ENT Flashcards
(143 cards)
1
Q
What is epistaxis?
A
Nosebleeds
2
Q
Where does bleeding usually originate in epistaxis?
A
From Kiesselbach’s plexus, which is located in Little’s area. This is an area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels. When the mucosa is disrupted and the blood vessels are exposed, they become prone to bleeding.
3
Q
What is the most likely location of the nose bleeding?
A
Little’s area
4
Q
Epistaxis tiggers
A
-nose picking
-colds
-sinusitis
-vigorous nose-blowing
-trauma
-changes in weather
-coagulation disorders (e.g., thrombocytopenia or Von Williebrand disease)
-Anticoagulant medication (e.g. aspirin, DOACs or warfarin)
-Snorting cocaine
-Tumours (e.g., squamous cell carcinoma)
5
Q
Bleeding is usually unilateral. Bleeding from both nostrils may indicate bleeding posteriorly in the nose. Posterior bleeding presents a higher risk of … of blood.
A
aspiration
6
Q
You may have to advise patients on how to manage a nosebleed in an exam:
A
Sit up and tilt the head forwards (tilting the head backwards is not advised as blood will flow towards the airway)
Squeeze the soft part of the nostrils together for 10 – 15 minutes
Spit out any blood in the mouth, rather than swallowing
7
Q
When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, bleeding is from both nostrils, or haemodynamically unstable, patients may require hospital admission. Treatment options are:
A
Nasal packing using nasal tampons or inflatable packs
Nasal cautery using silver nitrate sticks
After treating an acute nosebleed, consider prescribing Naseptin nasal cream (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection. This is contraindicated in peanut or soya allergy.
8
Q
What is otitis media?
A
Infection in the middle ear
9
Q
What is the middle ear and what is found here?
A
The space that sits between the tympanic membrane (ear drum) and the inner ear.
This is where the cochlea, vestibular apparatus and nerves are found.
10
Q
A bacterial infection of the middle ear is often preceded by a …
A
viral upper respiratory tract infection
11
Q
Otitis media may be caused by bacteria, which can enter from the back of the throat through the …
A
eustachian tube
12
Q
What is the most common bacterial cause of otitis media and also rhino-sinusitis and tonsilitis?
A
streptococcus pneumoniae
13
Q
Apart from streptococcus pneumoniae, name other common causes of otitis media
A
-Haemophilus influenzae
-Moraxella catarrhalis
-Staphylococcus aureus
14
Q
Presentation of otitis media
A
-ear pain, reduced hearing
-general symptoms of upper respiratory infection such as fever, cough, coryzal symptoms, sore throat, and feeling generally unwell.
-when the infection affects the vestibular system it can cause balance issues and vertigo.
-when the tympanic membrane has perforated there may be discharge from the ear
-symptoms in children can be very non-specific such as fever, vomiting, irritability, lethargy or poor feeding.
15
Q
How should the tympanic membrane look in normal children?
A
pearly-grey, translucent and slightly shiny
16
Q
What does cone of light in an ear mean?
A
The cone of light or light reflex is a visible phenomenon which occurs upon examination of the tympanic membrane with an otoscope. Shining light of the tympanic membrane causes a cone-shaped refection of light to appear in the anterior inferior quadrant.
17
Q
How does otitis media look?
A
Otitis media will give a bulging, red, inflamed looking membrane. When there is a perforation, you may see discharge in the ear canal and a hole in the tympanic membrane.
18
Q
What is otorrhoea?
A
Ear discharge
19
Q
Most cases of otitis media resolve within 3 days without antibiotics but what is the first line choice of antibiotics?
A
-Amoxicillin for 5 days
-Alternatives= erythromycin and clarithromycin
20
Q
Complications of otitis media
A
-otitis media with effusion
-hearing loss )usually temporary
-perforated eardrum (tympanic membrane
-recurrent infection
-mastoiditis (rare)
-abscess (rare)
21
Q
what is the medical name for eardrum?
A
Tympanic membrane
22
Q
What are acoustic neuromas?
