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ENT Flashcards

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1
Q

What is otitis externa ?

A

It is a diffuse inflammation of the skin lining the external auditory meatus.

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2
Q

What is the external auditory meatus ?

A

External part of the ear that lies between the surrounding environment and middle ear. It is 2cm long and lined with normal skin ending at the tympanic membrane.

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3
Q

What are the clinical features of otitis media ?

A

Rapid onset
Scanty discharge
Otalgia
Itching
Feeling of fullness

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4
Q

What is seen on examination of the ear in otitis media ?

A

Meatal tenderness
Narrowed, Oedematous meatus
Erythema and narrowing
Tuning fork may demonstrate mild conductive deafness

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5
Q

What are some causative agents of otitis externa ?

A

Bacteria - pseudomonas aeruginosa and staph aureus
Fungi - Candida and aspergillus
Allergy
Iatrogenic

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6
Q

What are some risk factors for otitis externa ?

A

Swimming
Increased humidity
Foreign objects in ear - cotton buds
Trauma to the ear canal
Scratching
Eczema or psoriasis
Diabetes
Previous ear surgery

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7
Q

What is the management of otitis externa ?

A

Swab ear canal
If pseudomonas give Ciprofloxacin
If not give oral flucloxacillin
Pain relief

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8
Q

What is a complication of otitis externa ?

A

Malignant otitis externa

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9
Q

What are some causes of noise related hearing loss ?

A

Occupational - prolonged industrial exposure
Recreational - loud music
Accidental - blast injury or gunfire

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10
Q

What is seen on an audio gram in noise induced hearing loss ?

A

Notching at 3000,4000 or 6000 Hz with recovery at 8000 Hz
Precise notching depends on the frequency of the noise and the length of the ear canal

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11
Q

What are some clinical features of noise-induced hearing loss ?

A

Always sensorineural and often accompanied by high-pitched tinnitus
Usually bilateral
Irreversible

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12
Q

What is the management of noise induced hearing loss ?

A

Cannot be treated as damaged hair cells do not recover
Use of hearing aids

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13
Q

What may be used as a preventative measure for noise related hearing loss ?

A

Foam - insert earplugs
High usage of noise protection

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14
Q

What is Ménière’s disease ?

A

A condition of the inner ear which causes sudden attacks of vertigo and tinnitus. It also causes a persons hearing to decrease over time.

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15
Q

What causes Ménière’s disease ?

A

Not fully understood but could be due to extra fluid in the inner ear called endolymph which could be due to poor drainage.

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16
Q

What symptoms are experienced in Ménière’s disease ?

A

Tinnitus
Dizziness
Feeling of fullness behind the ear - aural fullness
Nausea and vomiting
Hearing loss

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17
Q

What is the management of Ménière’s disease ?

A

No cure
Anti-emetics and antihistamines may help reduce the symptoms

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18
Q

What is Presbycusis ?

A

A progressive condition causing hearing loss that comes on with age. Usually bilaterally and is sensorineural.

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19
Q

What symptoms are present in Presbycusis ?

A

Hears Slurred or mumbled speech
Struggle to hear higher pitch sounds
Tinnitus

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20
Q

What is the management of Presbycusis ?

A

Hearing aids may help improve hearing

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21
Q

What is otitis media ?

A

Inflammation of the middle ear usually associated with a URTI.

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22
Q

What is the management of otitis media ?

A

Discuss and advise that most infections resolve without antibiotics after 3 days
Pain relief
Decongestants and antihistamines
Consider antibiotics ( amoxicillin 5-7 days )

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23
Q

What are some symptoms of otitis media ?

A

Ear pain
Ear rubbing
Cloudy eardrums
Bulging ear drums
Redness

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24
Q

What are some complications of otitis media ?

