ENT Flashcards by Louise Dodds

What are the two commonest causes of hearing loss in adults?

Wax and Presbyacusis

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Name causes of conductive hearing loss

Blocked ear canal (wax, pus, debris, foreign body)
Ear drum perforations (from trauma or AOM)
Middle ear effusions (e.g. glue ear)
Otosclerosis

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Name causes of sensorineural hearing loss

Presbyacusis
Noise exposure
Perilymph fistula
Ototoxicity
Acoustic neuroma
Inflammatory diseases e.g. measles, mumps, meningitis

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What does ‘Rinne’s test -ve’ indicate?

A conductive hearing loss in the tested ear (bone conduction better than air conduction)

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In which ear will sound localise to in Weber’s test if there is conductive hearing loss?

Sound will localise to the affected ear

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In which ear will sound localise to in Weber’s test if there is sensorineural hearing loss?

Sound will localise to the unaffected ear

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Above which decibel line is considered normal in an audiogram?

Above 20dB line

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What is the commonest cause of hearing loss in children?

Otitis media with effusion/ Glue Ear

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What are some risk factors for glue ear?

Male sex, downs syndrome, cleft palate, atopy, children of smokers, primary ciliary dyskinesia

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What signs would you see in OME?

Retracted ear drum

Bubbles or a fluid level

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What does an audiogram show in OME?

Conductive hearing loss

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What does a tympanogram look like in OME?

Flat tympanogram - ‘Type B’

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How long should you initially observe OME for?

12 weeks - most cases resolve themself in this time

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What surgery is done for OME?

Myringotomy + fluid aspiration + grommet insertion

+/- adenoidectomy

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How long will grommets be in for?

Usually fall out themselves in 3-12 months due to growth of the tympanic membrane
1 in 3 children will need reinsertion of grommets

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What condition is characterised by inflammation of the outer ear canal and causes symptoms such as redness, swelling, itch and increased wax?

Otitis Externa

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How is otitis externa treated?

Aural toilet
If mild –> acetic acid 2%
If moderate –> otomize (acetic acid, neomycine and dexamethasone)

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What causes acute otitis media?

Usually an URTI involving the middle ear via extension of infection via the eustachian tube

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What are the main organisms causing acute otitis media?

Haemophilus Influenzae
Pneumococcus
Moraxella
Strep Pyogenes

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Do all cases of acute otitis media need antibiotics?

No - 80% resolve within 4 days by themselves

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When would you consider antibiotics for acute otitis media?

If otorrhoea is present

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What antibiotic is used for acute otitis media?

Amoxicillin 500mg TDS 5 days

If allergic - Clarithromycin 500mg BD 5 days

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What condition commonly presents as severe facial pain worse on bending, nasal discharge/congestion and fever?

Acute sinusitis

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What organisms cause acute sinusitis?

Haemophilus Influenzae
Strep Pneumoniae
Strep Pyogenes

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When should antibiotics be given for sinusitis?

For severe/deteriorating cases which have been ongoing for more than 7-10 days

What antibiotics are given for acute sinusitis?

Penicillin V 500mg QDS/1g BD for 7 days | If allergic - doxycycline

What type of organism causes the majority of sore throats?

Viruses

What causes a severe sore throat with a greyish white membrane on the pharynx?

Diptheria

What condition presents as white patches on red raw mucous membranes?

Oral thrush

What is the treatment of oral thrush?

Miconazole gel QDS (7 days)

What condition presents as fever, enlarged lymph nodes, sore throat, malaise, lethargy and enlarged spleen?

Infectious Mononucleosis

What is the causative organism of infectious mononucleosis?

Epstein-Barr Virus

How is infectious mononucleosis treated?

Supportive - bed rest, paracetamol, fluids. Avoid sport to prevent splenic rupture.

What causes symptoms in Menieres disease?

Build up of fluid in the inner ear, resulting in dilatation of the endolymphatic spaces of the membranous labyrinth

What condition presents as recurrent, spontaneous episodes of vertigo with associated tinnitus, sensorineural hearing loss and an aural fullness?