A
Benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear.
AKA vestibular scheannomas
23
Q
What are Schwann cells?
A
Schwann cells are found in the peripheral nervous system and provide the myelin sheath around neurones.
24
Q
Where do acoustic neuromas occur?
A
At the cerebellopontine angle and are sometimes referred to as cerebellopontine angle tumours.
25
What are bilateral acoustic neuromas associated with/indicate?
Neurofibromatosis type II (a genetic condition that causes tumours to grow along your nerves).
26
Typical presentation of acoustic neuromas?
Aged 40-60 with gradual onset of:
-unilateral sensorineural hearing loss
-unilateral tinnitus
-dizziness or imbalance
-a sensation of fullness in the ear
-can also be associated with facial nerve palsy if the tumour grows large enough to compress the facial nerve
27
What is used to assess hearing loss?
Audiometry
28
What pattern of hearing loss is seen in acoustic neuromas?
Sensorineural
29
What is the difference between sensorineural and conductive hearing loss?
-Sensorineural hearing loss results from damage to the hair cells within the inner ear, the vestibulocochlear nerve, or the brain's central processing centres.
-Conductive hearing loss results from the inability of sound waves to reach the inner ear e.g. wax, fluid, otitis media, benign tumours
30
Name the notable risks associated with treatment of acoustic neuromas
-Vestibulocochlear nerve injury with permanent hearing loss or dizziness
-Facial nerve injury, with facial weakness
31
What is benign paroxysmal positional vertigo (BPPV)?
It is a common cause of recurrent episodes of vertigo triggered by head movement. It is a peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain. It is more common in older adults.
32
What is the presentation of benign paroxysmal positional vertigo?
-a variety of head movements can trigger attacks of vertigo e.g. turning over in bed
-symptoms settle after around 20-60 seconds, and patients are asymptomatic between attacks.
-often episodes occur over several weeks and then resolve but can reoccur weeks or months later
-BPPV does not cause hearing loss or tinnitis
33
Pathophysiology of benign paroxysmal positional vertigo?
BPPV is caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals.
This occurs most often in the posterior semicircular canal.
They may be displaced by a viral infection, head trauma, ageing or without a clear cause.
The crystals disrupt the normal flow of endolymph through the canals, confusing the vestibular system. Head movement creates the flow of endolymph in the canals, triggering episodes of vertigo.
34
Name the 3 manoeuvres/exercises associated with BPPV
-Dix-Hallpike Manoeuvre (for diagnosis)
-Epley Manoeuvre (to treat)
-Brandt-Daroff Exercises (to improve symptoms)
35
What is Meniere's disease?
A long-term inner ear disorder that causes recurrent attacks of vertigo, and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear.
36
What is the typical triad of Meniere's disease?
-Hearing loss
-Vertigo
-Tinnitus
37
Pathophysiology of Meniere's disease
Meniere's disease is associated with the excessive build up of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals. This increased pressure of the endolymph is called endolymphatic hydrops.
38
Presentation of Meniere's disease
-typical patient is 40-50 years old, presenting with unilateral episodes of vertigo, hearing loss (sensorineural and unilateral) and tinnitus
-other symptoms=a sensation of fullness in the ear, unexplained falls ("drop attacks") without loss of consciousness, imbalance
-spontaneous nystagmus (involuntary movement of the eyes) may be seen during an acute attack, usually unidirectional.
39
Management of Meniere's disease
For acute attacks to manage symptoms:
-Prochlorperazine
-Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
Prophylaxis is with:
-Betahistine
40
What is otitis extrena?
Inflammation of the skin in the external ear canal. The infection can be localised or diffuse. It can spread to the external ear (pinna). It can be acute (less than 3 weeks) or chronic.
41
Risk factors and protective factor of otitis externa
Risk factors:
-Otitis externa is sometimes called swimmers ear, as exposure to water can lead to inflammation in the ear canal.