A

Hearing impairment
Tympanic membrane perforation
Mastoiditis
Meningitis

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25
What is secretory otitis media ?
The accumulation of serous or mucoid fluid in the middle ear cavity without signs and symptoms of an acute infection. Conductive hearing loss
26
What are the clinical features of secretory otitis media ?
Hearing impairment Recurrent infections Ear fullness or popping Dull appearance of the tympanic membrane Retraction of the ear drum Rinne’s test - negative and Weber’s test is heard more on the deafer ear
27
What is the management of secretory otitis media ?
Resolves spontaneously within 6 weeks Decongestants and antibiotics If recurrent refer to ENT specialist
28
What is mastoiditis ?
The result of extension of acute otitis media into the mastoid air cells with an accompanying suppuration an bone necrosis which can cause extra dural and subperiosteal abscesses.
29
What are the clinical features of mastoiditis ?
Earache - persistent and throbbing Cramp profuse ear discharge Increasing deafness Pyrexial and looks ill Tenderness over the mastoid antrum Pinna may be pushed down and forward Red or perforated tympanic membrane
30
What investigations are performed for mastoiditis ?
FBC - raised neutrophils Mastoid radiograph - opacity and air coalescence
31
What is the management of mastoiditis ?
Antibiotics IV Cortical mastoidectomy is no response to antibiotics or there is a subperiosteal abscess
32
What are the complications of mastoiditis ?
Masked mastoiditis Cranial extra dural abscess
33
What is chronic suppurative otitis media ?
Chronic inflammation and infection of the middle ear and mastoid cavity characterised by ear discharge through the perforated tympanic membrane
34
When does otitis media become chronic ?
Differs per person Otorrhoea for more than 2 weeks or 6 weeks
35
What are some clinical features of chronic otitis media ?
Ear discharge Hearing loss
36
What is the management of chronic otitis media ?
Don’t swab the ear if diagnosis suspected Refer to ENT to confirm diagnosis
37
What are some complications of chronic otitis media ?
Acute mastoiditis Meningitis Extra dural abscess Brain abscess Labyrinthitis Facial nerve paralysis
38
What is acute sinusitis ?
Inflammation of the paranasal sinuses which completely resolves in 12 weeks
39
What are some features of acute sinusitis ?
Presence of nasal blockage or nasal discharge Facial pain / pressure Altered sense of smell Tenderness or swelling over the cheekbone or periorbital region Cough
40
When should acute bacterial sinusitis be suspected ?
Symptoms are longer than 10 days Discoloured or purulent discharge Severe local pain Fever greater than 38 Elevated ESR or CRP
41
What are some differentials for sinusitis ?
URTI Allergic rhinitis Nasal foreign body Adenoiditis or tonsillitis Sinonasal tumour Migraine GCA
42
What is the management of acute sinusitis ?
- If symptoms lest than 10 days - don’t offer antibiotics Advise that it is usually viral and can take 2-3 weeks to resolve. OTC meds - if symptoms have been longer than 10 days - consider high dose nasal corticosteroids and if antibiotics are required give phenoxymethylpenicillin
43
When should a referral to ENT be considered for acute sinusitis ?
Frequent recurrrent episodes Failure of treatment to work Unusual or resistant bacteria Immunocompromised Presence of nasal polyps
44
What is chronic sinusitis ?
Sinusitis that causes symptoms to last for longer than 12 weeks
45
What are some causes of sinusitis ?
Asthma Allergic rhinitis Smoking Impaired ciliary motility - CF
46
What is the management of chronic sinusitis ?
Nasal saline irrigation Topical intranasal corticosteroids CT is needed if all other meds fail and functional endoscopic sinus surgery could be an option
47
What advise should be given to people with chronic sinusitis ?
Avoid allergic triggers Stop smoking Avoid underwater diving
48
What is a thyroid nodule ?
Lumps that may be present in the thyroid gland upon examination.most lumps are adenomatous and there are usually multiple .
49
What are some causes of thyroid nodules ?
Graves’ disease Thyroid cancer Thyroid cyst Hashimoto’s disease Iodine deficient
50
What are some investigations for thyroid nodules ?
TFT’s USS Fine needle aspiration CT or MRI scan if malignancy suspected
51
If a thyroid lump is suspected on examination what should be done if there is also stridor ?
Arrange emergency hospital admission
52
When should an urgent referral be made to a thyroid surgeon or endocrinologist if there is a thyroid lump ?
