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Neuro and special senses block > ENT > Flashcards

ENT Flashcards

1
Q

What are the clinical features of otitis media?

A
  • Ear pain
  • Discharge
  • Fever
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2
Q

How do you manage otitis media?

A

Conservative - watch and wait, monitor childs development
Medical - abx after 2-3 day delay, amoxicillin first line, erythromycin if allergy
Surgical - grommet insertion to correct Eustachian tube dysfunc

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3
Q

What are the complications of otitis media?

A
  • Chronic otitis media and chronic ear discharge
  • Cholesteatoma
  • TM peforation
  • Conductive hearing loss
  • Infection spread intracranially - brain abscess
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4
Q

What is the management of chronic otitis media?

A

Cholesteatoma - surgery to remove and mastoidectomy
If no cholesteatoma found = repair perforation

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5
Q

What are the causes of pain in the ear?

A
  • Otitis externa
  • Otitis media
  • Otitis interna
  • TM perforation
  • Haemotympanum
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6
Q

What is haemotympanum? What are the signs and sx?

A

Blood in the middle ear, often associated w temporal bone fracture.
Signs - conductive hearing loss, blood seen through TM

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7
Q

What are the risks of mastoid surgery?

A
  • Facial nerve palsy
  • Alt taste due to damage of chorda tympani
  • CSF leak
  • Tinnitus, vertigo and complete hearing loss in operated ear
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8
Q

What are the clinical features of otitis media w effusion?

A
  • Conductive hearing loss
  • Ear pain
  • Can see effusion and fluid behind tympanic membrane
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9
Q

What are the ix of otitis media w effusion?

A
  • Tympanogram - type B/flat tracing w normal canal vol
  • Pure tone audiogram - conductive hearing loss
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10
Q

What is the management of otitis media w effusion?

A
  • Conservative to see if spont resolution
  • Grommets
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11
Q

What is a tympanogram?

A

Measure compliance of the TM in response to pressure changes in the middle ear. Can be performed at all ages.
Type A - normal, peak at 0
Type B - flat
Type C - peak earlier than 0, on the neg side of the chart

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12
Q

What is a pure tone audiogram?

A

Measures hearing sensitivity. Can be performed 4+.
The higher the line on the graph, the better the hearing.
Conductive - normal bone conduction and reduced air conduction
Sensorineural - reduced bone and air conduction

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13
Q

What are the different types of hearing loss and what are the results of tuning fork tests?

A
  • Conductive, outer or middle ear pathology, bone louder than air and sound louder in bad ear
  • Sensorineural, inner ear pathology, air louder than bone and sound loud in good ear
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14
Q

What are the causes of type B and type C tympanograms?

A

Type B - otitis media w effusion or perforation
Type C - eustachian tube dysfunction

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15
Q

How should sensorineural hearing loss be investigated?

A

With an MRI scan to exclude lesions along the pathway eg. acoustic neuroma/vestibular schwanoma

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16
Q

What are some causes of childhood hearing loss?

A

Congenital - infections eg. rubella, drug and alcohol use in pregnancy, genetic causes, preeclampsia, hypoxia at birth
Acquired -meningitis, perforated TM, otitis media, otosclerosis/Menieres disease, noise induced head injury

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17
Q

What is otosclerosis and what are the clinical features?

A

Autosomal dominant disease causing fusing of the ossicles and progressive hearing loss.
- Hearing loss
- Tinnitus
- Hearing improved in noisy surroundings
- FH
- Carhart’s notch on PTA = loss of bone conduction at 2000Hz

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18
Q

What is Schwartze sign?

A

Rare but pink hue to TM in otosclerosis

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19
Q

What are the ix into otosclerosis?

A
  • Tympanogram - type A trace
  • PTA - conductive hearing loss
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20
Q

What is the management on otosclerosis?

A
  • Hearing aid
  • Stapedectomy
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21
Q

What are some non vestibular causes of dizziness?

A
  • Hypoglycaemia
  • Postural hypotension/hypotension
  • Dehydration
  • Incontinence
  • Cervical dizziness
  • Visual disturbances
  • Stress and fatigue
  • Neuropathies eg. diabetic foot, less sensation in feet and feel unsteady and dizzy
  • Aneurysm
  • Arrythmia
  • Heart failure and MI
  • Medications
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22
Q

What are the vestibular causes of vertigo/dizziness?

A

Central - stroke, migraine, cancer, demyelination eg. MS, drugs
Peripheral - BPPV, Meniere’s, vestibular neuritis

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23
Q

What are the clinical features of BPPV?

A

Vertigo w head movements, lasts for a few seconds.

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24
Q

How do you diagnose and treat BPPV?

