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ENT Flashcards

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1
Q

3 regions of the nasal cavity

A

vestibule
resp
olfactory

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2
Q

turbinates and meatus

A

turbinates are bony

meatus are the air spaces

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3
Q

3 structures of nasal septum

A

vomer
perpendicualr plate of ethmoid
septal cartilage

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4
Q

choana

A

link between nasal cavity and naso-pharynx

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5
Q

vascular supply to nasala cavity

A
  • anterior/ posterior ethmoidal arteries (ophthalmic arteries)= superior
  • sphenopalatine (maxillary artery)- external carotid artery
  • greater palatine (maxillary artery)
  • superior labial (facial artery)
  • converge in anterior septum= little’s area/ kesselbachs plexus
    o prone to nose bleeds as anastomosis
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6
Q

drainage of 4 sinuses

A

maxillary= into middle meatus into floor of semi lunar hiatus

sphenoid into spheno-ethmoidal recess

frontal also into semi lunar hiatus through frontonasal duct

ethmoid
Anterior – Hiatus semilunaris middle meatus
Middle – Ethmoid bulla
Posterior – Superior meatus

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7
Q

oral cavity boundaries

A
  • anterior oral fissure
  • posterior oropharyngeal isthmus
  • lateral wall buccinator
  • roof hard and soft palates
  • floor tongue and muscular diaphragm
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8
Q

salivary glands

A

parotid
submandibular
sublingual

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9
Q

pharynx

A

nasopharynx
oropharynx
laryngopharynx

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10
Q

what is waldever’s ring

A 
tonsil formation
protects things from entering the pharynx
-pharyngeal tonsil
-palatine tonsil 
-lingual tonsil
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11
Q

weber test
normal
conductive
sensorineural results

A

place in centre of patient forehead

  • normal is to hear it central
  • noise is louder in the ear with conductive deafness
  • in symmetrical hearing loss it is still heard in the middle
  • in unilateral sensorineural deafness the sound is heard better in the better hearing ear

lateralises to conductive hearing loss
lateralises away from sensorineural hearing loss

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12
Q

types of hearing loss

A

sensorineural

conductive

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13
Q

Rinne test how to do

A

vibrate and place the tuning fork at the base behind the ear

  • ask if they can hear it and then to indicate when they can no longer hear the sound
  • when they say they cant hear it place the still vibrating prongs 2cm away from the external auditory meatus and ask if they can still hear it now
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14
Q

rinne test meaning

A
  • air conduction is better than bone conduction normally

- if bone conduction is louder than air conduction this is BC>AC and rinne negative- suggesting conductive deafness

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15
Q

dix hallpike positional testing

A
  • sit patient upright
  • turn head to 45 degrees
  • rapidly lower them so head is 30 degrees below horizontal
  • need to keep eyes open to look for nystagmus
  • repeat with head facing the other way
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16
Q

abnormal hallpike

-bppv vs central pathology

A
  • in BPPV there is a delay of up to 20 seconds before the patient experiences vertigo and rotational jerk nystagmus towards the lower ear
  • in central pathology there is an immediate nystagmus and not necessarily vertigo and does not adapt (ie doesn’t lessen with fatigue)
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17
Q

examination for Ears nose and throat-

A

-otoscope- ears and nose
-nasendoscopy-nose
-rhinometry= peak nasal flow
rhinomanometry
-ciliary function

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18
Q

ENT blood tests

A 
autoimmune
allergens RAST
immunology- SPT, RAST
skin prick test
UPSIT scratch and sniff test
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19
Q

symptoms for ears 8

A 
otalgia
otorrhoea
hearing loss
tinnitus
vertigo 
unsteadiness
nystagmus 
itching
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20
Q

causes of otalgia 7

A 
acute otitis media or externa
referred from pharyngitis, trauma, cancer
perichonditis
herpes zoster- ramsay hunnt
tonsillitis
dental disease
cervical spine disease
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21
Q

