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ENT Flashcards

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1
Q

What is conductive hearing loss?

A

Sensory system is working fine but the sound is not reaching it - problem with the sound travelling

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2
Q

What is sensorineural hearing loss?

A

Problem with the sensory system or vestibulocochlear nerve

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3
Q

What are the three bones in the middle ear?

A

Malleus
Incus
Stapes

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4
Q

What is Weber’s test?

A

Tuning fork in the centre of patient’s forehead
Which ear is loudest
In sensorineural: sound louder in normal ear
In conductive: sound louder in affected ear

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5
Q

What is Rinne’s test?

A

Tuning fork to mastoid process
Move to in front of ear
Normal is for air conduction to be better than bone conduction
Abnormal is bone conduction is better
Abnormal suggests conductive hearing loss

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6
Q

What are causes of sensorineural hearing loss?

A

Sudden sensorineural hearing loss (over less than 72 hrs)
Presbycusis (age-related)
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions
Infections
Medications (loop diuretics, amino glycoside antibiotics, chemo - furosemide, gentamicin, cisplatin)

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7
Q

Causes of conductive hearing loss

A

Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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8
Q

Causes of conductive hearing loss

A

Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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9
Q

What is plotted on the x axis in an audiogram?

A

Frequency

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10
Q

What is plotted on the y axis in an audiogram?

A

decibels (but with loud at the bottom and quiet at the top)
So better hearing is higher up on the y axis

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11
Q

What do X ] O and [ stand for in audiometry?

A

X - left sided air conduction
] left sided bones conduction
O right sided air conduction
[ right sided bone conduction

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12
Q

What is the normal hearing range for audiometry?

A

Between 0 and 20 dB

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13
Q

What is the difference on audiometry between sensorineural and conductive hearing loss?

A

Sensorineural: both bone and air conduction will be lower
Conductive: only air conduction is lower than normal
Mixed: Both are lower than normal but air conduction is more lower than bone

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14
Q

What is presbycusis?

A

Age-related hearing loss
Sensorineural, high pitched sounds first

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15
Q

What is the pathophysiology of presbycusis?

A

Several different mechanisms
Loss of hair cells in the cochlea
Loss of neurones in the cochlea
Atrophy of the stria vascular
Reduced end-lymphatic potential

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16
Q

What is one way of managing idiopathic sudden sensorineural hearing loss?

A

Oral or intra-tympanic steroids

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17
Q

What can happen when there is Eustachian tube dysfunction?

A

Unequal air pressure
Middle ear can fill with fluid
Reduced or altered hearing
Popping noises or sensations
A fullness sensation in the ear
Pain or discomfort
Tinnitus

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18
Q

What is tympanometry?

A

Creating different air pressures in the canal and measuring sound absorbed and reflected
Sounds is absorbed best when the air pressure matches the ambient air pressure
In Eustachian tube dysfunction, a tympanogram will show peak admittance (absorption) with negative ear canal pressures

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19
Q

What are the treatment options for Eustachian tube dysfunction?

A

Valsalva manoeuvre
Decongestant nasal sprays
Antihistamines and steroid nasal spray
Surgery (adenoidectomy, grommets, balloon dilatation eustachian tuboplasty)

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20
Q

What is otosclerosis?

A

Remodelling of the small bones in the middle ear leading to conductive hearing loss

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21
Q

Is otosclerosis more common in men or women?

A

Women

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22
Q

What is the normal presentation for otosclerosis?

A

Unilateral or bilateral hearing loss or tinnitus
Affecting lower-pitched sounds more than higher pitched sounds
Sensorineural is intact so patients can experience their voice as being loud even if they are talking quietly

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23
Q

What is a stapedectomy in otosclerosis management?

A

Surgical removement of the stapes bone and replaces it with a prosthesis

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24
Q

What is the presentation of vestibular neuritis?

A

Acute onset of vertigo
Recent history of viral URTI
Often associated with nausea and vomiting and balance problems
Essential to differentiate between peripheral and central causes - any neurological symptoms, consider a posterior circulation infarction
Don’t get tinnitus or hearing loss - if present consider labyrinthitis or menieres disease

