ENT Flashcards
(72 cards)
1
Q
Who do ENT work with?
A
ITU Oncology Respiratory and allergy SALT Anaesthetics Neuro Opthalmology Thoracic surgery
2
Q
What do you need to clinically diagnose chronic rhinosinusitis?
A
- Nasal obstruction or congestion bilaterally for at least 3 months
PLUS either:
- Rhinorrhoea
- Post nasal drip
AND either:
- Loss of sense of smell (or cough if child)
- Facial pain
oedema/ polyps/ CT findings
3
Q
What do you look for in the Hx of Chronic rhinosinusitis?
A
- Nosebleeds
- Allergies
- Surgeries
- Nasal steroids (not as bad as orals)
4
Q
What is the treatment for CRS?
A
- Many polyps = surgery
- Intranasal steroids
- Sea salt
5
Q
What are the serious complications of nasal surgery?
A
- Brain damage
- Eye damage
6
Q
What is a septal haematoma?
A
Blood supply damage causes revascularisation of the septal cartilage and causes it to seperate
Causes perforation and atrophy of septal cartilage and saddle nose
7
Q
What is allergic rhinitis?
A
- Positive allergy test
- Symptoms
8
Q
What are the symptoms of allergic rhinitis?
A
- Blocked congested nose
- Watery/ red/ itchy eyes
- Sneezing/ cough
- Sore throat
9
Q
How do you treat allergic rhinitis?
A
- Nasal antihistamines
- Intranasal corticosteroids (but not in glaucoma)
- Avoid allergen
10
Q
What is rhinoplasty?
A
Operation of the nose ‘nosejob’
11
Q
What is otology?
A
The study of hearing of balance
12
Q
What is the part of the outer ear?
A
Pinna/ auricle
13
Q
What is the in the middle ear?
A
Contains the ossicles (malleus, incus, stapes) attached to the tympanic membrane
14
Q
What is in the inner ear?
A
Semicircular canals and cochlea
15
Q
What is the pars tensa?
A
Taut part of the eardrum under the ossicles
16
Q
What is the pars flaccida?
A
Floppy part of the eardrum above the ossicles
17
Q
What is the central part of the tympanic membrane called?
A
Umbo
18
Q
Where are vulnerable points in the ear?
A
Pars flaccida
Facial nerve over the stapes
Eustachian tube
19
Q
What can cause otitis externa?
A
Staphylococcus
Klebsiella
E. Coli
Pseudomonas
20
Q
Who is more likely to get otitis externa?
A
People who have:
- Eczema
- Psoriasis
- Sebhorrhoeic Dermatitis
use of:
- Shampoo
- Detergent
- aerosols
21
Q
What does otitis media look like?
A
- Bulging
- Dilated blood vessels
- Pus
22
Q
What can otitis media cause?
A
- Mastoiditis with abscess which requires surgery 9can result in mastoid fistula if not treated
- Brain abscess which causes death
23
Q
What does a tympanic membrane perforation look like?
A
- Blood
- Hole
24
Q
What causes tympanic membrane perforation?
A
- Pressure changes
- Cottone buds
25
What happens if a tympanic perforation heals badly?
- Can be fine if kept clean and dry
- May cause pouching and dead cell aggregation resulting in a tumour like appearance and can grow into bone, sinuses, brain (cholesteatoma) needs surgery
26
What are the routes of ear surgery?
- Through the ear canal
- Through the Mastoid bone
- Both
27
How do you treat otitis media with effusion (glue ear)?
- Put in a grommet (to air out the middle ear when the eustachian tube can't)
28
What does unilateral glue ear suggest?
Compression of eustachian tube not from a cold (cancer more likely)
29
Why is an active middle ear implant better?
Drives stapes directly not through ear canal and membrane
30
What is a BAHA?
Bone Anchored Hearing Aid
Vibrate the cochlea throug the skull bone to hear
31
How do you treat a damaged cochlea?
Cochlea implant
| Stimulates 8th nerve directly via electical impulse
32
What happens if you don't have an 8th nerve?
Brainstem implant
| electrodes onto auditory nucleus on brainstem
33
What are the parts of the vestibular system?
- Vestibular apparatus (semicircular canals, utricle and saccule)
- 8th nerve (vestibular branch)
- Vestibular nuclei (medulla)
- Cerebellum, RETICULAR FORMATION, somatic motor neurone controlling eyes
- Thalamus
- Cerebral cortex
34
What are the semicircular canals oriented like?
Superior
Posterior
Lateral
35
Why are the SCC oriented like that?
To allow detection of movement of your head in any rotational direction
Allows focus on a fixed point (vestibular ocular reflex)
36
Which canals detect which movements?
Superior- Forward/ Back
Posterior- Sidewards (ear to shoulder)
Lateral- Sidewards (Look around)
37
How do SCC work?
Endolymph (filled with cations) moves around the SCC in movement which opens ion channels on hair cells causing nerve firing as cations rush in
38
How do the utricle and saccule work?
(Linear movements and gravity)
Have their own stereocilia
Endolymph moves up and down causing ion channel opening in hair cells
Gravity causes constant downward pushing so we know which way is down
```
Utricle = lying down
Saccule = gravity
```
39
What can the word dizzy mean?
Light headed (presyncope)
Unsteadiness (Dysequilibrium)
Spaced out (Dissociation)
Vertigo (Abnormal sensation of motion)
40
What is associated with vertigo?
