ENT Flashcards
(37 cards)
Conductive hearing loss - def and causes
D - Impaired sound transmission via external canal or inner ear.
C - Caused by external obstruction, drum perforation, ossicular degeneration (otosclerosis, infection, trauma) and inadequate eustachian ventilation e.g. nasopharyngeal carcinoma).
Sensorineural hearing loss - def and cause
D - Defects central to the oval window.
C - Caused by drugs (the mycins, chloroquine), post-infective (meningitis, measles, mumps, flu, herpes, syphilis). More rarely - acoustic neuroma, B12 def, MS, brain mets.
Otosclerosis - def, cause, sy, mx
D - New bone forms around stapes footplate.
C - AD, incomplete penetrance, 50% have FH.
Sy - Conductive deafness, hearing made better with background noise, worse in preg. +- vertigo and pink tinge to drum.
Mx - Hearing aid or stapedectomy.
Presbyacusis - def, when worst, Mx
D - Age-related, high freq SNHL due to loss of hair cells. Normal is -10 to 25dBHL
Most affected when there is background noise.
Mx - Hearing aids
Benign paroxysmal positional vertigo - def, Sy, Ix, Mx
D - otoconia stimulate semicircular-canals.
Sy - sudden 30s attack evoked by head turning. No other sy.
Ix - Dix-Hallpike test.
Mx - Usually self-limiting. Epley manoeuvre.
Meniere’s disease - Def, Sy, Mx.
D - Dilation of endolymphatic spaces of the labyrinth.
Sy - Sudden attack of vertigo 2-4hrs, nystagmus, tinnitus, fullness. +- fluctuating SNHL.
Mx - Prochlorperazine and betahistine for prophylaxis.
Acute vestibular failure - AKA vestibular neuronitis / labarynthitis - Sy, Mx.
Sy - sudden attcks of vertigo and vomiting following infection, often UTI. Lasts 1-2dys. Nystagmus away from affected side.
Mx - Prochlorperazine
Head and neck SCC - RF, Sy, Mx.
RF - smoking, alcohol, vit A/C def, nitrosamines in salted fish, HPV, GORD.
Sy - usually in hypopharynx. Neck lump/pain, >6wks hoarse voice/sore throat, mouth bleeding, numbness, sore tongue, ulcers, speech change, dysphagia.
Mx - Endoscopy then CT and MRI. Surgery. If mets can do block neck dissection to remove all the lymph nodes.
Oropharyngeal carcinoma - RF, Sy, Mx.
RF - Pipe smoking, chewing tobacco, HPV esp 16 (oral sex).
Sy - Older smoker with sore throat, sensation of lump, referred otalgia.
Laryngeal cancer - Sy, Ix, Mx.
Sy - either older smoker with progressive hoarseness then stridor, dysphagia, haemoptysis OR younger with HPV.
Ix - Laryngoscopy for biopsy, MRI, HPV status.
Mx - If small radiotherapy, if large laryngectomy. Post-laryngectomy can use voice prosthesis or artificial larynx.
Stridor - def, causes, Mx
Stertor - def
D - high pitched inspiritory noise caused by partial obstuction of larynx or large airways.
C - Congenital (laryngomalacia, vascular ring), inflammation (laryngitis, epiglottitis, croup, anaphylaxis), tumours, trauma.
Mx - Give O2 or heliox (helium and O2), neb adrenaline, consider intubation, or cricothyroidotomy.
Stertor - inspiratory snoring noise caused by obstruction of pharynx.
Croup - Cause, Sy, severity, Mx.
C - Viral URTI. Parainfluenza virus (esp T1), RSV.
Sy - MOST COMMON CAUSE OF STRIDOR, barking cough, resp distress.
S - Mild no stridor at rest, mod freq cough stridor at rest, severe resp distress.
Mx - Dexamethasone 0.15mg/Kg, nebulised 1:1000 adrenaline if severe. Admit and observe if moderate or severe.
Acute epiglottitis - Sy, Mx.
