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Year 4 > ENT > Flashcards

ENT Flashcards

1
Q

CN I: Olfactory nerve

A

Nerve type: sensory

Function: smell

exits skull via cribriform plate

palsy most commonly due to trauma to lateral/occipital regions, intracranial space occupying lesions

clinical features: anosmia

testing: identifying certain smells e.g. mint

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2
Q

CN II: Optic nerve

A

Nerve type: sensory

Function:
vision & afferent leg of pupillary light reflex

exits skull via optic canal

Causes of palsy: infection, tumours, ischaemic optic neuropathy, inflammation (MS), drugs (e.g. amiodarone, ethambutol)

clinical features:
impaired vision, ipsilateral blindness & absent direct pupillary light reflex

testing: visual fields, visual acuity, fundoscopy

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3
Q

CN III: Oculomotor nerve

A

Nerve type: somatic & parasympathetic motor

Function:

  • eye movements (superior rectus (elevation/intorsion/adduction), inferior rectus (depression/extorsion),medial rectus (adduction), inferior oblique (extorsion/elevation/abduction)
  • eyelid opening, pupillary constriction (efferent limb of pupillary light reflex), accommodation

exits skull via superior orbital fissure

Causes of palsy: strokes, MS, myasthenia gravis, aneurysms

clinical features:
down & out gaze, ptosis, weak adduction, horizontal diplopia, absent pupillary light reflex (both direct & indirect)

testing: ocular/extraoccular movements, pupillary response

NB parasympathetic fibres are on the outside so compression causes pupillary dilation before motor dysfunction

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4
Q

CN IV: Abducens nerve

A

Nerve type: motor

Function: 
eye movements (superior oblique (intorsion, depression, abduction))

exits skull via SOF

Causes of palsy: cavernous sinus thrombosis, microvascular damage

clinical features:
extortion of eye (inability to depress & adduct simultaneously) & diplopia (exacerbated on downward age e.g. going down stairs, reading)

testing: eye movements

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5
Q

CN V: Trigeminal nerve

A

Nerve type: sensory (V1/V2/V3) & motor (V3)

Function: 
facial sensation (V1 = ophthalmic, V2 = maxillary, V3 = mandibular), afferent limb of corneal reflex & jaw jerk reflex, muscle of mastication (V3)

exits skull via SOF (V1), foramen rotundum (V2), foramen ovale (V3)

Causes of palsy: cavernous sinus thrombosis, vascular compression

clinical features:
V1 = absent corneal reflex, loss of sensation to ipsilateral forehead
V2 = loss of sensation to ipsilateral midface
V3 = anaesthesia of lower 1/3 of face, anterior 2/3 of tongue, paresis of ipsilateral muscles of mastication & diminished jaw jerk reflex

testing: facial sensation, corneal reflex, jaw jerk, muscle of mastication

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6
Q

CN VI: Trochlear nerve

A

Nerve type: motor

Function: 
eye movements (lateral rectus = abduction)

exits skull via SOF

Causes of palsy: cavernous sinus thrombosis, diabetic neuropathy

clinical features:
horizontal diplopia worse when looking at far objects, esotropia (medial deviation of eye on neutral gaze), inability to abduct eye

testing: eye movements

NB most common ocular nerve plays

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7
Q

CN VII: Facial nerve

A

Nerve type: sensory, somatic & parasympathetic motor

Function:
taste (anterior 2/3 of tongue), sensation to tympanic membrane
muscles of facial expression, efferent limb of corneal reflex
salivation & lacrimation (submandibular/sublingual/lacrimal glands)

exits skull via internal acoustic meatus

clinical features:
flaccid paralysis of face, loss of taste, hyperacusis, loss of corneal reflex

testing: facial expression

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8
Q

CN VIII: Vestibulocochlear nerve

A

Nerve type: sensory

Function:
balance & equilibrium (vestibular)
hearing (cochlear)

exits skull via internal acoustic meatus

Causes of palsy:bacterial meningitis, lyme disease, acoustic neuroma, neurofibromatosis 2, basilar skull fracture

clinical features:
sensorineural hearing loss, vertigo, motion sickness, horizontal nystagmus

testing: audiometry (hearing test, Weber’s & Rhinnes)

