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WFH > ENT 18/5/2020 > Flashcards

ENT 18/5/2020 Flashcards

1
Q

causes of referred otalgia

A
  • dental pathology
  • TMJ dysfunction
  • infection of pharynx
  • Ramsey Hunt syndrome
  • oropharyngeal malignancy (posterior 1/3rd tongue)
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2
Q

otological causes of otalgia

A
  • acute otitis media
  • otitis externa
  • furunculosis
  • necrotising otitis externa
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3
Q

common causative organisms of otitis externa

A
  • Pseudomonas aeruginosa
  • Strep epidermidis
  • S. aureus
  • Aspergillus (fungal)
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4
Q

features of otitis externa

A
  • progressive ear pain
  • purulent discharge
  • erythematous/swollen ear canal
  • itchy EAM
  • may cause mild hearing loss
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5
Q

management of otitis externa

A
  • water precautions
  • acetic acid
  • microsuction
  • topical antibiotic (often with steroid) = gentamicin/ciprofloxacin
  • for fungal = clotrimazole 1% for 14 days+
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6
Q

features of a furuncle

A
  • staphylococcal abscess on hair follicle in ear canal
  • very tender
  • dry ear
  • sometimes visible abscess, often too tender for exam
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7
Q

treatment of furunculosis

A
  • irrigation and debridement

- oral flucloxacillin

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8
Q

what is necrotising otitis externa

A
  • osteomyelitis of the EAM and bony tympanic membrane, which can spread along skull base
  • usually caused by Pseudomonas aeruginosa
  • typically affects elderly diabetics
  • exacerbated by antibiotic resistance
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9
Q

features of necrotising OE

A
  • severe otalgia
  • purulent discharge
  • granulations visible
  • may be visible bone
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10
Q

causes of acute otitis media

A
  • viral (RSV, rhinovirus, parainfluenza)

- bacterial (S. pneumoniae, H. influenzae, Moraxella catarrhalis)

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11
Q

features of acute otitis media

A
  • middle ear inflam (bulging, red ear drum)
  • rapid onset earache (rapidly relieved pain with discharge suggests perforated eardrum)
  • preceding URTI
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12
Q

acute otitis media management

A
  • avoid antibiotics if possible - only if child very unwell/not improving after 72 hrs
  • delayed prescription role
  • 5 day course amoxicillin if prescribed
  • grommet may be used in recurrent
  • in perforation, stick to water precautions and should heal within 3 months
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13
Q

complications of otitis media

A
  • hearing loss
  • perforated tympanic membrane
  • mastoiditis (can lead to meningitis/intracranial abscess)
  • cholesteatoma (can lead to facial palsy, vertigo)
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14
Q

otitis media with effusion (glue ear)

A

chronic mucoid/serous effusion in the tympanic cavity in absence of infection lasting for > 3 months

  • conductive hearing loss (pure tone audiometry and tympanometry should be organised)
  • feeling of pressure without pain in ear
  • intact tympanic membrane (may see fluid level)
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15
Q

chronic suppurative otitis media

A

persistent drainage from the middle ear through a PERFORATED tympanic membrane lasting >6 weeks

  • bacterial infection following perforation
  • recurrent ear discharge
  • absence of fever or ear pain
  • conductive hearing loss (pure tone audiometry and tympanometry should be organised if language problems)
  • check for cholesteatoma
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16
Q

management of chronic suppurative otitis media

A

referral to ENT where they will do:

  • ear rinse
  • topical antibiotic (ciprofloxacin) and steroid drops (dexamethasone)
  • surgery may be required
17
Q

management of otitis media with effusion (glue ear)

A

watchful waiting (50% cases resolve within 3 months), ENT referral if language problems or non-resolving

  • non surgical = hearing aid, autoinflation (older children)
  • surgical = myringotomy and/or grommet
18
Q

Meniere’s disease features

A 
usually middle aged adults
- triad of
    > vertigo
    > tinnitus
    > sensorineural hearing loss
-  sensation of aural fulness common
- episodes last minutes to hours
19
Q

management of Meniere’s

A

ENT referral

acute: buccal or intramuscular prochlorperazine
prevention: betahistine and vestibular rehabilitation exercises, salt restriction

