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ENT lesions Flashcards

1
Q

Anterior triangle

A
  • Superiorly – inferior border of the mandible (jawbone).
  • Laterally – anterior border of the sternocleidomastoid.
  • Medially – sagittal line down the midline of the neck
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2
Q
A

Posterior border of the sternocleidomastoid
* The anterior border of the trapezius
* Middle third of the clavicle

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3
Q

Salivary glands : Types

A

3 pairs
* parotid (serous) - most tumours, large serous salivary gland anterior and inferior to the ear
* submandibular (mixed) - most stones, mixed serous and mucous salivary gland
Forms majority of saliva when not eating

  • sublingual (mucous)
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4
Q

Benign Salivary adenomas : Clinical features

A

Slowly growing painless mass
Facial palsies suggest malignancy.
1. Pleomorphic - most common
2. Adenolymphoma - second most common

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5
Q

Pleomorphic adenomas

A

(benign, ‘mixed parotid tumour’, 80%)
Most common being parotid tumor
* tumours: ‘80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe
* middle age
* slow growing, painless lump
* superficial parotidectomy; risk = CN VII damage

Mx : Has potential for malignant transformation thus requires Surgical excision

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6
Q

adenolymphomas

A

Warthin’s tumour (benign, ‘adenolymphomas’, 10%)
is a type of benign salivary gland tumor. It most commonly occurs in the parotid gland,
which is the largest of the salivary glands located near the ear.
* males, middle age
* softer, more mobile and fluctuant (although difficult to differentiate)

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7
Q

Salivary stones

A
  • recurrent unilateral pain & swelling on eating
  • may become infected → Ludwig’s angina
  • 80% are submandibular
  • plain x-rays; sialography
  • surgical removal
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8
Q

Sialilithiasis

A

Submandibular stone - presents with infection, shooting pain and swelling
Ix - A-ray
Mx - salivary dilatation and massage

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9
Q

Salivary stone infection

A

Acute vital sialdenitis
Mumps - viral cause of bilateral parotid gland enlargements

Enlarged purulent parotid glands - Sarcoidosis

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10
Q

Other causes of Salivary gland swelling

A

Other causes of enlargement
* acute viral infection e.g. mumps
* acute bacterial infection e.g. 2nd to dehydration diabetes
* sicca syndrome and Sjogren’s (e.g. RA)

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11
Q

Salivary gland tumores - Red flags

A
  • Hardness
  • Rapid growth
  • Tenderness
  • Infiltration of surrounding structures
  • Overlying skin ulceration
  • Facial weakness
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12
Q

Salivary gland malignancues

A
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13
Q

Paratidectomy

A

Indic : Neoplasms (benign & malignant)
1. Superficial/Total conservative : excision of lesion with preservation of facial nerve
2. Total radical parotidectomy (involves sacrifice of the facial nerve and may be combined with a nerve graft)

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14
Q

Branchial cyst

A

Upper neck masses in adults - often around 20-30 years
Soft cystic
Lateral border of neck, anterior/medial border of sternocleidomastoid

Ix - Neck US and FNAC
Mx - Surgical excision

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15
Q

Dysphonia : Causes

A

Dysphonia : horseless, altered vocal quality, pitch and loudness

Causes
1. Malignant e.g. squamous cell carcinoma
1. Benign e.g. vocal cord nodules, papillomas, or cysts
1. Neuromuscular e.g. Vocal cord palsy
1. Trauma e.g. surgery, intubation, excess use
1. Endocrine e.g hypothyroidism
1. Infective e.g. laryngitis, candida (inhaled corticosteroids may predispose to this)
1. Iatrogenic e.g. recurrent laryngeal nerve palsy secondary to thyroid surgery Functional e.g. muscle tension dysphonia

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16
Q

Dysphonia Ix :

A
  • Flexible nasendoscopic examination of larynx
  • TFTs
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17
Q

Red flags with dysphonia

A
  1. History of smoking and alcohol use
  2. Concomitant neck mass
  3. Unexplained weight loss
  4. Accompanying neurological symptoms **Accompanying haemoptysis,
  5. dysphagia, odynophagia, otalgia**.
  6. Hoarseness that is persistent and worsening (rather than intermittent)
  7. Hoarseness in an immunocompromised patient
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18
Q

Pharyngeal pouch : Definition

A

Zenker’s diverticulum, this is an out-pouching of the mucosa and submucosa in the pharynx. It occurs between 2 muscles (cricopharyngeus and thyropharyngeus) of the upper oesophageal sphincter

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19
Q

Pharyngeal pouch :Epidemiology

A

More common in elderly men

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20
Q

Pharyngeal pouch : Clinical features

A
  1. May be asymptomatic if small
  2. **Progressive dysphagia **
  3. Sensation of lump in throat
    1.** Regurgitation of undigested food Halitosis** (bad breath due to stasis of undigested food in pouch) Recurrent chest infections
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21
Q

Pharyngeal pouch : Ix and Mx

A

Barium swallow is the definitive investigation.