It is unexplained There is hoarseness of the voice Associated cervical or supraclavicular lymphadenopathy Rapidly expanding painless mass Red flags for malignancy
53
What should be performed on people with a suspected thyroid lump in primary care ?
Perform TFT’s Arrange a routine endocrinology referral if severe however manage condition if no red flags
54
If a thyroid nodule produces extra hormone what symptoms are likely to be present ?
Unexplained weight loss Increased sweating Tremor Anxiety Tachycardia or arrhythmias
55
What symptoms would indicate hypothyroidism ?
Increased Sensitivity to cold Fatigue Dry skin Memory problems Depression Constipation
56
What is acute labyrinthitis ?
An inflammatory condition of the otic capsule. Could be caused by an infection of the inner ear.
57
How does acute labyrinthitis present ?
Sensorineural hearing loss Vertigo Problems with balance
58
What is the difference between serous and suppurative labyrinthitis ?
Suppurative follows direct microbial invasion of the inner ear and usually presents with severe to profound hearing loss and vertigo - usually bacterial . Serous results from inflammation of the labyrinth only and presents with less severe hearing loss - usually viral
59
What is seen on examination in acute labyrinthitis ?
Weber’s and Rinne’s test - sensorineural Head impulse test - vertigo CT and MRI and possibly audio gram
60
What is the management of acute labyrinthitis ?
Viral Labyrinthitis is treated with anti-emetics to address the nausea such as Metoclopramide or Ondansetron and vestibular suppressants such as Cyclizine Suppurative - oral antibiotics and can be supplemented with anti-emetics and vestibular suppressants
61
What is a deviated septum ?
This happens when the nasal septum is significantly displaced to one side making one of the nasal passages smaller than the other. If severe one side of the nasal passage can be blocked and reduce air flow causing breathing difficulties.
62
What are some symptoms of a deviated septum ?
None Difficulty breathing through the nostril Nosebleeds due to the nasal septum becoming dry Facial pain
63
What are some causes of a deviated septum ?
Condition at birth Nose injury - trauma Due to ageing
64
what are the complications of a deviated septum ?
Dry mouth Pressure feeling Disturbed sleep
65
What is the management of a deviated septum ?
Decongestants to reduce nasal swelling Antihistamines to prevent allergy symptoms Nasal steroid spray to reduce swelling Surgical repair - septoplasty
66
What are some clinical signs of a nasal fracture ?
Pain Displaced bone/cartilage Changes on appearance Nose bleed Difficulty breathing Septal haematoma Swelling and bruising of the nose and eyelids
67
What are the causes of a nasal fracture ?
Facial injuries / contact sport / falls Injuries to the teeth and mouth
68
What investigations should be done for a nasal fracture ?
X ray Ct Otoscope
69
What is the management of a nasal fracture ?
If the nose is broken but not out of place - treatment may not be needed other than rest, ice and pain relief Manual realignment - needs to be done before 2 weeks - a splint may be used Surgery - severe or if longer than 2 weeks
70
What is a vestibular migraine ?
A type of migraine that mainly presents with dizziness
71
What can trigger a vestibular migraine ?
Stress Lack of sleep Dehydration Menstruation Weather changes
72
What symptoms are present in vestibular migraines ?
Severe, throbbing headache - on one side of the head Nausea and vomiting Vertigo Unsteadiness or loss of balance Sensitivity to motion
73
What investigations are performed for vestibular migraines ?
Mainly based upon symptoms of patient Neurological exam
74
What is the management of a vestibular migraine ?
There is no specific treatment options for this/ Conventional migraine management
75
What is vestibulopathy ?
Disorders of the inner ear - umbrella term for vestibular neuritis or labyrinthitis, BPPV, Ménière’s and more
76
What are the symptoms of vestibulopathy ?
Vertigo Nausea and vomiting Decreased balance Walking and balance difficulties Blurry vision Hearing loss - of cochlea involved
77
What are the investigations for vestibulopathy ?
ENG - electronystagmography Rotatory chair testing Romberg test, visual acuity Ophthalmoscope
78
What is the management of vestibulopathy ?
Treatment involves finding the cause and treating it however it is usually rare that a cause is identified. Anti-emetics and balance exercises
79
What are the types of allergic rhinitis ?
Seasonal - hay fever - caused by grass and tree pollen allergens Perennial - caused by house dust mites and animals Occupational - caused by allergens at the workplace eg. Flour
