ENT Flashcards
Acoustic Neuroma
aka Vestibular schwannoma
account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours.
- vertigo, hearing loss, tinnitus and an absent corneal reflex.
- CN 8: unilateral sensorineural hearing loss, unilateral tinnitus
- CN 5: absent corneal reflex
- CN 7: Facial Palsy
Management
- Patients with a suspected vestibular schwannoma should be referred urgently to ENT
- MRI of the cerebellopontine angle is the investigation of choice.
- Audiometry is also important as only 5% of patients will have a normal audiogram.
- Surgery
Benign paroxysmal positional vertigo
sudden onset of dizziness and vertigo triggered by changes in head position. The average age of onset is 55 years and it is less common in younger patients.
- may be associated with nausea
- Dizziness when turning head suddenly
- lasts 10-20secs
- positive Dix-Hallpike manoeuvre
- Rotatory nystagmus is indicative of a positive Dix-Hallpike manoeuvre
Management
- Epley manoeuvre (successful in around 80% of cases)
- betahistine (not really helpful)
- Patients at home: Brandt-Daroff exercises
Epiglottitis
- Children – life threatening
- Adults – supraglottitis
Symptoms
* Fever
* Recent URTI
* Sitting forwards, drooling
* Sore throat
* Plummy voice
* Dysphagia
Causative organism:
* Children: H Influenzae type B
* Adults: Broad
Urgent ENT referral
Epistaxis
Anterior: Kiesselbach’s plexus affected Posterior bleed: originate from deeper structures - appear in elder pts and risk of choking
Management
- Minor case: Pinch the cartilaginous (soft) area of the nose firmly
Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis - cautery should be used initially if the source of the bleed is visible
use silver nitrate stick
only do one side - packing may be used if cautery is not viable or the bleeding point cannot be visualised
- Epistaxis that has failed all emergency management
may require sphenopalatine ligation in theatre
Infectious mononucleosis
glandular fever)
Caused by EBV aka HHV4
Other causes CMV and HHV6
- The classic triad of sore throat, pyrexia and lymphadenopathy
- resolves in 2-4 weeks
- blood film: Atypical lymphocytes = glandular fever
- haemolytic anaemia secondary to cold agglutins (IgM)
- splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
- hepatitis, transient rise in ALT
- Palatal petichae
Diagnosis
* heterophil antibody test (Monospot test)
Management
- rest during the early stages, drink plenty of fluid, avoid alcohol
- avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
Meniere’s disease
disorder of the inner ear of unknown cause, excessive pressure and progressive dilation of the endolymphatic system
- recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
- a sensation of aural fullness or pressure is now recognised as being common
- other features include nystagmus and a positive Romberg test
- lasts minutes-hours
- unilateral
- symptoms resolve in the majority of patients after 5-10 years
- Patients usually left with degree of hearing loss
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine
Otitis Externa
infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
seborrhoeic dermatitis
contact dermatitis (allergic and irritant)
recent swimming is a common trigger of otitis externa
Features
- ear pain, itch, discharge
- otoscopy: red, swollen, or eczematous canal
Management
- topical antibiotic or a combined topical antibiotic with a steroid
- 2nd line: empirical use of an antifungal agent
- ENT referral if unresolved
- Otitis externa in diabetics: treat with ciprofloxacin to cover Pseudomonas
Otitis Media
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
- otalgia
- some children may tug or rub their ear
- fever occurs in around 50% of cases
- hearing loss
- URTI symptoms
- bulging tympanic membrane → loss of light reflex
Management
* Usually self limiting
if more than 4 days or discharge from ears
- Amoxicillin
Can lead to mastoiditis, meningitis, brain abscess
Glue Ear
RF
male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking
- Glue ear describes otitis media with an effusion (other terms include serous otitis media). It is common with the majority of children having at least one episode during childhood
- grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
GLUE EAR IN ADULT = ENT Referal
Rhinosinusitis
atopy: hay fever, asthma nasal obstruction Septal deviation/nasal polyps
Chronic rhinosinusitis affects up to 1 in 10 people. It is generally defined as an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.
Features
- facial pain: typically frontal pressure pain which is worse on bending forward
- nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
- nasal obstruction: e.g. ‘mouth breathing’
- post-nasal drip: may produce chronic cough
Management
- avoid allergen
- intranasal corticosteroids
- nasal irrigation with saline solution
RED FLAGS
persistent symptoms despite compliance with 3 months of treatment
epistaxis
1.
Tonsillitis
and complications
Treatment: Penicllin or Metronidazole
Complications
- Quinsy - refer for surgical drainage or tonisillectomy if unresolved for 6 weeks
- Dysphagia - refer
Primary haemorrhage within hours after tonsillectomy requires immediate return to theatre
Vertigo
Dizziness / dysequilibrium- patient is
feeling unsteady
Vertigo- room is spinning or patient is
spinning around the room
viral labyrinthitis: Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Conductive Hearing loss Vs Sensorineural
Cholesteotoma
Cholesteatoma is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.
Main features
* foul-smelling, non-resolving discharge
* hearing loss
Other features are determined by local invasion:
* vertigo
* facial nerve palsy
* cerebellopontine angle syndrome
Otoscopy
* ‘attic crust’ - seen in the uppermost part of the ear drum
Management
* patients are referred to ENT for consideration of surgical removal
seborrhoeic dermatitis
Blepharitis may be present in cases of seborrhoeic dermatitis