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9
Q

CN IX: Glossopharyngeal nerve

A

Nerve type: sensory & somatic/parasympathetic motor

Function:
taste (posterior 1/3 of tongue), afferent limb of gag reflex
carotid sinus/body (chemo & baroreceptors)
swallowing, innervates stylopharyngeus
salivation (parotid gland), sensation to posterior 1/3 of tongue/soft palate/upper pharynx

exits skull via jugular foramen

clinical features:
absent gag reflex, loss of carotid sinus reflex, sensory loss of back of mouth & upper throat, mild dysphagia

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10
Q

CN X: Vagus nerve

A

Nerve type: somatic/visceral sensory & somatic/parasympathetic motor

Function:
sensation (supraglottic region, larynx, trachea), couch reflex , efferent limb of gag reflex, swallowing (pharyngeal muscles) speech (laryngeal muscles via recurrent laryngeal nerve), SA & AV node innervation

exits skull via jugular foramen

Causes of palsy: trauma, diabetes inflammation

clinical features:
flaccid paralysis & ipsilateral lowing of soft palate, dysphagia, loss of gaga & cough reflex, uvuala deviation away from lesion, dysphonia (unilateral recurrent laryngeal) or aphonia (bilateral)

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11
Q

CN XI: Accessory nerve

A

Nerve type: motor

Function: head turn via sternocleidomastoid, shoulder elevation via trapezius

exits skull via jugular foramen

clinical features:
paresis, atrophy, asymmetry of sternocleidomastoid & trapezius, ipsilateral shoulder drooping & lateral winging of scapula

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12
Q

CN XII: Hypoglossal nerve

A

Nerve type: motor

Function: tongue protrusion (intrinsic & extrinsic muscled of tongue)

exits skull via hypoglossal canal

clinical features:
fasciculations & atrophy of tongue, tongue deviated towards lesion

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13
Q

Tonsillitis

A

an infection of the parenchyma of the palatine tonsils, frequently occurring i combination with inflammation of the pharynx = tonsilopharyngitis

common in children & young adults

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14
Q

Aetiology of tonsillitis

A

Viral (50-80%)
adenovirus, EBV, CMV,

Bacterial (15-30%)
strep progenes (Group A strep)

NB viral = cough, bacterial = no cough

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15
Q

Presentation of tonsillitis

A 
pain in throat/sore throat
dysphagia
fever
lymphadenopathy
headache
tonsillar exudates
tonsillar erythema
tonsillar enlargement
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16
Q

Investigations for tonsillitis

A

throat culture

rapid streptococcal antigen test

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17
Q

Management of tonsillitis

A

Viral:
self limiting, supportive (antipyretics, analgesia)

Bacterial:
if confirmed on swab/antigen test or CENTOR score >3
5-10 day course of phenoxymethylpenicillin (erythromycin/clarithromycin if penicillin allergy)

Surgical:
tonsillectomy, if recurrent (≥5x in previous year) / chronic episodes

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18
Q

CENTOR criteria

A

The Centor criteria are: score 1 point for each

  • presence of tonsillar exudate
  • tender anterior cervical lymphadenopathy/lymphadenitis
  • history of fever
  • absence of cough
  • age (<15 yrs = +1 point, >44 yrs = -1 point)

Abx indicated if CENTOR score >3

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19
Q

Peritonsillar abscess (Quinsy)

A

ENT emergency

usually in bacterial tonsillitis, seen in young adults & adolescents

presentation includes features of tonsillitis, drooling, severe throat pain, trismus, halitosis, ‘hot potato’ voice, contralateral uvula devotion, ↓ neck mobility

management:
1st line: needle aspiration or incision & drainage + Abx
2nd line: tonsillectomy, considered 6 weeks after

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20
Q

Acute otitis media (AOM)

A

a painful infection of the middle ear, generally secondary to a viral URTI as a bacterial superinfection e.g. due to strep pneumonia/H. influenzae/moraxella catarrhalis

very common in children (~80% experience AOM by age 3)

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21
Q

Presentation of Acute otitis media (AOM)

A

throbbing otalgia/earache
young children may be irritable & repeatedly touching/tugging at ear
hearing loss in affected ear
fever
otrohoea (if tympanic membrane perforated)

preceding URTI (coryza, rhinorrhoae etc)

