ENT Flashcards by Caitlin Brown

What are some indications for antibiotic use in otitis media?

bulging tympanic membrane
bilateral OM in a child <2 years
lasting >4 days
ottorhoea in a child

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Give some post-operative complications of a tonsillectomy

Pain - can increase for up to 6 days
Haemorrhage - usually in first 6-8 hours - urgent return to theatre
Secondary haemorrhage - 5-10 days, wound infection association, treat with admission and antibiotics

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What is the presentation of a cholesteatoma?

Offensive discharge
0 Hearing loss, gradual conductive, unilateral
vertigo and facial paralysis can occur if it erodes into bone
It is a destructive, expanding keratinised debris collection of squamous cells
Results in inflammation, discharge, vertigo, hearing loss

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What is preauricular sinus?

Foul smelling discharge
Common congenital condition in which an epithelial defect forms around the external ear
Small require no treatment, large may become blocked and develop and infection

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How might an acoustic neuroma present?

Gradual progressive unilateral deafness and tinnitus
Vertigo (if vestibular nerve involvement)
vestibular schwanoma
MRI must be done in unilateral hearing loss to rule this out
Mx watch and wait if small, stereotactic radiosurgery or microsurgery

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What is Ramsay Hunt syndrome?

Herpes zoster oticus
Vesicular lesions on anterior 2/3rd of the tongue and soft palate
Auricular pain
Facial nerve palsy
Vertigo, tinnitus
Treat with oral acyclovir and corticosteroids (PO Pred)

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Give some differentials to facial pain.

Sinusitis (cold, facial 'fullness', nasal discharge)
Trigeminal neuralgia (sharp, shooting pains, triggered by touch, unilateral)
Temporal arteritis (pain over trigeminal distribution)
Cluster headache (regular for 4-12 weeks, an 15mins to 2 hr duration, intense eye pain, redness, lacrimation, lid swelling)

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Give some differentials for a neck lump

Reactive lymphadenopathy (post-infection, common)
Lymphoma (rubebry, painless, night sweats, splenomegaly)
Thyroid swelling (moves upwards on swallowing)
Thyroglossal cyst (moves upwards on protrusion on the tongue)
Pharygeal pouch (posteromedial herniation, dysphagia, regurgitation, gurgling lump)
Cystic hygroma (congenital lymphatic neck lump)
Cervical rib (extra rib, risk of thoracic outlet syndrome)
Carotid aneurysm (pulsatile neck mass)

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What features are included in the CENTOR criteria?

Tonsillar exudate
Tender lympadenopathy
History of fever
Absence of cough

3+ give antibiotics

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What is your management for a perforated tympanic membrane and would anything change your management?

Reassure and follow-up, self-limiting

Amoxicillin if sign of infection

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What is Rinne’s and Weber’s and what does a positive test indicate?

Weber’s - midline, tuning for 512Hx, normal hearing should be in the middle, if sounds louder in one ear then this indicates conductive hearing loss in that ear, or sensorineural hearing loss in other ear
Rinne’s - mastoid tip, should be louder in air next to ear, if not indicates conductive deafness

AIR CONDUCTION SHOULD BE BETTER THAN BONE CONDUCTION

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What is the anterior and posterior triangle of the neck?

Anterior - sternocleidomastoid, mandible and midline

Posterior - trapezius, clavicle, sternocleidomastoid

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What is the difference between otitis externa and otitis media and what symptoms occur in each?

Externa - inflammatory of external auditory canal, otalgia, otorrhoea, ear discharge
Media - effusion of middle ear, hearing loss, itching, pain => can be acute or chronic or with glue ear

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What is the causative organism in ear infections?

Pseudomonas

Staph aureus

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What are some complications of acute otitis media?

Abscesses
CNS infections
Sinus thrombosis
Mastoiditis
Labyrithitis
COM - chronic otitis media

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What is Ludwig’s angina?

Cellulitis of the mouth that develops in immunocompromised patients with poor dentition
Swelling of lymph nodes, purexia

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What does the monospot test look for?

EBV - mononucleosis

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What risk factor exists for malignant otitis externa?

What is the usual causative organism?