80
What are some of the clinical features of allergic rhinitis ?
Rhinnorhea Nasal blockage Sneezing attacks Itching of the eyes and nose Watery eyes Malaise Headache Wheezing SOB
81
What other conditions usually coexist with allergic rhinitis ?
Asthma Eczema Chronic sinusitis
82
What are some of the investigations performed for allergic rhinitis ?
History is important - time of the day, what activity, seasonal Skin prick test assesses IgE bound to cutaneous mast cells Allergen specific IgE antibody testing ( RAST ) is useful for dust mites, pollen and pet dander.
83
What is the management of allergic rhinitis ?
Removal of trigger - pets Antihistamines Corticosteroids ( nasal, oral or IM ) Leukotriene receptor antagonist - Montelukast
84
When is surgery contemplated for allergic rhinitis ?
If medical treatment is unsuccessful Indications - - nasal polyps - septal deviation - inferior turbinate hypertrophy
85
What is the referral criteria from primary care for perennial rhinitis ?
Severe symptoms that are resistant to treatment - tried for 3 months Unilateral nasal symptoms Nasal perforation Serosangionous discharge Recurrent cellulitis
86
What are nasal polyps ?
They are yellowish, grey, pedunculated sacs which usually cause progressive nasal obstruction. Usually bilateral
87
Why is a unilateral nasal polyp deemed suspicious and what should be done following its finding ?
A unilateral polyp should be assumed to be neoplastic until proven otherwise. Sent for histological examination
88
What is the common origin for nasal polyps ?
Ethmoid sinus
89
What are some clinical features of nasal polyps ?
Progressive nasal obstruction Rhinorrhoea Post nasal drip Anosmia Sneezing Hyponasal voice
90
What are some investigations for nasal polyps ?
Test for allergies Exclude CF in children Biopsy unilateral polyps to exclude neoplasia
91
What is the medical management of nasal polyps ?
Topical steroids such as betamethasone drops
92
What are some surgical options for nasal polyps ?
Polypectomy - performed through the nostril Ethmoidectomy - clearing of the ethmoid air cells from which most polyps arise - carried out endoscopically
93
What can cause cervical lymphadenopathy ?
Lymphomata Secondary tumour deposit Local inflammation due to infection Generalised lymphadenopathy - HIV
94
Which cancers can cause cervical lymphadenopathy ?
Squamous carcinoma and melanoma of the skin of the neck, face, scalp and ear Squamous carcinoma of the mouth and tongue, nasopharynx, oropharynx, larynx and paranasal sinuses Adenocystic carcinoma of the salivary glands Papillary carcinoma of the thyroid
95
How can cervical lymphadenopathy be diagnosed ?
Physical examination of the neck region USS CT scan or MRI
96
What is Benign paroxysmal positional vertigo ?
A disorder characterised by brief recurrent attacks of vertigo provoked by certain changes in head position with respect to gravity.
97
What is the diagnostic criteria of Benign paroxysmal positional vertigo ?
At least 5 attacks of vertigo with one of the following : . Nystagmus . Ataxia . Vomiting . Pallor . Fearfulness Normal neurological examination and audoiometric and vestibular functions between attacks
98
What is the proposed pathophysiology of BPPV ?
The canalolithiasis hypothesis - small crystals called otocania come loose from their normal location on the utricle. When detached they can flow freely in the fluid filled spaces of the inner ear and cause vertigo.
99
What are some causes of BPPV ?
Idiopathic Secondary causes - . Head trauma . Mastoid surgery . Vestibular neuritis . Labyrinthitis . Ménière’s disease
100
What are some clinical features of BPPV ?
Symptoms are precipitated by a change of position of the head Vertigo Nausea Imbalance and lightheadedness
101
What are some differentials for recurrent vertigo ?
BPPV Ménière’s disease Migraines Panic disorders Cerebellar disease ( with nystagmus )
102
What is the management of BPPV ?
Observe and wait as it is usually self-limiting and may subside in 6 months Medial management - anti-emetics and vestibular sedatives - particle repositional manoeuvres - redirect the otoconial particles back to the utricle Surgery
103
What can help diagnosis of BPPV ?
Hallpike manoeuvre Supine roll test
104
What are the functions of the sinuses ?
Lightening the weight of the head Supporting immune defence of the nasal cavity Humidifying inspired air Increasing resonance of the voice
105
What are the functions of the nasal cavity ?
