ENT Flashcards
(213 cards)
1
Q
which nerve supplies the upper lateral surface of the external ear
A
auriculotemporal nerve
2
Q
what nerve is the auriculotemporal nerve a branch of
A
mandibular branch of the trigeminal
3
Q
which nerve supplies the superior medial surface of the external ear
A
lesser occipital nerve
4
Q
which nerve supplies the lower lateral surface of the external ear
A
greater auricular nerve
5
Q
which nerve supplies the external auditory meatus
A
auricular branch of the vagus nerve
6
Q
what is the management of a laceration of the external ear
A
clean wound and insert sutures, making sure cartilage is all covered with skin. if closure not possible or significant skin loss - seek opinion from a a plastic reconstructive surgeon
7
Q
what is the management for bites to the external ear
A
leave open and irrigate thoroughly. commence abx
8
Q
what can haematoma of the pinna of the ear lead to, and how
A
disruption of the blood to cartilage of the ear, as the cartilage obtains nutrients from the diffusion of vessels in the perichondrium.
disruption can lead to avascular necrosis, and deformity cauliflower ear
9
Q
what is the management for haematoma of the pinna of the ear
A
urgent drainage and pressure dressing to prevent reaccumulation of haematoma
10
Q
what is the management for tympanic membrane perforation
A
most heal by themselves - “watch and wait”
if it hasn’t healed by itself after 6 months, myringoplasty is performed to repair the tympanic membrane
11
Q
what are the symptoms of tympanic membrane perforation
A
pain, conductive hearing loss
12
Q
what is the management of haemotympanum
A
conservative - as it usually resolves itself
should be followed up to ensure no residual hearing loss from damage to ossicles
13
Q
what are the risk factors for otitis externa
A
hot humid climates, swimming, older age, immunocompromise, diabetes, narrow external auditory meatus
14
Q
what are the common organisms causing otitis externa
A
skin commensals - s. aureus
also Pseudomonas aeruginosa
some are fungal e..g aspergillus spp
15
Q
what is the presentation for otitis externa
A
painful discharging ear, may be itchy. erythema, may be hearing loss
16
Q
what is malignant otitis externa
A
aggressive infection mainly seen in immunocompromised and diabetics. the infection spreads from the ear canal and into the bone
signficant mortality rate even with treatment
17
Q
how does malignant otitis externa present
A
chronic ear discharge despite topical treatment
seated severe ear pain and sometimes CN palsies
can cause skull base osteomyelitis
18
Q
what is the management of otitis externa
A
- topical ear drops e.g. gentamicin given empirically
- swab dc if resistant to treatment
- topical antifungals if fungal
- microsuction of pus/debris to enable drops to get to source of infection
- wick may be used in severe infection to hold canal open and allow topical treatment to diffuse through
19
Q
how is malignant otitis externa managed
A
aggressive treatment with IV abx and topical treatment at the same time for extended periods of time
20
Q
what are the different types of otitis media
A
- acute
- chronic - mucosal and squamous types which can be active or inactive
21
Q
what type of epithelium lines the middle ear
A
pseudostratified squamous (same as the respiratory tract)
22
Q
what are the common pathogens causing acute otitis media
A
- s pnuemoniae
- h influenzae
- moraxella species
23
Q
what are the symptoms of acute otitis media
A
ear pain
ear pulling in your children
discharge if tympanic membrane rupture
fever
24
Q
what is the management for acute otitis media
A
- conservative: analgesia
- medical: amoxicillin/clarithromycin if pen allergic in severe/persistent cases
- surgery: grommets if recurrent
25
what is otitis media with effusion associated with
eustachian tube dysfunction
26
is otitis media with effusion painful
no - but can become painful if it becomes infected
27
what are the clinical features on examination of a patient's tympanic membrane and hearing with otitis media with effusion
- tympanic membrane shows middle ear effusion
| - hearing: conductive hearing loss, type B tymapnogram
28
what audiogram result do you get with tympanogram otitis media with effusion
type B
29
how can otitis media with effusion affect a child's development
inability to hear properly can lead to speech delay/problems at school
30
what is the management for otitis media with effusion
- conservative: leave for 3 months, hearing aid
| - surgery: grommets +/- adenoidectomy
31
what is the difference between active and inactive types of chronic otitis media
```
active = dc present
inactive = no dc