Diabetics

Normall caused by pneumococcus

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What are some ear-related causes of vertigo?

Viral labyrinthitis (recent viral infection, acute, n+v, hearing, nystagmus)
Meniere’s (tinnitus, aural fullness)
Vestibular neuronitis (recent viral infection, recurrent vertigo, NO hearing loss)
BPPV (nystagmus associated with moving in bed)
Vestibular schwannoma (focal neurology association, unilateral hearing loss)

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What medications are given for otitis externa and in what form?

Topical antibiotic - cipro/fluclox

2nd line - PO flucloxacillin

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What is a common cause of bacterial otitis media?

H. influenzae
Strep pneumoniae
Morazella catarrhalis

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When should antibiotics be prescribes in otitis media?

Symptoms >4 days
Systemically unwell
Immunocompromise
<2 years with bilateral otitis media
Performation and/or discharge in canal

Amoxicillin

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What is otosclerosis?

Genetic condition (AD inheritance)
Fusion of middle ear ossicular chain
Leads to progressive conductive deafness in middle-age, bilateral
worsens in pregnancy and menstruation because of oestrogen increase
‘Flamingo tinge’ to tympanic membrane

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What are some causes of hearing loss?

Presbycusis - age related sensorineual hearing loss, high frequency bilateral loss
Otosclerosis - conductive, low frequency, middle-age, genetic
Glue ear
Meniere’s disease - vertigo, tinnitus
Drug ototoxicity - gentamycin
Noise damage - bilateral, frequencies of 3000-6000
Acoustic neuroma - unilateral

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What drugs could cause tinnitus?

Quinine Loop diuretics Aminoglycosides Aspirin

What are complications of malignant necrotising otitis externa?

Meningitis Cerebral abscess Dural sinus thrombosis

What is acute mastoiditis and it's treatment?

Infection of the mastoid bone, occurs as a complication of acute otitis media Treat with broad spectrum antibiotics Corticol mastoidectomy if unsuccessful

What is the difference between conductive and sensorinueral hearing loss?

Conductive - affects the middle of outer ear | Sensorinureal - affects cochlear of CNVIII

What are some common causes of deafness in children?

Hereditary - Perre Robin, Alport, Usher's, Treacer-Collins Maternal infection - rubella, CMV Perinatal - anoxia, birth trauma, cerebral palsy Postnatal - meningitis, lead poisoning

What should always be done in asymmetrical hearing loss?

MRI | Rule out acoustic neuroma

What are the three components that affect balance?

Vision Proprioception Vestibular apparatus

What is your management for acute labyrinthitis?

``` Inflammation of labyrinth - vertigo, deafness, tinnitus Bed rest Demenhydrinate Prochlorperazine IV abx if infection ```

What is the curative manoeuvre for BPPV?

Epley's

What do you expect to see on Hallpike's Test for Benign Paroxysmal Positional Vertigo?

Positional nystagmus that fatigues

What are the three staple features of meniere's disease?

Vertigo episodes Tinnitus Hearing loss

What does the vertigo occur typically in BPPV?

When rolling over in bed or sharp head turns

Give some management options for Meniere's Disease

Reduce salt and caffeine intake Beta-histime Diuretics (furosemide, bendroflumethiazide) Cloproperazine for acute attacks

What is the more common location of epistaxis?

Anterior - Little's Area

What is your management for sinusitis?

Analgesia Topical nasal steroids Antibiotics - amoxicillin, metronidazole Nasal douching

What are some risk factors for epistaxis?

``` Dry climate Deviated nasal septum Vessel rupture Coagulation disorders Septal perforation ```

How do you treat epistaxis?

Cautery (AgNO3 (silver nitrate) | Packing

What is a Ringer's Tumour?

A benign tumour of the nose - inverted papilloma

A septal haematoma is a complication of what and how do you manage it?

Nasal trauma # Necrosis of nasal septum, risk of perforation or saddle-nose deformity Requires urgent drainage Prophylactic antibiotics

What would a 2-3 on the FEVER Pain or CENTOR criteria result in?

Consider delayed antibiotics

What are common bacterial causative organisms of tonsillitis?

