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ENT Flashcards

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1
Q

What are the 3 bones in the middle ear called?

A

Malleus
Incus
Stapes

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2
Q

What are the 2 muscles in the middle ear called?

A

Stapedius muscle

Tensor tympanic muscle

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3
Q

What are the 2 functions of the inner ear?

A

To convert mechanical signals from the middle ear into electrical signals for conduction via nerve
To maintain balance by detecting position and motion

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4
Q

How can you tell the difference between conductive and sensorineural hearing loss?

A

Weber’s test - Vibrating 256Hz tubing fork. Louder in the abnormal hear in conductive hearing loss and in the normal ear in sensorineural hearing loss.
Rinne’s test - Vibrating 256Hz tubing fork. Normally louder when held at external acoustic meatus than on mastoid bone. Opposite in conductive hearing loss.

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5
Q

What are the most common bacterial causes of acute otitis media?

A

haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
streptococcus pyogenes

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6
Q

How does acute otitis media present?

A

Pain
Fever
Irritability
Discharge from affected ear (if perforated)

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7
Q

TM appearance for acute otitis media?

A

Red, bulging, oedematous

Pus seen behind TM

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8
Q

Treatment for acute otitis media?

A

Analgesia
Watchful waiting
Delayed prescription of amoxicillin 5 days

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9
Q

What are the risk factors for otitis media with effusion (glue ear)?

A 
Age 1-6 years
Older sibling
Male
Breastfeeding
Parental smoking
Day care attendance
Immune deficiency
Allergy
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10
Q

Location in which part of the tympanic membrane is most likely to lead to mastoiditis?

A

Periphery, specifically upper ear drum

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11
Q

How does glue ear present?

A

(Otitis media with effusion)

Ear pain
Hearing loss (mispronouncing words, speech delay)
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12
Q

TM appearance for otitis media with effusion?

A

Opaque ear drum
Loss of light reflex
Indrawn/retracted TM

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13
Q

What is the management of otitis media with effusion?

A

Watch and wait for 3 months as most resolve
Surgery (grommets) is:
- persistant bilateral OME >3 months
- hearing loss >25dB in best ear
- language, educational, social developemental delay
Adenoidectomy if recurrent

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14
Q

What is chronic suppurative otitis media?

A

Chronic inflammation of the middle ear and mastoid cavity due to recurrent infections.
Recurrent infections -> ulceration and oedema -> breakdown of epithelial lining -> TM perforation

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15
Q

Risk factors for chronic suppurative otitis media?

A

Multiple AOM episodes
Living in crowded environment
Day care
Congenital abnormality eg cleft lip/palate, down’s syndrome

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16
Q

How does chronic suppurative otitis media present?

A

> 2 weeks ear discharge
Hearing loss
Ear pain

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17
Q

What is the management of chronic suppurative otitis media?

A

Referral to ENT for diagnosis and exclusion of complications
Aural cleaning
Topical quinolones eg ciprofloxacin ear drops

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18
Q

What are the complications of chronic suppurative otitis media?

A 
Cholesteatoma
Chronic hearing loss
Mastoiditis
Labyrinthitis 
Abscess formation
Facial paralysis
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19
Q

Common causative pathogens of otitis externa?

A 
Pseudomonas
Escherichia coli
Staphylococci
Enterobacter
Candida
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20
Q

Risk factors for otitis externa?

A 
Swimming/Water sports
Humidity
Trauma
Cotton bud use
Diabetes
Immunosuppression
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21
Q

What is the presentation of otitis externa?