-Trauma in the ear canal (e.g., from cotton buds or ear plugs)
Protective factor:
Ear wax (cerumen)
42
Causes of inflammation in otitis externa
-bacterial infection (pseudomonas aeruginsoa and staphylococcus aureus)
-fungal infection (e.g., aspergillus or candida)
-eczema
-seborrhoeic dermatitis
-contact dermatitis
43
What bacteria can colonise the lungs in patients with cystic fibrosis
Pseudomonas aeruginosa
44
Presentation of otitis externa
ear pain, itchiness, discharge, conductive hearing loss (if the ear becomes blocked)
45
What does examination show in otitis externa?
-erythema and swelling in the ear canal
-tenderness of the ear canal
-pus or discharge in the ear canal
-lymphadenopathy
-the tympanic membrane may be obstructed by wax or discharge
46
Treatment for mild otitis externa
Acetic acid 2% (EarCalm over the counter)
Acetic acid has an antifungal and antibacterial effect.
This can also be used prophylactically before and after swimming in patients that are prone to otitis externa
47
How is moderate otitis externa treated?
Topical antibiotic and steroid:
-Neomycin, dexamethasone and acetic acid (e.g., Otomize spray)
48
How is otitis externa treated in patients with severe or systemic symptoms?
Oral antibiotics e.g. flucloxacillin or clarithromycin
If the canal is very swollen, an ear wick may be used
49
Otitis externa caused by a fungal infection can be treated with...
Clotrimazole ear drops
50
Most common treatment of otitis externa
Otomize ear spray (antibacterial, steroidal)
51
Aminoglycosides (e.g., gentamicin and neomycin) are potentially ... , rarely causing hearing loss if they get past the tympanic membrane. Therefore, it is essential to exclude a perforated tympanic membrane before using topical aminoglycosides in the ear.
Ototoxic
52
What is malignant otitis externa?
A severe and potentially life-threatening form of otitis externa, The infection spreads to the bones surrounding the ear canal and skull. It progresses to osteomyelitis of the temporal bone of the skull.
53
Malignant otitis externa is usually related to underlying risk factors for severe infection, such as:
Diabetes
Immunosuppressant medications (e.g., chemotherapy)
HIV
54
Granulation tissue at the junction between the bone and cartilage in the ear canal (about halfway along) is a key finding that indicates...
malignant otitis externa
55
malignant otitis externa requires emergency treatment with:
-admission to hospital under the ENT team
-IV antibiotics
-Imaging (CT or MRI head) to assess the extent of the infection
56
Complications of malignant otitis externa
-facial nerve damage and palsy
-other cranial nerve involvement
-meningitis
-intracranial thrombosis
-death
57
What is sinusitis?
Sinusitis refers to the inflammation of the paranasal sinuses in the face. This is usually accompanied by inflammation of the nasal cavity and can be referred to as rhinosinusitis.
Rhinosinusitis is the preferred term because inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa
58
acute sinusitis is less than...
12 weeks
59
Function of the paranasal sinuses
Lightening the weight of the head, supporting the immune defence of the nasal cavity, humidifying inspired air, increasing resonance of the voice
60
Name the 4 sets of paranasal sinuses
-Frontal
-Maxillary
-Ethmoid
-Sphenoid
61
Inflammation of the sinuses can be caused by:
-infection, particularly following viral upper respiratory tract infections
-allergies
-obstruction of drainage due to a foreign body or polyps
-smoking
Patients with asthma are more likely to suffer from sinusitis
62
The typical presentation of acute sinusitis is someone with a recent viral upper respiratory tract infection presenting with:
-nasal congestion
-nasal discharger
-facial pain or headache
-facial pressure
-facial swelling
-loss of smell
63
Examination findings in sinusitis
-tenderness to palpation of the affected areas
-inflammation and oedema of the nasal mucosa
-discharge
-fever
-other signs of systemic infection (e.g., tachycardia)
64
Treatment for sinusitis
-Most are caused by viral infection which resolves within 2-3 weeks so no treatment needed.
