Diseases of the ENT System Flashcards
What is Acute Otitis Media?
What is the most common causes?
How does it present?
What are the Otoscopy Findings?
What is the Management?
What are the complications?
Acute otitis media means inflammation of the middle ear. It is extremely common in young children.
Viral URTI’s usually precede otitis media, however, most infections are actually secondary to a bacteria.
The most common of which are:
1. Strep Pneumoniae. 2. Haemophilus Influenzae. 3. Moraxella Catarrhalis.
Presentation: Otalgia, fever in 50%, reduced hearing in affected ear, prodroaml symptoms of a viral URTI. Ear discharge can occur if the tympanic membrane ruptures.
Otoscopy: Bulging, erythematous tympanic membrane with loss of the light reflex. If the tympanic membrane ruptures then purulent otorrhoea.
Management: Generally self-limiting and does not require antibiotics, EXCEPTIONS - where antibiotics should be prescribed immediately:
- Symptoms lasting more than 4 days.
- Ruptured tympanic membrane.
- Bilateral otitis media in children under 2 years.
- Children who are systemically unwell, immunocompromised or at high risk of complications due to significant co-morbidities.
Treatment is 5-7 days of Amoxicillin (In pen allergic patients Erythromycin or clarithromycin)
Complications:
- Perforation of the tympanic membrane can develop into chronic suppurative otitis media (CSOM). This is defined as perforated tympanic membrane with otorrhoea for >6 weeks.
- Rare but very dangerous = Mastoiditis, meningitis, brain abscess, facial nerve paralysis.
What is Acute Tonsilitis?
What is the most common cause?
How does tonsilitis present?
What do you seen on examination?
How do you diagnose?
What is the management?
What are the complications of tonsilitis?
Acute Tonsilitis is inflammation of the tonsils.
The most common cause of tonsilitis are viral infections and do NOT require antibiotics.
If tonsilitis is bacterial the most common cause is Group A strep (Strep Pyogenes) the 2nd most common bacterial cause is Strep Pneumonia.
Presentation:
Presents with a fever, sore throat and painful swallowing.
Examination will reveal red, inflamed and enlarged tonsils (exudates on tonsils suggestive of bacterial tonsilitis)
Diagnosis:
Clinical diagnosis using the Centor Criteria or the FeverPAIN score. Also always examine the ears and palpate for cervical lymphadenopathy.
Management:
Do not give antibiotics in viral tonsilits, Penicillin V is used to treat bacterial tonsilitis (Clarithromycin used if pen allergic).
Complications:
- Otitis Media.
- Bacterial Tonsilitis can cause a Quinsy (Peritonsilar Abscess).
- Rare complications include = Rheumatic Fever, Post- Streptococcal Glomerulonephritis, Post-Streptococcal Reactive Arthritis.
Explain the CENTOR Score?
Centor Score:
- Exudate on tonsils = +1
- Cervical Lymphadenopathy = +1
- Temp >38 = +1
- Cough Absent = +1
A score of 3+ means bacterial tonsilitis is likely and the prescription of penicillin V is appropriate.
What is a Quinsy?
How does it present?
What is the management?
A quinsy is a peritonsillar absecess, which occurs when there is a bacterial infection with trapped pus which forms an abscess in the region of the tonsils.
Presents with severe throat pain which lateralises to one side, painful/ inability to swallow, deviation of the uvula to the unaffected side referred ear pain, cervical lymphadenopathy, trismus (inability to open their mouth).
Patients with a quinsy must be referred immediately to hospital for ENT to surgically incise and drain the abscess and administer IV antibiotics.
What are the NICE indications for a tonsillectomy?
What is the main complication of tonsillectomy?
What is the arterial supply to the tonsils?
Tonsillectomy is only considered if the patient has 5 or more episodes of tonsilitis per year, the symptoms have been occuring for at least a year and the episodes of tonsilits are disabling and prevent normal functioning.
