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Flashcards in EENT Deck (44):
1

List the common Ear conditions?

Tinnitus
vertigo
menieres disease
otitis media
ototoxic drugs

2

List the common Nose conditions?

Allergic rhinitis
Nasal polyposis

3

List the common throat and mouth conditions?

Oral candidiasis
mouth ulcers
cold sores
Oral manifestations of drug reactions

4

Discuss Tinnitus?

-any sound perceived in the absence of external stimulus
-Not a disease, it is a symptom
-up to 10% people have mild tinnitus all the time
-can occur at any age however it is more prevalent in the elderly
-men > women
-usually bilateral presentation (sometimes unilateral= more serious)
-usually subjective (can be objective but this is more serious)
-Usually continuous (can also be pulsatile)

5

What is subjective tinnitus?

-Hearing loss
presbycusis (age related)
Noise induced

-disorder within the ear
impacted wax
otosclerosis
otitis media

-ototoxic medicines
-head or neck injury
-other conditions
metabolic disorders
neurological disorders
psychological disorders
Menieres disease

6

What is objective tinnitus?

-rare
-referal to ENT specialist
-vascular abnormalities such as turbulent blood flow
physical: arteriovenous shunts
anaemia
hypertension
atherosclerosis
-neurological disorders

7

How is tinnitus diagnosed?

-exclude other treatable causes
1)full bull count
2)thyroid function test
3)Blood glucose
4)treat otitis media with effusion (OME)
-external causes e.g. environmental noise
-Concurrent medicines
-visual examination of ear
-hearing test
-neurological assesment

8

what are the non-pharmacological treatment methods for tinnitus?

-treat/manage any underlying cause
-correct hearing loss
-sound therapy: environmental sound generators
-Counselling/ CBT
-tinnitus retraining therapy: counselling and sound therapy

9

What are the pharmacological treatment methods for tinnitus?

Tricyclic antidepressants- limited evidence, adverse effects, only use if patient also has depression.
Hypnotics- may be used short term in insomnia, caution withdrawal may aggravate tinnitus
Anticonvulsants e.g. gabapentin- no evidence of strong benefit, possible placebo effect
Gingko biloba- no reliable evidence
Lignocaine- Intratympanic injection offers relief for 2 to 3 hours

10

Define vertigo?

An abnormal sensation of rotary movement associated with difficulty in balance, gait and navigation of the environment arising from fluid abnormalities in the vestibular apparatus'
Not synonymous with dizziness or acrophobia

11

what is the prevalence of vertigo?

more common in elderly + migraine sufferers
could affect up to 25%

12

What are the associated symptoms of vertigo?

Nausea and vomiting

13

What are the classifications of vertigo?

peripheral- disorder of the inner ear or eighth cranial nerve
Central- disorder of brain-stem or cerebellum

14

what are the causes of peripheral vertigo?

benign paroxysmal positional vertigo: otoconia
-age related
-more common in females
-hallpike's manoeuvre

Menieres disease

Infection/ inflammation- nausea
-vestibular neuronitis
-labyrinthitis

Acoustic neuroma (sometimes central)

15

what are the causes of Central vertigo?

1)head injury
2)Stroke or transient ischaemic heart attack
3)MS
4)Tumour, benign or non-benign
5)anxiety
6)migraine

16

what are the non pharmacological treatment methods for vertigo?

BPPV
-epley manoeuvre
-brandt-daroff exercises

Vestibular rehabilitation exercises
-brain retraining

17

what are the symptom management methods for acute vertigo (not bppv)?

-immediate relief if vomiting: prochlorperazine 3-6mg bd buccal or 12.5mg IM

-3-7 days acute treatment then prn
*prochlorperazine 5mg tid
*severe symtpoms 10mg tid then reduce dose
*side effects: sedation, extrapyramidal effects, antimuscarinic effects

OR

1st generation antihistamines
-cinnarizine 30mg tid or cyclizine 50mg tid or promethiazine 25mg tid
*side effects are sedation and antimuscarinic effects

Advise patient to stop when attack is over

vestibular neuronitis- max 3 days treatment

18

which patients should you take care with when using pharmacological agents to treat vertigo?

-elderly
-renal impairment
-hepatic disease
-epilepsy
-Glaucoma (esp. sedating)
-Prostatic hypertrophy (esp. sedating)
-Urinary retention (esp. sedating)

19

what are some prophylactic ,measures that can be taken for people suffering from vertigo?

-restrict salt and fluid intake
-stop smoking and restrict excess coffee and alcohol

20

how long does a menieres disease acute attack last? and how often do they happen?

2-3 hours
acute episodes occur in clusters of about 6-11 per year

21

what is the prevalence of menieres disease?

13.1 per 100,000
women > men
30-60 years
genetic factors?

22

how is a diagnosis of menieres achieved?