.Warms and humidifies the inspired air .Removes and traps pathogens and particulate matter from inspired air .responsible for the sense of smell . Drains and clears the paranasal sinuses and lacrimal ducts
106
What are the major functions of the oral cavity ?
Digestion Communication Breathing
107
How is Weber’s test performed ?
Strike the tuning fork to make it vibrate and hum Place it in the centre of the patient’s forehead Ask them if they can hear the sound and which is the loudest
108
What indicates a conductive hearing loss when performing Weber’s test ?
The sound will be louder in the affected ear
109
What indicates sensorineural hearing loss in weber’s test ?
The sound will be louder in the normal ear as it is better at sensing sound.
110
How is the Rinne’s test performed ?
Strike the tuning fork to make it vibrate and hum Place the flat end on the mastoid process - testing bone conduction Ask the patient to tell you when they cant hear the humming noise When they can no longer hear it hover the tuning fork 1cm from the ear - testing air conduction Repeat on other ear
111
What is a normal result in the Rinne’s test ?
When the patient can hear the sound again when bone conduction ceases and the tuning fork has been moved next to the ear. This shows that air conduction is better than bone conduction.
112
what is an abnormal result in the Rinne’s test ?
This is when bone conduction is better than air conduction. This is when the tuning fork is not heard when holding it over the ear. This suggests conductive hearing loss
113
What are some causes of sensorineural hearing loss ?
Presbycusis Noise exposure Ménière’s disease Labyrinthitis Acoustic neuroma Infections such as meningitis Medications
114
What are some causes of conductive hearing loss ?
Ear wax Infection Middle ear effusions Eustachian tube dysfunction Otosclerosis Cholestatoma
115
What is an audio gram ?
Charts that document the volume at which patients can hear different tones. The frequency in hertz is plotted on the x axis from low to high pitches and the decibels are plotted on the y axis (loud is lower and quieter is higher )
116
What is seen in patients with sensorineural hearing loss on an audio gram ?
Both air and bone conduction readings will be more than 20dB. One ear can be affected or both can.
117
What is seen in conductive hearing loss in an audio gram ?
Bone conduction Readings will be normal Air conduction readings will be greater than 20dB as sound struggles to travel through the air due to pathology.
118
What are the risk factors for Presbycusis ?
Age Male Family history Loud noise exposure Diabetes Hypertension Smoking
119
How is a diagnosis of Presbycusis established ?
Audiometry - worsening hearing at higher frequencies
120
What is otosclerosis ?
A condition where there is remodelling of the small bones in the middle ear leading to conductive hearing loss.
121
What is the pathophysiology of otosclerosis ?
The tiny bones in the ear are affected by abnormal bone remodelling and formation. The base of the stapes is usually affected where it attaches to the oval window causing stiffening and fixation. This reduces the transmission of sound
122
How does otosclerosis present ?
Hearing loss - usually affects the hearing of lower pitched sounds. Tinnitus
123
What is seen on examination in otosclerosis ?
Otoscopy is normal Weber’s test - normal if bilateral, if unilateral the sound will be louder in the affected ear. Rinne’s test - heard better when placed on mastoid process.
124
What investigations are performed in otosclerosis ?
Audiometry - hearing loss in lower frequencies, air conduction will be greater than 20dB Tympanometry will show reduced admittance of sound CT
125
What is the management of otosclerosis ?
Hearing aids Stapedectomy or stapedotomy
126
What organisms are most likely to cause otitis media ?
Strep pneumoniae Haemophilus influenzae Staph aureus Moraxella catarrhalis
127
What is seen on examination in otitis media ?
Otoscopy - red bulging inflamed tympanic membrane
128
What can a build up of ear wax cause ?
Conductive hearing loss Discomfort in the ear Feeling of fullness Pain Tinnitus
129
What is tinnitus ?
A persistent additional sound that is heard but not present in the surrounding environment. It may be described as a ringing in the ears or buzzing, hissing or humming noise.
130
What are some causes of tinnitus ?
Impacted ear wax Ear infection Ménière’s disease Noise exposure Acoustic neuroma Trauma Medications
131
What is vestibular neuronitis ?
Inflammation of the vestibular nerve usually due to a viral infection. It distorts the signals travelling from the vestibular system to the brain confusing the signal required to sense movement. This results in vertigo.