Rigid oesophagoscopy may be useful to exclude carcinoma of the pouch wall.

If asymptomatic- conservative management.

If symptomatic, particularly if risk of aspiration and recurrent pneumonia- endoscopic stapling is the first line.

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22
Q

Globus Pharyngeus

A

This is the sensation of a lump, discomfort or foreign body in the throat without an obvious cause.
It is a diagnosis of exclusion, linked to stress or anxiety and a form of somatization.
t is associated with laryngopharyngeal reflux (30%)

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23
Q

Globus Pharyngeus : Investigations

A

Flexible nasopharyngolaryngoscopy to rule out other causes. If there is a history of smoking or excess alcohol consumption, consider a barium swallow, CT scan or upper GI endoscopy to exclude oesophageal patholog

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24
Q

Thyroid masses Investigations

A
  1. US of neck to stratify lesions
    Red flags on US
  2. Solid hypoechogenic nodule with micro calcifications, irregular margins
  3. Lymphadenopathy

If red flags
1. US guided fine needle aspiration cytology

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25
Q

Thyroglossal cyst or sinus

A

Cyst of epithelial remnants of the thyroglossal tract

Most commonly in children. But 1/3 present in over-20s. Most common congenital cyst in neck.

Embryological remnant of thyroglossal tract during descent of the thyroid from the foramen caecum at the tongue base

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26
Q

Thyroglossal cyst or sinus : Symptoms

A

Often asymptomatic
. May enlarge/become tender in upper respiratory tract infections May become infected, form an abscess or discharging sinus

Palpable neck lump, small, midline
. Can occur anywhere between base of tongue and trachea Usually in proximity to the hyoid bone Moves up on tongue protrusion and swallowing

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27
Q

Thyroglossal cyst or sinus : Mx

A

USS +/- Fine needle aspiration cytology. Delineates anatomy and demonstrates normal thyroid gland. Must ensure that thyroid gland is present. Removal of the only thyroid tissue in thyroglossal cysts renders patient hypothyroid

** Treatment** Most require no treatment unless there are complications e.g recurrent infections.

Surgical treatment (Sistrunk’s procedure) entails excision of cyst, thyroglossal tract and central portion of hyoid bone

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28
Q

Thyroid cancer
Risk factors

A

Exposure radiation
Women
Family history

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29
Q

Thyroid nodule : US staging

A

Thyroid nodules undergo further cytological classification, which is called THY,
* * THY1: non diagnostic due to lack of cellularity. THY2: non-neoplastic.
* THY3: follicular lesion. surgical resection of the nodule (lobectomy) to distinguish between a follicular adenoma and carcinoma (as cytology insufficient to assess perivascular or pericapsular invasion).
* . THY4: Suspicious but non-diagnostic of malignancy. Surgery is indicated as there is a 60-75% risk of malignancy. If the results are non-diagnostic and medullary carcinoma or lymphoma are suspected, then the FNAC should be repeated.
* THY5: Diagnostic of malignancy MDT will recommend appropriate combination of surgery +/- radiotherapy +/- chemotherapy if indicated

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30
Q

Papillary thyroid cancer : Epidemiology

A
  1. Most common 85%
  2. Adolescents, young adults 34-40 years
  3. RF : Radiation
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31
Q

Papillary thyroid cancer : Pathology and spread

A

Multifocal papillary structure, Psomma bodies, Lymphatic invasion
Spread : Lymphatic, cervical lymph nodes

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32
Q

Papillary thyroid cancer : Presentation

A
  1. Solitary or multiple nodules
  2. Painless
  3. Cold - euthyroid
  4. Cervical lymphadenopathy
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33
Q

Papillary thyroid cancer : IX

A
  1. USS
  2. FNAC - This can diagnose papillary carcinoma but cannot distinguish follicular adenoma (benign) from follicular carcinoma therefore the entire nodule must be assessed (by performing a diagnostic hemithyroidectomy)
  3. SCinotography - cold nodules
  4. Non contrast CT of Neck and chest
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34
Q

