ENT Flashcards by Francis Katoa

Old age hearing loss name

Presbycusis

How well did you know this?

Not at all

Perfectly

Hearing loss history questions

Onset & progression
Symptoms: otorrhoea, otalgia
Vertigo, tinnitus or disequilibrium
Headaches (acoustic neuroma)
Exposure to loud noise
Head trauma, ear trauma, barotrauma
Ear surgery
Recurrent ear infections, major infections
Family history
Ototoxic medications: frusemide, gentamicin
Systemic symptoms; eg thyrotoxicosis (late stage)

How well did you know this?

Not at all

Perfectly

Examination for hearing loss

Otoscopy
Pneumatic otoscopy
Weber & Rinne test
Cranial nerve exam

How well did you know this?

Not at all

Perfectly

Conductive hearing loss causes

OUTER EAR
- Otitis externa
- trauma
- Wax
- Exostotsis
- Osteoma
- Congenital atresia

MIDDLE EAR
- Otitis media
- Cholesteatoma
- Otosclerosis
- TM perforation
- Temporal bone trauma
- Congenital atresia

How well did you know this?

Not at all

Perfectly

Sensorineural hearing loss causes

Presbycusis (age related sensorineural HL)
Hereditary hearing loss
Accoustic neuroma
Menier’s
Ototoxic drugs
Noise exposure
CVA
Barotrauma
Meningitis
Thyrotoxicosis

How well did you know this?

Not at all

Perfectly

History questions for Ear ache

Fever
Otorrhoea
Hearing loss
URTI /coryzal symptoms (most AOM, OME follow on from nasal congestion/infection)
Swimming (OE) (barotrauma)
ATSI
Trauma
Speech issues
Attention /behaviour /school issues
Balance issues
Second hand smoke exposure
Air travel (barotrauma)

How well did you know this?

Not at all

Perfectly

Indications for antibiotics in acute otitis media

<6m
Bilateral <2
Systemically unwell
ATSI
Otorrhoea (perforation)
Immunocompromised
Cochlear implant

How well did you know this?

Not at all

Perfectly

Analgesia in AOM

Paracetemol 15mg/kg

Lignociane 2% 1-2 drops to INTACT TM

Ibuprofen 10mg/kg

How well did you know this?

Not at all

Perfectly

Acute otitis media NON Aboriginal no red flags

Analgesia
Review 48 hours –> can give abx then
Review 3 months to ensure effusion resolved

How well did you know this?

Not at all

Perfectly

Persistent otitis media with effusion AKA

Glue ear

How well did you know this?

Not at all

Perfectly

Features of chronic suppurative OM

Infection of middle ear
Perforated TM
Discharge
TIME COURSE: > 6 weeks

How well did you know this?

Not at all

Perfectly

Treatment for Chronic suppurative OM

Dry Aural Toilet 6hourly
Ciprofloxacin 0.3% 5 drops BD until no d/c for 3days

How well did you know this?

Not at all

Perfectly

OME (otitis media with effusion) Definition

Middle ear effusion without:
- Bulging membrane,
- fever

Looks like
- Loss of lucency
- Grey/white fluid
- Immobile TM with dilated vessels

How well did you know this?

Not at all

Perfectly

OME referral for grommets (tympanostomy)

<3 months of OME
BUT with hearing loss and or learning/speech problems

> 3 months
Bilateral hearing loss

How well did you know this?

Not at all

Perfectly

ATSI persistent otitis media with effusion (glue ear) for >3 months

Refer for hearing assessment
Consider 2-4 weeks of abx (amox 50mg/kg/day)
Referral to ENT if OME> 3 months OR DB>20 loss in better ear

How well did you know this?

Not at all

Perfectly

ATSI Acute Otitis Media with poor compliance antibiotics

Azithromycin 30mg/kg stat day 1 and 7

How well did you know this?

Not at all

Perfectly

ATSI AOMwiP (with perforation) management
= Small hole (difficult to see) but with discharge

Amox 50-90mg/kg/day for 14 days

OR
Single dose azithromycin 30mg/kg

Review at day 7
If no better then 90mg/kg amox or second dose azithro

How well did you know this?

Not at all

Perfectly

ATSI Recurrent AOM (rAOM)

Prophylactic not routine
but consider
Amox 50/mg on time per day for 3-6 months
??seems like a massive dose. (if child is <2)

How well did you know this?

Not at all

Perfectly

ATSI chronic suppurative OM (CSOM)
= visible perf and discharge

Clean pus
Cipro 0.3% ear drops 5 drops BD
Add amox 50-90mg/kg/day if perf not readily visible
Continue for at least 3 days after ear becomes dry3

How well did you know this?

Not at all

Perfectly

Tinnitis - causes

External ear:
- wax
- OE

Middle ear:
- OM
- Otosclerosis
- Cholesteatoma

Inner ear
- Schwannoma
- Menniers
- Ototoxicity
- nueritis

Non Auditory cuases
- Vascular anomalies
- Nasopharyngeal carcinoma

How well did you know this?

Not at all

Perfectly

Imaging for tinnitis - when is it reasonable?