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22
Q

Investigations of Acute otitis media (AOM)

A

Otoscopy (bulging tympanic membrane, opacification/erythema of tympanic membrane, visible perforation, purulent discharge from ear canal)

Weber’s/Rhinne’s test (conductive hearing loss)

consider culturing discharge

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23
Q

Management of Acute otitis media (AOM)

A

generally self limiting (~80%)
=pain relief & observation

Abx
1st line: amoxicillin (erythromycin if penicillin allergy)

indications for Abx
if >4 days of symptoms/no improvement, systemically unwell, bilateral AOM in <2y/o, perforation/discharge, immunocompromise

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24
Q

Indications for giving Abx in Acute otitis media (AOM)

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

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25
Q

Otitis media with effusion (OME)

or glue ear

A

chronic mucoid/serous effusion in the tympanic cavity in the absence of infection lasting >3 months, though to be due to eustachian tube dysfunction causing fluid to accumulate

most common cause of hearing impairment in childhood, where it usually follow and episode of AOM

usually seen age 1-6 yrs

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26
Q

Risk factors for Otitis media with effusion (OME)

A

craniofacial malformations e.g. cleft palate
Down’s syndrome
allergic rhinitis
impaired ciliary motility e.g. cystic fibrosis

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27
Q

Presentation of Otitis media with effusion (OME)

A

hearing loss*
presents as mishearing, difficulty communicating in a group, needing thing to be repeated, excessively high TV volume
painless sensation of pressure
school progress may be impaired

easily missed in young children

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28
Q

Otitis media with effusion (OME) in adults

A

acute unilateral presentation in adults should trigger thoughts of nasopharyngeal carcinoma

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29
Q

Investigating Otitis media with effusion (OME)

A

hearing test (mild conductive hearing loss i.e. ↓20-40 dB)

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30
Q

Otitis media with effusion (OME) management

A

generally self limiting

1st line: active observation
2nd line surgery e.g. tympanovstomy tubes (grommets)

indications for surgery:
bilateral OME ≥3 months, hearing loss >30dB, developmental/educational difficulties

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31
Q

Chronic suppurative otitis media (CSOM)

A

chronic inflammation of the middle ear & mastoid cavity with persistent drainage from the middle ear through a perforated tympanic membrane lasting >6-12 weeks

generally caused by bacterial infection following perforated tympanic membrane e.g. due to recurrent AOM, trauma, tympanostomy

most common seen in those <15 y/o

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32
Q

Presentation of Chronic suppurative otitis media (CSOM)

A 
painless recurrent otorrhoea 
conductive hearing loss
no pain
no fever
perforated tympanic membrane on otoscopy
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33
Q

Complications of Chronic suppurative otitis media (CSOM)

A

cholesteatoma (keratinising epithelium growing into middle ear)

hearing loss may improve but may not fully recover

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34
Q

Management of Chronic suppurative otitis media (CSOM)

A

specialist (ENT) referral
topical Abx
rinsing/cleaning of ear
topical steroids

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35
Q

Infective labyrinthitis

A

inflammation/infection of the inner ear
frequently secondary to AOM, where it spreads through the road window

presents with severe vertigo, nausea, sensorineural hearing loss, nystagmus towards healthy ear

management with IV Abx, tympanostomy, glucocorticoids

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36
Q

Otitis externa

A

acute otitis external (AOE) is a diffuse inflammation of the external ear canal which may involve the pinna or tympanic membrane, also known as swimmers ear

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37
Q

Aetiology of otitis externa

A

most common bacterial infection e.g staph aureus, pseudomonas aeruginosa

fungal is less common, but usually aspergillum

non infectious e.g. seborrhoeic dermatitis or contact dermatitis

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38
Q

Risk factors for otitis externa

A 
hot/humid climates
swimming
local trauma
diabetes
external auditory canal obstruction
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39
Q

Presentation of otitis externa

A 
intense itching of external ear canal
ear pain
tender tragus
ear canal swelling & erythema 
otorrhoea
aural fullness
conductive hearing loss
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40
Q

Management of otitis externa

A

1st line: topical Abx e.g. neomycin ± steroids

2nd line: ENT referral + systemic flucloxacillin + swab for culture

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41
Q

Perichondritis

A

infection of the tissue covering the cartilage of the pinna, usually after trauma e.g. piercing

