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ear nose throat Flashcards

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1
Q

What are common problems?

A

EAR-
Otitis externa, Ramsey hunt syndrome, glue ear, AOM, COM, cholesteatoma, mastoiditis, balance

NOSE-
Epistaxis, rhinosinusitis, nasal carcinoma, facial pain

THROAT-
Tonsillitis, quinsy, glandular fever, epiglottitis, malignancy

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2
Q

What is the basic structure of the ear?

A

Cochlea and cochlear nerve- hearing
Semicircular canals and vestibular nerve- balance
Tympanic membrane aka ear drum
Bones- ossicles, malleus, incus, stapes
External auditory canal
Pinna/auricle- outer part of ear

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3
Q

How do you take an ear history?

A

Hearing loss- onset/rate if progression
Otalgia (pain)- referred?
Otorrhoea (drainage)- mucoid
Tinnitus- pulsatile
Vertigo
Nasal
Drug hx- ototoxic drugs
Family hx- hearing loss when you do
Noise exposure

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4
Q

What is perichondritis?

A

Skin and soft tissue infection of pinna
Due to trauma (piercings, burns etc)
Pseudomonas sp.

Tx= IV antibiotics, analgesia

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5
Q

What is otitis externa?

A

Inflam and infection of external auditory canal
Pseudomonas, staph aureus
Pain, discharge, pruritis, hearing loss

Tx= aural toilet, analgesia, topical antibiotics +/- packing

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6
Q

What is Ramsey Hunt syndrome?

A

Acute LMN facial palsy + ear pain + varicella like cutaneous lesions
Anastamotic communications may affect CN V, IX, X

Tx= oral steroids/antivirals, analgesia, eye care, topical emollients

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7
Q

What is otitis media w effusion/glue ear?

A

Persistent mucoid/serous middle ear effusion
3 months+
Due to mucus overproduction/under clearance
Dull gray/yellow tympanic membrane
Reduced mobility
Occasional bubbles
Asymptomatic, hearing loss, delayed speech, recurrent infection

Tx= monitor, Gromment insertion +/- adenoidectomy, hearing aid

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8
Q

What is acute otitis media?

A

A. Non suppurative
No effusion

B. Suppurative
W pus usually following URTI
Strep. pneumoniae, Haem. influenzae, Moraxella catarrhalis

Intracranial complications
- meningitis, abscess, lateral sinus thrombosis

Extracranial complications
-mastoiditis, petrositis, palsy, labyrinthitis, hearing loss, TM perforation

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9
Q

What is chronic otitis media?

A

Persistent/intermittent discharge through non intact TM

Tx= aural toilet, topical/oral antibiotics

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10
Q

What is cholesteatoma?

A

Destructive and expanding keratinised squamous cell debris
Congenital/acquired
Slow destruction of middle ear/surrounding tissue
Hearing loss, chronic ear discharge, vertigo, abscess formation

Tx= aural toilet, mastoid surgery

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11
Q

What is acute mastoiditis?

A

Infection of mastoid air cells as a complication of AOM
Mastoid tenderness, pyrexia
Oedema and erythema of post auricular soft tissue
Thickened hyperaemic TM

Tx= broad spectrum IV antibiotic, CT +/- cortical mastoidectomy

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12
Q

What is BPPV?

A

Benign paroxysmal positional vertigo
Brief intense episodes of rotary vertigo worsened by head movements
Misplaces otoconia in middle ear
Diagnose- Dix-Hallpike maneuver

Tx= Epley manoeuvre

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13
Q

What is Menieres?

A

Vertigo lasting mins to hours due to fluid imbalance

Tx= low salt diet, meds (Furosemide, Stemetil, Betahistine), grommets, labyrinthectomy

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14
Q

What is labyrinthitis/vestibular neuronitis?

A

Acute debilitating vertigo lasting days to weeks followed by recovery

Tx=supportive care followed by vestibular rehab

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15
Q

What is deafness?

A

3 million- impaired hearing
Conductive= impediment to passage of sound waves between external ear and footplate of stapes
Sensorineural= cochlea or cochlear nerve fault

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16
Q

How do you do an ear exam?

A

Intro
Consent
Explain
Use otoscope
Inspect ear
Free field hearing tests
Tuning fork tests
Cranial nerve exam

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17
Q

What is the the basic structure of the nose?

A

Frontal sinus, sphenoid sinus
Ethmoid, palatine and nasal bone
Septal and vomeronasal cartilage
Sup, Mid, Inf turbinates
Vestibule
Choana
Sella turcica
Cribriform plate of ethmoid bone

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18
Q

How can you take a history for the nose?

A

Rhinorrhea
Nasal obstruction
Sneezing
Discharge
Olfaction
Allergies
Facial/dental pain
Post nasal drip
Congestion

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19
Q

How do you do a nasal exam?

A

Anterior rhinoscopy (inspection, palpating of facial bones, speculum and head lamp to inspect vestibule to turbinates)

Rigid rhinoscopy

Flexible nasoendoscopy

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20
Q

What is epistaxis?