-at least 2 episodes of vertigo lasting at least 20 minutes
-tinnitus and/or aural fullness
-hearing loss

23

what is the prognosis of menieres disease?

-episodic
-fluctuation of symptoms
-spontaneous resolution over 5-15 years

24

what is menieres disease?

backed up fluid in the endolymphatic sac resulting in distorted balance and sound information.

25

What are the potential risk factors for menieres disease?

-auto-immunity
-Genetic susceptibility
-metabolic disturbances
-vascular factors
-viral infection/otosyphilis
-head trauma

26

morbidity factors in menieres disease?

-slips and falls
-syncope
-depression
-anxiety
-progressive and potentially permanent loss of hearing

27

what are the pharmaceutical treatment methods for treating menieres disease?

-alleviate acute attacks: prochlorperazine or 1st gen antihistamines as per vertigo treatment
advise patient to stop treatment when attack is over

-prevention of recurrent attacks:
betahistine 16mg tid initially
some patients may use reduced dose subsequently: 8mg tid
6-12 months to prevent attack
then consider withdrawal
adverse effects = headache, GI distubances, rash and pruritis

-intratympanic gentamicin
ablates the vestibular end organ
1-2 injections 1 month apart
risk of hearing loss

-intratympanic dexamethasone
limited evidence- improvement in frequency and severity of vertigo after 24 months

28

What is some self care advice given to patients with menieres disease?

-sit or lie down imeediately if dizzy
-(bed) rest during attacks
-Move around after attack to compensate
-be aware of risk of falling
-consider risks associated with everyday life such as driving/ladders/machinery/sports and swimming
-low salt diet and avoid alcohol, caffeine and nicotine

29

what is ototoxicity?

damage to the hearing or balance functions of the ear by drugs or chemicals

30

is ototoxic hearing impairment reversible?

YES when medicine is stopped

31

what affects ototoxicity?

-dose/duration/co-administration
-renal disease
-genetic susceptibility

32

discuss aminoglycoside ototoxicity?

Irreversible, inc. vestibular and auditory damage, may occur at normal dose

33

discuss macrolide antibiotic ototoxicity?

reversible hearing loss with or without tinnitus after high IV dose

34

discuss loop diuretic ototoxicity?

reversible/irreversible. tinnitus and deafness may occur after RAPID HIGH DOSE IV ADMINISTRATION and in renal impairment.
Potentiate ototoxic drugs (caution with aminoglycosides)

35

Discuss NSAIDs, aspirin ototoxicity

often reversible, tinnitus, associated with toxic doses and/or long term use

36

Discuss chloroquine ototoxicity?

Reversible hearing loss, tinnitus, risk mainly with parenteral use

37

discuss chemotherapeutic agent e.g. cisplatin ototoxicity?

usually irreversible hearing loss and tinnitus due to cochlear damage

38

Discuss topical antiseptic ototoxicity?

damage can occur if ear perforated

39

What are the ototoxicity methods of prevention?

-smallest effective dose, according to patient weight, for shortest time possible
-administer IV infusions at correct rate
-measure hearing before,during and after therapy
-decrease dose in renal disease
-keep patient well hydrated
-patients with pre-existing sensorineural damage will be more vulnerable

40

What are nasal polyps?

Pale bags of benign oedematous tissue
Bilateral (unilateral more serious)
more common >40(rare <10)
Men > women (2:1), 2-4% of population
can be associated with allergy and infection
Asthma- 20-40% patients with polyps have asthma
Aspirin hypersensitivity
cystic fibrosis (1 in 2)

41

what are the symptoms of nasal polyps?

-blocked nose
-runny nose/sneezing (50%)
-poor olfactory abilities (hyposmia, anosmia)
-altered sense of taste
-catarrh/post nasal drip
-feeling of pressure in the face
-large polyps (headaches, snoring, sleep apnoea)
-Poor QOL

42

what are the pharmaceutical treatments for nasal polyps?

corticosteroids reduce the size and growth of inflammatory polyps
-topical (drops 1st then spray)
*mometasone 50mcg- 2 sprays once a day
*budesonide 64mcg- 1 spray twice a day
*delay in response
*often requires maintenance dose
-Oral
*prednisolone 5-30mg in the morning (1-2week course) followed by topical treatment
*shrinks large polyps faster

43

Discuss the use of surgery to remove nasal polyps?

-polyps return in 3 out of 4 patients
-long term use of steroid nasal spray will usually be recommended after surgery to help stop polyps returning quickly

44

What advice should be provided to a patient taking intranasal corticosteroids?

-dont use if signs of infection
-delayed response
-Common side effects include: dryness and irritation of nose + throat, sneezing, epistaxis (nosebleed), headache/sore throat, ulcers in nose
-oral: short term course, take after food, side effects