causes of itchy ear

A

otitis externa

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22
Q

otorrhoea purulent cause 2

A

eardrum perforation with infection

otitis externa

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23
Q

otorrhoea mucoid 2

A

eardrum perforation

severe trauma causing CSF leak

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24
Q

otorrhoea blood 2 causes

A

granulation tissue from infection

trauma

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25
hearing loss conductive causes 7
``` wax otitis externa middle ear effusion trauma to tympanic membrane oteosclerosis chronic middle ear infection tumours ```
26
hearing loss sensorineural causes 6
``` genetic prenatal infection degenerative- presbyacusis occupation or noise induced acoustic neuroma idiopathic ```
27
tinnitus 2 causes
presbyacusis | noise damage
28
vertigo causes 5 peripherally
``` BPPV vestibular neuronitis drugs eg gentamicin and anticonvulsant meniere trauma ```
29
vertigo 3 central causes
- brainstem ischaemia or infarction - migraine - MS
30
mouth and throat symptoms 8
``` sore mouth sore throat stridor dysphonia dysphagia hallitosis trismus xerostomia-dry mouth ```
31
sore mouth causes 4
gingivitis- gum inflammation apthous ulcers unilateral painful vesicles on palate- herpes zoster diffuse oral infection- candida
32
sore throat causes 7
``` viral pharyngitis acute tonsillitis infectious mononucleosis palatal petechiae peritonsillar abscess mass or ulcer globus pharyngeus ```
33
globus pharyngeus causes
anxiety acid reflux habitual throat clearing
34
types of stridor and indication
- inspiriatory- indicates narrowing at vocal cords - biphasic indicates tracheal obstruction - expiration suggests tracheobronchial obstruction
35
stertor
muffled hot potato speech | quinsy
36
dysphonia
disturbance of vocal cord function
37
dysphonia warning signs
>3 weeks | with bovine cough and breathy dysphosia suggest lung cancer causing recurrent laryngeal palsy
38
causes of dysphonia
``` croup congenital URTI laryngitis trauma lung cancer vocal cord nodules neurological functional ```
39
dysphagia causes
pharyngitis | oseophageal disease
40
lumps causes
lymphadenopathy
41
halitosis causes
poor dental hygiene
42
trismus- cause and meaning
trismus is inability to open mouth fully | -quinsy and tetanus
43
odynophagia
pain on swallowing
44
xerostomia
dry mouth | anticholinergic syndrome / sjorgen
45
rhinology symptoms 6
``` -obstruction discharge sneeze and itch pain and pressure nasal deformity sense of smell disturbance ```
46
bilateral water rhinorrhoea suggests
-allergic or vasomotor rhinitis
47
purulent rhinorrhoea suggests
bacterial infection eg cold or localised sinus infection or foreign body
48
new onset unilateral crystal clear rhinorrhoea suggests
Head injury CSF leak
49
anosmia causes
complete loss of smell - head injury with damage to the olfactory epithelium/ nerve - can occur after viral URTI - polyps - swelling in allergic rhinitis - severe mucosal oedema
50
cacosmia and cause
unpleasant smell | -chronic sepsis in nose or sinuses
51
parosmia
distorted sense of smell
52
nasal deformity causes 5
``` -trauma acne rosacea can cause rhinophyma -granulomatosis with polyangitis -congenital syphilis -cocaine ```
53
rhinophyma is
destruction of the nasal septum producing flattening of bridge and a saddle deformity -large red bumpy nose
54
nasal pain causes
rare | trauma
55
facial pain causes
- temporomandibular joint dysfunction - migraine - dental - sinusitits - trigeminal neuralgia
56
trigeminal neuralgia
Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums. It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start.
57
external ear pathologies 15
- pinna haematoma - other trauma - pinna-microtia - pre-auricular sinus - pinna cellulitis - skin neoplasis - external auditory meatus block - acute otitis externa - malignant otitis externa/ osteomyelitis - chronic otitis externa - exostois - furunculosis - foreign body - tympanosclerosis - granular myringitis
58
pinna haematoma pathology
- perichondrium stripped off cartilage - cartilage devascularised - blood accumulates between perichondrium and cartilage
59
pinn haematoma cause
contact sport- rugby
60
pinna haematoma presentation
cauliflower ear
61
risk of pinna haematoma
- risk of necrosis - risk of infection - risk of deformity
62
management pinna haematoma
needs aspiration drainage and pressure for 24 hours
63
possible trauma to the ear
- blunt trauma - head injuries risk of temporal # and hearing loss - surgical trauma
64
passage of sound in ear
``` concha external auditory canal tympanic membrane ossicles- malleus, incus, stapes oval window cochlea cochlea nerve ```
65
A 62-year-old man presents with a sore throat and 6 kg unintentional weight loss. He has smoked 1 pack of cigarettes daily for the past 45 years and drank 1 bottle of whiskey daily for the past 5 years. On examination, there is a large left tonsillar mass extending to the soft palate, with no cervical adenopathy
OROPHAYNGEAL carcinoma
66
A 74-year-old man presents with an 8-week history of right sided otalgia. This is associated with a sore throat and odynophagia. He smokes 20 cigarettes every day and is known to be a heavy drinker. On examination of the ear, there are no abnormalities noted.
nasopharyngeal cancer
67
children difference in anatomy
``` obligate nasal breathers large T and A large occiput tall tight supraglottis short trachea diaphragmatic breathers sensitive to small changes in airway epiglottis more concave and folded ```
68
foreign body ear canal classifications
witnessed unwitnessed- dont see but child tells you missed- never tells you and dont see till later
69
type of things used to remove things from ears
jobson horne synringing crococile forceps theatre if not successful
70
when would synringing be used
something dehydrated
71
when would crocidile forceps be used
