}  \tn
% Row 0
\SetRowColor{LightBackground}
External Ear & Auscultate periauricular area, temporal bone, orbit, vascular structures of the neck \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
Otoscopy & TMD Exam \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
CN Exam (VII, VIII) & Check for anaemia, thyroid, hyperlipidemia +diabetes \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
Assess for other causes of pain, tinnitus/hearing loss & Regional lymphnodes \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{If Tinnitus is pulsatile - head, neck exam, blood pressure + CV system (Murmurs, carotid + temporal artery bruits} \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Red Flags}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{EMERGENCY REFERRAL}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Sudden onset pulsatile tinnitus} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus with associated significant neuro symptoms} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus Secondary to head trauma} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus associated with sudden hearing loss} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{All patients with tinnitus should be referred to their GP - non-emergencies only \newline Referred to ENT - audiological assessment}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{URGENT REFERRAL - Same day to GP}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Objective/pulsatile tinnitus} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Unilateral tinnitus} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus with unilateral/asymmetric hearing loss} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus with persistent otalgia/otorrhoea that does not resolve with treatment} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus with vestibular symptoms -dizziness, vertigo} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{LESS URGENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus of unknown cause - not associated with hearing loss, ear pain, drainage or malodour, vestibular symptoms or facial weakness or hearing loss that cannot be distinguished} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Tinnitus that is causing distress - despite primary care management} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Otoscopy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Before inserting Otoscope, observe the outside of the ear - hearing aid, shape, discharge, deformities, skin} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Pull the pinna up and back for adults, up for children} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Slowly insert no more than 0.5cm in} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.2297 cm} x{5.7358 cm} x{5.9045 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Ear disorders}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Acute Otitis media}} & {\bf{S\&S}} & {\bf{Otoscopy Findings}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Fullness in the ear & Retracted, pink/red tympanic membrane \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Fever & Pus and membrane can bulge \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
 & Vomiting &  \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Headache &  \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
 & Hearing loss &  \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Fluid coming from the ear &  \tn 
% Row Count 12 (+ 2)
% Row 7
\SetRowColor{white}
 & Diarrhoea &  \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{17.67cm}}{{\bf{Serous Otitis media}}} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
 & Fullness, pressure, popping in the ear & Retracted Tympanic membrane - \seqsplit{yellowish/blueish} in colour \tn 
% Row Count 19 (+ 5)
% Row 10
\SetRowColor{LightBackground}
 & Hearing loss & Bubbles/ air/fluid level can be seen \tn 
% Row Count 22 (+ 3)
% Row 11
\SetRowColor{white}
 & Pain &  \tn 
% Row Count 23 (+ 1)
% Row 12
\SetRowColor{LightBackground}
{\bf{Chronic suppurative otitis media}} & Painless otorrhea & Defects in tympanic membrane \tn 
% Row Count 26 (+ 3)
% Row 13
\SetRowColor{white}
 & Bacterial  or fungal & Ear full of pus \tn 
% Row Count 28 (+ 2)
% Row 14
\SetRowColor{LightBackground}
{\bf{Perforated Eardrum}} & Painful &  \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.2297 cm} x{5.7358 cm} x{5.9045 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Ear disorders (cont)}}  \tn
% Row 15
\SetRowColor{LightBackground}
 & Hearing loss & Hole in eardrum with redness \tn 
% Row Count 2 (+ 2)
% Row 16
\SetRowColor{white}
 & Caused by: Repeated infections + trauma &  \tn 
% Row Count 5 (+ 3)
% Row 17
\SetRowColor{LightBackground}
{\bf{Exostosis}} & Surfer's ear - cold water & Nodular bony outgrowths covered with skin \tn 
% Row Count 8 (+ 3)
% Row 18
\SetRowColor{white}
 & Can occlude ear canal &  \tn 
% Row Count 10 (+ 2)
% Row 19
\SetRowColor{LightBackground}
{\bf{Tympanosclerosis}} & Hearing loss if affects ossicles & White plaques in tympanic membrane /middle ear cavity \tn 
% Row Count 14 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}