```
32
what type of chronic otitis media is cholesteatoma
active squamous type COM
33
what is inactive squamous type COM
retraction pocket which may potentially develop into active squamous type (cholesteatoma)
34
what is active mucosal type of COM
where there is chronic dc from the middle ear through a tympanic membrane perforation and often a conductive hearing loss
assoc with spread to temporal lobe/intracranially
35
what is cholesteatoma
A destructive expanding growth consisting of keratinising squamous epithelium. Can erode through the bone and cause destruction
36
how is cholesteatoma treated
surgical removal +/- mastoidectomy
37
how can cholesteatoma progress
grow from the middle ear into the mastoid bone
38
how is mucosal COM treated
topical antibiotics and aural toilet
if fails - surgery to look for cholesteatomy and repair a perforated eardrum
ensure good ventilation
39
what are the branches of the facial nerve from proximal to distal (motor and sensory root)
- greater petrosal nerve
- nerve to stapedius
- chorda tympani
- terminal motor branches
40
what does the greater petrosal nerve supply
lacrimal gland
41
what does the chorda tympani supply
taste buds of anterior tongue
42
is otosclerosis inherited
yes - can follow what appears to be an autosomal dominant pattern
43
what is the pathological process of otosclerosis
mature bone is gradually replaced with woven bone and stapes footplate becomes fixed to the oval window - symptoms develop
44
what is the history of someone with otosclerosis
progressive hearing loss, tinnitus, improved hearing in noisy environments in early stages of disease
45
what is schwartze's sign
a pinkish hue of the tympanic membrane o/e of someone with otosclerosis
46
what are the investigations you would do for someone with otosclerosis
- tympanogram - normal type a trace
| - pure tone audiogram - conductive hearing loss
47
what is the characteristic appearance of otosclerosis on pure tone audiogram
carhart notch at 2 KHz
48
what is the management of otosclerosis
- conservative - hearing aid
| - surgery - stapedectomy and replacement with prosthesis
49
in which bone is the inner ear situated
petrous part of the temporal bone
50
what are the part of the inner ear
- cochlea
| - vestibule and semicircular canals
51
what is the structure of the membranous labyrinth
filled with endolymph and contained in bony labyrinth
| the membranous labyrinth itself is suspended in in perilymph
52
what structure connects the perilymphatic system with the oval with the subarachnoid space
cochlear duct
53
how is sound transmitted in the ear
stapes -> oval window -> movement of perilymph -> vibrations transmitted through endolymph -> tectorial membrane -> movement of hair cells -> depolarisation of neuronal fibres -> cochlear nerve
low frequency sounds detected at apex of cochlea whereas high frequency at base
54
describ the components of the vestibular system
- 3 semicircular canals at 90deg to each other which detect rotatory movement
- Utricle: hairs point Up and detect linear/horizontal movement
- Saccule: hairs point to the Side and detect vertical movements
55
define vertigo
hallucination of movement, caused by central or peripheral vestibular pathology affecting the vestibular system
56
what are some of the central causes affecting the central system causing vertigo
stroke, migraine, neoplasms, dehydration
57
what are some of the peripheral causes affecting the central system causing vertigo
bppv, meniere's, vestibular neuronitis
58
what is BPPV
vertigo which occurs with particular head movement, which is benign in nature and lasts a short period of time.
59
what is the cause of BPPV
otholiths in semicircular canals causing abnormal stimulation of hair cells - gives hallucination of movmeents
60
describe the manouevre performed to diagnose BPPV
dix hallpike - turn head 45 deg towards the affected side and quickly lie patient down from sitting, with the neck extended 30 degrees. watch the eyes for nystgamus (rotatory?)
61
which maneouvre is performed to treat BPPV
Epley maneouvre
62
what is the aetiology of Meniere's disease
precise aetiology unknown - there i increased endolymph in the endolymph compartment
63
what are the clinical features of Meniere's disease
- tinnitus in affected ear
- episodic vertigo with nausea and vomiting
- fluctuating sensorineural hearing loss which over time become permament
- aural fullness
64
describe the progression of Meniere's disease
Initally between attacks patients are well, however as the disease progresses, there is progressive sensorineural hearing loss and reduced vestibular function on affected side.
