ENT Flashcards
(63 cards)
1
Q
Otitis Externa definition
A
Inflammation of the eternal ear canal
2
Q
Otitis Externa epidemiology
A
10% experience in lifeetime
3
Q
Otitis Externa aetiology
A
- Usually infectious, can be allergic / inflammatory
- Infection: 90% bacterial = S. aureus ± P. aeruginosa, 10% fungal = aspergillus and candida (usually follows prolonged antibiotic treatment)
4
Q
Otitis Externa risk factors
A
- hot humid climates
- swimming
- immunocompromised, elderly
- DM
- acoustic meatus obstruction
- insufficient or build up of wax
- trauma to ear canal e.g. cotton buds
5
Q
Otitis Externa presentation
A
Symptoms: -otalgia -itching -hearing loss and otorrhoea if more severe Signs: -erythematous ear canal -oedema -exudate -mobile tympanic membrane -pain on movement of tragus or auricle -pre-auricular lymphadenopathy
6
Q
Otitis Externa differentials
A
- otitis media
- foreign body
- impacted wax
- malignancy (swollen ear canal with regular bleeding)
- referred pain from sphenoidal sinus / teeth / neck / throat
7
Q
Otitis Externa investigation
A
- assess tympanic membrane
- cultures not useful for management
8
Q
Otitis Externa management
A
Acute:
- antibiotic ear drops
- if systemic symptoms, ENT review and may need IV abx
Chronic:
-remove agravating factors e.g. swimming, scratching
9
Q
Otitis Externa complications:
A
Necrotising otitis externa: life-threatening extension of infection into mastoid / temporal bones
- especially in elderly / immunocompromised / DM
- can cause facial nerve palsy
10
Q
Otitis Media definition
A
Infection of middle ear -acute -with effusion -chronic suppurative (disease continuum)
11
Q
Otitis Media epidemiology
A
- More common in children
- Occurs more in Winter, associated with cold
12
Q
Otitis Media aetiology
A
- Bacterial: H. influenzae, S. pneumoniae
- VIral: rhinovirus, RSV
- Suppurative OM means pus is present in middle ear - can lead to TM perforation
13
Q
Otitis Media risk factors
A
- Smoking
- Eustachian tube dysfunction
- URTI
- Allergies
- Chronic sinusitis
- Craniofacial abnormalities
- Immunosuppression
14
Q
Otitis Media presentation
A
- Hearing loss, otalgia and fever
- Followed by otorrhoea if TM perforates
- Otitis Media with Effusion: effusion of glue-like fluid behind intact TM with absence of SSx of acute inflammation
15
Q
Otitis Media differentials
A
- Otitis externa
- URTI
- Referred pain from teeth
- Foreign body
- Trauma
- Giant cell arteritis
16
Q
Otitis Media investigation
A
- acute phase Ix not helpful
- culture of discharge may be helpful if chronic perforation expected
17
Q
Otitis Media management
A
- analgesics and antipyretics
- no antibiotics - make little difference to symptoms
- steroids if persistent AOM with allergic background
18
Q
Otitis Media complications
A
- TM perforation
- Mastoiditis = facial nerve palsy
- Cholesteatoma
19
Q
Cholesteatoma definition
A
Collection of epidermal and connective tissues within middle ear. Grows independently and can damage bony ossicles.
20
Q
Cholesteatoma aetiology
A
- Congenital: squamous epithelium trapped within temporal bone during embryogenesis
- Primary acquired: negative middle-ear pressure due to Eustachian tube dysfunction causes TM to be ‘sucked back’. This erodes lateral wall which causes pocket lined by squamous non-keratinising epithelium to form.
- Secondary acquired: injury to TM = implantation of squamous epithelium to trigger process of cellular growth
21
Q
Cholesteatoma risk factors
A
Congenital: cleft palate
Acquired: ear trauma
22
Q
Cholesteatoma presetnation
A
Varies according to size.
