ENT Flashcards
(48 cards)
spot dx: unilateral sensorineural loss of hearing and tinnitus and ataxia
acoustic neuroma
disabling vertigo, hearing loss, tinnitus and nausea and vomiting
meniere’s disease
DDX: sudden acute loss of hearing in the last 72 hours
trauma/post operative: post stapedectomy, head injury, driving, flying
infections: mumps, measles, herpes zoster, syphilis, meningitis, encephalitis
iatrogenic: drug (gentamicin, furosemide)
neoplastic: cerebopontine tumors, cochlear otosclerosis
vascular: polycythemia, diabetic vascular disease
menierre’s
what is the treatment for sudden sensorineural hearing loss in the last 72 hours (monash powerpoint)?
emergency referral and specialist referral
start high dose steroid ASAP (1mg/kg up to 60mg)
DDX: hearing loss in an adult/elderly (Murtagh Model)
probability: prebyascus, otitis media/externa, cerumen (wax impactation)
dangerous conditions: cerebellopontine tumors (acoustic neuroma), infections (meningitis, syphilis, mumps, measles), perforated TM, cholesteatoma, perilymphatic fistula
pitfalls: meniere’s, Foreign body, otosclerosis, temporal bone fracture, baro induced, rare diseases (paget’s, multiple sclerosis, osteogenesis imperfecta)
masquerades; drugs, diabetic, thyroid disease
what does a +ve rinne test mean?
+ve rinne test means air conduction > bone conduction. essentially means it can be either normal or a present sensorineural loss
interpret the permutations of these results:
(1) webber central, rinne positive on the left
(2) webber lateralizes left, rinne negative on the left
(3) webber lateralizes right, rinne positive on the left
(1) normal
(2) conduction loss on the left
(3) sensorineural loss on the left
80 year old man, unable to understand speech, social withdrawal, and speaks quite loudly
presbyacius
20 year old man w/ unilateral ear discharge and hearing loss. otoscopy reveals a growth on the tympanic membrane. what is the treatment?
cholesteatoma (expanding growth of keratinized squamous epithelium in the middle ear)
tx: urgent referral to ENT surgeon, surgical removal
20 year old female presents w/ unilateral conductive hearing loss. this begins in lower frequencies initally, and has now progressed to higher frequencies as well. what is the most likely dx?
otosclerosis
(female, 20 - 30, middle ear bone replaced by spongy vascular bone structures that has become sclerotic, autosomal dominant inheritance, causing conductive hearing loss unilateral that progresses from lower frequencies to high)
tx: referral and stapedectomy
DDX: ear pain (otalgia) in Murtagh’s model
probability: otitis externa/media, TMJ arthraljia, eustachian tube dysfunction
dangerous disorders: perforated TM, FB, acute mastoiditis, cholesteatoma, neoplasia of external ear, Ramsay-hunt syndrome
pitfalls: FB, ear wax impactation, barotrauma, dental causes, referred pain (nose, throat), facial neuralgias (glossopharyngeal), post tonsillectomy
child complaining of ear pain and discharge. otoscopy reveals a opaque red tympanic membrane. what is the treatment?
assess severity of OM. usually OM does not warrant a/b (w/o the presence of systemic symptoms) and r/v in the next 24 - 48 hours if pt is not getting better
symptomatic; rest pt in warm room w adequate humidity, give analgesia, give nasal decongestants if needed
what are the indications for use of a/b in children w/ acute OM
suppurative OM
with systemic features (fever, n/v, lethargy)
for children < 6mths, as long as persistent beyond 24 hours, discharge present, bilateral AOM - give a/b
what antibiotic to use in acute OM if it is indicated/
amoxcillin 15mg/kg up to 500mg oral for 5 days
if inadequate response in the next 48 - 72h, possible inadequate response to amoxycillin therapy and hence use amoxcillin + clauvanate (augmentin)
what are some risk factors for recurrent bacterial OM
smoking group child care allergic rhinitis adenoid disease structural deformities (cleft plate and down syndrome)
what is the definition of chronic supparative OM and what is the treatment for it?
chronic supp OM = infection of middle ear w/ perforated eardrums and discharge for at least 6 weeks
when ear dicharge persists beyond 6 weeks = ciprofloxacin 0.3% ear drops 5 drops into the affected ear, 12 hourly until ear is free of discharge for 3 days
if recent perforation = treat as if acute OM (oral amoxicillin up to 500mg for 5 days) + topical antibiotics as above
what are some of the complications of chronic OM
acute mastoiditis intracranial infections facial palsy (bell's palsy)
what is the treatment for persistent OM with effusion i.e glue ear?
treat w/ course of 3 - 6 months of amoxicllin (oral) and insertion of grommet
optimize learning environment for the child
preventive measures to modify risk factors (smoking environment, allergic rhinitis, child care group) for recurrent bacterial OM
what is an unsafe perforation in the case of chronic suppurative otitis media
site of perforation at attic region (small area of the drum between the lateral process of the maleus and the roof of the external auditory canal immediately above it)
what is the tx for acute diffused otitis externa
preventive treatments; aural toilet (tissue spear) 6 hourly until ear canal is dry, remove discharge from ear, NO syringing. keep ear dry as much as possible
medical care: dexamethasone + framycetin + gramicidin ear drops 3 drops instilled into the affected ear, 3 times daily for up to 3 - 7 days
if fungal = flumethasone + clioquinol 1% ear drops OR triamcinolone acetonide + neomycin + gramicidin + nystatin
what are the organisms involved in acute OM
h influenzae
strep pneumoniae
moraxella catarrhiasis
what is the tx of localized otitis externa
most often than not caused by S aureus from a boil/hair follicle
flucox 500mg or if hypersensitive, use cephalexin 500mg
what prevention can be put in place to prevent recurrent otitis externa
use acetenic acid plus isopropyl alcohol ear drops following exposure to water
use ear plugs while showering and swimming
what is the treatment for a patient when his otitis externa complicates to become a necrotizing OE presneting with high fever, severe persistent pain, visible granulation tissue, progressive cranial neuropathies
urgent referral to ID physician and ENT surgeon
start patient on anti pseudomonas = gentamicin IV + tazocin