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42
Q

Malignant otits externa (necrotising otitis externa)

A

a necrotising inflammation of the external ear canal, i.e. an infection extending into the bony ear canal & deep soft tissue

95% of cases are due to pseudomonas aeruginosa

risk factors include poorly controlled diabetes, immunosuppression, elderly

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43
Q

Malignant otits externa (necrotising otitis externa)

A

a necrotising inflammation of the external ear canal, i.e. an infection extending into the bony ear canal & deep soft tissue

95% of cases are due to pseudomonas aeruginosa

risk factors include poorly controlled diabetes, immunosuppression, elderly

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44
Q

Malignant otitis externa presentation

A

typically elderly pt with poorly controlled diabetes

severe ear pain, erythematous/swollen periauricular soft tissue, otorrhoea,

may have facial nerve palsy

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45
Q

Complication of Malignant otitis externa

A

osteomyelitis of the skull base, which may cause intracranial expansion of the infection

46
Q

Investigations for Malignant otitis externa

A

CT/MRI (identify bone destruction & intracranial expansion e.g. cranial abscess or venous sinus thrombosis)

biopsy (to distinguish from a tumour)

47
Q

Treatment of Malignant otitis externa

A

IV Abx e.g. ciprofloxacin

high mortality even with treatment

48
Q

Epistaxis

A

Nosebleeds

types:
Anterior (~90%), bleeding usually from Kiesselbach plexus located on anterioinferioir nasal septum (Little’s area) and anastomoses of the anterior ethmoidal/sphenopalatine/greater palatine/superioir labial arteries

Posterior (~10%), more dangerous, generally seen in older individuals, ↑ risk of airway compromise & aspiration, usually bleeding from both nostrils & blood running own throat

49
Q

Causes of epistaxis

A 
trauma including picking nose
vascular malformations 
nasal septum defect (e.g. deviated septum)
tumours
bleeding disorders
50
Q

Management of epistaxis

A

1) ABCDE assessment
2) sit upright with torso forward, squeeze cartilaginous part of nose for 20 minutes

3) Cautery with silver nitrate = 1st line if source of bleeding is visible
use packing (nasal tampons, rapid rhino) if cautery not tolerated or source of bleeding not visible

4) if persistent epistaxis then artery embolisation/ligation

51
Q

Sinusitis

A

inflammation of the mucous membranes of the paranasal sinuses, rarely occurring without concurrent inflammation of the nasal mucous (rhinitis) = rhinosinusitis

52
Q

Type of sinusitis

A

Acute <4 weeks

subacute 4-12 weeks

chronic > 12 weeks

53
Q

Aetiology of sinusitis

A

viral: very common e.g. rhinovirus, influenza, parainfluenza, adenovirus
bacterial: strep pneumonia, H. Influenzae

54
Q

Risk factors for sinusitis

A

URTI
smoking
nasal obstruction e.g. septal deviation or nasal polyps
nasal foreign body

55
Q

Presentation of sinusitis

A 
facial pain (frontal pressure pain, worse on bending forward)
nasal discharge (thick & purulent)
nasal obstruction
56
Q

Management of sinusitis

A

intranasal decongestants/nasal saline

intranasal corticosteroids (>10 days of symptoms)

if severe = oral Abx

if chronic consider intranasal saline washout

57
Q

complications of sinusitis

A 
preseptal/orbital cellulitis
orbital abscess
cavernous sinus thrombosis 
brain abscess
subdural abscess (most common)
osteomyelitis (especially of frontal bone = Pott's puffy tumour)
58
Q

Rhinitis

A

inflammation & swelling of the nasal mucous membranes

can be allergic or non allergic

59
Q

allergic rhinitis

A

acute/chronic rhinitis due to inhaled allergens causing a type I hypersensitivity reaction (IgE mediated), may be seasonal, occupational or perennial (throughout year)

most common form of rhinitis

presents with sneezing, bilateral nasal congestion, clear nasal discharge, post nasal drip, nasal pruritis

managed with allergen avoidance, oral/intranasal antihistamines, short course of decongestants e.g. oxyetazoline