paper but not circular
72
AOM children management
-can delay abx 48-72 hrs give abx -bilateral <2 -otorrhoea admit and IV abx if unwell child neuro symptoms masoiditis suspected
73
glue ear
otitis media with effusion
74
why do children get glue ear
eustachian tube immature
75
commonest cause of conductive hearing loss children
glue ear
76
presentation glue ear
``` can be asymptomatic recurrent otalgia poor listening skills indistinct speech or delayed language behaviour problems fluctuating hearing reucurrent ear infection balance problems ```
77
chronic OM dx
fluid present behind ear drum for 12 or more weks
78
tympanometry finding for middle ear effusion
flat trace
79
management of Glue ear - indication for surgical intervention
children with persistent bilateral OME over a period of 3 months with a hearing level in the better ear of 25-30 should be considered for surgical intervention
80
management options for glue ear
-surgical =grommet or ventilation tube- always wait 3 months -abx -antihistamines decongestants steroids diet hearing aids if contraindicated surgery
81
acute mastoiditis cause
-often preceded by AOM | as pus builds up in the mastoid bone it starts corroding out
82
presentation of acute mastoiditis
``` swollen behind ear can turn the ear inwards and forwards severe pain over mastoid process perforation can relieve the initial discomfort tachycardic and pyrexia ```
83
management of acute mastoiditis
``` admit IV abs and analgesia swabs if discharging CT scan if -neuro -systemic -baby and cant assess ``` surgical intervention-mastoidectomy drainage
84
complications of acute mastoiditis
neurological intra-cranial temporal bones systemic eg sepsis, thrombosis
85
unilateral smelly nasal discarge in a child
foreign body until proven otherwise
86
assessment of foreign body in child
rhinoscopy | parental kiss
87
types of nasal foreign bodies
witnessed, unwitnessed and missed organic FB- need to remove in a week inorganic FB- remove electively no risk button batteries- remove immediately risk of erosion
88
management nasal foreign bodies
remove with jobson horne, wax hook, crocodile theatre list
89
neonatal hearing assessment
OAE otoacoustic emission
90
epistaxis management in children
nasceptin first line 2 weeks 3xa a day
91
peri-orbital cellulitis presentation
swollen eye proptosis need to dermine if swelling just eyelid or in the globe
92
cause of peri-orbital cellulitis
from ethmoid sinus- pus travels to the orbit
93
complications peri-orbital cellulitis
visual problems colour vision goes first intracranial infections
94
management peri-orbital cellulitis
IV abx and nasal decongestants CT scan- vision signs, >24hrs no improvement ,difficult to assess child surgical drainage
95
pharyngeal abscess in a child presentation
unwell torticollis trisumus
96
management of pharyngeal abscess
hot tonsillectomy | drain abscess
97
retropharyngeal abscess presentation
drooling dysphagia theatre
98
presentation of atypical mycobacterial infections in a child | and RX
-cold abscesses with well child need clarithromycin if not settling surgical tends to resolve by itself though
99
foreign body oesophagus management
admit CXR above lower oesophageal sphincter= rigid oesophagocsopcy and remove below diaphragm= usrgeons
100
foreign body airway
theatre immediatly bronchoscopy short live xh of recurrent croup and chest infections
101
laryngomalacia
``` prominent few of birth often related to reflux inspiratory stridor tracheal tug costal recession pectus cavum thriving issues- surgical ```
102
paediatric acute rhinosinusitis presentation
nasal obstruction, discharge and one of frontal pain cough
103
pinna haematoma pathology
perichondrium stripped off cartilage and devascularised get necorsis and deformity -aspiration drainage same day ENT
104
pinna-microtia is
-due to an embryological defect failure formation of ear develops from 6 hillocks of his spectrum of malformation- normal to abscence of EAM and pinna
105
management of microtia
speech and language development surgical prosthesis hearing aids
106
pre-auricular sinus presentation and rx
-pit at root of helix- embryologicla remanant no intervention require unless becomes infected pus coming out treat acute infection surgical excision if recurrent infection
107
pinna cellulitis
needs IV antibiotics complications of other infections perichondritis spares lobe can end up with necrosis
108
external auditory meatus blockage
-wax/ cerumen | conductive hearing loss
109
wax production
by ceruminous glands
110
management of wax blockage
- soften using almond/ olive oil, sodium bicarb | - syringe/ microsuction
111
when should syringing for wax not be done
if perforation risk of infection
112
assoc. conditions to acute OE
psoriasis seb k eczema bacteria eg strep, staph, pseudomonous, fungi
113
presentation of acute OE
``` itch and pain minimal hearing loss red, eczematous swollen external auditory canal discharge pain on palpation of tragus ```
114
causes of acute OE
- post-trauma eg cotton buds - frequent swimmers - patients with eczema
115
treatment of acute OE
- cleaning- syringe suction - topical steroids / antibiotics - oral antibiotics if not settling and refer to ENT if not responding to topical aural hydiene and keep dry -ear wick if extensively swollen
116
choice of abx for acute OE
- pseudonomas ciprofloxacin for DM | - not aminoglycosides if perforated tympanic membrane
117
complication of acute OE
malignant OE
118
what is malignant OE
-diabetic patient with excessive pain and OE -osteomyelitis of temporal bone due to pseudomonas infection aggressive form immunocompromised also affected
119
symptoms of malignant OE
DM or immunocompromised severe otalgia temporal headaches purulent discharge
120
treatment of Malignant OE
aural toileting insertion of wicks high dose ciprofloxacin surgery for debridement
121
chronic otitis externa presentation