Room spinning
on a boat
N/V
Nystagmus
41
What are peripheral causes of vertigo?
BPPV
Menieres
Vestibular neuritis/ labrynthitis
42
What is BPPV?
Otolith organ has dislodged otoconia causing abnormal sensation on movement
Seconds
Horizontal nystagmus
43
What tests are used to diagnose and cure BPPV?
```
Diagnose: Dix-Hallpike
Lie them down very quickly- causes horizontal nystagmus
Cure: Epley manouvre
Sit up
Lie down
Turn head
Sit up
(30 s between each)
```
44
What is menieres?
Abnormal sensation of motion (minutes)
Too much endolymph
Vertigo, hearing loss, tinnitus, ear fullness
45
What is the treatment of Menieres?
Betahistine
| Intr tympanic steroid injection
46
What is vestibular neuritis/ labrynthitis?
Vestibular neuritis- Inflamed nerve
| Labrynthitis- inflamed labrynth
47
What are central causes of Vertigo ?
Vestibular migraine
| Brainstem, cerebellar, thalamic or cortical pathology
48
What is a vestibular migraine?
Dizziness and migraine
| Treat like a migraine
49
What may indicate a central cause of vertigo?
Non horizontal nystagmus
50
What are the common conditions in paediatric ENT?
```
Tonsils
Adenoids
Glue Ear and grommets
Paediatric airways
Foreign bodies
```
51
What is tonsilitis?
Glandular rings at the back of the throat which become inflamed due to infection
52
Where is the adenoid?
Behind uvula
53
What are the tonsil diseases?
Acute tonsilitis
Recurrent tonsilitis
Obstructive hyperplasia
Malignancy
54
What are the symptoms of tonsilitis?
```
Prodrome (1-2 days) - fever and malaise
Sore throat, odynophagia, dysphagia
Otalgia
Cervical LN (>2cm) or tender LN
Off school/ work
```
55
What are the common tonsil infections?
- Virus (Adenovirus, EBV, RSV, CMV)
| - Bacteria (Strep pyogenes, Haemophilus influenza, Staph aureus, Strep pneumoniae)
56
What is the treatment of tonsilits?
- Analgesia
| - Antibioitic (penicillin, erythromycin)
57
What are the differentials for tonsilitis?
```
Infectious mononucleosis
Malignancy (lymphoma, leukaemia, carcinoma)
Diptheria
Scarlet fever
Agranulocytosis
```
58
What is obstructive hyperplasia?
```
Sleep disordered breathing
- snoring
- upper airway resistance
- obstructive sleep apnoea
(mild/ moderate/ severe)
```
59
What can obstructive hyperplasia cause?
Snoring
Restless sleep
Daytime symptoms (chronic mouth breathing, poor mentation, decreased attention, poor scholastic performance, dysphagia)
60
What conditions predispose to obstructive hyperplasia?
Downs
Craniofacial abnormalities (Pierre Robin, Treacher Colins)
NM disorders
61
What are the tonsil grades?
```
0- in fossae
1- <25% obstruction
2- 25-50%
3- 50-75%
4- >75%
```
62
What investigations might you do for obstructive hyperplasia?
Sleep study polysonography
+ Interpretation
perioperative issues (HDU post- op)
63
What are the complications of obstructive sleep apnoea?
- Pulmonary HTN
- Cor pulmonale
- Dysrhythmias
- Failure
- Intracranial HTN
64
What are the causes of unilateral tonsillar enlargement?
Apparent vs true
- Displacement by parapharyngeal mass
Non-neoplastic
- Hypertrophy
- Acute/ chronic infection
- Congenital
Neoplastic
- Benign papillomas
- Lymphoma
- SCC
65
What are some adenoid diseases?
Obstructive hyperplasia
Acute adenoiditis
Recurrent adenoiditis
Malignancy
66
What are some Adenoidal symptoms?
Obstruction
- Smoring
- Mouth breathing
- Hyponasality
Discharge
- Rhinorrhoea
- Post nasal drip
- Nocturnal cough
Adenoide facies
- Overbite
- long face
- crowded incisors
67
What are the investigations for adenoids?
Nasendoscopy
Posterior rhinoscopy
Lateral Neck soft tissue X ray
68
When is a lateral neck X ray useful?
When Hx/ Ex not in agreement
| Accuracy dependent on proper positioning and patient co-operation
69
What are the indications for a tonsilectomy?
```
- Recurrent or chronic tonsilitis
> Children: 7 episodes for 1 yr, 5/y or more for 2 years , 3/y or more in 3 years
- Peritonsilar abscess
- Hypertrophy causing SDB
- Unilateral tonsillar enlargement
- Halitosis, tonsiloliths
```
70
What are the indications for an adenoidectomy?
Obstruction
- chronic or obligate mouth breathing
- SDB/ OSA
- Speech problems
Infection
- Recurrent/ chronic adenoiditis
- Recurrent/ chronic glue ear
71
What are the contraindications for an adenoidectomy?
- Overt or submucous cleft palate
- Neuromuscular abnormalities with impaired palatal function
- anaemia or disorders of haemostasis
72
You need to evaluate a palate before an adenoidectomy- how?
- Cleft palate
- Bifide uvula
- midline muscle diastasis
- Velopharyngeal insufficiency
- Neuromuscular disease
- evaluate speech