A

Diagnose - Dix Hallpike manoeuvre - torsional geotrophic nystagmus, recreates sx
Treat - Epley manoeuvre

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25
Q

What are the clinical features of Meniere’s disease?

A
  • Vertigo
  • Nausea and vomiting
  • Tinnitus
  • Aural fullness
  • Sensorineural hearing loss, goes from fluctuating to permanent
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26
Q

What is the management of Meniere’s?

A

Medical - thiazide diuretics eg. bendrofluazide, betahistine, prochloperazine for acute attacks
Surgery - grommets, dex middle ear injection, vestibular destruction = inject gentamicin in middle ear, labrinthectomy

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27
Q

What are the clinical features of vestibular neuronitis?

A
  • Severe vertigo lasting days
  • nausea and vomiting
  • General unsteadiness for weeks following the episode
  • Horizontal nystagmus - HINTS exam
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28
Q

What is the management of vestibular neuronitis?

A

Vestibular sedatives during acute attacks and IV fluids if vomiting is severe enough

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29
Q

What is the prognosis of sudden onset sensorineural hearing loss?

A

Is an otological emergency
1/3 recover completely, 1/3 partially recover, 1/3 no recovery at all

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30
Q

What are the ix into sudden sensorineural hearing loss?

A
  • Pure tone audiogram
  • MRI scan to exclude lesion along central auditory pathway eg. acoustic neuroma
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31
Q

What is the management of sudden sensorinural hearing loss?

A
  • Steroids - oral or injected into middle ear
  • Anti virals
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32
Q

What is Weber’s test?

A

Tuning fork placed on patients forehead and pt is asked where they can hear the noise:
- Sensorineural - tone heard in good ear
- Conductive - tone heard in bad ear

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33
Q

What is Rinne test?

A

Tuning fork is placed on the pt mastoid and then just outside the ear:
+ve Rinnes = tuning fork louder in air, Sensorinueral (or not heard)
-ve Rinnes = tuning fork louder in bone, Conductive

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34
Q

What are the local causes of epitaxis?

A
  • Idiopathic (85%)
  • Trauma
  • Iatrogenic
  • Foreign body
  • Inflam - rhinitis, polyps
  • Neoplastic
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35
Q

What are the systemic causes of epitaxis?

A
  • HTN
  • Coagulopathies
  • Vasculopathies
  • Hereditary haemorrhagic telangiectasia
36
Q

How do you initially manage a pt presenting w epitaxis?

A
  • AtoE
  • Pinch soft part of nose and lean the head forward
  • Spit out any blood in mouth
37
Q

What is the conservative treatment of epitaxis?

A
  • Try topical adrenaline to help control bleeding
  • Cautery, if ant w ant rhinoscopy, topical silver nitrate or bipolar diathermy or it post w rigid endoscope
  • Nasal packing if cautery fails - ant pack and if bleeding cont can add post packing
38
Q

What is the surgical treatment of epitaxis?

A

Surgical ligation or radiological emobolism of sphenopalatine, ant ethmoid (can’t embolise as comes from int carotid) or ex carotid (last resort)

39
Q

What are the complications of nasal trauma?

A

Septal haemotoma - if undetected will lead to saddle nose deformity due to avascular necrosis or CSF leak w basalar skull fracture.
Ix - ant rhinoscopy and palpation, very painful

40
Q

What is rhinosinusitis?

A

Inflam or the nose and paranasal sinuses w two or more of the following sx:
- Nasal blockage, obstruction, congestion, discharge
- Nasal drip
+/- facial pain and reduction in smell and..
endoscopic signs of polyps, mucopurulent discharge or oedema in the middle meatus and/or
CT changes.

41
Q

What is the definition of acute rhinosinusitis? (ARS)

A

<12 weeks w complete resolution of sx, can be viral or non viral

42
Q

What is the definition of chronic rhinosinusitis? (CRS)

A

> 12 weeks w/o complete resolution of sx. Can be
- CRS w nasal polyps
- CRS w/o nasal polyps

43
Q

What are the causes of ARS?

A
  • Viral = rhinovirus or influenza virus, these sx normally resolve in 5 days
  • Non viral, considered if sx >5 days = S.pneumoniae, H.influenzae or M.catarrhalis
44
Q

How is ARS managed?

A
  • Nasal decongestants
  • Analgesia
  • Topical nasal steroids and oral abx if >5 days
45
Q

What are the RF of CRS?

A
  • Atopy and pollutants
  • Infections eg. S.aureus or fungal infections
  • Ciliary impairment eg. CF
  • Anatomical abnormalitiy - septal deviation, abnormal ucinate process
  • Immunocompromised
  • Aspirin hypertsensitivity
  • Pregnancy, nasal congestion high as O+P effect nasal mucosal vascularity
  • Foreign body
  • Swimming and diving
  • Trauma
46
Q

What are the ix into CRS?