Follicular thyroid cancer : Epidemiology

A

2nd most common thyroid ca - 5-15%
Middle aged and older adults
RF : Iodine deficiency

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35
Q

Follicular thyroid cancer : Genetic

A

RAS proto-oncogene mutlatiion

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36
Q

Follicular thyroid cancer : Pathology and spread

A

Unifocal, Haemorrhage
Haemategenous spread : brain, bone, lungs, liver

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37
Q

Follicular thyroid cancer : Presentation

A
  1. Slowly enlarging painless solitary nodule
  2. Euthyroid
  3. Evidence of metastases
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38
Q

Follicular thyroid cancer : Investigation

A
  1. USS
  2. FNAC
  3. SCinotography - cold nodules
  4. Non contrast CT of Neck and chest
39
Q

Papillary and follicular ca : Mx

A
  1. Thyroid lobectobectomy <1 cm or > 1 cm Thyridectomy
  2. Neck dissection : established metastasic cervical lymphadenopathy
  3. Post operative radio-iodine ablation - if well differentiated to remove residual microscoptc disease
40
Q

Medullar thyroid ca : Epidemiology

A

Medullary thyroid cancers originate from the parafollicular cells (C cells) of the thyroid. Middle-aged patients are most commonly affected. It is the 3rd most common thyroid cancer and it represents 5% of all thyroid cancers. 80% are sporadic. Hence, 20% are inherited-

41
Q

Medullar thyroid ca :Genetic cause

A

80% are sporadic, 20% inherited
FMTC: familial medullary thyroid cancer
MEN 2A: MTC, phaechromocytoma, hyperparathyroidism
MEN 2B: MTC, phaechromocytoma, Marfanoid habitus, mucosal neuromas

42
Q

Medullar thyroid ca : Investigation

A

USS neck

FNA Tumour markers (calcitonin and carcinoembyronic antigen) as well as genetic screening (RET proto-oncogene in both MEN 2A and 2B).

A urine sample (24 hours urine metanephrine) study can be used to assess for phaeochromocytoma (which is important to assess prior to potential surgical intervention)

43
Q

Medullar thyroid ca : IMx

A

total thyroidectomy and neck dissection
Radioiodine cannot be used as there is no iodine uptake (since the cancer is of neuroendocrine cells and not follicular cells).

44
Q

Anaplastic thyroid carcinoma

A

rare and aggressive undifferentiated thyroid cancer.

It represents 1% thyroid cancer and has a tendency to affect the elderly.

It presents as a rapidly enlarging bulky, hard, neck mass.

Appears over 2-3 months. Diagnosis often requires an ultrasound guided core biopsy or open biopsy rather than FNA. Prognosis is extremely poor and treatment is mostly palliative.

45
Q

Carcinoma of the pharynx

A

subdivided into the following regions: Nasopharynx
Oropharynx
Hypopharynx

46
Q

Carcinoma of the Nasopharynx

A

Highest incidence in the South Asian and North Asian population.
EBV is believed to have a major causative role in this carcinoma.

47
Q

Nasopharynx ca : Ix

A

lymphadenopathy.
Ear pain, secretory otitis media, hearing loss and cranial nerve palsies.
The nasal involvement can present with epistaxis*, discharge, changes in smell and nasal obstruction Persistent unilateral otitis media with effusion and no preceding URTI

48
Q

Nasopharynx ca : Ix

A

Nasendoscopy Formal biopsy FNA of any neck nodes
MRI (better to assess soft tissue involvement)

49
Q

Nasopharynx ca : Mx

A

Combined chemotherapy and radiotherapy.

50
Q

Carcinoma of the Oropharynx

A

Tumours of the tongue base (posterior third of the tongue) and the tonsils (or tonsillar fossae if

51
Q

Carcinoma of the Oropharynx : RF

A

moking Alcohol Strong association with HPV 16 and HPV 18

52
Q

Carcinoma of the Oropharynx : Clinical features

A
  1. Painless tonsillar swelling (unilateral)
  2. History of throat discomfort with worsening dysphagia
  3. Referred otalgia (involvement of Arnold’s nerve- branch of vagus) A ‘lump in the throat sensation’ or evidence of metastatic cervica

Trismus is a red flag for surrounding structure infiltration
condition characterized by difficulty in opening the mouth due to muscle spasms. The muscles involved in jaw movement are affected, leading to limited jaw mobility. This restriction can make it challenging for an individual to fully open their mouth, and it may be accompanied by pain or discomfort.