60
Q

Complications of intranasal decongestant use

A

prolonged use leads to tolerance meaning ↑ doses are needed to achieve the same affect & may cause rebound hypertrophy of the nasal mucosa when withdrawn

61
Q

types of non allergic rhinitis

A

rhinitis medicamentosum:
rebound nasal congestion when discontinuing nasal decongestant, pts often use ↑dose/frequency to treat leading to vicious cycle

atrophic rhinitis:
chronic rhinitis associated with atrophy & sclerosis of the nasal mucosa

drug induced rhinitis:
e.g. snorting cocaine or ketamine

62
Q

Epiglottitis

A

progressive inflammation of the epiglottis & supra glottis with the potential to cause airway compromise

caused by haemophilia infleuzae type B (Hib), has become rare since Hib vaccination

usually seen ages 2-5 yrs

63
Q

Presentation of epiglottitis

A

acute onset
high fever, sore throat, dysphagia, odynophagia
tripod position, stridor, respiratory distress
muffled (‘hot potato’ voice)
drooling

64
Q

Investigating epiglottitis

A

direct visualisation via laryngoscopy (must be airway trained/senior doctor)

lateral neck X-ray (thumb sign)

65
Q

Management of epiglottitis

A

immediate senior & airway trained personnel involvement

DO NOT examine throat (using tongue depressor may cause obstruction)

IV/PO Abx
supplemental O2
airway management if indicated

66
Q

Nasal polyps

A

associated with asthma cystic fibrosis, Kartengers
affect ~1% of adult population 2-4x more common in men

features include nasal obstruction, rhinorrhoea, sneezing, poor sense of taste & smell

NB unilateral nasal polyp should raise suspicion of cancer

management with ENT referral, topical steroids (↓ polyp size)

67
Q

Nasal septum deviation

A

most common cause of nasal obstruction, usually due to direct trauma to nose/face or due to Marfan’s/Ehler-Danlos syndrome

features include recurrent sinusitis, facial pain, mouth breathing, ↓ wens of smell, repetitive sneezing, noisy breathing

managed with topical decongestants, steroid, antihistamines & surgery

68
Q

Choanal atresia

A

congenital bony/membranous obstruction of the posterior nasal passage which can be unilateral/bilateral
associated with other abnormalities e.g. CHARGE syndrome

features:
if bilateral = obligate mouth breathing, cyanosis worse on feeding, noisy breathing, struggling with food intake
if unilateral: chronic rhinitis, congestion, rhinorrhoea

management surgical perforation (urgently if bilateral, or at 1-2y/o if unilateral)

69
Q

Thyroglossal cyst

A

a remnant of the thyroglossal duct formed during embryonic development of the thyroid gland & normally regress before birth

2nd most common neck abnormality (~7% of population)

Presents as cyst present from birth, painless firm midline neck mass that elevates with swallowing & tongue protrusion

USS neck (evaluate cyst & confirm location of thyroid)

elctive surgical removal to treat

70
Q

Brachial cyst

A

remand of the embryological 2nd brachial cleft/cervical sinus which normally regresses after birth

~20% of paediatric neck masses

presents as cyst diagnosed in late childhood/adolescence usually when cyst becomes infected, painless firm mass located lateral to midline usually anterior to SCM and does not move on swallowing

USS neck & CT/MRI (to plan surgery)

managed with surgical excision

71
Q

Head & neck cancers

A

90% are squamous cell carcinomas

72
Q

Risk factors for head & neck cancer

A 
smoking
heavy alcohol consumption
poor dentition
poor diet
GORD
HPV 16 +ve
male gender
73
Q

Cancer of the oral cavity

A

cancers of oral mucosa, tonsils, salivary glands & tongue, usually seen in males aged 55-60

present as dysphagia, non healing ulcers, halitosis, unusual bleeding in mouth, facial swelling, lymphadenopathy

biopsy & histopathology, panednoscopy (to assess extent of tumour), CT chest/abdo/pelvis (check for spread)

treat with surgical resection if local, or resection +radio/chemotherapy

74
Q

Pharyngeal cancer

A

cancer of the oro/naso/hypopharynx, less common than other head & neck cancers, generally seen in males aged >50yrs

presents as enlarged lymph nodes, severe air pain, dysphagia, sore throat, foreign body sensation, recurrent otitis media & conductive hearing loss, epistaxis

investigate with panendoscopy, biopsy, MRI/CT (to check infiltration into surrounding structure)