OR
-high dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily)
-delayed antibiotic prescription (phenoxymethylpenicillin)
65
Options for chronic sinusitis
-Saline nasal irrigation
-Steroid nasal sprays or drops (mometasone or fluticasone)
-Functional endoscopic sinus surgery (FESS)- to correct obstruction caused by swollen mucosa, bone, polyps or a deviated septum
66
Proper technique for nasal spray
Tilting the head slightly forward
Using the left hand to spray into the right nostril, and vice versa (this directs the spray slightly away from the septum)
NOT sniffing hard during the spray
Very gently inhaling through the nose after the spray
67
Name for surgery that corrects a deviated septum
Septoplasty
68
What is tonsitilis
Inflammation of the tonsils
69
Most common cause of tonsilitis
viral infection e.g. influenza
70
Most common cause of bacterial tonsilitis
group A streptococcus (streptococcus pyogenes)
71
Treatment for Streptococcus pyogenes infection
penicillin V (phenoxymethylpenicillin)
72
Most common cause of otitis media and rhinosinusitis
Streptococcus pneumoniae
73
What is Waldeyer's Tonsillar Ring?
The tonsils are collections of lymphatic tissue within the pharynx. They collectively form a ringed arrangement, known as Waldeyer's ring:
Pharyngeal (adenoid) , tubal (X2), palatine (x2) and lingual tonsil
74
What are the tonsils classified as and what is their function?
Mucosa-associated lymphoid tissue (MALT), and therefore contain T cells, B cells and macrophages.
They have an important role in fighting infection- the first line of defence against pathogens entering through the nasopharynx or oropharynx.
75
Which tonsils are typically infected and enlarged in tonsilitis?
The palatine tonsils
76
Name all the tonsils in descending order
Adenoid
2 tubal
2 palatine
lingual
77
Features of tonsilitis
-typical presentation= a child with a fever, sore throat and painful swallowing
-non-specific symptoms e.g. fever, poor oral intake, headache, vomiting or abdominal pain
-inflamed, enlarged tonsils with or without exudates (white patches of pus on tonsils)
Always examine the ears (otoscopy) to visualising the tympanic membranes and palpate for any cervical lymphadenopathy when assessing a child with suspected tonsillitis.
78
What is the Centor criteria?
Centor Criteria
The Centor criteria can be used to estimate the probability that tonsillitis is due to a bacteria infection, and will benefit from antibiotics.
A score of 3 or more gives a 40 – 60 % probability of bacterial tonsillitis, and it is appropriate to offer antibiotics. A point is given if each of the following features are present:
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)
79
What is FeverPAIN score?
The FeverPAIN score is an alternative to the Centor criteria. A score of 2 – 3 gives a 34 – 40% probability and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:
Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
80
What is the choice of antibiotic for tonsilitis
Penicillin V (phenoxymethylpenicillin) for a 10 day course (tastes bad)
Clarithromycin is the first line choice in true penicillin allergy
81
Complications of tonsilitis
Chronic tonsillitis
Peritonsillar abscess, also known as quinsy
Otitis media if the infection spreads to the inner ear
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
82
What is epiglottitis and what causes it?
Epiglottitis is inflammation and swelling of the epiglottis caused by infection, typically with haemophilus influenza type B. The epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing. Therefore, epiglottitis is a life threatening emergency.
83
Presentation suggesting possible epiglottitis
Patient presenting with a sore throat and stridor
Drooling
Tripod position, sat forward with a hand on each knee
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance
84
why is epiglottitis rare?
Epiglottitis is now rare due to the routine vaccination program, which vaccinates all children against haemophilus. You need to be extra cautious and have high suspicion in children that have not had vaccines. It can present in a similar way to croup, but with a more rapid onset. In you exams keep a lookout for an unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling and suspect epiglottitis.
85
investigations in epiglottitis
If the patient is acutely unwell and epiglottitis is suspected then investigations should not be performed. Performing a lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”. This is a soft tissue shadow that looks like a thumb pressed into the trachea. This is caused by the oedematous and swollen epiglottis. Neck xrays are also useful for excluding a foreign body.
