content Flashcards
(118 cards)
1
Q
3 pathologies of outer ear
A
otitis externa
pinna haematoma
perichondritis
2
Q
definition of otitis externa
A
inflammation of outer ear
3
Q
history of otitis externa
A
- itchy, painful ear canal
- foul smelling discharge
4
Q
tx for otitis externa
A
- microsuction
- steroid/abx drops (gentamicin + hydrocortisone)
- pope wicks
5
Q
complications of otitis externa
A
necrotising/malignant otitis externa
perichondritis
6
Q
epidemiology of necrotising otitis externa
A
older, male, diabetic
chronic otitis externa
7
Q
tx of necrotising otitis externa
A
admit with IV long course (ceftriaxone)
8
Q
common causative organism in necrotising otitis externa
A
pseudomonas
9
Q
aetiology of pinna haematoma
A
shear force trauma
10
Q
management of pinna haematoma
A
must be drained before it solidifies - haematoma separates the perichondrium from the underlying cartilage therefore can destroy cartilage
11
Q
features of perichondritis vs pinna cellulitis
A
perichondritis = inflammation of cartilage in ear therefore lobe sparing
pinna cellulitis does not have lobe sparing and may have inflammation in pre-auricular area
12
Q
complications of otitis media
A
mastoiditis
13
Q
complication of mastoiditis
A
sigmoid sinus thrombosis
14
Q
definition of cholesteatoma
A
build up of dead skin cells behind the tympanic membrane - trapped in that area and can affect nearby nerve
15
Q
tx of cholesteatoma
A
urgent tympanoplasty
16
Q
main cause of sudden onset sensorineural hearing loss
A
viral infection
17
Q
tx of sudden onset sensorineural hearing loss
A
steroids (60mg pred PO) + PPI
?intratympanic steroid injections
18
Q
causes of facial nerve palsy
A
Bell’s palsy (if no underlying disorder found)
parotid disease
varicella zoster
ear infection
19
Q
tx of Bell’s palsy
A
steroids and aciclovir
tape down eyelid at night if can’t close it -> can get corneal ulceration
20
Q
differentials for vertigo
A
stroke BPPV Meniere's vestibular neuritis viral labyrinthitis
21
Q
presentation of BPPV
A
feeling of ‘vertigo’ on head movements
22
Q
presentation of Meniere’s
A
‘vertigo’ and ear fullness and change in hearing
23
Q
pathophysiology of BPPV
A
crystal build up in semicircular canals
24
Q
tx of Meniere’s
A
prochlorperazine (acute)
beta-histidine (longer-term)
25
difference between vestibular neuritis and viral labyrinthitis
```
VN = inflammation of nerve, hearing not affected
VL = inflammation of labyrinth, hearing affected
```
26
questions to ask in epistaxis
```
which nostril
how long
how often
anticoagulation
how they feel
how much blood loss
```
27
management of epistaxis
- sit forward and pinch fleshy bit of nose ~20mins
- if still trickling => co-phenylcaine cotton wool +/- cautery if anterior
- if hosing or posterior, pack with rapid rhino
- then surgery
28
what to be concerned about in nasal fracture
septal haematoma
29
features of septal haematoma
blueberry/grape in nostril on septum
30
tx of septal haematoma
co-phenylcaine + drain with green needle
31
causes of peri-orbital cellulitis
```
pre-septal
- insect bites
- ENT procedures
post-septal
- sinus causes
```
32
examinations for peri-orbital cellulitis
- eye exam
- CN exam
- colour vision
- nasal exam
- flexi-nasoendoscopy
33
triangles of the neck
```
anterior:
- submandibular
- submental
- carotid
- muscular
posterior:
- supraclavicular
- occipital
```
34
questions for throat history
```
difficulty swallowing
pain on swallowing
voice changes
weight loss, night sweats
bleeding from back of throat
ear and nose symptoms
chest pain
```
35
differentials for hoarse voice
benign:
- vocal cord nodules (bilateral)
- vocal cord polyps (unilateral)
- papillomas (HPV)
- muscle tension dysphonia
- reflux
- Reinke's oedema
infectious:
- supraglottitis
- epiglottitis
neuro:
- recurrent laryngeal nerve palsy (trauma, MS, thyroid cancer, lung cancer)
malignant:
- SCC
36
benign causes of hoarse voice