A

Idiopathic 85%
Coagulopathy, rhinitis, trauma
Drugs (aspirin, warfarin)
Chronic granulomatous disease (Wegners, Sarcoid)
Neoplastic (SCC, adenocarcinoma, juvenile angiofibroma)

Tx= ABCDE, cautery (AgNO3), packing, surgery, interventional radiology

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21
Q

What is Littles area?

A

Anastomoses of 5 arteries (LEGS)

Labial artery (ant and post)
Ethmoid artery
Greater palatine artery
Sphenopalatine artery

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22
Q

What are the different types of packing?

A

Balloon tamponade
Absorbable packs
Haemostatic packs
Posterior packs (foley catheter, rapid rhino, BIPP, Vaseline)
Flow seal

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23
Q

What is rhinosinusitis and nasal polyposis?

A

Inflam of nose and para nasal sinuses w 2 symptoms

Tx= nasal douching, topical steroids, antibiotics, FESS

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24
Q

What is nasal carcinoma?

A

1. Undifferentiated non keratinising SCC
- southern China, Hong Kong, EBV virus

2. Differentiated keratinising SCC
- smoking, alcohol, HPV

Epistaxis, nasal obstruction, middle ear effusion, CN palsies

Tx= staging, chemotherapy/radiotherapy/excisional surgery +/- neck dissection

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25
How do you take a history for the throat?
Oral cavity- pain, bleeding, dysarthria, numbness, otalgia Swallowing- dysphasia, odynophagia, aspiration, reflux, regurgitation Hypopharynx and larynx- dysphonia, cough, haemoptysis, pain, dyspnoea, globus, stridor
26
What is tonsillitis?
Viral 50-80% (herpes simplex, adenovirus, rhinovirus, influenza, coronavirus, RSV, EBV) Bacterial (B haemolytic strep, pneumococcus, H. influenza) Tx= analgesia, antibiotics, fluids, antiseptic mouthwash
27
What is centor criteria?
Diagnoses presence of group A strep (is sore throat bacterial) 4 criteria Modified- adds pts age 0-1 points- no antibiotics 2-3 points- throat culture, if +ve antibiotic 4-5 points- empirically w antibiotic Most likely 5-15 yrs
28
What is quinsy?
Peritonsillar abscess in potential space between tonsilar capsule and pharyngeal muscle bed Sore throat, dysphasia, hot potato voice, trismus, uvula deviation Tx= drainage, tonsillitis tx
29
What is glandular fever?
EBV Sore throat, fever, malaise, lethargy Cervical lymphadenopathy, white film on tonsils, hepatosplenomegally Tx= analgesia, steroids, +/- antibiotics, avoid contact sports 6 weeks
30
What are indications for tonsillectomy?
Recurrent bacterial tonsillitis 2 peritonsillar abscess Suspected malignancy Sleep disordered breathing/OSA
31
What is epiglottitis?
Life threatening inflam of the epiglottis +/- supraglottic tissue Less common- Haemophilus influenza B vaccine Dysphasia, drooling, dysphonia, fever, pooling of saliva Tx= stay calm, don’t examine, adrenaline nebulisers, oxygen, steroids, antibiotics, intubation/tracheostomy
32
What is laryngeal carcinoma?
Nearly always SCC Smoking, alcohol, HPV, 4:1 male to female TNM staging Tx= surgery/laser excision +/- radiotherapy +/- chemotherapy
33
What are anatomical considerations of the neck?
Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels
34
What are the different lymphatic levels?
I- oral cavity, tongue, submandibular gland II- oral cavity, oropharynx, tonsil, parotid gland III- tonsil, larynx IV- larynx, hypopharynx, upper oesophagus V- nasopharyngeal, scalp VI- thyroid gland VII- thyroid gland, lung
35
What are general considerations?
Paeds and YA- 90% benign >40 yrs- rule of 80s
36
What is deep neck space abscess?
Neglected quinsy can lead to this Neck space- area enveloped in fascia Infection can easily spread and compromise airway
37
What are different neck spaces?
Peritonsillar area Parapharyngeal space- skull base to hyoid bone Retropharyngeal space- skull base to T1-T2 Danger space- skull base to diaphragm Prevertebral space- skull base to diaphragm
38
What is ludwigs angina?
Odontogenic infection spreads to suprahyoid spaces in FOM Strep, staph, fusebacterium, actinomyces Abscess displaces tongue- airway obstruction Pain, trismus, drooling, fever, neck swelling Blood tests, inflam markers, OPG Tx= admit, secure airway, drain, remove affected teeth, IV antibiotics/steroid, rehydrate
39
What is acute viral parotitis?
Mild pain, swelling (90% bilateral), pyrexia Due to paramyxovirus Complications- meningoencephalitis, pancreatitis, orchitis, deafness Tx= rehydrate, analgesia
40
What is acute bacterial parotitis?
Pain, swelling, pyrexia, dehydration 80% mortality if untx Due to Staph aureus, anaerobes Tx= antibiotics, rehydrate, analgesics, drain
41
What is ranula?
Painless masses Mucus filled cyst arising from sublingual salivary glands Tx= marsupialisation, gland excision, suture, sclerosis agent
42
What is lymphadenopathy?
