ENT 2 Flashcards by John Darlington

What is a serious infection of the ear that must be considered in someone presenting with severe otalgia and discharge, how is it diagnosed and what is the treatment?

Malignant/ necrotizing otitis media:
- severe infection usually pseudomonas

CT Scan to diagnosis - as can cause osteomyelitis of temporal bone

Treatment:

IV antibiotics
surgical debridement

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What are some differentials for otalgia:

Primary:

Otitis external
Otitis media
Barotrauma
Temporomandibular Joint Dysfunction

Referred:

Dental disease via 5th cranial nerve
Ramsay Hunt Syndrome via 7th cranial nerve
Throat/ mouth cancer via IX and X nerve
C1, C2 trauma

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What are the common organisms to cause otitis media?

H. Influenza
Pneumococcus
Moraxella

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What are the clinical signs of mastoiditis and how should it be treated?

Swelling behind the ear
Pushing anterior of the pinna
Pain

CT scan
IV antibiotics

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What are the complications of acute media otitis?

Intracerebral abcsess

Mastoiditis

Facial nerve palsy

Labyrinthitis

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What investigations are done into otitis media with effusion/ glue ear? and why do adults get more tests? and which group are particularly prone to the worrying factor?

Pure Tone Audiometry
Tympanogram - Type B will be shown

Flexible nasoendoscopy

ENT examination

*adults are at increased risk of nasopharyngeal carcinoma

**Young south asian males

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What is the biggest cause of hearing loss in children?

Otitis media with effusion/ Glue ear

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What can worsen otosclerosis?

Pregnancy

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What investigations and treatment should be given to someone presenting with sudden onset hearing loss?

Examination:

External ear (exclude conductance)
Tunning forks

Investigations:

FBC, U&Es, Coagulation, Autoimmune panel, ESR, CRP
Audiometry + audiological brainstem responses

Management if no underlying cause found:
- Prednisolone 80mg

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What investigations and management should be done into tinnitus?

Tinnitus:
defined as sound perceived by patient in the absence of stimulus for >minutes. without previous noise exposure.
- primary
- secondary (underlying condition)

Investigations:

Audiological assessment
Tympanogram
Cranial nerve examination
TFTs
FBC
U&Es
MRI of head

Management:

Habituation training
Tinnitus retraining therapy
CBT
Hearing aids to mask sound

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What are the diagnostic features for rhinosinusitis? and what is needed for a diagnosis of acute bacterial rhinosinusitis?

Nasal blockage 
Nasal discharge 
\+/- 
Fascial pain 
Loss of sense of smell

Bacterial, at least 3 of the following:

discoloured discharge
several localised pain
fever
high CRP
Double sickening
swelling is not that common

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What are the complications of bacterial rhinosinusitis?

Orbital cellulitis

Intracranial involvement

meningitis
cerebral abscess

Osteomyelitis

Pott’s puffy tumour
- osteomyelitis of frontal bone

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What is the criteria used to figure whether someone should receive antibiotics for a sore throat? and what antibiotic is prescribed for strep throat?

Centor Criteria

fever
swelling
lymph swelling
absence of cough

Penicillin V

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What are some differentials for a hoarse voice and how is it investigated?

Laryngeal cancer 
Laryngitis 
Reinke's oedema 
Vocal cord nodules 
Muscle tension dystonia

Investigations:

Neck examination
Flexible nasal Endoscopy
Stroboscopy
CT head/ neck and thorax

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Name some pre-malignant conditions seen in the mouth:

Leukoplakia

Erythroplakia

Erythroleukoplakia

Oral Lichen planus

Actinic Cheilitis

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What is the clinical set of symptoms which can be associated with advanced nasopharyngeal cancer?

Trotter’s syndrome

unilateral conductance deafness (middle ear effusion)
Trigeminal neuralgia
Defective mobility of the soft palate

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What are the symptoms of laryngeal cancer, what are the different types and which has the best prognosis?
and what are the treatment options?

Hoarse voice 
Dysphagia 
Persistent cough 
Stridor 
Referred otalgia

Glottis
Supraglottis
Hypoglottis

Treatment:

Transoral laser therapy
Laryngectomy
Neck resection - radical or modified
Adjuvant therapy

Glottis has best prognosis due to relatively low lymphatic drainage.

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Give some differentials for facial palsy:

Intracranial:

tumour
stroke
MS

Intratemporal:

Otitis media
Ramsay hunt syndrome
Cholesteatoma

Infratemporal:

Parotid tumour
Trauma

Others:

lyme disease
Bell’s palsy
Diabetes
sarcoidosis

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What are the features and what is the diagnostic mechanism for sialolithiasis and how are they treated?

Intermittent pain
Swelling around meals
Palpation

Clinically diagnosed
Sialogram (x-ray)

Management:

Hydration
Sialogogues
Surgical

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Which medication can cause ototoxicity inducing tinnitus and hearing loss?

NSAIDS 
Loop diuretics
Gentamicin
Quinine 
Vancomycin

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Which medication are nasal polyps sensitivity associatted with?

Aspirin

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What is the most common cause of snoring in children and list another symptom often seen with it?
and what is the most important thing to enquire about?

Adenoid hypertrophy
- usually reduces in size after 6 years of age.

Green discharge of rhinitis is also seen

Sleep disturbance.

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What are the antibiotics used in otitis externa?