Pulsatile
- Vascular cause- get CT angio

Unilateral
- Focal lesion

Asymmetrical hearing loss
- MRI

How well did you know this?

Not at all

Perfectly

Risk factors for head and neck cancers

Smoking
etOH
> 40
Previous neck malignancy

How well did you know this?

Not at all

Perfectly

RED flags for head and neck masses

Mass <2 weeks
Voice change
Dysphagia, odynophagia
Otaliga, epistaxis, nasal obstruction (ipsilateral)
Weight loss, loss of apetite

How well did you know this?

Not at all

Perfectly

Investigation of neck mass

CT with contrast
FNA

Oral /mucosal ulcer: time course for suspicion?

>2 weeks (as cell turnover <10 days)

Leukoplakia & erythroplakia- what to do?

Biopsy is mandatory NOTE: white plaques vs red plaques

Jaw swelling first line investigation

OPG

Otitis media step wise approach (no red flags)

1.Analgesia and review 48 hours 2. Amoxicillin 15mg/kg TDS for 5 days 3. If not improving at 48 hours: Augmentin DF (22.5/3.2mg/kg) BD 5 days

Intranasal antihistamine example

Azelastine 1mg/ml 1 spray each nostril BD

Allergic rhinitis intranasal cortisteroid

Mometasone 100microg daily 4 weeks then 50microg (2 spray to 1 spray) = Nasonex

Allergic rhinitis combination therapy

Azelastine + fluticasone propionate 125+50mcg 1 spray BD Olopatadine & mometasone 665+25mcg 2 sprays BD

Allergic rhinitis severe: intranasal atrovent

Ipatropium 44 mcg (2 sprays each nostril up to TDS

Caution with intranasal decongestants

Rhinitis medicamentosa (rebound congestion)

What type of hearing loss (specific)

Presbyacusis

Type of hearing loss pattern?

Sensorineural

Type of hearing loss pattern?

Conductive

Type of hearing loss pattern?

Noise induced hearing loss (sensorineural)

Otosclerosis features & managment

- Conductive hearing loss - Develops 20s-30s - Family hx (autosomal dominant) - Lower frequencies then progresses REFERRAL TO ENT (consider stapedectomy)

Symptomatic relief of acute rhino-sinusitis

- Simple analgesia - Saline nasal preparations - Intranasal corticosteroid - Intranasal decongestant (short term) - Intranasal ipatropium

Acute rhino-sinusitis- antibiotic regime & step wise

Shared decision making Amoxicillin 15mg/kg (up to 500mg) TDS 5 days Review in 5 days Step up to Augmentin DF (22.5/3.2 mg/kg) BD 5 days

Middle ear effusion (OME) time course for referral

Persistent >3 months --> ENT REFERRAL

Cervical lymphadenitis Abx

Cephalexin 12.5mg (up to 500mg) 6hourly for 7 days

Persistent Cervical Lymphadenopathy (2-6 weeks) paeds investigations

- FBC, blood film - CRP, ESR - LDH - LFT - Serology; EBV/CMV/HIV - Toxoplasmosis/Bartonella Henselae - TB - CXR - Neck USS - biopsy (excisional is gold standard, FNA less helpful)

What is the cause of 90% of unilateral hearing loss?

Idiopathic

Treatment of idiopathic SNHL

Prednisolone 1mg/kg up to 60mg for 7-14 days

Menier's disease management

- Hydrochlorothiazide 25mg daily - Betahistine - Vestibular rehabilitation

AOM with perforation antibiotics

Amoxicillin 15mg/kg TDS for 5 days ADD Ciprofloxacin drops

weber test: Lateralising to one side. 2 options

Sensorineural hearing loss in the other ear Conductive in that ear

Menniers non- pharmacological advice

Sodium <2g /day Limit caffeine Limit etOH Referral to audiologist for hearing aid Referral to AEP for vestibular rehab

Menniers pharmacological management

Hydrochlorothiazide 25mg daily

Sore throat: RED flag populations necessitating antibiotics

- ABORIGINAL - Maori/ pacific islanders - RF or RHD - Family history of RHD or RF - Immunosuppressed

Dose of Phenoxymethylpenicillin for Strep Pharyngitis (and alternative for non compliance)

PMP 15mg/kg up to 500mg 12hourly for 10 days Benzathine benzylpenicillin IM stat dose

Tympanostomy Tube Otorrhoea (TTO)

Dry mopping Topical ciprofloxacin 5drops BD 7 days

Sudden onset (idiopathic) sensorineural hearing loss treatment

Prednisone 60mg 7-14 days

Mometasone dose for a child

50 microg each nostril daily

Mennier's pharmacotherapy

HCT 25mg daily

Vestibular Neuritis Pharmacology

Prednisolone 1mg/kg (up to 75mg) daily for 5 days

Examination for hearing loss (what are your three key exams)

Otoscopy Weber and rinnes Cranial nerve exam

Persistent Cervical Lymphadenopathy (2-6 weeks) paeds investigations

- FBC, blood film - CRP, ESR - LDH - LFT - Serology; EBV/CMV/HIV - Toxoplasmosis/Bartonella Henselae - TB - CXR - Neck USS - biopsy (excisional is gold standard, FNA less helpful)