- characteristic is progressive hearing loss and painless otorrhoea
- progressive conductive hearing loss
- vertigo
- headache
- facial nerve palsy
- painless otorrhea, may be foul-smelling
- pus-filled canal with granulation tissue
23
Q
Cholesteatoma differentials
A
Myringosclerosis
Myospherulosis
24
Q
Cholesteatoma investigation
A
- CT to assess lesion extent and bony defects
- MRI if soft tissue concern
25
Cholesteatoma management
Surgical removal
| Topical antibiotics and potentially steroids if granulation tissue present
26
Cholesteatoma complications
Will continue to grow if left in situ causing all symptoms to worsen
27
Vertigo definition
False sensation that surroundings are spinning, usually accompanied by nausea and loss of balance
28
Vertigo aetiology
Central causes: cerebral cortex, cerebellum, brainstem
- cerebrovascular disease
- migraine
- MS
- acoustic neuroma
- diplopia
- alcohol addiction
Peripheral causes: vestibular labyrinth, semi-circular canals, vestibular nerve
- viral labyrinthitis
- vestibular neuritis
- BPPV
- Meniere's disease
- Motion sickness
- Ototoxicity
- Herpes zoster (ramsay hunt) n
29
Vertigo presentation
Sensation that surroundings are spinning accompanied by nausea and balance loss.
Associated symptoms:
-Ear: hearing loss, otorrhoea, tinnitus
-Neurological: headache, diplopia, paraesthesia, muscle weakness, ataxia
-Autonomic: N+V, sweating palpitations
-Migraine aura
30
Vertigo differentials
- Postural hypotension
- Disequilibrium
- Presyncope
- Panic attacks with hyperventilation
31
Vertigo investigations
- Romberg's test to identify central or peripheral cause
| - Dix-Hallpike: to confirm BPPV
32
Vertigo management
- Treat underlying cause
- Symptomatic treatment: prochlorperazine, cinnarizine, cyclizine or promethazine - maximum 1 week
- Rehabilitation: vestibular conditioning for unilateral disorder with at home exercises
33
Vertigo complications
- Increased falls risk
| - Confines to home = depression
34
Facial nerve palsy definition
Damage to facial nerve - can be LMN or UMN lesion
35
Facial nerve palsy Aetiology
LMN
- Bell's palsy (idiopathic compression and paralysis of CNVII): pregnancy, DM
- Cerebrovascular disease
- Iatrogenic: local anaesthetic
- Infective: HSV1, Ramsay Hunt (VZV), EBV, CMV, Lyme disease, otitis media / cholesteatoma
- Trauma
- Neurological: Guillain-Barre syndrome, mononeuropathy
- Neoplastic: parotid gland tumours
UMN
- Cerebrovascular disease
- Intracranial tumours
- MS
- Syphillis
- HIV
- Vasculitides
36
Facial nerve palsy presentation
- Weakness of facial expression muscles
- Face sags, drawn across to opposite side on smiling
- Voluntary eye closure not possible
LMN
- Rapid onset unilateral full facial paralysis
- Aching pain below ear / mastoid ear
- Hyperacusis
- Lesions proximal to geniculate ganglion unable to produce teras, loss of taste
UMN:
- Upper facial muscles spared
- Muscle weakness in unilateral lower face
- Usually caused by cerebrovascular event
37
Facial nerve palsy investigation
Serology - lyme, herpes and zoster
38
Facial nerve palsy managment
MDT approach depending on cause
- eye care
- steroids
- antivirals
- surgical e.g. facial decompression
39
Facial nerve palsy complications
- lack of regain of function in facial muscles
- facial asymmetry
- gustatory lacrimaiton
- inadequate lid closure, brow ptosis, drooling, hemifacial spasm
40
Acute rhinosinusitis definition
Inflammation of membranous lining of one or more of sinuses. Lasts 7-30 days.
41
Acute rhinosinusitis aetiology
Viral infection with sinus drainage obstruction followed by secondary bacterial infection.
Bacteria: S. pneumoniae, H. influenzae, M. catarrhalis
42
Acute rhinosinusitis risk factors
- URTI
- Allergy
- Smoking
- Hormonal status e.g. pregnancy
- Nasal dryness
- DM
- Foreign body
- Iatrogenic
43
Acute rhinosinusitis clinical presentation
- Non-resolving cold with biphasic character
- Pain over affected sinus
- Pyrexia
- Purulent nasal discharge
- Poor response to decongestants
Sinusitis diagnosed if:
- facial discomfort
- nasal obstruction or discharge
- decreased / absent sense of smell
44
Acute rhinosinusitis management
- Reassure that viral infection will take 3 weeks to resolve
- Symptomatic relief: pain, nasal decongestant / irrigation, fluids, rest
- Abx only if severe and prolonged
45
Chronic rhinosinusitis definition
Lasts over 90 days.
