3D ENT Flashcards

Question

Labyrinthitis - cause? Symptoms? Diagnosis? Treatment?

Answer 1

Air conduction is louder s goes through amplification process of middle ear. AC goes through outer ear & middle ear. BC goes straight to inner ear. If AC better than BC = normal (or sensorineural hearing loss) Conductive hearing loss = BC better than AC Rinne positive is normal (air conduction better) Rinne negative is abnormal (bone conduction better)

Answer 2

Will localise to diseased ear in conductive hearing loss Louder in normal ear in sensorineural hearing loss

Answer 3

1. 0 dB 2. 25-40

Answer 4

congenital hearing loss - cookie bite curve - low in middle and higher at either end.

Answer 5

Conductive: - Perforated ear drum / trauma - Foreign body - Ear infection - Ear wax (can be sudden) Sensorineural ? - Meniere's disease Labyrinthitis Acoustic neuroma Vestibular neuritis Strokes Viral - herpes zoster, varicella zoster

Answer 6

Conductive - Ear wax build up Sensorineural - Age - Presbycuisis Vestibular schwannoma Prolonged noise exposure Medication - gentamicin, loop (high frequency loss) diuretics Ménière's disease (low frequency loss) Congenital deformity Diabetes Mumps Otosclerosis (low frequency hearing loss) - can have surgery

Answer 7

Hearing loss Pain (location?) Fullness / pressure (fluid inside?) Discharge / bleeding Dizziness / vertigo (feeling of movement /room spinning). Tinnitus Swelling/ discolouration Skin changes eg. redness, eczema, crusting, vesicles.

Answer 8

Vestibulochoclear nerve Compress facial nerve

Answer 9

https://geekymedics.com/hearing-ear-examination-osce-guide/#checklist Introduction Wash your hands and don PPE if appropriate Introduce yourself to the patient including your name and role Confirm the patient's name and date of birth Briefly explain what the examination will involve using patient-friendly language Gain consent to proceed with the examination Position the patient sitting on a chair Ask if the patient has any pain before proceeding Gather appropriate equipment General inspection Perform a brief general inspection, looking for clinical signs suggestive of underlying pathology Gross hearing assessment Ask if the patient has noticed any recent changes to their hearing Whisper a number or word 60cm from the ear whilst masking the ear not being tested Ask the patient to repeat the number or word back to you Weber’s test Tap a 512Hz tuning fork and place in the midline of the forehead Ask the patient “Where do you hear the sound?” Rinne’s test Place a vibrating 512 Hz tuning fork firmly on the mastoid process Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it When the patient can no longer hear the sound, move the tuning fork in front of the external auditory meatus to test air conduction Ask the patient if they can now hear the sound again Otoscopy Ask the patient if they have any ear discomfort (if so examine the non-painful side first) Inspect the pinnae and the surrounding area (pre-auricular, post-auricular) Pull the pinna upwards and backwards with your other hand to straighten the external auditory meatus Position otoscope at the external auditory meatus Advance the otoscope under direct vision Examine the tympanic membrane Withdraw the otoscope carefully Discard the otoscope speculum into a clinical waste bin To complete the examination… Explain to the patient that the examination is now finished Thank the patient for their time Dispose of PPE appropriately and wash your hands Summarise your findings Suggest further assessments and investigations (e.g. cranial nerve examination, audiometry, tympanometry)

Answer 10

A - Normal B - Bulging C - Eustacian tube blockage eg. Glue ear

Answer 11

Low tone sensorineural hearing loss Fluctuating Usually conservative. Betahistine.

Answer 12

1. Conductive, sensorineural, mixed 2. Ear wax, ageing (presbycusis), trauma 3. Pain, discharge, vertigo, hearing loss, tinnitus. 4. MRI of internal auditory meatuses NOT brain, NOT CT. 5. Vestibular schwannoma / acoustic neuroma 6. Infected Ruptured TM, supperiative chronic otitis media. 8. Conductive loss R? 9. Age-related - presbyacusis 10. Try conservative tx first. Normally self resolves. Otherwise amoxicillin.

Answer 13

Thyroid goitre Thyroid cancer Lymphoma Thyroglossal cysts - painless, moves with swallowing and sticking tongue out. Central? Branchial cysts - Unilateral. Congenital abnormality.

Answer 14

~ peripheral/vestibular causes of vertigo~ *BPPV* - vertigo, tinnitus. comes on suddenly when the patient moves their head. lasts for a few seconds/minutes. (Betahistine) *Meniere's* - similar. vertigo, tinnitus, aural fullness, hearing loss. lasts for hours, not related to head position. *Viral labyrinthitis* - recent viral infection. sudden onset vertigo. hearing loss *Vestibular neuronitis* - recent viral infection. sudden onset vertigo. no hearing loss. Persistent, not positional. /n/eur/o/nitis - /no/ hearing loss (prochlorperazine) ~ central causes of vertigo~ *Multiple sclerosis* - a whole topic on its own *Stroke* - best if you go over stroke syndromes separately *Acoustic neuroma* - very important not to miss, red flag Vertigo, tinnitus, sensorineural hearing loss. This is sudden onset and doesn't go away. May also have facial nerve palsy and other systemic signs (weight loss) Urgent ENT referral to rule out Acoustic Neuroma; MRI

Answer 15

3 steps HI - Head impulse. Ask patient to fixate on your nose. Move head gently to side then briskly to centre. Look for catch ups saccade. Presence of catch up saccade = abnormal (good = vestibular neuritis). N - Nystagmus Test of vertical Skew - Cover/uncover test. NB. You never need to do HINTs and Dixhallpike on same patient as three for different symptoms. https://www.youtube.com/watch?v=1q-VTKPweuk

Answer 16

Good results - vestibular neuronitis Worrisome results - POCS. Posterior circulation stroke. https://www.youtube.com/watch?v=1q-VTKPweuk

Answer 17

1. Oral? Amoxicilin 2. Oral? Flucloxacillin 3. IV Ciprofloxacin (for pseudomonas) 4. Topical ( ciprofloxacin / gentamicin - not if perforated eardrum as ototoxic)

Answer 18

1. Little's area (kiesselbach plexus) 2. Sphenopalatine artery

Answer 19

History - before, during, after. Before - Bending, trauma, epistaxis as a child/before, pre-existing drugs (eg. warfarin), health conditions (eg. AF) During - What have they done to stop the bleeding, where are they pressing, how long has to been going on, vomitting? Dizziness? Treatment - A-E assessment careful of aspiration - Apple pressure at end of nose, tip head forward. - Check bloods: Hb & clotting - Nasal packing eg . rapid rhino (wet it first) - Cautery later in clinic - Naseptin 7-10days (Peanut pil) or mupirocin Advice : for 7 days - Don't bend forward - Don't strain - No nose picking - No hot drinks or hot showers

Answer 20

Right sided, unilateral sensorineural hearing loss Acoustic neuroma / Vestibular schwannoma MRI (Gadolinium-enhanced) , with the tumour commonly located at the cerebellopontine angle. High dose oral steroids . Urgent referral to ENT if sudden onset. (Rinne's positive means air condition > bone conduction ie. normal)