A 
Ear pain
Itching
Purulent discharge
Pre-auricular lymphadenopthy
\+/- hearing loss
\+/- fever
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22
Q

Investigation for otitis externa

A

Swab discharge for MC+S

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23
Q

Management of otitis externa

A 
Aural cleaning
Analgesia (paracetamol and NSAIDs)
Topic antibiotics + corticosteroid combination eg sofradex
Ear wick
Oral antibiotics
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24
Q

Complications of otitis externa

A

Chronic otitis externa
Temporary hearing loss
Cellulitis
Necrotising otitis externa

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25
Causes of referred ear pain
Tonsillitis Cervical arthritis TMJ disorders
26
What score is used to determine if a patient needs antibiotics for tonsillitis?
Centor score | FeverPAIN
27
What factors are taken into consideration on the centor score?
``` Age (3-14= +1, >45=-1) Exudate Tender lympadenopathy Fever (>38) Cough (absent) ```
28
What is the 1st choice antibiotic for tonsillitis?
Pen V (phenoxymethylpenicillin)
29
What is the first 1st line antibiotic for tonsillitis in a penicillin allergic patient?
Erythrocmycin
30
How might you treat a patient systematically unwell with tonsillitis?
IV Benzylpenicillin stat Steroids IV Fluids
31
What is Ramsay Hunt Syndrome?
Herpes zoster oticus Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal. Infection of the facial nerve (CNVII)
32
What pathogen causes Ramsay Hunt Syndrome?
Varicella Zoster Virus
33
Symptoms of Ramsay Hunt Syndrome?
PURPLE acronym P - Pain in face, head, ear or mouth U - Unsteady (vertigo/dizziness) R - Red rash, vesicles in mouth, ear, throat, hairline P - Palsy (LMN facial palsy, forehead not spared) L - Loss of hearing, tinnitus E - Exception, there is not always a rash)
34
Treatment of Ramsay Hunt Syndrome?
Acyclovir Steroids Analgesia
35
Complications of Ramsay Hunt Syndrome?
Lasting neurological damage in approx 30%.
36
Investigations for Ramsay Hunt Syndrome?
Bloods: Antibodies for VZV Saliva: PCR for VZV MRI: Inflammation of facial nerve
37
What is mastoiditis?
Inflammation of the mastoid lining of the mastoid antrum and mastoid air system inside the mastoid process of the temporal bone.
38
What organisms are the most common cause of mastoiditis?
``` haemophilus influenzae streptococcus pneumoniae moraxella catarrhalis streptococcus pyogenes staphylococcus aureus ```
39
What is the clinical presentation of mastoiditis?
Red, painful, swollen mastoid process Fever Ear pain Headache
40
Investigation for mastoiditis
Blood cultures MRI - to confirm diagnosis and look for extra cranial complications Fluid from middle ear due to perforated drums or by intervention (tympanocentesis) for MC+S LP - if intracranial spread is suspected
41
Management of mastoiditis
IV broad spec antibiotics eg ceftriaxone Analgesia Surgery (myringotomy +/- tympanostomy) to drain pus from middle ear
42
Complications of mastoiditis
``` Labyrinthitis (hearing loss) Facial nerve palsy Abscess formation Meningitis Epidural Brain abscess ```
43
Through what 2 anatomical connections can bacteria gain access to the membranous labyrinth?
Between CNS and subarachnoid space via internal auditory canal and cochlear aqueduct Through congenital or acquired defects of the bony labyrinth
44
How does labyrinthitis present?
Sudden, spontaneous, severe and incapacitating vertigo. Not triggered by movement but can be exacerbated by movement. N+V Hearing loss Tinnitus
45
What investigations would you do for labyrinthitis?
MC+S if ear discharge | CT of temporal bone
46
Management of labyrinthitis
Antiemetics eg prochlorperazine (buccal or deep intramuscular injection if severe) Surgery: Myringotomy
47
Complications of labyrinthitis
Falls Unilateral hearing loss BPPV
48
What condition is associated with acoustic neuromas?
Neurofibromatosis type 2
49
What is the inheritance of neurofibromatosis type 2?
Autosomal dominance
50