- vocal cord nodules (bilateral)
- vocal cord polyps (unilateral)
- papillomas (HPV)
- muscle tension dysphonia
- reflux
- Reinke's oedema
37
infectious causes of hoarse voice
- epiglottitis
| - supraglottitis
38
neuro cause of hoarse voice
recurrent laryngeal nerve palsy
39
malignant cause of hoarse voice
squamous cell carcinoma
40
tx of tonsillitis
```
IV abx (ben pen)
IV steroid one off
```
41
investigation to do in tonsillitis and why
LFTs
| common cause is infectious mononucleosis (glandular fever)
42
what is a quinsy
peritonsillar abscess
43
tx of pinna cellulitis
flucloxacillin
44
questions for ear hx
pain (otalgia)
discharge (otorrhoea)
hearing loss
added sounds (tinnitus)
45
most common cause of bacterial tonsillitis
group a strep (strep pyogenes)
46
tx of tonsillitis from group a strep
penicillin v
47
most common cause of otitis media
strep pneumoniae
48
most common cause of rhinosinusitis
strep pneumoniae
49
causes of bacterial tonsillitis
1. strep pyogenes
2. strep pneumoniae
3. haemophilus influenzae
4. morazella catarrhalis
5. staph aureus
50
6 areas of lymphoid tissue in the pharynx
1. adenoid
2. 2x tubal tonsils
3. 2x palatine tonsils
4. lingual tonsils
51
which tonsils are infected and enlarged in tonsillitis
palatine
52
peak ages of incidence of tonsillitis
age 5-10
| age 15-20
53
examination in suspected tonsillitis
- throat exam looking for red, inflamed and enlarged tonsils +/- exudate
- otoscopy (ears) to visualise tympanic membrane
- palpate for cervical lymphadenopathy
54
what scores are used to determine the likely cause of tonsillitis
centor criteria
| feverPAIN score
55
centor criteria in tonsillitis
score of 3+ indicates likely bacterial tonsillitis (give abx)
- fever >38
- tonsillar exudates
- absence of cough
- tender anterior cervical lymphadenopathy
56
feverPAIN score in tonsillitis
- fever during previous 24hrs
- pus on tonsils
- attended within 3 days of onset of symptoms
- inflamed tonsils
- no cough or coryza
57
mx of viral tonsillitis
- reassurance
- advise simple analgesia
- safety net: return if pain not settled after 3 days or fever above 38.3
58
when to prescribe abx in tonsillitis
centor = 3+
feverPAIN = 4+
consider in young infants, immunocompromised patients, those with significant comorbidity or hx of rheumatic fever
59
abx choice in tonsillitis
penicillin v - 10 day course
| if penicillin allergic: clarithromycin
60
complications of tonsillitis
- chronic tonsillitis
- peritonsillar abscess (quinsy)
- otitis media
- scarlet fever
- rheumatic fever
- post-strep glomerulonephritis
- post-strep reactive arthritis
61
definition of a quinsy
peritonsillar abscess formed when bacterial infection traps pus and forms an abscess
usually after untreated/partially treated tonsillitis
62
presentation of quinsy
- sore throat
- painful swallowing
- fever
- neck pain
- referred ear pain
- swollen tender lymph nodes
- trismus (unable to open mouth)
- change in voice
63
common cause of quinsy
bacteria: strep pyogenes, staph aureus, haemophilus influenzae
64
mx of quinsy
refer to ENT for incision and drainage of abscess under GA
abx (co-amoxiclav)
may give dexamethasone
65
requirement for tonsillectomy
- 7+ episodes in 1 year
- 5 episodes per year for 2 years
- 3 episodes per year for 3 years
- recurrent quinsy (2x)
- enlarged tonsils causing difficulty breathing, swallowing or snoring
66
complications of tonsillectomy
- pain
- damage to teeth
- infection
- post-tonsillectomy bleeding (can be significant)
- risks of GA
67
what is found in the middle ear
bones: malleus, incus and stapes
68
what is found in the inner ear
cochlea
vestibular apparatus
nerves
69
pathophysiology of otitis media
bacterial infection of the throat/URT
| bacteria enter the middle ear from the back of the throat through the eustachian tube
70
common causes of otitis media
strep pneumoniae
| also: haemophilus influenzae, moraxella catarrhalis, staph aureus