Infective- increase in size of cervical lymph nodes in response Neoplastic- -lymphoma- haematological malignancy -metastatic disease
43
How do you diagnose head and neck swelling?
Developmental time course Associated symptoms (dysphagia, otalgia, voice) Personal habits (tobacco, alcohol) Previous irradiation, surgery Complete exam Emphasis on location, mobility and consistency
44
What are diagnostic tests?
Fine needle aspiration cytology Needle core biopsy Computed tomography- CT/PET (solid vs cyst, extent, vascularity) MRI (better for upper neck and skull base, vascular delineation w infusion) Ultrasonography (solid vs cyst, noninvasive) Radionucleotide scanning (para/thyroid masses, FNAC prefer)
45
Should FNA or core needle biopsy be used?
FNA- gold standard in thyroid Core- all other except vascular FNA- small gauge, reduces bleeding, seeding of tumour not a concern Core- bigger needle- better sample
46
What is the nodal mass work up in an adult?
12% cancer is asymptomatic cervical mass 90% of these SCC Panendoscopy Directed biopsy (mucosal lesions, areas of radiographic concern) Open exicional biopsy (frozen section results)
47
What are examples of primary tumours?
Thyroid mass Lymphoma Salivary tumours Lipoma Carotid body and glomus tumours Neurogenic tumours
48
What are thyroid masses?
Paeds- most common neoplastic, more boys, higher incidence of malignancy Adults- more women, mostly benign
49
Why is FNAB the gold standard for thyroid masses?
Decreases no of pts w surgery Increased no of malignant tumours found at surgery Doubled no of cases followed up Unsatisfactory aspirate- repeat in 1 month
50
What is lymphoma?
More common paeds- 80% of Hodgkins have neck mass Lateral neck mass only, fever, hepatosplenomegaly, diffuse adenopathy Open biopsy Full work up- CT, bone marrow biopsy
51
What are salivary gland tumours?
Parotid 80% (80% benign), submandibular 15% (50%), sublingual 5% (20%) Malignancy- rapid growth, skin fixation, cranial nerve palsy FNAC- >90% accuracy CT/MRI- deep lobe tumours, intra vs extra parotid
52
What is a carotid body tumour?
Rare in paeds Pulsatile, compressible Mobile medial/lateral Clinical diagnose, CT/angiogram to confirm Tx=irradiation, monitor, surgical resection
53
What is lipoma?
Soft ill defined mass >35 yrs Asymptomatic Clinical diagnose/excise to confirm
54
What is a neurogenic tumour?
From neural crest More in neurofibromatosis syndromes Schwannoma most common in head and neck (sporadic, 20-50yrs, usually mid neck, medial tonsillar displacement, hoarseness, horners syndrome)
55
What are congenital and developmental masses?
Epidermal and sebaceous cysts (most common, older, clinical- elevation and movement of overlying skin, skin dimple/pore, confirmed by excisional biopsy) Branchial cleft cysts (2nd cleft most common, older paeds/YAs often following URI, smooth fluctuant mass under SCM, control infection and excise, maybe parotidectomy if 1st cleft) Thyroglossal duct cysts (most common congenital, usually midline inferior to hyoid, elevates on swallowing, surgical removal) Vascular tumours (in 1st yr of life, CT/MRI, lymphangiomas unchange- excise, hemangiomas resolve- excise if rapid growth/thrombocytopenia w/o med therapy)
56
What is granulomatous lymphadenitis?
Weeks to months Minimal systemic TB, atypical TB, cat scratch fever, actinomycosis, sarcoidosis Firm, fixed nose w injection of skin TB- more common adults, posterior triangle nodes, rare, responds to anti TB, may excisional biopsy Atypical TB- paeds, anterior triangle nodes, brawny skin, induration, pain, responds to complete excision/curettage Cat scratch fever (Bartonella)- paeds, preauricular and submandibular nodes, spontaneous resolution +/- antibiotics
57
How do you do a neck exam?
Wash hands Introduce Consent Adequate exposure Look, feel, move Look- scars, mass, voice, systemic, swallow water, protude tongue Feel- lymph nodes, pre/post auricular, occipital, thyroid gland (swallow, protrude tongue) Thank Wash hands Summarise findings
58
How should you assess a neck lump?
Size Location Consistency Fluctuance Pulsatility Temp Skin change Relation to structures Auscultation
59
What are red flags from lumps?
Raise suspicion of malignancy- -hard fixed mass ->35 yrs -hx of persistent hoarse voice/dysphagia -trismus -otalgia
60
How would you further assess for a neck mass?
Examine oral cavity, oropharynx, nasal cavity USS lesion, MRI neck FNAB Thyroid status
61
How would you assess the thyroid status?
Observe pt Inspect hands for clammy cold/irregular pulse Inspect face for lid lag, exophthalmos Assess lump Feel for tracheal deviation Percuss for retrosternal goitre Auscultate for thyroid bruits Assess reflexes Inspect for pretibial myoxoedema Assess for proximal muscle wasting

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