86
management in epiglottis
Epiglottitis is an emergency and there is an immediate risk of the airway closing. A key point that is often talked about with epiglottitis is the importance of not distressing the patient, as this could prompt closure of the airway. If you see a child with suspected epiglottitis, leave them well alone and in their comfort zone. Don’t examine them and don’t make them upset. The most important thing is to alert the most senior paediatrician and anaesthetist available.
Management of epiglottis centres around ensuring the airway is secure. Most patients do not require intubation, however there is an ongoing risk of sudden upper airway closure, so preparations need to be made to perform intubation at any time. Intubation is often difficult and needs to be performed in a controlled environment with facilities available to do a tracheostomy (intubating through the neck) if the airway completely closes. When patients are intubated they are transferred to an intensive care unit.
Additional treatment once the airway is secure:
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)
87
prognosis of epiglottitis
Most children recover without requiring intubation. Most patients that are intubated can be extubated after a few days and also make a full recovery. Death can occur in severe cases or if it is not diagnosed and managed in time.
A common complication to be aware of is the development of an epiglottic abscess, which is a collection of pus around the epiglottis. This also threatens the airway, making it a life threatening emergency. Treatment is similar to epiglottitis.
88
What is tinnitus?
Tinnitus refers to a persistent addition sound that is heard but is not present in the surrounding environment.
The additional noise experienced with tinnitus is thought to be the result of a background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system.
In a quiet enough environment, almost everyone will experience some background noise (tinnitus). This becomes more prominent the more attention it is given.
89
Causes of primary tinnitus
Primary tinnitus has no identifiable cause and often occurs with sensorineural hearing loss
90
What are the causes of secondary tinnitus?
-Secondary tinnitus refers to tinnitus with an identifiable cause.
-Impacted ear wax
-Ear infection
-Meniere's disease
-Noise exposure
-Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
-Acoustic neuroma
-Multiple sclerosis
-Trauma
-Depression
91
What systemic conditions can tinnitus be associated with?
-anaemia
-diabetes
-hypothyroidism or hyperthyroidism
-hyperlipidaemia
92
What is objective tinnitus and what causes it?
Objective tinnitus refers to when the patient can objectively hear an extra sound within their head. This sound can also be observable on examination by auscultation with a stethoscope around the ear.
Causes:
-Carotid artery stenosis (pulsatile carotid bruit)
-Aortic stenosis (radiating pulsatile murmur sounds)
-Arteriovenous malformations (pulsatile)
-Eustachian tube dysfunction (popping or clicking noises)
93
Helpful analogy to explain primary tinnitus
I think of primary tinnitus as the ears trying to “turn up the volume” when they cannot hear the surrounding noises as well. This is a helpful way of explaining it to patients who have tinnitus associated with hearing loss. Using hearing aids allows the ears to pick up noises better and “turn the volume down”, improving the tinnitus. The actual cause of tinnitus is not entirely understood, so this is not entirely accurate, but it is a helpful analogy.
94
Investigations for tinnitus
-blood test- FBC (anaemia), glucose (diabetes), TSH (thyroid disorders), lipids (hyperlipidaemia)
-audiology
-imaging e.g., CT or MRI- may be rarely required doe underlying causes such as vascular malformations or acoustic neuromas
95
Red flags of tinnitus
Unilateral tinnitus
Pulsatile tinnitus
Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
Associated unilateral hearing loss
Associated sudden onset hearing loss
Associated vertigo or dizziness
Headaches or visual symptoms
Associated neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
Suicidal ideation related to the tinnitus
96
Management for tinnitus
-tends to improve/resolve without any interventions
-treat underlying cause such as impacted wax or infection
-hearing aids
-sound therapy (adding background noise to mask the tinnitus)
-cognitive behavioural therapy
97
What is vertigo?
The sensation that there is movement between the patient and their environment. They may feel like they are moving or that the room is moving. Often this is a horizontal spinning sensation. Vertigo is often associated with nausea, vomiting, sweating and feeling generally unwell.
98
Name the 3 sensory inputs that are responsible for maintaining balance and posture
-vision
-proprioception
-signals from the vestibular system
Vertigo is caused by a mismatch between these sensory inputs
99
What 2 types of problems cause vertigo?
