ENT Flashcards
(42 cards)
Bilateral hearing loss
Normal tympanic membrane
Audiometry: conductive hearing loss
Usually < 50yrs old
Otosclerosis
Treatment: Stapedectomy +/- hearing loss
What is the CENTOR criteria
-Tonsillar exudate
-Tender lymph nodes
-Fever
-No cough
(need 3+ to give antibiotics)
What is the typically protocol with a sore throat?
Supportive measures Check CENTOR: 3+ give ABs (penicillin/eryhtromycin) Worry if: - Cancer history - > 3 weeks dysphagia - Get ambulance if stridor
How is a perforated tympanic membrane dealt with?
Keep dry
Review in 4 weeks
ENT referral if not better (for myringoplasty)
Vesicles on tympanic membrane (or ant 2/3rds tongue)
facial weakness
Tinnitus
Vertigo hearing loss
Ramsay hunt syndrome ( Varicella Zoster Virus on genciculate ganglion)
Treatment: Oral aciclovir + corticosteroids
Vertigo Tinnitus 'fullness' in ear Audiometry: sensorineural hearing loss Recurrent attacks >20 mins each
Menieres (Imbalance in perilymph/endolymph)
Treatment: Therapy + steroids + gentamicin
Slow onset of hearing loss Usually bilateral Loss of high frequency first Otoscopy: Normal Tympanometry: normal middle ear with hearing loss Audiometry: Sensorineual hearing loss
Presbycusis (age-related deterioration of hearing)
Hearing loss: Baseline for normal is: >20db Sensorineural: \_\_\_ conduction is impaired Conductive: \_\_\_ conduction is impaired Mixed: \_\_\_ conduction is impaired
S: both
C: bone
M: Both (air more severe than bone)
Asian male Ear pain/dysfunction without any signs Sore throat Odynophagia Nasal discharge +/ nosebleeds Signs of cranial nerve palsy
Nasopharyngeal carcinoma
- SqCC
- EBV associations
Confirm with: CT and MRI
Treatment: Radiotherapy
Red, irritated ear
Debris and discharge
Otitis externa
Confirm organism with swab ( usually Staph aureus, P. aeruginosa/fungal)
Treatment:
Irrigate
gentamicin or ciprofloxacin (bacteria)/clotrimoxazole (fungal)
+ Steroids
Diabetic/ Immuno-compromised Severe ear pain Discharge Facial nerve dysfunction Hoarse voice
Malignant otitis externa
(P.aerunginosa infection that spreads to bone and causes osteomyelitis)
Confirm with CT
Treatment: IV ciprofloxacin
Patient with cleft palate Foul smelling discharge from ear Hearing loss Can have: -vertigo -facial nerve palsy Otoscopy: 'attic crust'
Cholesteatoma (trapped squamous epithelium causing local destruction)
Management: ENT referral
Sudden onset of vertigo when changing head position
Lasts about 20s
Tends to be >50s
Benign Paroxysmal
Positional vertigo
Confirm with: Dix-Hallpike manouvre Treatment: -Epley manouvre -Betahistine can help
Vertigo lasting hours
nausea and vomiting
Horizontal nystagmus
NO HEARING LOSS
Vestibular neuronitis (inner ear inflammation)
Treatment: Self-limiting
Haemorrhage 5-10 days post tonsillectomy warrants
IV antibiotics (wound infection)
Haemorrhage 6 hours post tonsillectomy warrants
Return to theatre
Short history of earache
hard of hearing
Bulging of eardrum
Acute otitis media ( viral URTI causing bacterial infection)
Usually resp pathogens (H.influenzae, S.pneumoniae, S. pyogenes)
Enlarged tonsils that meet in midline
White film
Systemically well
Acute bacterial tonsilitis
(GAS or ‘resp’ pathogens)
Treatment; Penicillin
Stubborn: Tonsillectomy
kid/teen presents with large tonsils that meet in midline
White patches on red-raw membrane
-Nodes: Anterior and posterior chain enlarged
-Fever
-Haemorrhages on oropharynx
-Systemic upset
(splenomegaly)
Infective mononucleosis
(EBV, CMV)
Diagnosis: FBC and Monospot
Management :
- Supportive
- Dont play sport
Aspirin insensitivity + asthma + nasal polyps indicates what triad?
Samters triad
Vertigo Hearing loss Nerve palsy: V: absent corneal reflex affected side VII: facial palsy VIII: hearing loss, vertigo, tinnitus Verocay bodies on histology
Acoustic neuroma (vestibular schwannoma)
Ix: ‘Ice cream cone’ CT
Treatment: Removal
Severe throat pain
Deviation of uvula to unaffected side
Opening mouth is difficult
Quinsy (peri-tonsillar abscess)
Treatment: ENT specialist
Needle aspiration under anaesthesia
-IV antibiotics
Intermittent discharge
Perforation of pars tensa/flaccida
Chronic otitis media
Can co-exist with cholesteatoma
Leave for 4 weeks and review
Myrinngoplasty if severe
If flaccida then mastoidectomy
Sensorineural loss
Patient on chemo/antibiotics/NSAIDS
Drug induced hearing loss (ABs: Gentamicin and Aminoglycosides)
Stop drugs and give cochlear implant