71
presentation of otitis media
- ear pain
- reduced hearing
- symptoms of URTI: fever, cough, coryzal symptoms, sore throat, generally unwell
72
signs of otitis media on otoscopy
bulging, red, inflamed tympanic membrane
| discharge in ear canal and hole in membrane if perforated
73
mx of otitis media
most will resolve in 3 days without abx
consider abx in children under 2 with bilateral otitis media, those with otorrhoea, immunocompromised or comorbid or systemically unwell
74
abx choice in otitis media
amoxicillin for 5 days
| alternatives: erythromycin, clarithromycin
75
complications of otitis media
- otitis media with effusion
- hearing loss (temporary)
- perforation
- recurrent infection
- mastoiditis
- abscess
76
conditions associated with nasal polyps
```
asthma
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener's syndrome
Churg-Strauss syndrome
```
77
presentation of nasal polyps
nasal obstruction
rhinorrhoea
sneezing
poor sense of taste or smell
78
mx of nasal polyps
referral to ENT for full examination
| topical corticosteroids e.g. drops/nasal spray
79
explanation of Weber and Rinne test
Weber = tuning fork in middle of forehead, ask if it is louder on one side
- lateralizes to one side = conductive hearing loss in ipsilateral side or sensorineural hearing loss in contralateral side
Rinne = tuning fork against mastoid then air in front of ear
- air conduction should be louder than bone -> if bone conduction louder, conductive hearing loss
80
what is the result of a Weber test lateralizing to the right and Rinne's test showing bone conduction louder on RHS
conductive hearing loss in right ear
- > lateralizing to RHS = conductive loss in RHS or sensorineural loss in LHS
- > bone conduction louder in RHS = conductive loss in RHS
81
mx of sudden onset sensorineural hearing loss
urgent referral to ENT
82
causes of sudden onset sensorineural hearing loss
idiopathic
| vestibular schwannoma
83
contraindications for cochlear implant
- lesions of CN VIII or in brainstem causing deafness
- chronic infective otitis media, mastoid cavity or tympanic membrane perforation
- cochlear aplasia
84
mx of post-tonsillectomy haemorrhage
all cases need ENT assessment
- primary/reactionary (6-8hrs post-op) = immediate return to theatre
- secondary (5-10 days post-op) associated with wound infection = admission + abx
85
causes of gingival hyperplasia
- phenytoin
- ciclosporin
- calcium channel blockers
- AML
86
definition of chronic rhinosinusitis
inflammatory disorder of the paranasal sinuses and linings of the nasal passages lasting 12 weeks or longer
87
predisposing factors for chronic rhinosinusitis
- atopy
- nasal obstruction e.g. septal deviation, nasal polyps
- recent local infection
- swimming, diving
- smoking
88
presentation of rhinosinusitis
- facial pain: frontal pressure worse on bending forwards
- nasal discharge usually clear
- nasal obstruction: mouth breathing
- post-nasal drip
89
mx of chronic sinusitis
avoid allergen trigger
intranasal corticosteroids
nasal irrigation with saline
90
red flags of chronic sinusitis
unilateral symptoms
persistent symptoms despite compliance with 3 months of tx
epistaxis
91
features of thyroglossal cyst
- more common in <20yo
- midline, between isthmus of thyroid and hyoid bone
- moves upwards with tongue protrusion
- may be painful if infected
92
features of pharyngeal pouch
- commonly older men
- posteromedial herniation between thyropharyngeus and cricopharyngeus muscles, not usually seen
- if large, midline lump which gurgles on palpation
- dysphagia, regurgitation, aspiration, chronic cough, halitosis
93
differentials for neck lumps
- reactive lymphadenopathy
- lymphoma
- thyroid swelling
- thyroglossal cyst
- pharyngeal pouch
- cystic hygroma
- branchial cyst
- cervical rib
- carotid aneurysm
94
features of vestibular neuronitis
- recurrent vertigo attacks lasting hours or days
