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Flashcards in ENT Deck (15):
1

Otitis externa | Clinical features & RFs

Otalgia
Itching
Tragal tenderness
Otorrhoea
Reduced hearing

RFs; swimming, skin conditions, local trauma, immunocompromised

2

Otitis externa | Management

Advice
Medical

[Advice]
Keep ear dry
No swimming
Do not scratch the ear canal
Do no use cotton buds

[Medical]
Topical abx/steroid drops; cipro/dex, gent/hyd (gentisone)
Should resolve within 1/52

3

Otitis externa | Complications

Perichondritis
Facial cellulitis
Osteomyelitis of temporal bone

Otomycosis
Ear canal stenosis with hearing loss

4

Otitis media | Clinical features & RFs

Glue ear

Acute onset within 24hrs-1/52
Otalgia, crescendo pain
Purulent discharge if perforates
Preceding URT sx
Fever, irritability, sleep disturbance

RFs; children, recent URTI

[Glue ear]
Hearing loss

May see pus fluid level behind tympanic membrane

5

Otitis media | Management

Advice
Medical
Surgical

AOM complications
COM complications

Self-limiting, should resolve within 2-3/7
Delayed abx; amoxicillin

[Medical]
OTC analgesia
PO abx; if complicated with fever/headache/pain, unresolving, or age <2yrs

[Surgical]
Grommets; if persistent glue ear

[AOM complications]
Labyrinthitis
Mastoiditis
Facial palsy
Meningitis
Intracranial abscess

[COM complications]
Perforation
Cholesteatoma

6

Perforation | Clinical features, RFs & Management

Medical
Surgical

Painless intermittent discharge
Hearing loss
Tinnitus

Recurrent infections
Precipitated by swimming/water contact

[Medical]
Topical abx/steroid drops; Gentisone

[Surgical]
Myringoplasty; pars flaccida
Tympanoplasty

7

Cholesteatoma | Clinical features & RFs

Painless
Chronic intermittent offensive discharge
Hearing loss
Tinnitus
Keratin cyst in retraction pocket

RFs; eustachian tube dysfunction, chronic otitis media

8

Cholesteatoma | Management & Complications

Local
Systemic

Mastoidectomy; surgical removal of cholesteatoma in mastoid air cells

[Local]
Dead ear
Tinnitus, vertigo
Facial nerve palsy
Altered taste

[Systemic]
Meningitis
Intracranial abscess
Sigmoid sinus thrombosis

9

Neck Lumps | Differentials

H&N cancers

Lymphadenopathy
Submandibular swelling (ant triangle)
Thyroglossal cyst (midline)
Thyroid goitre (midline)

Oropharyngeal SCC
Laryngeal SCC
Thyroid carcinoma

10

Acute rhinosinusitis | Clinical features & Management

Viral
Bacterial
Allergic

Purulent nasal discharge
Nasal obstruction
Facial pain/pressure

Acute onset <4/52
Viral < 10days
Bacterial > 10days
Complete resolution of symptoms

Allergic ocular/nasal pruritus, sneezing

[Management]
Supportive therapy
OTC analgesia
Decongestant
Intranasal corticosteroid

11

Chronic rhinosinusitis | Clinical features & Management

Medical
Surgical

Duration >3/12

Without
With polyposis

[Management]
1. Topical nasal steroid spray; flixonase
2. Oral prednisolone
3. Nasal saline irrigation
4. Oral abx
5. Antihistamine
6. Allergen avoidance

[Surgical]
Endoscopic sinus surgery

12

Epistaxis | Management

Anterior
Posterior

Advice

[Anterior]
1. Reuscitation
2. Apply pressure
3. Topical decongestant
4. Silver nitrate cautery; never cauterise both sides of septum, risk of perforation
5. Antiseptic ointment
6. Anterior nasal packing/balloon catheter

[Posterior]
1. Resuscitation
2. Suction clots
3. Apply pressure
4. Silver nitrate cautery
5. Anterior packing
6. Admit to ward
7. Posterior packing/balloon catheter
8. Consider prophylactic abx if packing for >48hrs
9. Surgical ligation; sphenopalatine/anterior ethmoidal arteries

[Advice]
Avoid blowing your nose
Do not pick your nose
Avoid strenuous exercise for 2/52
Avoid hot baths/showers
Avoid hot/spicy food/drink

Apply firm pressure for 15mins
Apply ice pack
Sit up and tilt head forwards to prevent swallowing of blood

13

Investigations | ENT

Ear
Nose
Throat

[Ear]
Rinne's & Weber's
Otoscope
Ear swab
Audiometry
Tympanometry; pressure
MR brain; for ?intracranial complications

[Nose]
Flexible nasoendoscopy
Coagulation profile, G&S
Angiogram; epistaxis
CT sinuses; for mastoid surgery only

[Throat]
Flexible nasopharyngolaryngoscopy
USS
FNA and cytology
Panendoscopy and biopsy
MR
CT neck and chest

14

Vertigo | Differentials

BPPV
Labyrinthitis
Meniere's disease
Acoustic neuroma
Herpes zoster oticus
Head trauma

Vertigo; room is spinning
Lightheadedness; feel faint
Unsteadiness; imbalance

BPPV; triggered by turning head
Labyrinthitis; vertigo, nystagmus
Meniere's disease; progressive hearing loss, cluster attacks of vertigo, tinnitus, aural fullness, triggers (caffeine, alcohol, smoking)
Acoustic neuroma; progressive episodes of vertigo, unilateral hearing loss, facial numbness, raised ICP
Herpes zoster oticus; painful blistered canal, facial nerve palsy, hearing loss, tinnitus
Head trauma; decreased consciousness

15

H&N cancer | RED FLAGS

New onset unilateral nosebleed with unilateral mass

[Nasopharyngeal cancer]
Unilateral glue ear
Sore throat with earache

Oral cavity red/white patch; erythroleukoplakia

[Oropharyngeal cancer]
Persistent ulceration
Asymmetrical tonsils/mass
Persistent hoarseness of voice
Dysphagia, odynophagia
Persistent foreign body sensation; feeling of a lump in the throat


Referred otalgia
Cervical lymphadenopathy
Stridor
Haemoptysis
Painless firm, irregular, fixed mass
Weight loss