Disease burns itself out, but persisting reduced hearing and generally unbalanced (if other ear normal - can compensate)
65
what is the general management of Meniere's disease
- general: reduce salt, chocolate, alcohol, caffeine, chinese food
66
what is the medical management of meniere's
- medical: thiazides, betahistine, prochlorperazine (vestibular sedative)
67
what is the surgical management of meniere's
- surgical: grommets, middle ear injection of dexamethasone, endolypmhatic sac decompression, vestibular injection using middle ear injection of gentamicin
rarely: surgical labyrinthectomy
68
what is vestibular neuronitis
inflammation of the inner ear causing severe incapacitating vertigo lasting several days with N+V
69
what are the clinical features of a vestibular neruonitis attack o/e
vertical nystagmus, but otherwise normal on exam
70
what is the treatment during an acute attack of vestibular neuronitis
vestibular sedatives, fluids
71
what is the progression of vestibular neuronitis
often long term vestibular deficit after the acute episode which can lead to a generalised unsteadiness, which takes a few weeks for the brain to recover from
72
how can patients with long term poor balance due to vestibular neuronitis be managed
vestibular rehab exercises - cawthorne-cooksey
73
what are the investigations you would do on a patient with sudden onset sensorineural loss (emergency)
- pure tone audiogram
| - mri (acoustic neuroma)
74
what is the management for sudden onset sensorineural loss
- steroids (po/injected into middle ear)
| - antivirals
75
describe the weber test
- tuning fork made to vibrate
- placed on centre of patient's forehead
- bone conduction occurs via base of skull to both cochlear
76
what would be the result of a weber test with sensorineural hearing loss
tone will be heard louder on opposite side to hearing loss
77
what would be the result of a weber test with conductive hearing loss
tone will be heard louder on the same side as the hearing loss (conductive hearing loss blocks out background noise, so relative to the other ear the tone will sound louder)
78
describe the Rinne's test
- tuning fork made to vibrate
| - place on mastoid for a few minutes then when its stops ringing, place lateral to the external auditory meatus
79
what is Rinne's positive
when sound is heard louder when tuning fork lateral to the external auditory meatus (normal)
80
what is Rinne's negative
when sound is heard louder when tuning fork is placed over mastoid process (i.e. conductive hearing loss)
81
what result would you get with a Rinne's test where you have sensorineural hearing loss (if they retain some hearing)
rinne's positive
82
what are the axes on a pure tone audiogram
```
x = frequency (Hz) of sound
y = decibel (loudness)
```
83
what is the threshold for normal hearin gon a pure tone audiogram
anything above 20db
84
how should you investigate asymmetrical hearing loss
mri
85
what does presbyacusis appear like on pure tone audiogram
as frequency increases, decibels increases in magnitude as well (therefore higher frequencies require more voume in order for it to be heard by patient)
on PTA looks like it "drops off"
86
how do you know someone has a conductive hearing loss with pure tone audiogram
you plot on a PTA air and bone conduction in each each, and look for a discrepancy between the two lines (air line lower than bone = conductive hearing loss)
87
what does a tympanogram measure
compliance of the tympanic membrane
88
what is on the x and the y axis of a tympanogram graph
```
x = pressure (decpascals)
y = compliance (ml)
```
89
what are the three different types of tympanogram charts
type A = normal (peak at 0 decapascals)
type B = perforation (line higher) or fluid in middle ear (line lower)
type C = peak below 0 (negative pressure) i.e. -200, or -400 etc, which means eustachian tube dysfunction
90
name the vessels that supply kiesselbachs triangle
- posterior ethmoidal
- anterior ethmoidal
- sphenopalatine
- greater palatine
- superior labial
91
what is it important in the patient's history to ask about when presenting with a nosebleed
htn
anticoag
inherited thrombophilias
vasculopathies
92
list some of the causes of epistaxis
- idiopathic mainly
- trauma
- iatrogenic
- foreignn body
- inflammation e.g. rhinitis, polyps
- neoplastic (should exclude)
93
what is the management of epistaxis
- a-e assessment
- pinch soft part of nose tilting head forward and spit out any blood in the mouth
- locate source of bleed and cauterise with silver nitrate/bipolar diathermy
- anterior pack
- posterior pack if continues bleeding
- surgical vessel ligation/ radiological embolisation if nothing is working
94
what are the serious complications of nasal fractures
- septal haematoma
| - basal skull fracture and csf leak
95
what is the management of nasal trauma
a-e/epistaxis management
examine for septal haematoma
if deviated nose, consider manipulation under anaesthesia within 2 weeks
(no xr required)
96
what is the lamina papiracea
thin plate of bone of ethmoid bone that forms the medial wall of the orbit (air/blood can track up from nose into eye through this)
97
where does the sphenoid sinus drain