53
Q

Carcinoma of the Oropharynx : Ix

A

Panendoscopy + Biopsy FNA of any neck nodes

Treatment Surgery +/- radiotherapy or chemotherapy Chemoradiotherapy

54
Q

Carcinoma of the Hypopharynx

A

Hypopharyngeal cancers are named for their location. Most cancers arise in the pyriform sinus

atients are typically men aged 55-70 years old with a history of tobacco use and/or alcohol use

55
Q

Carcinoma of the Hypopharynx - Clinical features

A

Cervical lymphadenopathy,
pain that radiates from the throat to ear, sore throat,
progressive difficulty with or painful swallowing, voice changes
Progressive dysphagia from solids to liquid

Paterson- Brown- Kelly syndrome: dysphagia , hypochromic microcytic anaemia, oesophageal webs and potential development of postcricoid carcinoma

Endoscopy
Biopsy
Pharyngo- oesophagoscopy

56
Q

Recurrent nerve palsy

A

Commonly affect left laryngeal nerve caused by
- Lung cancer tumor compression
- Thyroid surgery
Bilateral vocal chord paralysis : stridor and osbstruction of airway
Mx - Immediate tracheostomy

57
Q

Vocal chord nodule

A

Hoarse voice without pain in singers

58
Q

Carcinoma of the Hypopharynx - Ix and max

A

Endoscopy Biopsy
Pharyngo- oesophagoscopyy

Management Early cancers (rare)- surgery + radiotherapy. Advanced cancers- surgery + radiotherapy +/- neoadjuvant chemotherapy

59
Q

Carcinoma of the Larynx

A

he larynx is subdivided into 3 components. Supraglottis: from tip of epiglottis to laryngeal ventricle
Glottis: true vocal folds and 1cm inferiorly Subglottis: down to lower border of cricoid cartilage

Glottic cancer is the most common. Histology is squamous cell origin in 90% .

60
Q
A

Risk factors Smoking (most important) Alcohol consumption (cumulative risk increases with smoking)

Hoarseness is the most common presentation
Progressively worsening over 6- 12 weeks Noisy breathing/stridor
Noisy breathing/stridor.

Supraglottic cancer ;
Odynophagia Dysphagia (commonest in supraglottic carcinoma)
Neck lymphadenopathy (commonest in supraglottic carcinoma)

61
Q

Investigations

A

Flexible nasoendoscopy
Microlaryngoscopy for biopsy CT neck and chest for staging
Second line : Laryngoscopy

Mx
smaller tumours : radiotherapy or endoscopic laser excision
Larger tumours : (Chemoradiotherapy) or larynegectomy with postoperative radiotherapy
Most - squamous cell carcinoma
Mx : partial or total laryngectomy

62
Q

Laryngopharygeal reflux (LPR)

A

describes a group of upper respiratory tract symptoms secondary to irritation from gastric contents.

63
Q
A

upper respiratory tract symptoms secondary to irritation from gastric contents.
Symptoms The commonest symptoms are hoarseness, throat clearing, chronic cough,
globus pharygeus and dysphagia.

Symptoms of indigestion and heartburn are poorly correlated with LPR.

Diagnosis The Reflux Symptom Index (RSI) is a commonly used self-report patient questionnaire. A score of >13 signifies LPR

64
Q
A

Visualisation of the larynx using a fibreoptic laryngoscopy or video laryngostroboscopy may demonstrate laryngeal (or specifically vocal cord) oedema or erythema,

The gold standard for diagnosing LPR is 24 hour dual probe pH manometry combined with intraluminal impedance studies.

65
Q
A

Treatment Conservative measures include lifestyle modification. This includes
Speech therapy can help as well as acid suppression using alginates or proton pump inhibitors. Alginates are seaweed compounds that has been proven to reduce reflux

66
Q
A

Snoring and Obstructive Sleep Apnoea (OSA) Snoring implies upper airway resistance that causes an undesirable sound during sleep that affects up to 50% of the population. However, OSA is associated with apnoea (breath-holding for >10 sec leading to arousal from sleep) or hypopnea (reduced airflow with oxygen desaturation).

is classified using the apnoea-hypopnea index (AHI

67
Q
A

Cause In children, the most common cause are large tonsils and adenoids.

n adults it is predominately multifactorial. A raised body mass index is not uncommon but consider each potential anatomical level that may obstruct airflow Nasal obstruction – e.g. obstructive nasal polyps Oropharynx – large tonsils Pharyngeal airway collapse: obesity

68
Q
A

witnessed breath-holding / gasping / choking, restlessness, daytime sleepiness and irritabilit

69
Q
A

Flexible nasopharyngolaryngoscopy to assess anything that may obstruct the passage of airflow from the nasal cavity to the level of the vocal cords.

