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MSPA4023 - Clinical medical & public heath > ENT > Flashcards

ENT Flashcards

(74 cards)

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1
Q

What is acute otitis media?

A

infection of the middle ear section, typically from the eustachian tube dysfunction

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2
Q

What is the eustachian tube?

A

Opening that connects the middle ear with the nasal-sinus cavity

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3
Q

What is the function of the eustachian tube?

A
  • equilibration of the middle ear with atmospheric pressure
  • Protect middle ear from reflux of nasopharyngeal content
  • Drain secretion from the middle ear into the nasopharyngeal
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4
Q

Causes of Eustachian tube dysfunction

A

Infection
- oedema of the eustachian tube
- adenoid hypertrophy
Failing of the
- tensor veli palatini
- levator veli palatini

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5
Q

Common infection species that occur in acute otitis media are_____

A

Streptococcus pneumoniae
Haemophilus influenzae
morexilla catarrhalls

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6
Q

What is the pathophysiology of acute otitis media?

A

–> Viral infection happens in the nasal cavity and causes congestion oedema
–> The oedema causes the eustachian tube occlusion and create negative pressure in the middle ear
–> Which can cause accumulation of the fluid in the middle ear
–> Leading to secondary viral and bacterial infection in the middle ear

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7
Q

What is suppurative otitis media?

A
  • It is where build-up pressure in the middle ear,
  • causing perforation of the tympanic membrane
  • and discharge (otorrhea)coming out of the ear
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8
Q

What terminology describes the discharge that comes out from the ear?

A

otorrhea

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9
Q

What is otitis media with effusion?

A

residual fluid in the middle ear cavity after acute otitis media

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10
Q

How can we resolve otitis media with effusion?

A

Nothing…it’ll resolve by itself after 3 months

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11
Q

recurrent acute otitis media definition

A

reinfection of the middle ear
/
The middle ear got infected again

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12
Q

Clinical presentation of otitis media

A

otalgia (ear pain)
pyrexia (fever)
hearing loss
otorrhea
—————————-
Upper respiratory tract infection
irritability
reduced appetite
fatigue

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13
Q

Otitis media is a sensory hearing loss/conductive hearing loss

A

conductive hearing loss

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14
Q

How can you diagnose otitis media?

A

direct visualization of the tympanic membrane with an otoscope / pneumatic otoscope
- culture of the middle ear

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15
Q

What is the first-line treatment for AOM?

A

oral analgesia & observe
*If no improvement after 24/48hrs
vv
Consider antibiotic therapy
(amoxicillin) –>5-7days

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16
Q

What is acute otitis externa?

A

Inflammation of the external auditory canal

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17
Q

how to know whether otitis externa is acute or chronic?

A

acute - less then 3 weeks
chronic - more than 3 months

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18
Q

How common is acute otitis externa?

A

most common in children and adolescents
ages around 7-12

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19
Q

Risk factors of otitis externa

A

Swimming
Humid air
Young age
Diabetes
Trauma
Narrow external auditory meatus
Obstructed external auditory meatus
Eczema, psoriasis
Radiotherapy

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20
Q

What is the most common cause of acute otitis externa?

A

Bacterial
Pseudomonas aeruginosa or Staphylococcus aureus

Fungal
Candida albicans or Aspergillus species.

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21
Q

Clinical features of otitis externa

A

Symptoms
- Itch
- Tenderness
- Hearing loss
- Discharge
Signs
- Inflamed external auditory canal
- Erythema
- Scaly skin
- Pre-auricular lymphadenopathy

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22
Q

investigation to diagnosis otitis externa

A

Ear swab (MC&S)

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23
Q

What is the treatment & management for otitis external?

A
  • cleaning the external canal
  • avoid swimming for at least 7-10 days
  • analgesia —> paracetamol and ibuprofen
  • topical antibiotic / topical steroid
    (ciprofloxacin w fluocinolone)
    -otomycin
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24
Q

what is mastoiditis?

A

a rare life-threatening complication of acute otitis media
Where infection of the mastoid air cells