Sy - Short hx of fever, irratability, sore throat, drooling, no cough. Now rare due to HIb vaccine.
Mx - Do not examine, diagnosis made by laryngoscopy in theatre.
Acute otitis media - Sy, Mx, complications.
Sy - Rapid onset otalgia, fever, irritability, often after viral infection. If tympanic membrane perfs will releave pain but cause purulent d/c.
Mx - Analgesia. Amox if systemically unwell.
C - Glue ear - usually resolves, refer for audiogram, observe for 3m, can insert grommet. Chronic OM - perf with chronic infection, Mx topical Abx.
Cholesteatoma - Def, Sy, Mx.
D - A locally destructive pocket of epithelia.
Sy - Foul d/c, deafness, headache, pain, facial paralysis. Can be post-chronic OM.
My - mastoid surgery.
Facial fracture
Nasal - drain septal haemoatoma, reassess one week after injury, can manipulate if fracture.
Mandible - order orthopantogram and refer to maxfax.
Bells palsy - RF, Sy
RF - pregnancy, diabetes.
Sy - sudden onset paralysis of one side of the face. Mouth sags, dribbling, watery eyes. Idiopathic, most common cause of facial palsy.
Mx - 25mg pred for 10days if present within a few days of onset. Refer to ENT if recurrent, bilateral, or does not improve in 1month.
DDX - Ramsay Hunt, check ear!
Rhinosinusitis - acute, chronic, allergic.
D - Inflammation of the nose/sinuses with 2+ sy.
Sy - Congestion, nasal discharge, facial pressure/pain, loss of smell.
Acute - common cold, consider nasal steroids if persists.
Chronic - Can be due to polyps or not. Give 4 weeks mometasone or fluticasone (head down on insertion). Mouth breathing, snoring, obstruction makes polyps more likely. If does not improve consider endoscopy and surgery. N.B. rare in children, rule out neoplasms.
Acoustic neuroma - Def, Sy, Mx.
D - Indolent benign tumour that causes problems by mass effect.
Sy - Progressive ipsilateral tinnitus, +- deafness, giddiness.
Mx - stereotactic radiosurgery. Difficult.
Salivary gland tumours - Histology, RF, Sy, Ix, Mx.
H - 80% occur in parotid, 80% are benign pleomorphic adenomas, 80% superficial lobe.
RF - Radiation to the neck, smoking.
Sy - Increased risk of malignancy if hard, fixed, painful, does not vary in size when eating, facial nerve palsy.
Ix - US/MRI, FNAC/biopsy.
Mx - surgery/radiotherapy.
Salivary gland obstruction - name the 3 pairs of glands, sialadenitis, sialolithiasis, differentials.
Pairs - parotid, submandibular, sublingual.
Sialadenitis - infection of the glands usually in elderly with poor oral hygiene. Swelling of the gland with fever, pus may be seen. Mx - Abx, lemon drops to stimulate salivation.
Salivary stones - usually submandibular gland as thicker secretions, pain and swelling of the gland during and after meals. Ix - USS, sialogram. Mx - lemon juice (sialogogues) or surgery if large.
If no stones - Sjogrens syndrome (dry mouth and eyes), mumps, HIV, TB and sarcoid.
Cervical lymphadenopathy - Acute, persistent
Acute - usually a local infection, also Kawasaki disease.
Persistent - eczema, infections (EBV, cytomegalovirus, TB, HIV), lymphoma/leukaemia, arthritis, lupus. Follow up with bloods if concerned.
Midline lumps - younger patient, moves on swallowing only, moves when protrude tongue, bony hard.
Dermoid cyst - younger patient, embryological remnant, removed surgically when older as can have malignant core.
Thyroglossal cyst - between hyoid and thyroid.
Thyroid mass - Within thyroid, seen in older patients.
Chondroma - benign cartilage tumour.
Submandibular triangle
Reactive lymphadenopathy
Malignant lymphadenopathy - firm, non-tender, fever, night sweats, weight loss.
Submandibular stone, tumour or infection.
