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ENT + Opthalmology > Common ENT problems > Flashcards

Common ENT problems Flashcards

1
Q

Purpose of the ear

A

Hearing and balance

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2
Q

Outer ear problems

A 
Otitis externa
Impacted wax
Foreign bodies
Trauma
Tumours
Cosmetic complaints
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3
Q

Middle ear problems

A 
Glue ear
Acute otitis media
Perforated ear drums
Retracted ear drums
Cholesteatoma
Trauma
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4
Q

Inner ear problems

A

Age related hearing loss
Noise induced hearing loss
Acoustic neuroma
Congenital hearing loss

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5
Q

Outer ear covers

A

Pinna to tympanic membrane

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6
Q

Middle ear covers

A

Tympanic membrane to oval window (where stapes goes in to inner ear)

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7
Q

Inner ear

A

Cochlea and vestibular system

Lobe, helix, tragus, antitragus, antihelix, contrabowl, ear canal

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8
Q

Pinna haematoma/ abscess

  • cause
  • symptoms
  • treatment
A

Blow to the ear, blood has collected between skin and lining of cartilage
Lifts skin and pericondrium
Can get infected, area is devascularised –> can lead to cauliflower ear
Treatment: treat as medical emergency, needs draining promptly

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9
Q

Pure tone audiogram

A

To measure hearing
Lower down hearing gets worse
Anything below 20 is considered normal hearing

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10
Q

Conductive vs sensorineural hearing loss

A

Air conduction - e.g. though headphones
Bone conduction - played through bone
-suggests that inner ear isn’t working

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11
Q

Conductive vs sensorineural hearing loss

A

Air conduction - e.g. though headphones
-outer of middle ear problem
Bone conduction - played through bone
-suggests that inner ear isn’t working

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12
Q

Foreign body

A

Children usually

Be careful taking them out because one shot before pt might get frustrated

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13
Q

Swimmer’s ear

  • cause
  • symptoms
  • treatment
A 
Otitis externa
Pseudomonas aerigonosa
Can swell shut completely
Symptoms: itchy, pus, tender
Treatment: ear drops (antibiotic drops), can suck out gunk
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14
Q

Impacted wax

  • symptoms
  • cause
  • treatment
A

Pushed up against ear drum
Causes some hearing loss
Caused by cotton buds or swimming
Suck it out by microsuction, soften it with olive oil or sodium bicarbonate drops

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15
Q

Squamous cell carcinoma

A

Wedge excision
Good aesthetic result, looks like you have a slightly smaller ear on one side
Look for knobbly bits or scabby areas, especially on helix

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16
Q

Correction of protruding ears

A

Pinnaplasty

Score or suture cartilage back

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17
Q

Glue ear

A

Otitis media with effusion
Middle ear fluid (behind eardrum)
Common in children
Hearing loss
Treatment: conservative, grommets, hearing aids
Left untreated, may interfere with speech development

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18
Q

Grommets

A

Tiny plastic tube sitting in air drum, stops hole closing up
Glue doesn’t come out
Infection can lead to pus coming out

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19
Q

Acute otitis media

A

Infection of middle ear
Build up of pus and fluid, pressure builds up and after 48/72hrs eardrum perforates, blood and pus come out
Gets better quite quickly afterward

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20
Q

Acute otitis media bacteriology

A 
Strep. Pneumoniae (40%)
Haemophilus influenzae (30%)
Moraxella Catarrhalis (20%)
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21
Q

Chronic otitis media bacteriology

A

Gram –ve organisms
Staphylococci
Anaerobes eg. bacteroides fragilis

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22
Q

Mastoiditis

A

Urgent admission to hospital, will drain and give Abx

Abnormal acute otitis media eardrum and red inflamed mastoid bone

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23
Q

Complications of acute/ chronic ear infections: extracranial/ intratemporal

A 
Mastoiditis
Petrositis
Labyrinthitis/Fistula
Facial nerve paralysis
Hearing loss
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24
Q