- with polyps
- without polyps
- with associated fungal infection
46
Chronic rhinosinusitis aetiology
- Anaerobes
- GNB
- S. Aureus
- Coagulase -ve staph
-Usually underlying chronic issue
47
Chronic rhinosinusitis risk factors
- URTI
- Allergy
- Smoking
- Hormonal status e.g. pregnancy
- Nasal dryness
- DM
- Foreign body
- Iatrogenic
48
Chronic rhinosinusitis presentation
- Non-resolving cold with biphasic character
- Pain over affected sinus
- Pyrexia
- Purulent nasal discharge
- Poor response to decongestants
Sinusitis diagnosed if:
- facial discomfort
- nasal obstruction or discharge
- decreased / absent sense of smell
49
Chronic rhinosinusitis managment
- Topical nasal steroids / oral steroids
- Good dental hygiene
- Smoking cessation
- No evidence of Abx benefit
50
Chronic rhinosinusitis complications
- Adenoiditis, dacryocystitis and laryngitis
- Orbital complications - cellulitis, abscesses cavernous sinus thrombosis
- Intracranial: meningitis, abscess
- Oteomyelitis
- Mucocele
51
Epistaxis aetiology
- Trauma to nose: picking, foreign body, blowing
- Platelet disorders
- Drugs: aspirin, anti-coagulant, cocaine
- Vessel abnormality
- Malignancy, especially juvenile angiofibroma in males
- Granulomatosis with polyangiitis
52
Epistaxis presentation
Anterior haemorrhage:
-source of bleeding visible, usually from nasal septum, especially Little's area (kiesselbach's plexus)
Posterior haemorrhage
- deeper structures of nose
- more common in elderly
- more profuse
53
Epistaxis management
Treatment ladder:
1. Stem bleed: ask patient to sit forwards and squeeze cartilage
2. Cautery: silver nitrate used to chemically burn vessels to stem bleed
3. Consider packing
54
Acute sore throat definition
Inflammation of URT.
- pharynx
- larynx
- tonsils
- epiglottitis
55
Acute sore throat aetiology
Viral infection: rhinovirus, coronavirus, influenza, parainfluenza, adenovirus
Bacterial infection: group A beta-haemolytic strep
56
Acute sore throat presentation
Symptoms:
- headache
- malaise
- rhinitis
- cough
- hoarse voice
Signs:
- red pharynx / tonsils
- tonsillar enlargement
- exudate, enlarged cervical lymph glands
Epiglottitis:
-drooling, leaning forward, pyrexia
57
Centor criteria for bacterial tonsillitis
- History of fever
- Tonsillar exudate
- Absence of cough
- Tender anterior cervical lymphadenopathy
58
Supraglottitis / Epiglottitis
- Above larynx = supraglottitis
- Below larynx = epiglottitis
- Hoarse voice, odynophagia
- Stridor is late symptom
- Seen in immunocompromised
Causes:
- Adults: H. influenzae, S. pneumoniae, group A strep
- Paeds: H. influnzae, gourp A strep, S. pneumoniae
Management
- Emergency
- ABCDE assessment
Treat with IV cefotaxime
59
Head and neck lumps differentials
Most common cause is reactive lymph nodes:
- Bacterial: beta-haemolytic strep, S. aureus, TB, syphilis
- Viral: URTI viruses, EBV, CMV, HIV, HSV
- Parasitic
- Non-infective: sarcoidosis, connective tissue disease
```
Other causes
-Malignant lymph nodes
-Skin infections
-Lipomas and other benign tumours
-Thyroid swellings
-Thyroglossal cyst, brachial cyst
Carotid body aneurysm or tumour
-Malignant tumour
```
60
Head and neck lumps diagnosit tools
- Age: inflammatory more likely than malignancy in young. Branchial cyst present in late teens.
- Onset: inflammatory = sudden, 2-6 weeks resolution, malignant = progressive enlargement over time, transient with eating .= salivary gland.
- Consistency: hard mass = malignant, thyroid gland swellings move with swallowing, fluctuant mass = cystic.
- Location: midline = thyroid, posterior triangle = lymph nodes, bilateral across mandibular angle = mumps
61
Head and neck lumps investigations
- Bloods: FBC, ESR, TFTs
- Viral serology
- Throat swab
- CXR if supraclavicular lymph node swelling
- USS for thyroid swellings
- CT or MRI
62
Meniere's disease triad
Vertigo, tinnitus and hearing loss
| with a feeling of fullness
63
Ramsay Hunt Characteristic features
Bell's palsy, herpetic rash, deafness, tinnitus, vertigo