132
How does vestibular neuronitis present ?
Vertigo Nausea and vomiting Balance problems
133
what is the management of vestibular neuronitis ?
Short term options - prochlorperzine Antihistamines
134
What is a cholesteatoma ?
An abnormal collection of squamous epithelial cells in the middle ear. It is non-cancerous but can invade other local tissues and nerves and erode the bones of the middle ear.
135
What is the pathophysiology of cholesteatoma ?
Not fully understood The main theory is that negative pressure in the middle ear caused by Eustachian tube dysfunction causes a pocket of the tympanic membrane to retract into the middle ear. The squamous cells still proliferate and grow into the surrounding space, bones and tissues. It can damage the ossicles resulting in permanent hearing loss.
136
How does cholesteatoma present ?
Foul discharge Unilateral conducive hearing loss Pain Vertigo Facial nerve palsy
137
What is seen on Otoscopy in a cholesteatoma ?
An abnormal build-up of whitish debris or crust in the upper tympanic membrane. However it may not be possible to visualise the ear drum if discharge or wax are blocking the canal.
138
What is the management of cholesteatoma ?
A CT head can be used to confirm the diagnosis and plan for surgery MRI may help assess the invasion and damage to local soft tissues. Treatment involves surgical removal of the cholesteatoma.
139
What is obstructive sleep apnoea ?
It is caused by the collapse of the pharyngeal airway and characterised by episodes of apnoea during sleep where the person can stop breathing for up to a few minutes. The person is usually unaware of this.
140
What are some risk factors of obstructive sleep apnoea ?
Middle age Male Obesity Alcohol Smoking
141
What are some clinical features of sleep apnoea ?
Episodes of apnoea during sleep Snoring Morning headache Waking up unrefreshed from sleep Daytime sleepiness Concentration problems
142
What is the management of obstructive sleep apnoea ?
ENT referral or specialist sleep clinic to perform sleep studies. Advise against smoking, stop drinking alcohol and lose weight. CPAP machines at night
143
What is tonsillitis ?
Inflammation of the tonsils usually caused by viral infections.
144
What is the most common causes of bacterial tonsillitis ?
Group A strep ( pyogenes ) Strep pneumoniae Haemophilus influenza
145
How does tonsillitis present ?
Sore throat Fever Pain when swallowing
146
What is seen on examination of tonsillitis ?
Red, inflamed and enlarged tonsils Possible exudate Swollen lymph nodes
147
What is used to assess if the tonsillitis is viral or bacterial ?
Centor score FeverPAIN score
148
What is the management of tonsillitis ?
If centor score is above 3 and feverPAIN score is above 4 give antibiotics - penicillin 5 also called phenoxymethylpenicillin
149
What are some potential complications of tonsillitis ?
Peritonsillar abscess Otitis media Scarlet fever
150
What is a peritonsillar abscess ?
It arises when there is a bacterial infection with trapped pus forming an abscess in the region of the tonsils.
151
How does tonsillitis present ?
Sore throat Painful swallowing Fever Neck pain Referred ear pain Swollen lymph nodes Trismus - unable to open their mouth Change in voice Swelling and erythema beside the tonsils
152
What is the usual cause of a peritonsillar abscess ?
Bacterial infection usually due to streptococcus pyogenes Can be staph aureus and Haemophilus influenzae
153
What is the management of a peritonsillar abscess ?
Referral to ENT hospital care for needle aspiration or surgical incision and drainage to removed the pus. Antibiotics should be given - co-amoxiclav Possibly give Dexamethasone to settle inflammation and help recovery.
154
What is glossitis ?
Inflamed tongue - red swollen and sore. The papillae shrink and give it a smooth appearance
155
What are some causes of glossitis ?
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease
156
What is oral candidiasis ?
Refers to the overgrowth of candida in the mouth. This results in white spots or patches that coat the surface of the tongue and palate.
157
What factors can predispose someone to developing oral candidiasis ?
Inhaled corticosteroids Antibiotics Diabetes Immunodeficiency Smoking
158
What are some treatment options for oral candidiasis ?
Miconazole gel Nystatin suspension Fluconazole tablets
159
What conditions cause a strawberry tongue ?
Scarlet fever Kawasaki disease

Y3 GP (12 decks)

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