Complications of acute/ chronic ear infections: intracranial

A 
*all very serious and require admission to hospital*
Extradural/subdural/brain abscess
Meningitis
Sigmoid sinus thrombophlebitis
Otic hydrocephalus
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25
Complications of acute/ chronic ear infections: other
Otitis externa, pinna cellulitis and perchondritis
26
Traumatic perforation
Due to infections (usually heals quite quickly), overenthusiastic cotton blood cleaning, trauma, post surgery Normally don't have to treat them Can cause recurrent infections (don't let any water near their ear)
27
Cholesteatoma
Ball of skin invades ear drum, goes through middle ear, destroys balance systems, can destroy facial nerve and cause brain abscess and meningitis History: persistent discharging ear (months or years) Refer to ENT
28
Facial nerve palsy
Unable to close eye on that side Bell's palsy (idiopathic, cause may be viral infection) Cholesteoma, parotid gland tumour (check tonsil and parotid gland), other causes
29
Facial nerve palsy
Unable to close eye on that side Bell's palsy (idiopathic, cause may be viral infection) Cholesteoma, parotid gland tumour (check tonsil and parotid gland), other causes
30
Causes of vertigo
Benign paroxysmal positional vertigo Labyrinthitis Meniere's syndrome/ disease Occasionally stroke
31
Vertigo definition
Illusion of movement | -usually rotatory movement (room spinning)
32
Sudden sensorineural hearing loss
Suddenly gone deaf, can only hear ringing | Need urgent systemic dose of steroids (prednisolone)
33
Vestibular Schwannoma - cause - symptoms
Also called acoustic neuroma Benign tumours that mainly happen on vestibular part of 8th cranial nerve which slowly expands Ringing in that ear (unilateral tinnitus)
34
If inner ear stops working
Don't have way of repairing balance | Inner ear regenerative medicine
35
The nose and sinuses - common problems
``` Epistaxis Foreign body Nasal fractures Septal haematoma Septal deviation Acute sinusitis Rhinitis -Acute/Chronic Chronic Rhinosinusitis Nasal polyps Cosmetic and functional nasal surgery Sinonasal tumours CSF leak ```
36
Function of the nose
``` Temperature regulator of air Moisture regulation Air filter Smell Immune defence Resonance ```
37
History: sinonasal symptoms
``` Blockage/congestion Sense of smell/taste Sneezing Rhinorrhoea/post nasal drip Nasal/ocular/palatal pruritis Facial/sinus pain(infection) acute/recurrent/chronic Snoring ?Bleeding – less common and maybe due to tumour ```
38
Nasal cavity anatomy
Septum, 3 sets of turbinates (see inferior turbinates if you looks up nose), adenoids
39
Sinuses anatomy
Ethmoid sinuses Maxillary sinuses Frontal sinuses Sphenoid sinuses
40
Epistaxis
Little's area most common | Pinching (pressure on little's area) and tilt head forwards and sit quietly for 20 minutes with a tissue
41
Fractured nose
Standard practice: see them 7 days after when swelling has gone down If significantly deviated, use LA or ?GA? and straigten Can cause septal heamatoma -blood collected between skin and cartilage -devascularise the cartilage -can cause septal perforation because it is devascularised Can cause infection Check for orbital/ maxillary/ skull fractures
42
Saddle nose
Nose no longer supported | - characterized by a loss of height of the nose, because of the collapse of the bridge
43
Foreign body in nose
Removed by ENT specialists
44
Periorbital cellulitis
Resulting from sinus infections, especially ethmoid sinuses Pus from sinuses have gone behind the eye Refer to ENT ophthalmology
45
Nasal polyps
** Treat medically, otherwise take them out May open up the sinuses as well If only on one side be more concerned - could be malignancy
46
Sinonasal tumours
Squamous cell carcinomas Surgery to correct Fairly rare -can present as lump around nose or lump around eye
47
The pharynx: common problems
``` Tonsillitis and peritonsillar abscess Glandular fever -EBV Foreign bodies Ludwig’s angina Tumours causing upper airway obstruction ```
48
Tonsils grading
1-4
49
Tonsilitis
Exudate covering tonsils -spots: bacterial -covering: glandular fever Swollen tonsils
50
Quinsy
Peritonsillar abscess Big swollen area around tonsil Dispaced uvula Urgently send to ENT to be drained
51
Tonsil cancer
Unilateral abnormal large tonsil | Refer to ENT
52
Parapharyngeal infection
Further back than tonsil Swollen Refer urgently
53
Foreign bodies
E.g. swallowed a bone, dental bur
54
Ludwig's angina
Infection tracked down to floor of mouth, swells up a lot -careful of airway obstruction -make sure airway is secured Send to A&E
55
Tongue base cancer
Really bad pain - point exactly to it -may radiate to ear Endoscopy, look, feel Confirm with MRI
56
The larynx: common problems
Epiglottitis and supraglottitis Foreign bodies Tumours causing upper airway obstruction
57
Epiglottitis
Big red and swollen More common in children Secure their airway Expiratory stridor - A&E
58
Foreign body in trachea or bronchus
Pull it out | **
59
Presentation of laryngeal cancer
``` Hoarse voice Short of breath Stridor Pain Swallowing difficulty Neck lump Often smokers ```
60
The neck: common problems
``` Trauma Superficial infections Deep neck space infections Salivary gland swellings Thyroid swellings ```
61
The neck: superficial infections
Submandibular abscess
62
Ominous ENT symptoms
``` Ulceration Pain Swallowing difficulties Weight loss Unilateral secretion from nose Glue ear in an adult Bleeding Hoarseness more than three weeks Neurological symptoms Lump in neck ```
63
Ominous ulcerations
Non-healing ulcerations Wait and watch for 2-3 weeks Same physician Proper biopsy

ENT + Opthalmology (4 decks)

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