20
Q

features of vestibular schwannoma/acoustic neuroma

A 
CN8 
- vertigo
- unilateral sensorineural hearing loss
- unilateral tinnitus
CN5
- absent corneal reflex
CN7
- facial palsy

bilateral seen in NF2

21
Q

vestibular schwannoma/acoustic neuroma management

A

investigation with MRI of cerebellopontine angle

  • surgery
  • radiotherapy
  • observation
22
Q

features of benign paroxysmal positional vertigo

A

average age = 55yrs

  • vertigo triggered by change in head position (often when rolling over in bed or looking upwards)
  • episode lasts 10-20s
  • positive Dix-Hallpike manoeuvre (rotary nystagmus)
23
Q

management of benign paroxysmal positional vertigo

A

commonly self-resolving after few weeks to months

  • epley manoeuvre can relieve symptoms
  • vestibular rehabilitation lessons for patient to do at home (eg. Brandt-Daroff exercises)
24
Q

labyrinthitis vs vestibular neuritis

A

labyrinthitis

  • vestibular nerve AND labyrinth affected
  • vertigo exacerbated by movement
  • hearing loss
  • tinnitus

vestibular neuronitis

  • vestibular nerve only
  • only vertigo (no hearing loss) and lasts hours/days

BOTH

  • usually viral so may be preceded by URTI symptoms + may have N+V
  • often horizontal nystagmus towards the unaffected side
25
Q

FeverPAIN criteria

A 
Fever in last 24hrs
Purulent tonsils
ABSENCE of cough/coryza
Inflammation of tonsils = severe
oNset of symptoms ≤3 days

4+ points = consider immediate pen V/erythromycin

26
Q

infectious mononucleosis (glandular fever) symptoms

A

triad of:

  • fever
  • lymphadenopathy (ant/post triangles of neck)
  • sore throat

may have splenomegaly or lymphocytosis

27
Q

diagnostic test for glandular fever

A

Monospot test/heterophil antibody test (should be tested in 2nd week of illness)
Also check LFTs for viral hepatitis

28
Q

management of glandular fever

A
  • supportive
  • usually subsides after 2-4 wks
  • avoid contact sport for 8wks after recovery to prevent splenic rupture
  • as it is viral, treatment with amoxicillin/co-amox leads to a pruritic rash in 99%
29
Q

peritonsillar abscess (quinsy) symptoms

A
  • severe throat pain on one side (hot potato voice)
  • deviated uvula away from quinsy
  • difficulty opening mouth

needs draining

30
Q

epistaxis management

A

ABC

  • 20 mins pinching nose
  • ant/post rhinoscopy - identify bleeding point
  • nasal cautery (silver nitrate)
  • nasal packing
  • surgery could be necessary (sphenopalatine artery tie)
31
Q

RFs for epistaxis

A
  • trauma
  • dry air, rhinitis
  • warfarin, aspirin
  • hereditary haemorrhagic telangiectasia
  • coagulopathy
  • neoplastic: SCC, adenocarcinoma
    > MULTIPLE UNILATERAL BLEEDS = 2WW ENT referral
32
Q

features of nasal polyposis

A
  • nasal congestion
  • anosmia
  • snoring
  • postnasal drip
33
Q

management of nasal polyposis

A

unilateral = 2WW to ENT
bilateral = routine to ENT
- flexible endoscopic sinus surgery + polypectomy

34
Q

management of nasal trauma

A
  • septal haematomas need urgent drainage + IV abx
    > they may compress cartilage causing necrosis, they can collapse and cause saddle deformity
  • fractures need moving back within 21 days otherwise will need rhinoplasty
35
Q

indications for tonsillectomy in recurrent tonsillitis

A
  • 7 episodes of bacterial tonsillitis in the last year
  • 5 episodes per year in last 2 years (5 and 5)
  • 3 episodes in the last 3 years (3 and 3 and 3)
  • 2 peritonsillar abscesses (quinsy)
  • Suspected malignancy (asymmetrical tonsils)
  • Sleep disordered breathing (snoring)
36
Q

features of cholesteatoma

A
  • hearing loss
  • chronic foul smelling ear discharge, abscess formation
  • vertigo
  • attic crust on otoscopy
37
Q

management of cholesteatoma

A
  • keep ear dry
  • ENT referral
    > tympanoplasty/tympanomastoidectomy

WFH (18 decks)

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