``` usuall bilateral painless relapse thickened skin of canal chronic discharge rare hearing loss ```
122
management of chronic otitis externa
-cleansing ear | antibacterial ear drops
123
exostosis is
a bony growth - bony protuberance
124
cause of exostosis
-triggered by cold water-surgers
125
management exostosis
-surgery only if obstructive and problems with wax | otherwise leave alone
126
presentation exostosis
conductive hearing loss
127
what is furunculosis
infection in the hair follicles lateral 1/3 of EAM is hairy follicle infection s.aureus main cause
128
presentation of furunuculosis and rx
-severe throbbing pain with pyrexia usually precedes the rupture of the abscess rx - abx - drain
129
round foreign object use
blunt hook | syringe as long as not dehydrated
130
tympanosclerosis is
calcification of the fibrous layer previous ear disease not clinically relevant
131
granular myringitis is
inflammation of the lateral surfaces of the ear drum granulation on ear surface of TM causes discharge slow to settle rx-topical
132
acute otitis media pathology
- often follows an URTI which ascends via the eustachian tube-viral - eardrum becomes retracted as the tube is blocked an an inflammatory middle ear develops
133
presentation AOM
``` red bulging ear drum fever severe otalgia discharge n and v in children ```
134
treatment of AOM
-pain relief antipyreitcs analgesia and nasal congestants delayed abs for 48 to 72 hrs?
135
antibiotics indication for AOM
1. <2 bilateral 2. immunocompromised 3. unwell 4. discharge or perforation 5. already present >4 days
136
abx for AOM
amox first line
137
complications of AOM
``` perforations hearing loss vertigo intra-cranial infection CN7 palsy acute mastoiditis ```
138
acute perforation causes
AOM | traumatic
139
AOM perforation presentation and rx
-relief of pain discharge topical antibiotics and waterproofing normally heals -refer at 6 weeks if not
140
perforation signs
ear obscured by thin transluencent layer of wax | hearing loss- conductive
141
traumatic perforation management
pain at time visible hole normally heals in a few weeks waterproofing
142
surgical option for perforation
myringoplasty
143
unilateral OME should consider
nasopharyngeal mass
144
chronic squamous otitis media- cholesteatoma pathology
- squamous debris retained in the middle ear/ cleft - long standing eustachian tube dysfunction can cause retractions and perforations of the tympanic membrane can occur with a choelsteatoma which is a non cancerous growth of squamous epithelium - perforated pars flaccida
145
presentation of chronic squamous otitis media
non resolving unilateral discharge which is offensive hearing loss poor antibiotics response
146
management of chronic squamous otitis media
surgery - mastoidectomy, excision of disease | regular microsuction if not fit for surgery
147
complications of cholesteatoma
``` -hearing taste tinnitus vertigo facial nerve palsy intracranial infection ```
148
otoscopy cholesteatoma
shows attic crust in uppermost part
149
chronic mucosal otitis media symptoms
otorrhoea-mucoid- blood stained | -hearing loss
150
two types of chronic mucosal otitis media
active or inactive
151
management of chronic mucosal OM
aural toilet | steroid eardrops
152
inactive chronic mycosal OM
-perforation in Tympanic membrane longstanding not healing may be mild hearing loss
153
management of inactive chronic mucosal OM
-no action mandatory | waterproof
154
management of active chronic mucosal OM
-perforation with discharge | persistent or intermittent
155
presentation of active chronic mucosal OM
-pain hearing loss balance otorrhoea-discharge
156
active chronic mucosal management
-waterproof topical steroid drops -myringoplasty-surgery
157
indications for myringoplasty for chronic mucosal OM management
-recurring discharge regular swimmer improve hearing
158
complications of middle ear infections
extracranial -acute mastoiditis facial paralysis labyrinthitis intracranial meningitis abscess lateral sinus thrombosis
159
tympanic membrane retraction cause
negtive pressure in the middle ear previous perforations in TM weak TM medialised progression unpredictable
160
complications of tympanic membrane retraction
erosion | cholesteatoma
161
Glomus tumours what sort of tumours
neuroendocrine - can secrete catecholamines
162
presentation of a GLomus tumour
pulsatile tinnitus conductive hearing loss facial weakness
163
types of glomus tumours
tympanicum jugulare vagale
164
treatment of glomus tumours
surgery radiotherapy or none
165
unilateral ear effusion in adults
need to consider nasopharyngeal carcinoma | 2 week ENT referral
166
features of middle ear effusion
muffled hearing click or pop on swallowing usually predisposing cold mostly children
167
Facial nerve palsy causes
-LMN CNVII palsy -idiopathic= Bell's palsy - ramsay hunt -middle ear pathology parotid tumour trauma CPA tumours
168
Bell's palsy presentation
``` dropping mouth ptosis drooping face- facial paralysis most recover 2-12 weeks idiopathic ```
169
bell's palsy management
prednisolone | protect eye with lubricants
170
severity of Bell's palsy
house brackmann definition
171
hearing loss types
sensorineural conductive mixed
172
cause of sensorineural hearing loss
``` iatrogenic- surgery, drugs, congenital eg genetic, infective, autoimmune, malignant excessive noise exposure meniere cochlear failure presbyacusis ```
173
drugs causing SNHL
-gentamicin platinum chemo anti TB meds
174
cause of presbuacysis
bilateral age related SNHL due to degeneration of hair cells cochlea
175
presentation of presbyacusis
affects high frequency first
176
conductive hearing loss causes
-EAM-wax occlusion -middle ear disease OME with effusion cholesteatoma perforation otosclerosis trauma ossicular discontinuity
177
SNHL management
hearing aids
178
types of hearing aids
conventional implantable cochlear implant
179
treatment of conductive hearing loss