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25
what is the typical clinical feature of mastoiditis?
pain swelling and erythema behind the ear systemic upset
26
What are the management to treat mastoiditis?
- early antibiotics - myringotomy (drain the middle ear with a hole in the tympanic membrane) - mastoidectomy (removal of infected tissue/bone)
27
What is Otosclerosis
Otosclerosis is a condition where there is remodelling of the small bones in the middle ear, leading to conductive hearing loss.
28
features about otosclerosis
- conducting hearing loss - more common in women - before 40years - development can be environmental/genetic but not fully understood - mostly autosomal dominant
29
what are the 3 auditory ossicles in the ears?
Malleus incus stapes
30
What does cochlea do in the ears?
coverts vibration into sensory signals
31
What is the site that binds between stapes and the cochlea?
Oval window
32
Explain the pathophysiology of otosclerosis
abnormal bone remodelling and formation of the oval window causing stiffening and fixation of the base of the stapes and leading to conductive hearing loss
33
Clinical presentation of otosclerosis
- can be unilateral/bilateral - affects hearing of lower-pitched sounds - can hear female speech easier - hearing loss - tinnitus - talks more quietly ^ (can hear their voice very loudly)
34
what examination can it be done to find otosclerosis?
otoscopy weber's test rinne's test
35
What result will it show in the examination of an otosclerosis patient?
otoscopy --> normal Weber's test bilateral --> normal result unilateral --> affected side will be louder Rinn's test --> Bone conduction - able to hear --> Air conduction - can't hear
36
What investigations can it be done to find otosclerosis?
Audiometry - conduction hearing loss tympanometry High-resolution CT scan
37
What is the management for otosclerosis?
Conservative - hearing aids surgical - stapedectomy - stapedotomy
38
What is the difference between stapedectomy and stapedotomy?
stapedectomy Replace the whole stapes, put a prosthesis in it and hook it around the oval window stapedotomy drill a whole of the base of the stapes and put a prosthesis between the incus and the base of the stapes
39
What is Presbucusis?
Age-related hearing loss. It is a type of sensorineural hearing loss that occurs as people get older. It tends to affect high-pitched sounds first and more notably than lower-pitched sounds. The hearing loss occurs gradually and symmetrically.
40
Causes of presbycusis
loss of hair cells loss of neurones atrophy of the stria vascularis reduce of the endolymphatic potential
41
Risk factors of presbycusis
increase age male family history *** Loud noise exposure diabetes hypertension ototoxic medication smoking
42
Clinical presentation of presbycusis
gradual and insidious hearing loss loss of high-pitched sounds -male voices are easier to hear not paying attention missing details of conversations concern about dementia tinnitus
43
Diagnosis of Presbycusis
Audiometry Normal at lower frequencies Worsening hearing loss at higher frequencies
44
Management of presbycusis
CAN'T REVERSED supporting normal function - optimising the environment - hearing aids - cochlear implants
45
What is acoustic neuroma?
Acoustic neuromas are benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear.
46
Where does the acoustic neuroma occur?
at the cerebellopontine angle
47
What do bilateral acoustic neuroma associate with?
neurofibromatosis type II
48
Clinical presentation of Acoustic neuroma
40-60s * unilateral sensorineural hearing loss * unilateral tinnitus - dizziness or imbalance sensation of fullness in the ear *leading to Facial nerve palsy ^ If the tumour grows large enough to compress the facial nerve
49
investigation for acoustic neuroma
Audiometry MRI / CT
50
Management & treatment for acoustic neuroma
Conservative - monitoring surgery - partial/total removal of tumour Radiotherapy - reduce the growth of the tumour
51
What are the risk factors for treatment in acoustic neuroma?
Injury to: - vestibulocochlear nerve -->hearing loss --> dizziness - facial nerve --> facial weakness
52
What is sinusitis
Sinusitis refers to inflammation of the paranasal sinuses in the face. This is usually accompanied by nasal cavity inflammation and can be referred to as rhinosinusitis.
53
How do we differentiate acute and chronic sinusitis?
Acute sinusitis - less then 12weeks chronic sinusitis - more than 12 weeks
54
What are the 4 sinuses in the nose?
Frontal Ethmoid sinuses Maxillary sinus Sphenoid
55
Causes of sinusitis
Infection - viral upper respiratory tract infection allergies - hayfever obstruction of drainage - foreign body, trauma, polyp smoking
56
Clinical presentation of sinusitis
- nasal congestion - nasal discharge - facial pain/headache - Facial pressure - facial swelling - loss of smell cough and sore throat
57
What is the likely cause of acute sinusitis?
viral upper respiratory tract infection
58
What will the examination show for a sinusitis patient?
tenderness inflammation and oedema discharge fever signs of systemic infection (tachycardic)
59
investigation of sinusitis
Nasal endoscopy sinus culture CT head
60
How to treat acute sinusitis?
Systemic infection/sepsis --> admission to hospital symptoms < 10days--> no antibiotics resolve within 2-3weeks symptoms >10days - steroid nasal spray 14 days (mometasone 200mcg twice a day) - delay antibiotic prescription (phenoxymethylpenicillin)
61
How to treat chronic sinusitis
saline nasal irrigation steroid nasal spray/drops functional endoscopic sinus surgery
62
What to do if a patient experiences recurrent episodes of sinusitis?
Refer to ENT specialist
63
another term for ear wax
cerumen
64
What is acute rhinosinusitis?
acute inflammation of the nose and paranasal sinuses
65
what's the difference between acute and chronic rhinosinusitis?
acute - less than 4 weeks chronic - more than 12 wwk
66
How does acute recurrent rhinosinusitis occur?
develop more than 4 episodes of acute rhinosinusitis within a year with resolution of symptoms between episodes
67
causes of sinuses
smoking obstruction o drainage allergies swimming and asthma Viral - Rhinovirus bacterial - Streptococcus pneumoniae - Haemophilus influenzae
68
Clinical Presentation for sinusitis
symptoms: - nasal congestion - nasal discharge - facial pain / headache - facial pressure - facial swelling over the affected areas - loss of smell - ear pain - fever Signs - tenderness to palpation fo the zygomatic arch / maxillary sinus - Erythema or swelling around the maxillofacial area
69
feature that support a bacterial over a viral infection in rhinosinusitis?
- persistent clinical features with no improvement more than 10 days - double worsening - persistent severe symptoms (fever, severe facial pain for 3-4 days)
70
Red flags on rhinosinusitis
Severe, persistent headache Periorbital oedema Visual changes (e.g. reduce acuity, double vision) Abnormal extra-ocular eye movements Cranial nerve palsies Proptosis Pain on eye movement Altered mental status Meningism: headache, neck stiffness, photophobia
71
What investigation would you do for rhinosinusitis?
Cultures: nasal, sputum, sinus, blood Bloods: FBC, U&E, LFT, Bone, CRP Facial and head imaging (e.g. CT, MRI)
72
When should you give antibiotics to patients with rhinosinusitis?
Not give antibiotics for up to 10 days
73
What treatment would you give to a patient with rhinosinusitis?
first-line - phenoxymethylpenicillin steroid nasal spray for 14days - mometasone 200mcg twice daily
74

MSPA4023 - Clinical medical & public heath (16 decks)

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