The Epworth Sleepiness Score (a self-reported patient questionnaire) is often used to screen for excessive daytime sleepiness (abnormal score is >10)

The gold standard for diagnosis of OSA is nocturnal polysomnography which can record upper airway airflow oxygen saturation monitoring, ECG, EMG, EEG, and body position.

70
Q
A

Treatment Conservative measures include lifestyle modification.
In children this commonly includes adenotonsillectomy, which is highly effective. In adults,

surgery may be considered if the patient fails conservative measures or as an adjunct to conservative measures in the setting of moderate to severe OSA.
Operations for adult OSA include palatal surgery, tonsillectomy, septoplasty or endoscopic sinus surgery.

71
Q
A

Nasendoscopy, if safe to perform, can help identify the cause Investigations which agitate patients
Oxygen,
Nebulised adrenaline. 1mL of 1:1000 adrenaline in 4 mL saline.
Steroids. Nebulised and IV. 0.1mg-0.2mg/kg dexamethasone.
If condition fails to improve/worsens-

Intubation. Secures airway. Awake fibreoptic intubation can be useful.

Nasopharyngeal airway may bypass obstruction if obstruction is high (e.g. swollen tongue secondary to angio-oedema)

Tracheostomy. Front of Neck Access to the airway to bypass the obstruction may be necessary either by cricothyroidotomy or tracheostomy

72
Q

Nasal septum haematoma

A

A septal haematoma is blood which collects between the perichondrium and septal cartilage. There is an increased risk of devascularisation of the septal cartilage and this can lead to necrosis, perforation and deformit

The patient needs an urgent incision and drainage under general anaesthetic

73
Q

FB in the pharynx or oesophagus

A

In children, this tends to be an inanimate object such as a coin

In adults, it tends to be a food bolus. The most important question is whether there is any bone as this requires immediate removal because the oesophagus is at a higher risk of perforation.

74
Q

Foreign body in pharynx

A

Presentation Dysphagia, odynophagia, drooling In children, the presentation can be very non-specific. e.g. off their food, lethargic

Batteries – removal as soon as possible. This is a surgical emergency

Food bolus with bone – needs to be removed as soon as possible to minimize the possibility of perforation

Food bolus without bone – this may spontaneously pass overnight (the oesophageal muscles & sphincters relax when a patient sleeps) or muscle relaxants such as hyoscine butylbromide (Buscopan) can be given

f it does not pass, patient may need an upper rigid oesphagoscopy or an OGD (for a lower food bolus). Asking the patient to swallow a sip of water can be useful (immediate regurgitation implies a high obstruction whereas delayed regurgitation implies a low obstruction).

75
Q

Deep neck space infections

A

auses The causative agent is normally bacterial & it often originates from poor dental hygiene particularly in the case of Ludwig’s angina

. In children, retropharyngeal infections tend to be more common than in adults. They present with difficulty swallowing and trismus and when examined have limited neck movement or torticollis (hold their neck in a twisted position)

In adults, parapharyngeal infections are more common. Nasendoscopy may show a parapharyngeal bulge

Symptoms to watch out for include pain, trismus (unable to open mouth fully), dysphagia, dysphonia, stridor and drooling. Patients typically look very unwell with pyrexia and malaise.

76
Q
A

Fluid administration as are very dehydratedand broad-spectrum antibiotics need to be administered (e.g. Co-amoxiclav).

Imaging (CT scan with contrast) is normally performed to confirm the diagnosis and delineate which deep neck space compartments are affected. Definite treatment involves surgical drainage of the abscess (surgery may be per-oral/external or both

77
Q

Ludwigs angina

A

this infection typically arises from poor dentition and spreads rapidly involving the floor of the mouth, submandibular space and into adjacent deep neck spaces. Treatment involves draining the collection and removing the source of infection (e.g. a rotten tooth)

78
Q

Nasendoscopy

A

This uses a flexible fibreoptic endoscope or a rigid straight or angled scope to examine the nose, postnasal space, pharynx and larynx. It can be performed in the outpatients department and is commonly done without the need of any anaesthetic spray

To examine the nose, the sinuses, pharynx and larynx for pathology To assess the voice To evaluate swallowing To evaluate the airway and assist in intubation

79
Q

Oto-Microscopy and Foreign Body Removal Description Examination

A

Indications To examine an ear Removal of impacted ear wax Treatment of ear infections Removal of a foreign body

80
Q

Pure Tone Audiometry

A

a subjective test that aims to evaluate the quietest sound that can be heard with each ear at various frequencies

a whisper from 1m has an intensity of 30dB, normal conversational voice is 60dB, shouting equates to about 90dB and discomfort can be felt at around 120dB.

