ENT Flashcards
Benign paroxysmal positional vertigo
o crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
o symptoms triggered by movement and last around a minute
o Dix-hallpike manoeuvre to diagnose, Epley manoeuvre to treat
Meniere’s disease
o excessive buildup of endolymph in the semicircular canals, causing a higher pressure than normal, disrupting the sensory signals.
o It causes attacks of hearing loss, tinnitus, vertigo and a sensation of fullness in the ear – last several hours, middle ages adults, not associated with movement, nystagmus, hearing deteriorates over time
o Treat with beta histamines
vestibular neuronitis
o Inflammation of vestibular nerve, usually linked with viral infection, acute vertigo that improves over a few weeks
labyrinthitis
o Inflammation of the inner ear, linked with viral infection, improves within few weeks, can cause hearing loss
central causes of vertigo
- Posterior circulation infarction (stroke)- sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms.
- Tumour – gradual onset with associated symptoms
- Multiple sclerosis – relapsing and remitting symptoms
- Vestibular migraine - symptoms lasting minutes/hours with trigger, manage similar to migraine
what is an acoustic neuroma
- benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear
- also called vestibular schwannomas
presentation of acoustic neuroma
- 40-60 y/o with gradual onset of:
o Unilateral sensorineural hearing loss (often the first symptom)
o Unilateral tinnitus
o Dizziness or imbalance
o A sensation of fullness in the ear
o Can be associated with facial nerve palsy (forehead not spared = LMN)
what condition is bilateral acoustic neuroma linked to
neurofibromatosis type 2
where is the most common site for epistaxis
Kiesselbach’s plexus, which is located in Little’s area- area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels
what can be prescribed after epistaxis to improve healing
- Naseptin cream (chlorhexidine and neomycin) - contraindicated in peanut and soy allergy
otitis externa
- Inflammation of the skin of external ear canal
- Acute <3w, chronic >3w
- Swimmers ear
- Can be caused by bacterial infection, fungal, eczema, dermatitis
bacterial causes of otitis externa
pseudomonas aeruginosa (gram negative aerobic rod-shaped bacteria), staph.aureus
mild/moderate/severe management of otitis externa
- mild - acetic acid 2% (can be used prophylactically)
- moderate - otomize spray (neomycin, dex, acetic acid)
- severe - oral flucloxacillin
- if fungal then clotrimazole drops
malignant otitis externa
- potentially life threatening
- spreads to bone - osteomyelitis of temporal bone
- at risk if immunocompromised
otitis media
- Infection of middle ear – between tympanic membrane and inner ear
- Bacteria enter through the eustachian tube
- A viral upper resp infection often preceded bacterial infection of the middle ear