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ENT Flashcards

(45 cards)

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1
Q

Identify these parts of the ear

A

A Malleus
B Incus
C Stapes
D Semicircular canals
E Cochlea
F Vestibular nerve
G Cochlear nerve
H Eustacian tube
I Tympanic cavity
J Tympanic membrane
K Auditory bulla
L Concha
M Pinna
N Antihelix

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2
Q

Where is the border between the outer and middle ear?

A

Tympanic membrane

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3
Q

Where is the border between the middle and inner ear?

A

In between the stapes and the cochlea

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4
Q

What are these structures/features?

A

A Malleus
B Incus
C Light reflex

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5
Q

What part of the ear is dysfunctional in conductive hearing loss?

A

External or middle ear. Usual causes include wax FBs and scar tissue

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6
Q

What parts of the ear are dysfunctional in sensorineural hearing loss?

A

The inner ear

Impairment develops with damage to the organ of Corti or the auditory nerves

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7
Q

What are the risks of cauliflower ear and what is the medical name for it?

What treatment is required?

A

Auricular haematoma

Blood accumulation in the sub perichondral space results in decreased blood flow, cartilaginous necrosis and infection

Prompt incision and drainage is required

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8
Q

What are the signs and symptoms of mastoiditis?

A

Tender red swollen painful mastoid
Otorrhea
Pyrexia
Fatigue
Headache
Hearing loss in the affected ear

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9
Q

What are the complications of mastoiditis?

A

Ossicular erosion
Facial paralysis (CNVII)
Abscess formation
Infection spreading (Meningitis, Labrynthitis)
Sinus thrombosis (cerebral veins)
Cholestaetoma (lump/cyst of dead cells behind ear)
Labrynthine fistula (hole)

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10
Q

What is the treatment for mastoiditis?

A

Urgent admission
IV ABx
Surgery
- drainage
- removal of part of mastoid bone

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11
Q

What is the medical name for ear wax?

A

Cerumen

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12
Q

What groups of people are more likely to develop deposits of wax?

A

Elderly and swimmers
Q-tip users

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13
Q

What are the symptoms of a buildup of earwax?

A

Earache
Hearing loss
Tinnitus
Itchiness
Ear infections

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14
Q

What is the treatment for earwax buildup?

A

Self treatment with ear drops (oil) to soften the wax and help it fall out

If no improvement after 1 week GP can use irrigation or micro-suction

Specialist ENT referral for severe cases

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15
Q

What is the treatment for FB in the ear?

A

Inert ear foreign bodies can often be removed by gentle syringing in the practice. If the foreign body is a living insect, oil instillation will suffocate and kill them.

Not all foreign bodies, particularly in ears, need to be removed. Small, inert foreign bodies, for example plastic beads, often migrate out of the ear with wax or during water exposure (swimming, bathing, shower).

Paramedics OOH should not attempt to remove FBs of the ear. Hospital/UTC is recommended if GP is unavailable or will take too long (esp if child is distressed)

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16
Q

What are the symptoms of Otitis Externa?

A

Red, painful and itchy ear canal
Discharge along ear canal
Reduced hearing
Pressure and fullness of air
Swollen and sore glands
Flaky skin (eczema)

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17
Q

What causes otitis externa?

A

Most commonly a bacterial infection, scratching and water increase the risk by opening the skin and providing ideal growth areas.

Irritation allergies and fungal infections can also happen

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18
Q

What is the treatment of otitis externa?

A

It is usually self limiting but recovery can be improved by limiting water in the ear and removing pus and any irritants

Eardrops and analgesics are also recommended.

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19
Q

What is the cause of tympanic membrane rupture and how is it treated?

Study These Flashcards
A

Caused by trauma, blast injuries and blows to the head

It is usually self healing and supportive care is sufficient (avoiding water and foreign bodies)

Persistent deafness may indicate damage or displacement of ossicular chain and may require surgery

20
Q

What is otitis media, what are the symptoms?

Study These Flashcards
A

Presence of inflammation in the middle ear, usually associated with an effusion. Caused by viruses or bacteria.

Sx:
Pain
Pyrexia
Malaise
Headache
N&V
Tinnitus
Reduction in hearing

21
Q

What are the symptoms of otitis media in children?

Study These Flashcards
A

Young children may present with general symptoms including fever, crying, poor feeding,, restlessness, cough, rhinorrhoea.

Specific symptoms include holding, tugging and rubbing of the ear.

22
Q

What are the treatments for otitis media?

Study These Flashcards
A

ABx
Analgesia
Antipyrexics
Nasal decongestants
Gromits

23
Q

What are the red flags for otitis media?

Study These Flashcards
A

Severe headache
Nystagmus or blurred vision
Nausea or vomiting
Photophobia
Vertigo
High fever
Facial paralysis
Swollen/tender/red mastoid

Repeated/untreated episodes
- may lead to infections spreading and worsening

24
Q

What are the otoscopic signs of otitis media?