-wax softening | surgery
180
vestibular schwannoma
slow growing benign tumours | also called acoustic neuroma
181
CN VII vesticular schwanoma
facial palsy
182
CV V vestibular schwanoma
absent corneal reflex
183
CN VIII vestibular schwanoma
-vertigo unilateral SNHL unilateral tinnitus
184
inx vestibular schwanoma
MRI urgent ENT audiogram
185
management acoustic neuroma
surgical
186
what is otosclerossi
replacement of normal bone by vascular spongy bone | causes progressive conductive deafness due to fixation of the stapes at the oval windown
187
inheritance of otosclerosis
autosomal dominant
188
presentation of otosclerosis
``` usually 20-40 conductive bilateral deafness tinnitus normal tympanic membrame- occasionally flamingo tip positive fhx can be precipitated in pregnancy ```
189
inx for otosclerosis fundings
normal rine and weber norm otoscopy audiometry shows conductive pattern with hearing loss at low frequency
190
causes of tinnitus
``` otosclerosis meniere acoustic neuroma drugs presbyacusis damage ```
191
what drugs can cause tinnitus
ASPIRIN NSAID aminoglycosides loop diuretics quinine
192
2 red flag features of tinnitus and cause
- pulsatile- suggest vascular | - asymmetric or unilateral look for CPA tumour
193
2 types of tinnitus
subjective -only by patient | objextive- heard also by observer
194
causes of objective tinnitus
AV malformation | carotid body tumour
195
management of tinnitus
reassurance hearing aid therapy
196
acoustic trauma
loud noises tinnitus unilateral HL resolves over hrs to days permanent damage to hair cells
197
BPPV presentation
``` sudden onset on head change transient ot seconds vertigo on movement following other inner disease/ trauma self-limiting last 10-20 seconds nausea ```
198
assessment BPPV
hallpike positive
199
pathology BPPV
calcium carbonate crystals loose in semi-circular canal
200
management of BPPV
``` Epley manoeuvre -roll around to get crystals out habituation vestibular rehab betahistine only short term ```
201
labyrinthitis presentation
``` vertigo- not triggered but is exacerbated on moving nausea and vomiting hearing loss tinnitus preceding symptoms of URTI episodes last days lie in bed with unaffected ear upwards ```
202
signs of viral labyrinthitis
- spontaneous unidirectional horizontal nystagmus to unaffected side - SNHL - abnormal head impulse - gait disturbance - normal skew test - abnormality on inspection of ear
203
management viral labyrinthitis
support and wait | promethazine, meclizine only if severe
204
meniere presentation
lasts minutes to hours fluctuating hearing loss -mostly unilateral but over yrs becomes bilateral low frequency SNHL ``` episodes usually resolve 5-10 days degree of overall hearing loss nystagmus fluctuating tinnitus aural pressure and fullness ```
205
A 65-year-old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upwards. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurological symptoms
bppv
206
A 56-year-old woman presents with a 3-week history of imbalance, right-sided hearing loss, and tinnitus. She reports having an upper respiratory infection 1 week before the onset of her symptoms. Her symptoms began with a severe episode of room-spinning vertigo with associated nausea and vomiting that lasted all day. The next day she noticed right, high-pitched tinnitus and was unable to use the telephone in her right ear. She now reports constant imbalance and slight vertigo with quick head turns to the right.
labyrinthitis
207
A 40-year-old woman presents with a 1-year history of recurrent episodes of vertigo. The vertigo spells are described as a sensation of the room spinning that lasts from 20 minutes to a few hours and may be associated with nausea and vomiting. The spells are incapacitating and are accompanied by dizziness, vertigo, and disequilibrium, which may last for days. No loss of consciousness is reported. The patient also reports aural fullness, tinnitus, and hearing loss in the right ear that is more pronounced around the time of her vertigo spells. Physical examination of the head and neck is normal. A horizontal nystagmus is noted. She is unable to maintain her position during Romberg's testing or the Fukuda stepping test. She turns towards the right side and she is unable to walk tandem. Her cerebellar function tests are normal.
meniere
208
management of meniere
refer to ENT DVLA low cafffeine and salt diet betahistine- prophylactic- reduce blood flow diuretics can also help intratympanic injection steroid or gentamicin prochlorperazine in acute attacks surgery decompress inner ear/ labyrinthectomy
209
vestibular migraine presentation
``` mimics meniere otheer symptoms eg headache, visual, tibling phx of fhx of migraine no flucutation in hearing or tinnitus episodic mins to hours ```
210
vestibular neuronitis presentation
``` following URTI Sudden onset often unilateral severe initially and subsides over severall days positional vertigo can be present for several weeks n and v pain in ear hrs to days horizontal nystagmus no hearing loss or tinnitus ```
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vestibular neuronitis management
-rehab exercises | prochlorperazine only short courses for relief
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SNHL on audiogram
both AC and BC reduced
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conductive on audiogram
AC reduced | so BC >AC
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mixed on audiogram
both air and bone decreased | but air is worst
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tympanometry for fluid in ear, perforation
flat
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retracted tympanic membrane tympanometry
shift curve left
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causes of presbyacusis
``` multifactorial arteriosclerosis diabetes noise drugs eg salicylates, chemo stress genetics ```