sphenoethmoidal recess
98
where do the posterior ethmoidal cells drain
superior meatus
99
which structures drain into the middle meatus
anterior ethmoidal cells
maxillary sinus
frontal sinus
100
what are the complications of sinus surgery
damage to the orbit and its contents
| csf leak and brain damage in sphenoid and frontal sinus breach
101
what are the complications to the eye that can result from rhinosinusitis
infection can spread to the orbit and cause peri-orbital sinusitis which is sight threatening
102
what are the complications to the brain that can result from rhinosinusitis
meningitis, intracranial brain abscess
103
list the symptoms of rhinosinusitis
- nasal blockage/obstruction/discharge
- anterior/posterior nasal drip
- facial pain/pressure
- reduction in sense of smell
104
how is rhinosinusitis diagnosed
- endoscopic signs of polyps, mucopurulent discharge, oedema of middle meatus
- ct showing mucosal changes within the osteomeatal complex or sinuses
105
what is the difference between acute and chronic rhinosinusitis
- acute: less than 12 weeks, complete reoslution of symptoms
| - chronic: more than 12 weeks, without complete resolution of symptoms
106
what are the subdivisions of chronic rhinosinusitis
with or without nasal polyps
107
list the viruses commonly causing acute rhinosinusitis
rhinovirus, influenza virus
| resolution of symptoms within 5 days
108
what is considered as causative agents of acute rhinosinusitis is symptoms do not resolve in 5 days
bacterias e.g. strep pneumoniae, h influenzae, m catarrhalis
109
what conditions can predispose patients to acute rhinosinusitis episodes
allergy
| cilliary impairment
110
what is the management of acute rhinosinusitis
- analgesia
- nasal decongestants
- topical nasal steroids
- po abx if lasts over 5 days
111
list some of the predisposing factors for chronic rhinosinusitis
- allergy/atopy
- infections e.g. s aureus
- ciliary impairment e.g. cf
- anatomical abnormalities e.g. septal deviation
- immunocompromise
- aspirin hypersensitivity
- swimming/diving
112
are polyps usually unilateral or bilateral
bilat
113
when would a polyp require biopsy for histology
worrying history/examination
| unilateral
114
what are the investigations for nasal polyps apart from examination
- skin prick test if allergy suspected
- ct sinuses if surgery planned
- some need biopsy
115
what is the management for polyps
- conservative: nasal douching, avoid allergens
- medical: antihistamines, nasal/po steroids if severe
- antibiotics if infected
- surgery: polypectomy - endoscopically, correcting anatomical abnormalities
116
what is ARIA
allergic rhinitis according to its impact on asthma
117
list the different fascial layers that make up the neck
1) superficial investing layer
2) pretracheal fascia
3) fascia of infrahyoid muscles
4) carotid sheath
5) prevertebral fascia
118
what are the borders of the anterior triangle of the neck
midline of the neck, anterior border of scm, lower border of mandible
119
what are the borders of the posterior triangle of the neck
posterior border of the scm, anterior edge of the trapezius, middle 1/3rd of the clavicle
120
which nerves run in the posterior triangle of the neck
cnXI
| vagus nerve
121
what is the anatomical site where a retropharyngeal abscess develops
anterior to the prevertebral fascia, behind the pharynx
122
where does the retropharyngeal space extend to
base of the skull to mediastinum
123
what are the clinical features of a retropharyngeal space abscess
- rigid head and neck
- systemically unwell
- airway compromise
- dysphagia/odynophagia
124
what are the investigations you would do in a retropharyngeal abscess
```
ct neck
lateral cxr (may show widening of retropharyngeal space)
```
125
what is the management of retropharyngeal abscess
- secure airway
- iv abx
- surgery - incision and drainage
126
what is ludwig's angina
infection of the space between the floor of the mouth and the myelohyoid
127
what is ludwigs angina usually caused by
dental infection
128
what are the clinical features of ludwigs angina
- swelling of the floor of the mouth
- painful mouth
- protruding tongue
- airway compromise
- drooling
129
where is parapharyngeal abscess located anatomically
potential space posterolateral to the pharynx
130
what are the clinical features of parapharyngeal abscess
- odynophagia
- trismus
- reduced neck movement
- neck swelling at upper part of scm
131
what is the treatment for parapharyngeal abscess
- secure airway
- iv abx
- surgical drainage
132
what is the main causative organism for epiglottitis
h influenzae
133
what is the presentation of epiglottitis
stridor, choking, pyrexia
134
what is the management of epiglottitis
secure airway,
dont examine, keep clam
theatre for intubation by paeds anaesthetist
iv abx - cephalosporins
135
where are jugulodigastric lumps located typically
angle of the mandible
136
where are thyroglossal cysts located
in the midline between the hyoid bone and thyroid gland
137
where is a branchial cyst located
anterior border of the scm
138
what is the gold standard investigation you would perform on any patient presenting with a neck lump
us-guided fna
| unless pulsatile!