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25
What is the head impulse test in vestibular neuronitis?
Patient sat upright and fixing gaze on examiners nose Examiner rapidly jerks it 10-20 degrees left or right while the patient continues looking at the examiner's nose. Repeat opposite direction. Abnormal result: eyes will saccade (rapidly move back and forth). Normal: no current symptoms or central cause
26
What is the management for vestibular neuronitis?
Prochlorperazine Antihistamines (e.g. cyclising, cinnarizine, promethazine)
27
What is the presentation of labyrinthitis?
Acute onset vertigo Hearing loss Tinnitus Recent viral URTI or meningitis
28
What is the management for labyrinthitis?
Prochlorperazine Antihistamines
29
What are the triad of symptoms in Menieres disease?
Hearing loss Vertigo Tinnitus
30
What is the pathophysiology of Ménière's disease?
Excessive buildup of endolymph in the labyrinth of the inner ear (end-lymphatic hydrops)
31
What is the classic presentation of Menieres disease?
Middle aged person Unilateral episodes of vertigo, hearing loss and tinnitus Hearing loss is sensorineural and affects low frequencies first Nystagmus can be seen Can cause drop attacks without loss of consciousness
32
What is used in prophylaxis of menieres?
Betahistine
33
Where does bleeding usually originate in nosebleeds?
Kiesselbach's plexus, located in Little's area (remember the area most affected by little fingers picking noses)
34
What does bilateral nose bleeding indicate?
Bleeding posteriorly in the nose - higher risk of aspiration of blood
35
What is the management for nosebleeds?
Sit up and tilt head forwards Squeeze the soft part of the nostrils together for 10-15 mins Spit out any blood in mouth, rather than swallowing. If it does not stop after 10-15 mins or is bilateral = hospital admission
36
What is the hospital treatment for nosebleeds?
Nasal packing with nasal tampons or inflatable packs Nasal cautery using silver nitrate sticks Naseptin after treatment to reduce inflammation (chlorhexidine and neomycin)
37
What is naseptin contraindicated in?
Peanut and soya allergy
38
Are nasal polyps usually bilateral or unilateral?
Bilateral Unilateral is red flag for tumour
39
What are nasal polyps associated with?
Chronic rhinitis or sinusitis Asthma Samter's triad (nasal polyps, asthma, aspirin intolerance/allergy) Cystic fibrosis Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
40
How do people with nasal polyps present?
Chronic rhinosinusitis Difficulty breathing through the nose Snoring Nasal discharge Loss of sense of smell
41
What do nasal polyps look like?
Pale grey/yellow growth on the mucosal wall
42
What is the management for nasal polyps?
Intranasal topical steroid drops or spray Intranasal polypectomy Endoscopic nasal polypectomy
43
What is quinsy?
Peritonisllar abscess Untreated or partially treated tonsillitis Presents similarly to tonsillitis
44
What are the three additional symptoms that indicate peritonsillar abscess?
Trismus (unable to open mouth) Change in voice ('hot potato voice') Swelling and erythema
45
What are the three organisms that can cause a peritonsillar abscess?
Strep progenies (group A strep) Staph aureus H. influenzae
46
What type of cancer is most head and neck cancer?
Squamous cell carcinoma
47
How are head and neck cancer's usually found?
Abnormal lymphadenopathy
48
What are risk factors for head and neck cancer?
Smoking Chewing tobacco Chewing betel quid (south-east Asia) Alcohol HPV EBV
49
What are the red flags for head and neck cancer?
Lump in mouth or lip Unexplained ulceration in the mouth lasting more than 3 weeks Erythroplakia or erythroleuoplakia Persistent neck lump Unexplained hoarseness of voice Unexplained thyroid lump
50
What monoclonal antibody is used in treated squamous cell carcinomas of the head and neck?
Cetuximab - targets epidermal growth factor receptor Also used in bowel cancer
51
What does glossitis look like?
Red, sore and swollen tongue with atrophy of the papillae making it look smooth
52
What are the causes of glossitis?
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury or irritant exposure
53
What are the top three causes of angioedema in the tongue?
Allergic reactions ACEi C1 esterase inhibitor deficiency (hereditary angioedema)
54
What is a geographic tongue?
Patches of the tongue lose the epithelium and papillae making it look like a map. Relapsing and remitting
55
What can geographic tongue be associated with?
Stress and mental illness Psoriasis Atopy Diabetes
56
What are the two key causes of strawberry tongue?
Scarlet fever Kawasaki disease
57
What causes a black hairy tongue?
Decreased shedding of keratin from the tongue's surface. Papillae elongate and look like hairs, with bacteria and food causing the dark pigmentation Sticky saliva and metallic taste Causes: dehydration, dry mouth, poor oral hygiene, smoking
58
What is leukoplakia?
White patches in the mouth, often on the tongue or inside of cheeks Precancerous condition Asymptomatic, irregular and slightly raised
59
What is erythroplakia?
Red lesions in the mouth - associated with high risk of squamous cell carcinoma
60
What is lichen planus?
Autoimmune condition that causes chronic inflammation of the skin Shiny purplish, flat topped raised areas with white lines across the surface (Wickham's striae) Usually in women over 45
61
What are the three patterns that lichen planus can take?
Reticular - web like Erosive - bright red and sore Plaques - larger continuous areas of white mucosa
62
What is acute necrotising ulcerative gingivitis?
Painful rapid onset of gingivitis usually caused by anaerobic bacteria
63
What are the risk factors for gingivitis?
Plaque build up Smoing Diabetes Malnutrition Stress
64
Which is gingival hyperplasia?
Abnormal growth of the gums
65
What can cause gingival hyperplasia?
Gingivitis Pregnancy Vit C def AML Medications, particularly calcium channel blockers, phenytoin and ciclosporin
66
What can apthous ulcers be an indication of?
IBD Coeliac Behçet's disease Vitamin deficiency HIV

Finals Revision (20 decks)

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