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acute rhinosinusitis definition
``` <12 weeks of nasal discarhge or obstruction change of smell pain ```
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avr
<10 days common cold
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acute post viral shinusitis
symptoms increase after 5 days or persist >10days but <12 weeks
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acute bacterial rhinosinusitis
``` at least 3 of discolored discharge severe local pain temp >38 raised ESR double sickenings ```
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chronic rhinosinusitis
>12 weeks nasal obstruction or discharge pain reduction or loss of sense of smell
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unilateral polyps management
red flags | refer
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main causes acute sinutisi
usually s.pneumoniae, h.influenzae and rhinovirus
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mangement acute sinusitis
<5 DAYS common cold only supportive symptoms persisting >10days or worsening after 5 days then topical steroids and if no effect after 14 days then refer symptoms persisting >10 days or worsening after 5 and severe bacterial suggesting then only trial intralnasal steroids for 48hrs and refer if no effect also can consider phenoxymethylpenicillin
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acute frontal sinusitis
potentially serious condition as a risk of intracranial complications severe frontal headache and tenderness CT if suspect intracranial infection
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complications of acute coryza
``` otitis media nasopharyngitis acute sinusitis cervical lymphadenitis laryngitis pneumonia ```
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acute sinusitis predisposing factors
nasal obstruction recent local infection swimming smoking
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chronic sinusitis
>12 weeks | retained secretions allow a spectrum of bacteria to colonise the sinuses further inhibiting clearance
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management of chronic rhinosinusitis without polyps
mild 0-3 topical steroids, irrigation ``` moderate/ severe topical steroids nasal saline irrigation culture consider long term abx (if not allergic) CT scan surgery ```
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management of chronic rhinosinusitis with polyps
mild disease- topical steroid spay and reviwe at 3months moderate- topical steroid spray and consider democycline severe- topical or short course oral steroids- review at 1 month if improved continue if not improved CT and surgery
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polyps are
bag of oedematous mucosa arise from ethmoid cells and prolapse via the middle meatus bilateral
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rhinitis is
inflamamtion of lining of the nose | inflammed turbinates swell
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symptoms rhinitis
loss of smell congested loss of taste
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types of rhinitis
allergic non-allergic- eosinophilia infective- viral
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allergic rhinitis
``` IgE seasonal watery discharge, sneezing clinical dx trial of allergy avoidance allergy skin prick testing ```
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allergic rhinitis classification
mild normal sleep, daily activities, school and work moderate to severe abnormal sleep, impaired activities, problems school or work troublesome activities intermittent <4 days a week persistent >4 days a week
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management rhinitis
mild= oral/ topical ah1 severe and mod= topical nasal steroid check use compliance, increase dose watery rhinorrhoea- add ipratopium itch/sneeze= add ah1 catarrh= addd LTRA if asthma blockage = add decongestant, oc consider immunotherapy if due to allergy infection or anatomical- surgery eg turbinoplasty, septoplasty
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vasomotor rhinitis
imbalance sympathetic and parasympathetic supply increased vascularity during ``` change in temp preganncy puberty menopause COCP ``` decongestants diathermy
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rhinitis medicamentosa
overuse of decongestants causes reactive vasodilatation of the nasal mucosa
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atrophic rhinitis
``` severe crusting of the nasal cavities and atrophy of mucosa klebsiella foul stench crust epistaxis ``` nose hygiene
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epistaxis causes
``` idiopathic infection trauma neoplasia- juvenile angiofriboma FB HTN drugs blood disease HHT ```
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management epistaxis
1st aid cautery silver nitrate-diathermy anterior packing surgical arterial ligation of sphenopalatine artery nasceptin
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when to admit for epistaxis
if packed haemidrynamic unstable co-morbidities <2 yrs old
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nasal #
5-7 days post injury trial MUA | needs to be done in 2 weeks
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septal devitation
cant move cartilage | would need to wait 6 months for septoplasty if severe breathing problems
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septall haematoma
need to exclude on all nasal # can get saddle nose -infection corrodes through septum needs to be drained
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pott's puffy tumour is
complication of infection sinusitis causes osteomyelitis of frontal bone and formation of abscess boggy frontal swelling CT surgical drain and IV abx
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risk of facial abscess