-Peripheral problem, usually affecting the vestibular system
-Central problem, usually involving the brainstem or the cerebellum
100
Pathophysiology of vertigo
Vertigo is caused by a mismatch between the sensory inputs which are...
-vision
-proprioception
-signals from the vestibular system
101
Describe the vestibular system
-The vestibular apparatus is located in the inner ear. It consists of three loops called the semi-circular canals that are filled with fluid called endolymph.
These semi-circular canals are orientated in different directions to detect various movements of the head. As the head turns, the fluid shifts inside the canals. This fluid is detected by tiny hairs called stereocilia found in a section of the canal called the ampulla.
This sensory input of shifting fluid is transmitted to the brain by the vestibular nerve and lets the brain know that the head is moving in a particular direction.
The vestibular nerve carries signals from the vestibular apparatus to the vestibular nucleus in the brainstem and the cerebellum. The vestibular nucleus then sends signals to the oculomotor, trochlear and abducens nuclei that control eye movements and the thalamus, spinal cord and cerebellum. The cerebellum is responsible for coordinating movement throughout the body. Therefore, the vestibular signals help the central nervous system coordinate eye movements and other movements throughout the body.
102
What are the 4 most common causes of peripheral vertigo?
-Benign paroxysmal positional vertigo
-Meniere's disease
-Vestibular neuronitis
-Labyrinthitis
103
Causes of central vertigo
Central vertigo= pathology that affects the cerebellum or brainstem disrupt the signals from the vestibular system and cause vertigo:
-posterior circulation infarction (stroke)
-tumour
-multiple sclerosis
-vestibular migraine
104
What are some triggers of a vestibular migraine?
Stress, bright lights, strong smell, certain foods (e.g., chocolate, cheese, caffeine), dehydration, menstruation, abnormal sleep patterns
105
Examinations for vertigo
-Ear examination
-Neurological examination
-Cardiovascular examination
-Cerebellar examination: DANISH
Dysdiadochokinesia
Ataxic gait (ask patient to walk heel-to-toe)
Nystagmus
Intention tremor
Speech
Heel-shin test
-Romberg's test
-Dix-Hallpike manoeuvre (to diagnose BPPV)
-HINTS examination (to distinguish between central and peripheral vertigo)
106
What is the HINTS examination?
The HINTS examination is used to distinguish between central and peripheral vertigo:
HI-Head Impulse (positive = peripheral)
Nystagmus (bilateral or vertical nystagmus suggest central cause)
Test of Skew (aka alternate cover test) (vertical correction = central cause)
107
Short-term options for managing symptoms of peripheral vertigo
-Prochlorperazine
-Antihistamines
108
Dysphonia meaning
Hoarseness
109
What is commonly known as glue ear?
otitis media with effusion (otoscopic examination reveals viscous bubbles behind the tympanic membrane) AKA serous otitis media
110
Why should all adults exhibiting unilateral signs of glue ear (otitis media with effusion) have an urgent 2 week referral?
Due to the potential risk that a posterior nasal space tumour could be altering Eustachian tube pressure
111
Treatment for patients with sudden-onset sensorineural hearing loss?
High-dose oral corticosteroids e.g. prednisolone
112
What is Ramsey hunt syndrome?
Shingles affecting the facial nerve.
Results in ear pain, vesicles in the external ear canal associated with deafness and vertigo
113
Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as...
Ludwig's angina
114
What does coryza mean?
Acute inflammation of the mucous membrane of the nose, with discharge of mucus; a head cold
115
In tonsilitis, what does uvular deviation indicate?
development of a peritonsillar abscess (quinsy)
116
What is presbycusis?
Bilateral age-related hearing loss
117
Which bone in the ear is affected the most by otosclerosis?
Stapes
118
Name some ototoxic medications
Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
119
What electrolyte disturbance is most likely after thyroid surgery?