139
name the 4 muscles that make up the pharynx
superior, middle and inferior constrictors, and the cricopharyngeus
140
where does the killian's dehisence, which is vulnerable to herniation, lie
between inferior constrictor and cricopharyngeus muscle
141
what are some of the symptoms of pharyngeal pouches
dysphagia, regurgitation, recurrent chest infections from aspiration in some, halitosis
142
list the 3 muscles that cause depression and elevation of the pharynx
- stylopharyngeus
- salpingopharyngeus
- palatopharyngeus
143
what are the commonest causes of OSA in children and adults respectively
children - adenoid hypertrophy
| adults - obesity
144
what are the investigations you would perform on a patient with OSA
- weight/bmi
- tfts
- cxr (signs of obstructive lung disease)
- ecg (signs of rvf)
- sleep study
145
what is the management of OSA
- advice and lifestyle changes about weight loss, not drinking alcohol before bed etc
- cpap
- mandibular positioning devices
146
list the bacteria that can cause tonsillitis
- beta haemolytic streptococci
- staphylococci
- s pneumoniae
- h influenza
- e coli
147
list the viral causes of tonsillitis
- rhinovirus
- adenovirus
- enterovirus
- ebv
148
where may tonsilitis pain be referred to
ear - otalgia
149
what is trismus
spasm of the jaw muscles leading to reduced opening of the jaw
150
what are some of the clinical features/presentations of head and neck cancers
- dysphonia
- dysphagia
- dyspnoea
- neck mass
- pain from site, referred pain to ear
- bleeding from nose or mouth
- nasal blockage
often unilateral
151
what histological type are the majority of head and neck cancers
squamous cell carcinomas
152
list the risk factors for head and neck cancer
- alcohol
- tobacco
- beetle nut chewing (oral cavity ca)
- chinese ethnic origin for nasopharyngeal malignancy
153
what are the types of examination under anaesthetic you can perform on head and neck cancer patients
panendoscopy or laryngooesophagoscopy
154
when is ct performed in patients with head and neck cancer
lymphadenopathy present with a proven scc - presumed 2ndary spread
155
why is an fna performed in head and neck cancers and a direct biopsy avoided
direct biopsy can lead to seeding of the cancer onto the surface of the skin
156
what investigation can be performed to look for secondary mets in head and neck cancer
ct chest - done routinely
157
what is the palliative management of head and neck cancer
chemo, radio, occassional surgery
158
what is the curative management of head and neck cancer
radiotherapy to primary site, and often the neck too
chemotherapy
surgery - endoscopic laser resection, open surgery to site/neck
159
what is the blood supply to the thyroid gland
superior and inferior thyroid arteries from the external carotid artery and thyrocervical trunk respectively
160
what is the venous drainage of the thyroid gland
superior, middle and inferior thyroid veins
161
where does the recurrent laryngeal nerve run with relation to the thyroid gland
tracheo-oesophgeal groove
162
what do the recurrent laryngeal nerve supply
muscles of the larynx except the cricothyroid muscle, vocal cords, sensation below vocal cord
163
what are the investigations for thyroid gland cancers
- tft's, thyroid antibodies
- us guided fna
- hemithyroidectomy + histology if any diagnostic doubt
164
list some non neoplastic nodules
- single nodule: colloid, cystic
| - multinodular: goitre
165
list some thyroid neoplasms
- benign: adenoma
| - malignancy: different types
166
list the different types of malignant thyroid cancers
- papillary
- follicular
- medullary
- anaplastic
- hurthe cell
- lymphoma
167
what is the management for non neoplastic thyroid nodules
conservative unless diagnostic uncertainty
| surgery: compressive symptoms, cosmesis (try to only do hemithyroiedectomy)
168
what is the management for thyroid adenoma
diagnostic hemithyroidectomy, then no further treatment
169
what is the management for thyroid carcinoma
total thyroidectomy for papillary, follicular and medullary thyroid cancers
anaplastic disease is often too far advanced for curative surgery
radioiodine for papillary and follicular thyroid cancer
170
list some of the complications of thyroid cancer surgery
post op haemorrhage
airway obstruction
vocal cord palsy
hypocalcaemia due to parathyroid gland damage/removal
171
what consistency of saliva do each of the salivary glands produce
- parotid: serous
- submad: mixed mucous and serous
- subling: mucous