Group A beta-haem strep Staph aureus Strep pneumonia Mycoplasma pneumonia

What are common viral causes of tonsillitis?

``` Herpes simplex Adenovirus Rhinovirus Influenza RSV EBV ```

What are indications for tonsillectomy?

``` Recurrent tonsillitis >7 in a year >5 each year for 2 years >3 each year for 3 years Unilateral tonsillar changes ```

What is Quincy and how is it treated?

Peritonsillar abscess Presents with sore throat, dysphagia, a 'hot potato' voice (patient can't open their mouth fully) Aspiration

What is the organism that causes glandular fever?

Infectious mononucleaosis

What should be advised to patients with glandular fever?

No contact sports as risk of splenic rupture | No alcohol

What is the organism that causes epiglottitis?

Haemphilus influenza

What is your management priority in epiglottitis?

Secure the airway - call an anaethetist, intubation or tracheostomy may be necessary

What type of cancers are laryngeal carcinomas?

Squamous cell carcinomas - risk factors include smoking, alcohol and HPV

What does a nasal septal haematoma look like on examination?

Bilateral red swelling from midline Slightly boggy Post-trauma Urgent ENT review for surgical drainage and IV antibiotics

How might a nasopharyngeal carcinoma present? What is an at-risk ethnic group?

``` Cervical lymphadenopathy Otalgia Unilateral serous otitis media Nasal obstruction/discharge/epistaxis Cranial nerve palsies III-VI ``` Southern China

What are epidermoid cysts?

``` Common Cutanous cyst Asymptomatic, can occur at any age Firm, round nodules Central punctum ```

What is a lipoma?

Transillumination is equal to surrounding tissue Intradermal Soft and mobile Asymptomatic

What is your management order in haemorraging epistaxis?

Compression - sit forwards with mouth open, pinch the cartilaginous tissue for 15 minutes and breath through their mouth If site identifiable: cautery with silver nitrate Anterior packing

How do you distinguish vestibular neuritis from labyrinthitis?

Vestibular neuritis - vestibular nerve is involved and there is NOT HEARING IMPAIRMENT Labyrinthitis - when both the vestibular nerve and labyrinth and involved

What is a worrying feature of nasal polyps?

Unilateral - refer to ENT, risk of malignancy

What is presbycusis?

Occurs in older people The loss of outer hair cells in the cochlear Gradual progressive bilateral hearing loss Loss of high frequencies first Mx - hearing aids or cochlear implant

What hearing loss pattern occurs in noise induced hearing loss?

Excess sound history Gradual bilateral hearing loss Not progressive Tympanic membrane looks normal

What must be done in Meniere's Disease?

Inform the DVLA

Ear pain + fever + conductive hearing loss is typically...?

Acute otitis media

What are some symptoms of glandular fever?

``` Tonsillar enlargement Petechiae on palate Lymphadenopathy Fever Sore throat ```

What is the main difference between labyrinthitis and vestibular neuritis?

L - inflammation of labyrinth as well so there is hearing loss VN - no hearing loss Similarities - incapacitating rotational vertigo not triggered by head movement, nausea and vomiting, self-limiting Advise not to drive

What are some risk factors for throat cancer (oropharyngeal cancer)?

Alcohol Smoking Age HPV

What is the most common histology of laryngeal cancer?

Squamous Cell Carcinoma

What investigations are done in oropharyngeal cancer? List 6

``` Nasal endoscopy Biopsy Fine Needle Biopsy CT Scan MRI scan PET scan Bloods ```

What is your management plan for oropharyngeal cancer?

Radiotherapy (if small) | Surgery (if larger, can be curative or symptom relief)

What are some clinical features of chronic otitis media?

Recurrent otorrhoea, conductive hearing loss

Do you get tinnitus in labyrinthitis?

No, just vertigo and hearing loss

What are some complications of an acoustic neuroma due to cranial nerves being affected?

Cranial nerve VIII – vertigo, unilateral sensorineural hearing loss, unilateral tinnitus Cranial nerve V – absent corneal reflex Cranial nerve VII – facial palsy

What is your investigation of choice for a vestibula schwannoma?

MRI of cerebellopontine angle