A
  • Skin prick tests if suspect allergy
  • CT sinuses only if surgery planned or atypical features on hx/exam
47
Q

What is the management of CRS?

A

No cure, just symptomatic:
- Conservative = avoid allergens and nasal doucing
- Medical = antihistamines, topical nasal/oral steroids if severe, oral abx at least 6-8 week course
- Surgery = nasal polypectomy but recurrence, surgery to improve drainage of sinuses = Functional Endoscopic Sinus Surgery

48
Q

What are the causes of allergic rhinitis and how is it classified?

A

Caused by IgE mediated type 1 hypersensitivity reaction in mucous membranes of nasal airways.
Intermittent = sx <4 days a week for less than 4 weeks
Persistent = sx >4 days a week, more than 4 weeks
Mild = can cont normal daily activities and sleep
Mod to severe = impairs daily activity and sleep

49
Q

What is the treatment of allergic rhinitis?

A
  • Avoid allergens
  • Nasal douching
  • Antihistamines
  • Topical nasal steroids
  • Immunotherapy
50
Q

How is a retropharyngeal abscess able to form?

A

Ant to the prevertebral fascia behind the pharynx is a potential space = retropharyngeal space, a abscess may form here. From base of skull to mediastinum. There is associated mortality due to airway problems and mediastinitis.

51
Q

What are the clinical features of a retropharyngeal abscess?

A
  • Young child following URTI
  • Pt unwilling to move neck, held rigid
  • Systemically unwell
  • Airway compromise
  • Dysphagia/odynophagia
52
Q

What are the ix and management into retropharyngeal abscesses?

A

Ix - CT neck
M - secure airway, IV abx, surgery for incision and drainage

53
Q

What is Ludwig’s angina?

A

Cellulitis of the soft tissue of the floor of the mouth, commonly associated w dental infection. Is life threatening.

54
Q

What are the CF of Ludwig’s angina?

A
  • Swelling of the floor of the mouth
  • Painful mouth
  • Protruding tongue
  • Airway compromise
  • Drooling
55
Q

What are the ix into Ludwig’s angina and how is it managed?

A

Ix - CT neck
M - secure airway, IV abx, surgery to drain collections

56
Q

What is the presentation of a parapharyngeal abscess?

A
  • Hx of febrile illness
  • Odynophagia
  • Trismus
  • Reduced neck movement
  • Swelling in neck around upper part of SCM

Management the same for other ENT abscesses.

57
Q

What is the cause of epiglottis?

A

H.influenzae but incidence has reduced w vaccine against it

58
Q

What is the presentation of epiglottits?

A
  • Stridor
  • Drooling
  • Pyrexia
  • Child aged 2-6
59
Q

What is the management of epiglottis?

A
  • Secure airway - don’t examine or upset pt, may precipitate obstruction
  • Intubate and have ENT surgeon to do surgical airway if not possible
  • Iv abx and then extubate
60
Q

What are some differentials for neck lumps?

A

Midline - dermoid cyst, thyroglossal duct cyst, thyroid gland pathology
Lateral - submandibular pathology, branchial cyst on SCM, lymph node (inflam/infective/metastatic), vascular

61
Q

What are the CF of head and neck cancer? What type of cancer are they?

A
  • Dysphonia
  • Dysphagia/odynophagia
  • Dyspnoea/stridor
  • Mass in the neck
  • Pain or referred pain
  • Bleeding from mouth/nose
  • Nasal blockage

Vast majority (90%) SCC

62
Q

What are the RF of head and neck cancer?

A
  • Alcohol
  • Smoking
  • Beetle nut chewing for oral cavity cancer
  • Chinese ethnic origin for nasopharyngeal malignanyc
63
Q

What are the ix into head and neck cancer?

A
  • US guided FNA of all neck masses except those that are palpable
  • EUA to biopsy, assess size of tumour and assess if others
  • CT neck - size of tumour and mets
  • CT check to test for mets
64
Q

What is the management of head and neck cancer?

A
  • Palliation - reduce suffering eg. chemo and RT to reduce size of tumour and reduce sx
  • Curative - RT to primary site +/- neck and chemo or surgery eg. laser resection or laryngectomy or neck dissection
65
Q

What is the most common type of thyroid cancer?

A

Papillary adenocarcinoma, (70%) seen in young pt or those w ht of radiation to neck.
Follicular carcinoma 20%

66
Q

What are some non neoplastic nodules of the thyroid and what is the management?