cavernous sinus thrombosis
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facial palsy causes
``` bell's diagnosis of exclusion acoustic neuroma CVA brainstem tumour ramsay hunt middle ear infection trauma parotid tumour ```
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causes of a bilateral facial nerve palsy
``` sarcoidosis guillain barre lyme bilateral acoustic neuroma bell's palsy but rare ```
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bells' palsy cf
``` often get otalgia before onset of facial weakness loss of hearing taste hyperacusis dropping eyelid and mouth ``` ``` 3 weeks and improves idiopathic cause most common cause dx of exclusion inflammation of facial nerve ```
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ramsay hunt syndrome cf
``` shingles outbreak in facial nerve painful red rash vesicular rash on ear or tongue facial weakness or paralysis ear pain often 1st feature hearing loss vesicles on tympanic membrane tinnitus vertigo ```
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complications of ramsay hunt
permanent hearing loss and facial weakness eye damage postherpetic neuralgia
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rx of ramsay hunt
aciclovir and steroids
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acoustic neuroma cnviii
tinnitus vertigo hearing loss
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acoustic neuroma cnv
absent corneal reflex
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acoustic neuroma cnvii
facial palsy
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who gets bilateral acoustic neuroma
neurofibromatosis 2
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management of acoustic neuroma
urgent referral ENT MRI audiometry surgical, radiotherapy, observed slow growing benign
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types of parotid tumours benign
benign pleomorphic adenoma warthin tumour- papillary monomorphic adenoma haemangioma
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benign pleomorphic adenoma
``` most common proliferation of epithelial slow growing recurrence possible surgical malignant degeneration 2-10% ```
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warthin tumour- papillary cystadenoma
``` second mot common bilateral benign neoplasm of parotid male 6th and 7th decade lymphocytic and cystic infiltrates malignant transformation v..rare ```
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monomorphic adenoma
slow growing
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haemagioma parotid
consider in child 90% of <1yr old partotid hypervascular can spontaneous regress
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malignant parotid tumours
``` mucoepidermoid carcinoma adenoid cystic carcinoma mixed acinic cell adenocarcinoma lymphoma ```
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quinsy cf
``` unilateral trismus temp referred otalgia ulvar deviation reduced neck mobility hot potato ```
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management quinsy
urgent referral ENT lance iv abx theatre if not improving
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sore throat diff dx
pharyngitis tonsillitis laryngitis infectious mononucleosis
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indications for antibiotics for sore throat
``` 3/4 centor marked systemic upset unilateral peritonsillitis hx rheumatic fever immunodeficiency ```
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tonsillitis cf
``` sore throat difficulty swallow pain temperature drooling vpoice change oedematous tonsils white film that bleeds when attempt to remove ```
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main causes of tonsillitis
s.pyogenes | EBV
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management tonsillitis
if meets centor 3/4 give phenoxymethylpencillin
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tonsillectomy indications
``` 7 in 1 5 in 2 3 in 3 sleep apnoea enlarged adenoids 2 quinsy malignancy disabling tonsillitis ```
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post tonsillectomy bleeds
all assess by ENT 6-8hrs primary= immediate return to theatre 5-10 days= secondary often assoc. to wound infection so admit and abx
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glandular fever cf
lymphadenopathy hepatosplenomegaly can look like tonsillitis EBV
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acute laryngitis
refer >3 weeks
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pharyngeal abscess cf
``` hx of URTI throat pain odoynophagia fever neck swelling/ tenderness/ lymphadenopathy neck stiffness compromised airway ```
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management of pharyngeal abscess
IV fluids IV abx airway protection needle open surgical drainage
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retropharyngeal abscess
mostly children inflammation and swelling in retropharyngeal space child assists hyperextension of the neck which is held rigid
281
vocal cord nodules
``` dysphonia low pitch quality husky most resolve rest voice ```
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vocal cord palsy
recurrent laryngeal nerve injury from iatrogenic, lung, malignancy CT scan to check
283
sialolithiasis
stones colicky pain and post prandial swelling on eating pain
284
sialadenitis
staph aureus infection of salivary glands pus erythema abscess
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submandibular tumour is ususally
adenoid cystic carcinoma
286
red flags for neck lumps
``` not tender neck lump hoarseness dysphagia otalgia throat pain ulceration stridor ```
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midline massess
thyroid thyroglossal cysts midline dermoids
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lateral nedk lumps