Managed with surgery ± radio/chemo therapy

NB nasopharyngeal cancer usually not SCC

75
Q

Laryngeal cancer

A

cancers of supraglottis, glottis, subglottis, 2nd most common head & neck cancer, usually seen in males age 40-70

presents with hoarseness, change in voice, foreign body sensation, dyspnoea, dysphagia, stridor, aspiration

investigate with direct laryngoscopy, CT/MRI or USS neck

Management with radiotherapy/transednoscpopic laser resection if early, larynectomy if advanced

76
Q

Reineke’s oedema

A

benign build up of fluid in the lamina propria of the true vocal cords, looks like a sac-like fluid filled vocal cords

due to irritation & inflammation secondary to smoking

presents with deep/low pitched voice,rough voice, dysphonia, bilaterally swollen vocal cords on laryngoscopy

managed with smoking cessation & voice therpay

77
Q

Laryngeal papillomatosis/recurrent respiratory papillomatosis (RRP)

A

being tumour of the laryngeal epithelium caused by HPV infection (the 6&11)

presents as white exophylic cauliflower like lesion located in the larynx/trachea/vocal cords which may cause dysphonia, hoarseness, stridor

should be surgical removed but may reoccur

78
Q

Laryngopharyngeal reflux (LPR)

A

inflammatory changes of the larynx/pharynx secondary to GORD, common

presents with globes (felt in midline, worse on swallowing), hoarseness, chronic cough, dysphagia, heart burn

managed with lifestyle changes, PPIs or alginates e.g. gaviscon

79
Q

Laryngopharyngeal reflux (LPR)

A

inflammatory changes of the larynx/pharynx secondary to GORD, common

presents with globus (felt in midline, worse on swallowing), hoarseness, chronic cough, dysphagia, heart burn

managed with lifestyle changes, PPIs or alginates e.g. gaviscon

80
Q

Laryngitis

A

inflammation of the larynx

acute: <3 wks, usually viral ± bacterial superinfection
chronic >3 wks, usually GORD related or smoking related

81
Q

Presentation of laryngitis

A

hoarseness of voice, dysphonia, dry cough, stridor, fever, dysphagia, lymphadenopathy, globus, sore throat

mainly clinical diagnosis, consider laryngoscopy (shows oedema, eryhtma, or cobble stoning (if GORD))

82
Q

Management of laryngitis

A 
vocal rest
smoking cessation
speech therapy
humidification 
Abx for bacterial superinfection
83
Q

Foreign nasal body

A

mostly young children (<2.5yrs)

presents as unilateral nasal obstruction, epistaxis or mould smelling purulent rhinorrhoea

nasal cavity inspection (otoscope) or flexible fiberoptic endoscopy

removal via positive pressure, forceps or endoscopy

84
Q

Foreign bodies in the ear

A

usually seen in children (older children/adults will know something is i their ear)

may present as ear pain, deafness, ↓hearing or discharge

visualise on otoscopy

remove with forceps (if insect should kill insect first)

85
Q

Swallowed foreign bodies

A

generally seen in children <5yrs

coins = most common object to swallow, items like button batteries are very dangerous

presents with vomiting, choking, refusal to eat, blood stained saliva, drooling, wheezing, respiratory distress

investigate with plain CXR or endoscopy

managed by endoscopic removal or if in stomach waiting for it to pass in stool

86
Q

Obstructive sleep apnoea (OSA)

A

characterised by episodes of complete/partial upper airway obstruction during sleep

most common breathing related sleep disorder, 2x more common in men

87
Q

Risk factors for OSA

A 
obesity
adenotonsillar hypertrophy (in children)
nasal septum deviation 
nasal polyps
macroglossia
family history
Down's syndrome
88
Q

Presentation of OSA

A

excessive snoring
reports of apnoea (from sleep partner/parents)
day time somnolence
restless sleep
frequent waking
mouth breathing
impaired cognitive function (poor concentration)

89
Q

Investigating OSA

A

Polysomnography (1st line)