Study These Flashcards
A

Red bulging tympanic membrane sometimes with fluid collecting behind it (effusion)

25
What is labrynthitis? What are the symptoms?
An infection that causes inflammation to the inner ear and vestibulocochlear nerve. Usually a viral cause, in rare cases it can be bacterial. Some allergies and medications are also associated with it. Symptoms include: Dizziness Nausea and vomiting Loss of hearing Vertigo (constant and ongoing) Loss of balance Tinitus
26
What are the treatments for labrynthitis?
Anti emetics Vestibular sedatives ENT referrals Welfare support (falls risks, support for food work etc.)
27
What are three signs and symptoms of ENT involvement of a temporal bone fracture?
Mastoid ecchymosis (battle signs) Bloody otorrhoea Blood in middle ear Disziness Altered eye movements Facial muscle paralysis **CT Head req within 1hour** (NICE) Temporal fractures may require surgery, steroids prophylaxis ABx etc. in hospital.
28
What is an acoustic neuroma?
A rare slow growing tumour which presses on hearing and balance nerves. They are non cancerous but dangerous if left untreated. Hydrocephalus is a common complication.
29
What are the symptoms of an acoustic neuroma?
Unilateral hearing loss Tinnitus Occasional vertigo Ataxia (unilateral) Persistent headaches Blurred or double vision Unilateral facial weakness, paralysis or pain Voice changes or dysphasia
30
What is facial palsy (Balls palsy)? What are the symptoms?
Swelling of the facial nerve in three facial canal resulting in lower motor neurone paralysis of CN VII Symptoms include: - Sharp ear pain - Impaired or altered sense of taste - sensitivity to loud noise - inability to closea eye on affected side - dysphasia
31
What is treatment for Bells palsey?
80% of cases are self-limiting Steroids Eye care (drops and steroids)
32
What are the main complications of a nose fracture?
Deviated septum Septal haematoma Neck injury **Assosciated head injuries** **Airway obstruction especially in paeds (also safeguarding for paeds)**
33
How can you manage FBs in the nose?
Nasal foreign bodies often declare themselves with unilateral foul smelling discharge. Urgent intervention is required if the foreign body is a button battery as this can be immensely destructive. Less urgent are organic materials but they can be irritating. Fresh nasal foreign bodies can often be dislodged using the “mother’s kiss”. This works in about 60% of cases and even if not entirely successful might dislodge to foreign body enough to facilitate removal.
34
What considerations are there for epistaxis?
Structural abnormalities On anticoagulant therapy Hypertension Where is bleeding coming from (anterior/posterior) Cause Interventions done by them
35
What are the red flags of sinusitis?
High fever Sudden, severe pain in face Swelling, puffiness or redness around one or both eyes Double or loss of vision Confusion, drowsiness Neck stiffness
36
What are the red flags for foreign body throat obstruction?
Any signs of airway compromise: - Stridor - Dysphonia - Drooling Any signs of oesophageal perforation: - Chest pain - Surgical emphysema - Sepsis signs **Any history of button battery ingestion**
37
What virus causes glandular fever and what is the proper name for the infection?
Epstein-Barr virus (EBV), infectious mononucleosis (mono)
38
What are the symptoms of glandular fever?
Sore throat Lymphoedema Fever Fatigue Swollen tonsils Headache Muscle aches
39
What are the complications of glandular fever?
Blood cell problems (anaemia) Nervous system problems (meningitis, encephalitis, Guillian-Barre) Heart problems (myocarditis, pericarditis) Ruptured spleen
40
What would indicate a bacterial aetiology of pharyngitis?
No cough, no nasal congestion, no discharge
41
What risk must you consider with pharyngitis?
Risk of Group A Strep (GAP)
42
Where is strep A carried and what minor and major infections can it cause?
Carried in the throat and skin Minor infections include: - Scarlet fever - Impetigo - Cellulitis -Pharyngitis Major infections are caused by invasive group A strep (iGAS), which can lead to acute rheumatic fever.
43
What are the criteria for minor and major rheumatic fever (iGAS) infections?
Major: Joint involvement myOcarditis Nodules (subcutaneous) Erythema marginatum Sydenham chorea Minor: CRP raised Arthralgia Fever ESR raised Prolonged PR Anamnesis (Hx) of rheumatism Leukocytosis
44
What is erythema marginatum?
Reactive inflammatory erythema seen with acute rheumatic fever, psittacosis and hereditary angiodema. It can described as an evanescent, blanchable, non-pruitic macular rash seen generally on the trunk and extremities. It lasts hours to weeks healing with residual hypopigmentation.
45
What is Sydenham's chorea?
Sydenham's chorea, also known as rheumatic chorea, is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea is an autoimmune disease that results from childhood infection with Group A beta-haemolytic Streptococcus. Huntingdon's disease can also cause chorea.

PMMH (5 decks)

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