Hypocalcaemia- due to damage of parathyroid glands
120
Name features of otosclerosis
-onset in usually at 20-40 years
-conductive deafness
-tinnitus
-positive family history
-majority have normal tympanic membrane
121
What is myringoplasty for?
operation to close perforated tympanic membrane
122
Name a common cause of bacterial otitis media
Haemophilius influenzae
123
A history of ... is a recognised risk factor for recurrent or persistent OME, which may continue even after surgical intervention such as palatoplasty. Consequently, patients with this congenital anomaly should be referred to an ear, nose and throat (ENT) specialist due to the heightened risk of hearing loss that can lead to delays in speech and language development.
cleft palate
124
Describe vestibular neuronitis
Vestibular neuronitis is characterised by isolated, spontaneous vertigo and is thought to develop due to inflammation of the vestibular nerve following a viral infection. It is associated with spontaneous onset of rotational vertigo, which can present on waking. As in this patient, the vertigo is worsened by changes in head position, although is usually constant even when the head is still. Horizontal nystagmus is usually present and this is always unilateral. Unlike the differential diagnosis of labyrinthitis, vestibular neuronitis is not associated with hearing loss or tinnitus. In this patient, coryzal symptoms followed by the development of acute vertigo with horizontal nystagmus alongside a lack of hearing loss or tinnitus points to vestibular neuronitis as the cause.
125
Difference between vestibular neuronitis and labyrinthitis
-Hearing loss or tinnitus is a feature of labyrinthitis
-No hearing loss or tinnitus with vestibular neuronitis
126
What is the first line antibiotic for treating bacterial otitis media?
Amoxicillin
127
NICE recommend that ... should be suspected in any patient with unexplained unilateral ear discharge that is not responsive to antibiotics.
cholesteoatoma
128
Name the most important causes of vertigo (6)
-viral labyrinthitis
-vestibular neuronitis
-benign paroxysmal positional vertigo
-Meniere's disease
-vertebrobasilar ischaemia
-acoustic neuroma
other causes :
-multiple sclerosis
-trauma
-posterior circulation stroke
-ototoxicity e.g. gentamicin
129
definition of vertigo
false sensation that the body or environment is moving
130
What is multiple sclerosis
An autoimmune condition where demyelination occurs causing various neurological symptoms depending on which part of the CNS are affected
131
What is the treatment for Ramsey Hunt syndrome?
Oral aciclovir and corticosteroids
132
What is Ramsey Hunt syndrome and what are the features?
Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
133
What is Samter's triad?
The association of asthma, aspirin sensitivity and nasal polyps
134
What is atopy?
Atopy refers to the genetic predisposition of experiencing an exaggerated immune response to allergens via an overproduction of immunoglobulin E (IgE).
The atopic triad typically consists of atopic dermatitis, asthma and allergic rhinitis.
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What are the most likely findings on an audiogram for Presbycusis?
Bilateral high-frequency hearing loss. Air conduction better than bone. Presents as sensorineural hearing loss.
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Air conduction is better than bone conduction in which type of hearing loss?
Sensorineural hearing loss
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Treatment in the acute phase of vestibular neuronitis
Prochlorperazine- short term
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Initial management of epistaxis
-resus or clinic room if active epistaxis
-ABCDE
-first aid advice- pressure and ice
-IV access + bloods
-TXA if heavy epistaxis
-IV fluids if required
-blood transfusion if required
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Subsequent management of epistaxis
-identify + stop bleeding is best choice
-apply co-phenylcaine soaked cotton balls +suction
-anterior vs posterior rhinoscopy
-cautery- AgNO3, electrocautery
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interventional options for epistaxis
-interventional radiology - arterial embolization
-surgical approach- tie off sphenopalatine artery, tie off maxillary artery, tie off external carotid artery
post treatment advice= Naseptin (contains peanuts) (antibiotic and disinfectant cream)or Bactroban,
first aid advice, epistaxis precautions
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What are some other causes of a sore throat (excluding bacterial and viral)
-referred pain
-gastro-oesophageal reflux
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What is trismus?
Spasm of the jaw muscles, causing the jaw to remain tightly closed
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