Epworth sleepiness scale

90
Q

Management of OSA

A

weight loss, sleep hygiene, lateral sleeping position
CPAP
surgical removal of tonsils/adenoids in children

91
Q

Vertigo

A

dizziness is a general, non specific term to indicate the sense of disorientation
vertigo is a type of dizziness & refers to the false sensation that oneself or the surroundings are moving/spinning

due to mismatch of vestibular, visual & somatosensory systems

92
Q

Causes of vertigo

A

cerebral:
CVD, migraine, MS, acoustic neuroma, alcohol intoxication

Vestibular:
vestibular neuritis, viral labyrinthitis, BPPV, Meniers, motion sickness, ototoxicity (e.g. gentamicin), HZV (ramsay hunt syndrome)

93
Q

Benign paroxysmal positional vertigo (BPPV) presentation

A

gradual onset, triggers by change in head position, episodes lasts 10-20secs

94
Q

Meniere’s disease presentation

A

hearing loss, tinnitus & sensation of pressure/fullness in one/both ears
nystagmus

95
Q

Vertebrobasillar ischaemia

A

elderly pts, presents with dizziness on extension of neck

96
Q

acoustic neuroma presentation

A

hearing loss, vertigo, tinnitus ± absent corneal reflex/facial nerve palsy

if bilateral then neurofibromatosis 2

97
Q

Investigating vertigo

A 
Romberg's test 
Dix-Hallpike manoeuvre 
head impulse test
CT/MRI
audiometry
vestibular function
98
Q

Laryngeal nerve palsy/vocal cord paralysis

A

clinical features depend if one or 2 cords are affected & position of chords, due to injury of one/both recurrent laryngeal nerves

unilateral: hoarseness
bilateral: dysphonia, stridor, snoring, breathing problems

treatment: voice therapy, surgery

99
Q

Benign lesions of the vocal cords

A

present as hoarseness

include:
vocal cord nodules (bilateral), treated with voice therapy
polyps of vocal folds (unilateral), treated with excision to exclude malignancy

100
Q

Voice overuse/misuse

A

common in professions such as acting/singing/teaching

may lead to being lesions such as nodules (singers nodules) or cysts

treated with voice therapy or surgery

101
Q

Labyrinthitis

A

inflammatory disorder of the membranes of the labyrinth affecting both vestibular & cochlear organs, usually preceded by URTI

may be viral (most common), bacterial or associated with systemic disease

usually seen age 40-70

102
Q

Presentation of labyrinthitis

A

acute onset vertigo (not triggered by movement but exacerbated by movement)
hearing loss*
nausea&vomiting, tinnitus
spontaneous unidirectional horizontal nystagmus towards unaffected side, sensorineural hearing loss

103
Q

Vestibular neuritis

A

inflammation of the vestibular nerve, usually follows a viral illness

104
Q

Presentation of vestibular neuritis

A

recurrent vertigo attacks lasting hours to days, nausea & vomiting, horizontal nystagmus

NO hearing loss or tinnitus (unlike labyrinthitits)

105
Q

Management of vestibular neuritis

A

vestibular rehabilitation exercises

106
Q

Cholesteatoma

A

presence of keratinising squamous cell epithelium within the middle ear or in other pneumatised areas of the temporal bone, the epithelium exhibits independent growth leading to expansion & reabsorption of underlying bone

risk ↑ 100x with cleft palate

107
Q

presentation of cholesteatoma

A

painless otorhhoea (scant but foul smelling discharge from affected ear)
conductive hearing loss (painless)
retraction pocket/attic crust seen on otoscopy

108
Q

Pleomorphic adenoma

A

commonest tumour of parotid glands

Slow growing, lobular, and not well encapsulated

109
Q

Normal Webers & Rhinnes test

A

Rhinnes:
Air conduction > bone conduction bilaterally

Webers:
equal on both sides, no lateralisation, stays in midline

110
Q

Conductive hearing loss Webers & Rhinnes test

A

Rhinnes:
Bone conduction > air conduction in affected ear
Air conduction > bone conduction in unaffected ear

Webers:
Lateralises to affected ear

111
Q

Sensorineural hearing loss Webers & Rhinnes test

A

Rhinnes:
Air conduction > bone conduction bilaterally

Webers:
Lateralises to unaffected ear

Year 4 (12 decks)

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