Normal hearing is defined to be 20dB or better. Mild hearing loss is between 21-40dB. Moderate hearing loss is between 41-70dB. Severe hearing loss is considered to be 71-90dB. Profound hearing loss is worse than 90dB.

81
Q

Tympanometry

A

Impedance is the resistance to the passage of sound. Tympanometry indirectly measures the “compliance” or freedom of movement of the middle ear structures. Sound transmission from the outer to the middle ear is optimal when the pressure in the ear canal matches the middle ear pressure

82
Q

Hearing Tests In Children

A

Otoacoustic Emissions Outer hair cell vibrations can be detected in the external auditory meatus as otoacoustic emissions and can be used as an objective measure of cochlear function
NHS Newborn Hearing Screening Programme. This screens for congenital hearing loss

Behavioural Techniques Used in 0-6 months age Based on presenting a sound stimulus and observing the baby’s response. A significant change in activity represents a positive response.

Distraction Techniques Used in 6-18 months In this test the parents are given the instructions and advised that they must not react to the sounds. An assistant distracts the baby with a toy, which is then phased out. The tester in the mean time presents a sound from behind the baby and from the right or left side. A positive response is if the baby turns in response to the sound

Visual Reinforcement Audiometry Appropriate for 9-36 months
his test involves the child sitting and playing with toys. Sound stimuli are produced by one of two loud speakers positioned at either side of the child. On turning to the sound the child is rewarded by a visual stimulus such as a flashing light or toy bobbing

ure tone audiograms Generally used in children above the age of 5 years.

83
Q

Grommet Insertion

A

grommet is a ventilation tube which helps to ventilate the middle ear. The procedure can be performed under local or general anaesthetic.

Indications
Otitis media with effusion persisting for more than 3months Recurrent acute otitis media Tympanic membrane retraction secondary to impaired Eustachian tube function

84
Q

Myringoplasty

A

A procedure to repair a perforation of the tympanic membrane

85
Q

Ossiculoplasty

A

his involves reconstruction of the middle ear ossicles –the method used depends upon which ossicles are missing/present.

86
Q

Mastoidectomy

A

preservation/removal of the posterior external auditory canal wall respectively
e.g. cholesteatoma

A cortical mastoidectomy is a procedure to expose the mastoid air cells usually in acute mastoiditis. It is also performed as part of procedures for cochlear implantation and combined approach tympanoplasty,

87
Q

Adenoidectomy Indications

A

Nasal obstruction +/- obstructive sleep apnoea Recurrent otitis media

88
Q

unctional Endoscopic Sinus Surgery (FESS)

A

Indications Acute or Chronic Sinusitis not relived by medical management Nasal Polyposis Orbital complication of Sinusitis Drainage of mucocoele/pyocoele or pneumatocele

89
Q

Neck Dissection

A

Indications Almost always for metastatic carcinoma

90
Q

Surgical Tracheostomy

A

A tracheostomy is a surgically created opening in the front of the neck into the trachea. It can be performed electively or as an emergency depending on the indication and can be permanent or temporary. Indications Airway obstruction (See Chapter on ENT Emergencies) Weaning. Tracheostomy reduces physiological dead space therefore helps with weaning patients from mechanical ventilation and allows trachea-bronchial suctioning.

91
Q

Tonsillectomy indications

A

Tonsillectomy indications
Adenoids only removed if suffering from sx of sleep apnea
> 7 documented sore throats in past year
>5 in past 2 years>3 in past 3 years

92
Q
A
93
Q
A

Nasal fracture
R/v 7 days after fracture when swelling has subsided
< 14 days - can be manipulated under anaesthesia
> 14 days will require a rhinoplasty

94
Q
A

Glue ear - advised not to fly, change in a atmospheric pressure with glue ear and result in pain, wetigo and hearing loss. Deconngestants can be use pre flight or during

ENT (9 decks)

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