A

Single nodule = colloid, cystic or multinodular goitre.
M - surgery for compressive sx or cosmesis = hemithyroidectomy. Total thyroidectomy = increased morbidity and lifelong thyroxine replacement needed.

67
Q

What is the management of neoplastic nodules?

A

Adenoma - hemithyroidectomy
Carcinoma - total thyroidectomy for most types unless disease too advanced. Radio iodine for papillary and follicular carcinoma after surgery.

68
Q

What are the complications of thyroid surgery?

A
  • Post op haemorrhage
  • Airway obstruction secondary to haemorrhage or bilat vocal cord palsy
  • Vocal cord palsy
  • Hypocalcaemia
69
Q

What are the causes of acute and chronic sialadenitis?

A

Acute - mumps (paramyxovirus), HIV
Chronic - rare but TB, sarcoidosis, syphilis

70
Q

What are sialothiasis and what are the ix into them?

A

Stones in the salivary duct - cause obstruction = pain and swelling, worse during meals. Most common in submandibular gland.
Ix - USS, sialogram

71
Q

What is the management of sialothiasis and what are some complications?

A
  • Conservative - settle on their own mostly w analgesia + hydration
  • Endoscopy
  • Radiological removal
  • Surgical removal of stones or salivary gland

Complications = sialadenitis, abscess formation

72
Q

What are the causes of nasal blockage?

A
  • Rhinosinusitis (viral, bacterial, allergic)
  • Nasal polyps
  • Rhinitis
  • Adenoiditis and tonsilitis
  • Sinonasal tumour
  • Turbinate hypertrophy
  • Deviated nasal septum
73
Q

What are some causes of deafness/hearing loss in adults?

A
  • Presbycusis
  • Acoustic neuroma
  • Cholesteatoma
  • Meniere’s disease
  • Ototoxic drugs - loop diuretics, quinine, NSAIDs,
  • Otosclerosis
  • Noise related deafness
74
Q

What are some differentials for pain in the ear?

A
  • Foreign body
  • Otitis media/externa/w effusion
  • Wax impaction
  • Referred ear pain - TMJ disorder, dental pain, head and neck malignancy (need to exclude red flags when taking otalgia hx), temporal arteritis
  • TM perforation
  • Chronic suppurative otitis media
  • Myringitis
75
Q

What are some differentials for pain in the throat? (children and adults)

A
  • Tonsilitis/quincy
  • Pharyngitis
  • Oesophageal cancer
  • GORD and oesophagitis
  • Foreign body
76
Q

What are some differentials for dysphagia?

A
  • GORD
  • Oesophageal cancer
  • Neurological causes eg. MS, Parkinsons
  • Oesophageal strictures
  • Myasthenia Gravis
  • Achalasia
77
Q

What are some differentials for facial pain?

A
  • Sinusitis
  • Migraine
  • GCA
  • TMJ disorder
  • Trigeminal neuralgia
  • Dental pain
78
Q

What are some causes of conductive hearing loss?

A
  • Wax impaction
  • Otitis media w effusion
  • Eustachian tube dysfunction
  • Ear infections
  • Perforation of TM
  • Chronic supprative otitis media
79
Q

What are some causes of sensorineural hearing loss?

A
  • Presbycusis
  • Noise related hearing loss
  • Congenital infections
  • Neonatal complications
  • Drug induced deafness
  • Vascular pathology eg. stroke, TIA
80
Q

What are some causes of a hoarse voice?

A
  • Laryngeal cancer, >3 weeks = 2WW for ENT, smoke hx
  • Chronic laryngitis, associated w GORD, worse in morning
  • Laryngitis, viral and self limiting
  • Reinke’s oedema, enlargement of vocal cords, associated w hypothyroidism
  • RLN palsy, thyroid surgery
81
Q

What are some of the complications of FESS?

A
  • Bleeding and infection
  • CSF leak
  • Visual loss/disturbance
82
Q

Why is Little’s area significant and what vessels make it up?

A
  • Sphenopalantine artery
  • Ant and post ethmoidal artery
  • Sup labial artery
  • Greater palantine artery

Is the area of the nose where most epitaxis originates from. Also called Keisselbach’s plexus

83
Q

What are some complications of submandibular gland removal?

A
  • Bleeding and infection
  • Palsy of hypoglossal nerve, lingual nerve or cervical branch of facial nerve
84
Q

What structures are within the submandibular triangle?

A

Borders - mandible and ant and post belly of diagastric muscle
Contents:
- Submandibular gland and lymph nodes
- Hypoglossal nerve
- Cervical brand of facial nerve
- Lingual nerve and artery and vein
- Facial artery and vein

85
Q

What is the management of perforated TM ?

A

Review in 6 weeks - should self resolve ~6-8 weeks

Neuro and special senses block (4 decks)

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