Meniere's disease

How long do episodes of Meniere's last?

A few hours

What conservative management options are there for Menieres?

Reduce salt, caffeine and alcohol intake Reduce stress Stop smoking

What is the medical management of Menieres?

Acute - prochlorperazine | Prevention - betahistine

What condition is characterised by sudden attacks of rotational vertigo caused by turning the head?

Benign Positional Paroxysmal Vertigo (BPPV)

How long does the vertigo last in BPPV?

<30 seconds

What test is used to investigate BPPV?

Dix - Hallpike test

What is a positive Dix-Hallpike test?

A reproduction of vertigo symptoms and rotational nystagmus towards the affected side for 30secs

How is BPPV treated?

Epley Manoevre - dislodges the crystals thought to be causing symptoms

What condition causes sudden onset vertigo lasting days with associated hearing loss and tinnitus?

Labyrinthitis

What condition causes sudden onset vertigo lasting days with NO associated hearing loss and tinnitus?

Vestibular Neuronitis

What genetic condition is acoustic neuroma associated with?

Neurofibromatosis Type 2

Where (anatomically) do 90% of nosebleeds occur?

Anteriorly in the anterioinferior nasal septum

What is the name of the area where most nosebleeds occur?

Kiesselbach's Plexus / Little's Area

What are the main arteries that form Littles area?

``` Ophthlamic artery (anterior and posterior ethmoidal arteries) Maxillary artery (spehnopalatine and greater palatine arteries) Facial artery (septal branch of superior labial artery) ```

Name some local causes of epistaxis

Idiopathic, infection, trauma, neoplasia, iatrogenic | In children remember juvenile angiofibromas

Name some systemic causes of epistaxis

Von Willebrands, Haemophilia, anti-coagulant drugs, Hereditary Haemorrhagic Telangastasia

What is the initial first aid management of epistaxis?

Get patient to sit forward with mouth open to reduce blood flow to the area and allow blood to get spat out Pinch the soft part of the nose firmly for 10-15 mins Suck an ice cub to induce vasoconstriction

Which patients with epistaxis should be sent to A&E?

Patients who are deemed to be haemodynamically unstable | Patients with posterior nosebleeds

If bleeding stops with first aid measures, what should be given to prevent crusting?

Naseptin cream

If bleeding does not stop with first aid measures in 10-15 minutes, what should be done next?

``` Nasal Cautery (silver nitrate applied to bleeding point for 10-15 secs) If cautery ineffective or cannot locate bleeding point - Nasal Packing. ```

If nasal cautery or packing does not work for epistaxis, what should be done next?

EUA and arterial ligation | If this does not work, radiological arterial embolization

What is the commonest cause of neck lumps?

Lymphadenopathy

What neck swellings move upwards when swallowing?

Thyroid swellings

What neck lump is an embryological remnant of thyroid descent and moves upwards with tongue protrusion?

Thyroglossal cyst

What would you suspect in a patient with dysphagia, regurgitation and aspiration and a neck lump that gurgles on palpation?

Pharyngeal pouch

Where is a cystic hygroma found on the neck?

Between the sternocleidomastoid muscle and the side of the neck. Classically on the left side. Most of them are present at birth.

What is an oval, mobile cystic mass found between the sternocleidomastoid and the pharynx?

Branchial cyst

What causes a branchial cyst?

Failure of obliteration of the 2nd branchial cleft in embryonic development

What would be the cause of a pulsatile lateral mass that does not move on swallowing?

Carotid aneurysm

Where do the majority of salivary lumps occur?

In the parotid (80%), 80% of which are benign and 80% of these are pleomorphic adenomas

When do pleomorphic adenomas occur in life?

Occur in middle age and are slow growing

Are pleomorphic adenomas malignant?

No they are benign but DO have malignant potential

Which salivary tumour is cystic with abundant lymphocytes with germinal centres?

Warthin's tumour - usually occurs in elderly male smokers

What are some features of malignant salivary tumours?

Rapid growth, painful, fixation of skin, facial nerve palsies

ENT Flashcards

(69 cards)