What cell type to acoustic neuromas arise from?
Schwaan cells
51
Symptoms of acoustic neuroma other than hearing loss?
Subtle balance disturbance Facial pain/numbness Earache
52
Investigations for acoustic neuroma?
Audiogram | MRI
53
What types of drugs can cause hearing loss?
``` Loop diuretics Aspirin Quinines Cisplatin Gentamicin Carboplatin ```
54
What is the most common bacterial cause of pharyngitis?
Group A streptococcus
55
What investigations can be done for patients with suspected pharyngitis?
Rapid antigen test for GAS | Throat swab for MMC+S
56
What is the antibiotic of choice for confirmed group a strep pharyngitis?
Phenoxymethylpenicillin
57
Presentation of quinsy
``` Sore throat Fever Drooling of saliva Foul smelling breath Trismus Painful swallowing Ear ache Headache General malaise ```
58
What symptom indicates pharyngitis over tonsillitis?
Trismus
59
What is the management of quinsy?
``` Same day referral to ENT IV fluids Analgesia IV antibiotics Needle aspiration, incision and drainage ```
60
What condition is characterised by the triad of vertigo, tinnitus and hearing loss?
Meniere's disease. | Symptoms occur for about 2-3 hours approx 6-11 times a year, remitting for months at a time.
61
What is the most common salivary gland tumour?
Pleomorphic adenoma | Benign, slow-growing, rubbery
62
2 most common locations for epistaxis to occur
Anterior bleed from Kiesselbach’s plexus - secondary to trauma. It predominantly involves the anterior and posterior ethmoid arteries as well as the superior labial artery and greater palatine artery. Posterior bleed from the sphenopalatine artery - this occurs as a result of underlying pathologies such as hypertension of due to old age
63
What are the 5 parts of the temporal bone?
``` Mastoid Styloid process Tympanic bone Squamous part Petrous part ```
64
Differentials for parotid swelling
``` Pleomorphic ademoma Parotid abscess Lymphoma Adenocarcinoma of the parotid Parotid adenitis ```
65
What nerves innervate the larynx? What muscles do they innervate?
Recurrent laryngeal nerve - All except cricothyroid (+sensory innervation of to trachea and larynx below vocal cords) Superior laryngeal nerve - divides into external which supplies cricothyroid muscle and internal which is responsible for sensation
66
What is Meniere's disease?
Increase in volume of the fluid within the vestibular apparatus causing progressive distension of membranous labyrinth. Cause is unknown.
67
Differentials for vertigo
Otological: BPPV, meniere's, vestibular neuritis Central: Migraine, stroke, SOL, multiple sclerosis
68
Management of Meniere's disease?
Anti-emetics eg prochlorperazine Regular betahistine Lifestyle factors - avoid caffeine and chocolate Surgery
69
What test on examination is diagnostic of BPPV?
Dix-Hallpike manoevure
70
What manoeuvre can be done for the management of BPPV?
Epley's manoeuvre
71
What is the main different between BPPV, Meniere's and vestibular neuritis?
The duration of symptoms. BPPV: seconds Meniere's: minutes-hours Vestibular neuritis: days
72
What cause of vertigo is likely to be preceded with a viral URTI?
Vestibular neuritis
73
How do you treat vestibular neuritis?
Usually self limiting | Antihistamiens/antiemetics (vestibular sedatives)
74
What is a complication of vestibular neuritis?
Long term vestibular deficit | Cawthorne-Cookey exercises
75
Causes of epistaxis
Trauma Coagulopathies Medications Cocaine
76
What is the treatment of epistaxis?
``` Nasal cautery (silver nitrate or electrically charged wire) Vaseline ```
77
What is a cholesteatoma?
Keratinising squamous cell epithelium and connective tissue collection within the middle ear which is locally invasive and destructive due to the production of osteolytic enzymes.
78
Presentation of cholesteatoma?
``` Progressive unilateral conductive hearing loss Vertigo Otorrhoea Headache Facial nerve palsy ```
79
How is cholestatoma diagnosed?
CT
80
How do you treat a cholesteatoma?
Surgically

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