- nausea and vomiting
- horizontal nystagmus
- no hearing loss or tinnitus
- develops after viral infection
95
mx of vestibular neuronitis
- vestibular rehabilitation exercises for chronic symptoms
- buccal/IM prochlorperazine for rapid relief of severe symptoms
- short course oral prochlorperazine or antihistamine for milder
96
definition of sialadenitis
inflammation of the salivary gland likely secondary to obstruction by stone impacted in the duct
97
most common cause of malignant otitis externa
pseudomonas aeruginosa
98
risk factors for malignant otitis externa
- diabetes (90% of cases)
| - immunosuppression
99
presentation of malignant otitis externa
- diabetic or immunocompromised
- severe, unrelenting, deep-seated otalgia
- temporal headaches
- purulent otorrhoea
- dysphagia, hoarseness +/- CN VII dysfunction
100
mx of malignant otitis externa
urgent referral to ENT
| IV abx which cover pseudomonas
101
mx of tympanic membrane perforation
- should usually heal spontaneously in 6-8 weeks (avoid getting ear wet)
- common to prescribe abx if perforation follows acute otitis media
- myringoplasty if doesn't spontaneously heal
102
definition of meniere's disease
excessive pressure and progressive dilation of the endolymphatic system
103
features of meniere's disease
- recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural)
- aural fullness or pressure
- nystagmus
- typically symptoms are unilateral but may become bilateral
104
prognosis of meniere's disease
symptoms resolve in majority of pt after 5-10 years
| majority are left with degree of hearing loss
105
mx of meniere's disease
- ENT assessment to confirm dx
- inform DVLA
- acute attacks: buccal/IM prochlorperazine
- prevention: betahistine and vestibular rehab
106
definition of acoustic neuroma
tumour of the vestibulocochlear nerve, arising from the Schwann cells of the nerve sheath
107
bilateral acoustic neuroma is associated with
neurofibromatosis type 2
108
symptoms of acoustic neuroma and why
compression of local structures and associated symptoms:
- vestibular nerve = hearing loss and balance disturbance
- trigeminal and facial nerve = altered facial sensation and muscle movements
- cerebellum and brainstem
109
risk factors for acoustic neuroma
- high-dose ionising radiation to head and neck
| - NF2
110
typical presentation of acoustic neuroma
- unilateral sensorineural hearing loss (normally progressive) +/- tinnitus
- dizziness and disequilibrium
- facial pain, numbness
- facial weakness
- headaches, nausea and vomiting
111
results of rinne and weber test in acoustic neuroma
- AC>BC bilaterally
| - weber lateralises to unaffected ear
112
investigations in suspected acoustic neuroma
- hearing test including weber and rinne
- cranial nerve exam
- pure-tone audiometry
- MRI brain
113
mx of acoustic neuroma
1. conservative - active observation
2. microsurgery - rectosigmoid, translabyrinthine or middle fossa approach
3. stereotactic radiosurgery
114
complications of acoustic neuroma
- hearing loss
- facial paralysis
- hydrocephalus
- compression of cerebellar peduncles, cerebellum, brainstem and CN IX-XI
115
causes of BPPV
- idiopathic
- head injury
- vestibular neuronitis
- labyrinthitis
- complications of mastoid/stapes surgery
116
risk factors for BPPV
- older age
- female
- meniere's disease
- patients with migraines or anxiety disorders
117
causes of secondary epistaxis
- trauma
- intranasal drugs (decongestants, steroids, illicit)
- weather
- anatomical variants
- systemic causes
- tumours
118
step-wise approach to mx of epistaxis
- basic first aid: pinch soft cartilaginous portion of nose for ~20 mins
- rhinoscopy/endoscopy to localise source
- silver nitrate cautery
- anterior packing
- posterior packing (1st line for posterior bleeds)
- surgery: ligation of sphenopalatine, internal maxillary or anterior ethmoid arteries
- angiographic embolisation