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Ciprofloxacin drops

*this is usually combined with topical dexamethasone

What condition is highly associated with cleft palate affecting the ear?

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Cholesteatoma

- active squamous epithelium of the external canal

Which neck lymph nodes drain the external auditory meatus?

Pre-auricular (Mastoid)

Where are the deep cervical lymph nodes located?

Through the carotid sheath with superior and inferior poles. Drainage of the entire head and neck either directly or indirectly

What makes up Waldeyer's ring?

Adenoids x1 Tubal x2 Palatine x 2 Lingual x 2

Where do the parathyroid glands lie?

Superior at 1st tracheal ring Inferior at the inferior thyroid artery level

Otosclerosis causes conductive hearing loss at higher tones, what is this pattern called on the pure auditory tone?

Cathart notch

What test can be conducted to assess for a vestibulospinal reflex defect?

Romberg's test | - The person will tend to fall to the side of the vestibular defect

What is the initial hearing exam done in neonates?

Otoacoustic emissions - ear probe in the ear makes clicks which stimulates the hair cells on the outer edge to move in response (a motor function). this is picked up by the microphone attached to probe

What are the most common bacterial causes of otitis externa and list some risk factors:

Staph Aureus Pseudomonas - swimming - ear trauma - eczema - diabetes

If a perforation is to occur on the tympanic membrane, where is it most likely to occur?

Pars tensa

Where is a grommet most likely to be inserted? and when is it used? And what signs of this condition would you see on otoscopy?

Anterior inferior portion of tympanic membrane Used for otitis media with effusion (glue ear) Signs: - retracted membrane - no inflammation - loss of light reflex

Following a large epistaxis, what further measurements may need to be undertaken?

Hypertension control | Anti-coagulation monitoring/ control

if surgery is needed to remove a nasal polyp what is it called? what other conditions is this surgery used for and name some complications:

Functional Endoscopic Sinus Surgery (FESS) - rhinosinusitis - polyps - Epistaxis - CSF leaks Complications: - CSF leak - intraorbital bleeding - Nasolacrimal duct damage - optic nerve injury

What maneuver can be done for sleep apnea which identifies if the oro and/or hypopharynx collapses?

Muller's Manoeuvre | - inhalation through mouth with nose closed viewing it with flexible nasoscopy

What are the criteria and contraindications for tonsillectomy. and name some complications:

Indications: - >7 episodes in 1 year - >5 episodes in 2 years Contraindications: - acute infection - cleft palate - bleeding disorder Complications: - primary haemorrhage (within 24hours) - secondary haemorrhage (5-10days) - tooth damage - temporal mandibular joint dislocation

What are the triangles of the neck, and what are theyre borders?

Anterior Triangle: - Superior: Mandible - Middle: Midline - Lateral: SCM Posterior Triangle: - Anterior: SCM - Inferior: Clavicle mid 1/3rd - Posterior: Trapezius

What surgeries are carried out for a cholesteatoma?

Mastoidectomy Atticotomy Endoscopic approaches

What are the two major types of cholesteatomas?

Acquired - retraction - non- retracted (perforation) Congenital

What are the treatment options for Active mucosal (discharging) chronic otitis media?

Medical: - aura toileting - Antibiotic/ steroid sprays Surgical: - Myringoplasty - Tympanoplasty

What are the red flags for otitis media with effusion?

Young south east asian males Adults with neck lymph nodes

What is the criteria for bacterial sinusitis? and how many episodes are needed in a year before referral to ENT?

``` Fever >38 Double sickening Unilateral Severe pain Raised CRP/ ESR ``` Must have >3 or more then treat with antibiotics >3 or more episodes a year for referral

What is the treatment for parotid malignant tumour? What are some complications of treatment?

Formal conservative parotidectomy - sparing of the facial nerve or Total parotidectomy +/- Radiotherapy +/- Neck dissection Complications: - Haematoma - facial nerve damage - Frey's syndrome (sweating, flushing due to nervous dysfunction) - Salivary fistula

List some non-cancerous causes enlarged parotid glands:

Viral: - Mumps - Coxsackievirus Granulomatous sialadenitis - sarcoidosis - TB - Syphilis

Which foramen does the facial nerve exit the skull at?

stylomastoid foramen

What is Chronic Squamous Otitis Media? and how is it treated?

Cholesteatoma - Atticotomy - Mastoidectomy +/- reconstruction

With facial pain, name what areas you wish to examine and why:

External face: swelling, spasms Oral cavity: dental irregularities Temporomandibular joint: crepitus/ clicking Nose: discharge, crusting secondary care: - nasoendoscopy

Will anosmia improve or worsen once a polyp is removed?

It usually worsens

What is the term for a cluster headache?

Trigeminal Autonomic Cephalgia

What is the headache called which causes pain across the face with facial tenderness. associated with stress and usually occurs daily?

Mid-facial Segment Pain | - subtype of tension headache

What surgery is conducted for sinusitis if indicated?

Functional Endoscopic Sinus Surgery

Why might previous thyroid or neck tumours increase risk of malignancy in future?

radiation exposure

How many weeks of hoarseness requires referral?

>6 weeks | - after which a two week referral is needed

Which muscle does the recurrent laryngeal nerve not supply?

Cricothyroid

In a young person what factors must you consider for a potentially malignant neck lump?

HPV infection Inherited conditions such as Fanconis

ENT 2 Flashcards

(57 cards)