172
which nerve runs through the parotid gland to split it into deep and superficial lobes
facial nerve
173
what is the path of the parotid duct
pierces the buccinator muscle and buccal mucosa to open opposite the 2nd molar tooth
174
which is the most common gland for salivary duct neoplasms
parotid gland (80%)
175
what proportion of parotid gland tumours are benign
80%
176
what is the main type of parotid gland tumour
pleomorphic adenoma
177
which muscle is the submandibular gland superior to
diagastric
178
where does the submandibular duct open
close to the frenulum of the tongue
179
which nerves run medial to the submandibular gland
hypoglossal and lingual nerves
180
what proportion of submand neoplasms are malignant
50%
181
what can cause a submandibular abscess to form
sialolithiasis
| sialadenitis
182
what is sialadenitis
inflammation of a salivary gland
183
what are the common viral causes of sialadenitis
- mumps
- coxsackie virus
- echovirus
- hiv
184
which bacteria typically causes sialadenitis
staph aureus
185
what are some of the causes of chronic sialadenitis (rare)
tb, hiv, sarcoidosis, syphillis
186
what are sialithiesis
stones in salivary duct causing obstruction, pain and swelling - worse during meals
187
what are the investigations you would do for sialadenitis
uss, sialogram
188
what is a sialogram
contrast medium is injected into gland duct
189
what is the management of sialolithiesis
conservative: analgesia, hydration
meds: sialologues (promote saliva excretion)
removal surgery
190
what are the complications of sialolithiesis
sialadenitis, abscess
191
what is the pathophsyiology of sjogren's syndrome
lymphocytic infiltration into ductal tissue of secretory glands
192
what are the signs and symptoms of sjogrens
xerostomia, xerophthalmia, enlarged salivary glands
193
which cancer is associated with sjogrens
increased risk of lymphoma
194
what are the investigations you would do for sjogrens syndrome
anti-ro/-la
| biopsy of salivary glands and inner lip
195
what are the generic treatments for thyroid cancer
- radioiodine
- thyroidectomy
- LN excision, neck dissection
- levothyroxine replacement
- chemotherapy for palliation (esp in anaplastic thyroid cancer)
196
what are the symptoms of laryngeal and pharyngeal cancers
- hoarseness, voice changes
- lump in neck
- sore throat/feelings something stuck in throat
- persistent cough
- stridor
- hallitosis
- referred ear ache
- dysphagia
197
what is a glottis T2 in the classification of laryngeal cancers
extends to supraglottis +/- subglottis +/- impaired vocal cord motility
198
what biological agent can be used in oropharyngeal cancer
cetuximab
199
what are important questions to ask in the history of someone presenting with hoarseness
- duration and nature
- occupation
- voice misuse
- smoking, alcohol
- dysphagia, reflux
- chest problems, infections, operations
- thyroid disease
- weight loss
200
what are the investigations you would perform in someone presenting with hoarseness of voice
- endoscopic evaluation of larynx, microlaryngoscopy
- biopsy
- cxr
- uss thyroid
- ct neck and chest
- mri
201
list some of the causes of hoarseness
- vocal nodules
- muscle tension
- vocal polyp
- reinke's oedema
- vocal cord palsy
202
what is the treatment for vocal nodules due to chronic voice abuse
speech therapy
203
what is the treatment for muscle tension causing hoarseness of voice
reassurance and speech therapy
204
what is reinke's oedema
mucosal oedema of the cords
205
who is reinke's oedema more common in
smokers, hypothyroid
206
when would you refer for visualisation of the vocal cords in a patient with hoarseness
if it lasts 3 or more weeks
207
what are the risk factors for bell's palsy
dm, urti
208
what may be some other more sinister causes of facial droop if not bell's palsy
brain tumour, stroke, ramsay hunt syndrome, lyme disease
209
what is ramsay hunt syndrome
reactivation of herpes zoster in the lateral geniculate ganglion - can present as LMN of facial nerve (hence differential for bell's)
210
what is the prognosis of bells palsy
should start improving at 14 days, and recovered completely by 6 months
211
what is the management of bell's palsy
corticosteroids, antivirals (HSV1), eye drops
212
which muscle is paralysed to cause eyelids being unable to close with bell's palsy
obicularis oculi
213
what is the bell's phenomenon
when attempt is made to close the eyes, the eye drifts upwards and out (this is a protective mechanism)