The main complication of tonsillectomy is haemorrhage. Primary haemorrhage which occurs in the first 24 hours is most commonly caused by inadequate haemostasis. Secondary haemorrhage (24 hours- 10 days) is most commonly caused by infection.
The tonsils are suppllied by the tonsilar artery which is a branch of the facial artery.
What is Glue Ear?
Why does glue ear occur?
What do you see on otoscopy?
What is the management of glue ear?
Glue Ear is otitis media with effusion. The middle ear becomes filled with fluid which causes a conductive hearing loss in the affected ear. Secondary problems such as speech and language delay and behavioural problems can occur
The eustachain tube connects the middle ear to the back of the throat. It helps drain secretions from the middle ear, but when it becomes blocked the secretions build up in the middle ear space.
On otoscopy you see a dull tympanic membrane with air bubbles or a visible fluid level.
Management - Refer for audiometry to establish the diagnosis, usually treated conservatively but may require insertion of a grommet (tiny tube inserted into the tympanic membrane to allow fluid to drain)
What lines the Auricle and the External Acoustic Meatus?
The auricle and the external acoustic meatus are lined with stratified squamous epithelium. The epidermis contains sebaceous and ceruminous glands which secrete cerumen (earwax).
What is epistaxis?
How is epistaxis classified?
What are the causes?
How is it managed?
Epistaxis is a nosebleed. They most commonly originate from Kiesselbach’s Plexus (Little’s Area) which is found on the anterior nasal septum.
Classification:
Epistaxis can either be an anterior (most commmon and account for 90%) or posterior bleed:
- Anterior bleeds originate from ruptured blood vessels in Little’s area which is a highly vascularised anastomosis of 5 arteries on the anterior nasal septum (anterior ethmoidal, posterior ethmoidal, sphenopalatine, greater palatine, and the septal branch of the superior labial artery).
- Posterior bleeds originate from the branches of the sphenopalatine arteries.
Aetiology:
The most common cause is trauma, other causes include hypertension, iatrogenic (anti-coagulants), platelet disorders, coagulopathies, vasculitis, rhinosinusitis, malignancy and cocaine use.
Management:
1st Line = Sit up and tilt head forward and squeeze the soft part of the nostrils together for 20 minutes.
2nd Line = If bleeding point can be visualised, cauterise bleeding using silver nitrate stick. If not then nasal packing.
3rd Line = If nasal packing fails to stop the bleeding then surgical ligation or radiological embolisation can be carried out.
Nasal Trauma
What is really important to rule out in nasal trauma?
How do you diagnose a nasal fracture?
What can complicate a nasal fracture?
It is really important to rule out a septal haematoma because the blood supply to the nasal septum is within the mucopericondrium surrounding the septal cartilages. Therefore, shearing forces from trauma can tear these vessels and a septal haematoma forms in the potential space between the 2 layers which can cause septal abscesses and avascular necrosis.
A nasal fracture is a clinical diagnosis.
Nasal fractures can cause CSF leaks which presents with unilateral watery discharge. Usually resolves within 10 days but if not requires treatment.
What is ankyloglossia?
How is it managed?
Ankyloglossia is also known as tongue tie. This is when a baby is born with a short and tight lingual frenulum (the attachment of the tongue to the floor of the mouth). This prevents the infantfully extending their tongue out their mouth making it difficult for them to latch onto the breast and therefore, presents with poor feeding.
Usually resolves itself but can be treated with a frenotomy.
What is Otitis Externa?
What are the most common causes?
Otitis Externa is a common condition of the external ear.
The most common causes are staph aureus and psuedomona aerguinosa (specifically known as swimmers ear).
What is an apthous mouth ulcer?
Are apthous ulcers normal?
Apthous mouth ulcers are painful, shallow ulcers on the tongue or mucosal surface of the mouth which heal without scarring.
Common and usually a normal finding but recurrent apthous ulceration is associated with Crohn’s Disease and Bechet’s Syndrome.
What is Infectious Mononucleosis?
Infectious Mononucleosis (glandular fever)