``` tumour lymphoma metastatic infective sjorgen sarcoidosis sebaceous cysts lymph nodes ```
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brachial cyst
embryological remanant young adult anterior triangle assess to exclude cystic degeneration
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thyroglossal cyst
embruological remanant of thyroid duct moves on swallowing and tongue protrusion midline
291
submandibular mass
sialolithiasis | siladenitis
292
juvenile nasal angiofriboma
``` more common in teenage boys benign vascular tumour appears in nasal cavity expands quickly and extensively including into the brain intercurrent epistaxis need to remove tumour ```
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reactive lymphadenopathy
most common cause of neck swelling tender hx of URTI
294
lymphoma
rubbery, painless lymphadenopathy assoc. night sweats and splenomegaly phenomenon pain on drinking uncommon
295
pharyngeal pouch
older men midline lump gurgles on palpation but not usually visible dysphagia ,reflux hallotosis
296
cystic hygroma
congenital <2 yrs translluminates soft and mobile painless
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branchial cyst
``` oval mobile cystic mass - scm and pharynx dont translluminate early adulthood failure to close 2nd branchial cleft ```
298
carotid aneurysm
pulsatile lateral neck mass | not mobile
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red flags head and neck cancer
``` hoarseness >2 weeks neck lump >2 weeks throat pain >2 weeks swallowing problems smoking hx weight loss cough unexplained oral cavity ulceration >3 weeks -unilateral epistaxis ```
300
lip cancer
often squamous cell carcinoma rf UV light tobacco rx lip shave ulcer excision
301
oral cavity cancer
mostly malignant squamous cell on tongue rf - betel nut chewing - smoking - alcohol - chronic dental infection
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tongue cancer
``` -lateral border indian painless ulcers difficulty chewing dx on biopsy L1 under chin lymph node spread tongue fixation and invasion of mandible diffculty swalloing and speech management- surgery ```
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floor of mouth cancer
``` presents late with invasion of the mandible dysphagia and pain odynophagia CT biopsy surgical resection ```
304
alveolar ridge
``` presents late direct invasion of mandible inferior alveolar nerve ill fitting dentures can be presenting symptom treatment surgery ```
305
buccal mucosa cancer
indian tobacco betel nut chewing
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tonsil cancer
unilateral tonsil with L2 spread risk of lymphoma
307
larynx cancer
most squamous cell | based on location
308
supraglottis
neck lumbs | dysphagia
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glottis
hoarsness dysphonia prevents early
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subglottis
respiratory
311
inx for larynx cancer
CXR laryngoscopy FNA lump
312
glottic carcinoma vocal cords
early symptoms hoarseness management - radiotherapy - endoscopic laser resection - laryngectomy parital or total
313
supraglottic carcinoma
early symptoms are often subtle and ignored often bilateral dysphagia early -laser excision, radiotherapy, laryngectomy late chemoradiotherapy total or partial laryngectomy with pharyngectomy
314
subglottic cancer
rarest laryngeal subsite prevents late invasion of surrounding structures total laryngectomy
315
oropharyngeal
tonsil common site related to HPV ``` signs unilateral enlarged tonsil L2 node enlargement throat discomfort dysphagia otalgia neck lump ``` ``` inx MRI CT FNA CXR ``` rx - early= primary resection and radiotherapy - advanced= primary surgery and chemoradiotherapy
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nasopharyngeal carcinoma causes
malignant squamous cell chorodoma angiofibroma benign
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rf nasopharyngeal
- asian - salted fish - EBV - smoking - herbal medicine
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CF of nasopharyngeal
``` cervical painless lymphadenopathy otalgia nasal obstruction- unilateral epistaxis, discharge, palsy 3-6 posterior triangle lump facial pain speech ```
319
A 62-year-old man presents with a sore throat and 6 kg unintentional weight loss. He has smoked 1 pack of cigarettes daily for the past 45 years and drank 1 bottle of whiskey daily for the past 5 years. On examination, there is a large left tonsillar mass extending to the soft palate, with no cervical adenopathy.
oropharyngeal
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57-year-old man presents with a 6-month history of hoarseness. He has a reactive airway disease diagnosis and is treated for asthma. Over the past week he has noted progressive difficulty breathing. He also has otalgia, dysphagia, odynophagia (painful swallowing), and a 9-kg weight loss
laryngeal
321
laryngopharynx cancer
causes -tobacco alcohol -plummer vinson or paterson brown syndrome
322
laryngopharynx cancer presentation
``` odynophagia dysphagia referred otalgia hoarsenesss neck nodes ```
323
inx laryngopharynx
barium swallow CXR CT
324
management laryngopharynx
surgery chemoradiotherapy radical surgery
325
nasal neoplasia
benign-osteoma, papilloma | malignant, scc, adenocarcinoma melanoma
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risk factors nasal malignancy
``` smoking hardwood dust-adenocarcinoma ethmoid nickel dust to SCC radiation of nose transitional cell papillomatoma assoc. snuff ```
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cf nasal neoplasia
``` frontal sinus cancer- orbital, proptossis nasal cavity- obstruction, epistaxis mouth-ill fitting dentures, loose teeth face swelling antral tumours usually present late ephiphoria trigemenial nerve trismus ```

year 5 (9 decks)

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