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Year 5 Special Senses > ENT > Flashcards

ENT Flashcards

(60 cards)

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1
Q

Why is otitis media more common in children? (3-6yrs)

A

Due to their anatomy- small + horizontal eustachian tube > poor drainage function > increased infection risk.

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2
Q

What are common organisms that cause Otitis Media?

A

Bacteria: Strep pneumonia, Group A B-haemolytic, Heamophilus influenzae
Virus: RSV, rhinovirus

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3
Q

Difference between acute and secretory Otitis Media?

A

Acute: infection of middle ear.
Secretory: middle ear effusion w/o sx of acute OM.

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4
Q

Presentation of Acute OM?

A

(often follows viral URTI)
Otitis > otalgia (bulging TM, resolves when TM bursts) > purulent discharge (resolves in 48hrs)
Hearing loss (mild)
Systemic: fever, irritability, anorexia, N&V

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5
Q

Presentation of Secretory OM?

A

Middle ear infusion (lasts months)
Can be serous (thin), mucoid (thick), or purulent.
Hearing loss
Inattentive

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6
Q

Appearance on an otoscope of:

a) Acute
b) Secretory

A

a) TM bright, red, bulging. Loss of normal light reflection.

b) TM retracted + opaque.

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7
Q

Management if a child comes to a GP with OM?

A
  • Admission if child <3months with temp >38C, or 3-6months with>39C.
  • Supportive: 1st presentation of acute cases (oral fluids + simple analgesia)
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8
Q

When would you prescribe antibiotics (and which?) in OM?

A

5/7 day course of:
1st line= amoxicillin
2nd line= clarithro/erythromycin

Systemic upset
^risk of comps
Sx >4days with no improvement
<2yrs with B/L AOM
Perforation/ Otorrhoea
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9
Q

How can OM be managed surgically?

A

Myringotomy (tiny incision in TM to relieve pressure)

+ Grommet insertion (tympanostomy)

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10
Q

What are some complications/ red flags with OM?

A
  • Effusion: swollen/bulging TM +/- air fluid level, often follows acute OM.
  • Perforation (fairly common)
  • Mastoiditis
  • Cholesteatoma
  • Hearing loss
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11
Q

What is the presentation and risk of mastoiditis?

A

(can be due to recurrent OM or Hx of cholesteatoma)
Severe pain, forward protrusion of ear w/ tender boggy mass behind ear.
Can progress to meningitis.
Requires URGENT treatment.

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12
Q

What is cholesteatoma?

A

Keratinizing squamous epithelium colonises middle ear due to tympanic membrane retraction.

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13
Q

What is Sialolithiasis and where do they mainly occur?

What is the presentation?

A

Salivary gland stone- 80% occur in the submandibular gland.
70% of these are radio-opaque (calcium)

Presentation:
Colicky oral pain
Post-prandial swelling of gland

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14
Q

How do you manage sialolithiasis?

A
  1. Sialography

2. Stones in Wharton’s duct may be removed orally, others may require gland excision.

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15
Q

What pathogens are mostly responsible for tonsillitis in:

a) Young child
b) Older child + exudative

A

a) Adenovirus, Enterovirus, Rhinovirus, RSV

b) EBV, group A β-haemolytic strep

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16
Q

Main differences between Viral and Bacterial tonsilitis?

A

Viral:
Pre-coryzal sx, fever, cough, painful throat, odynophagia, earache. Enlarged inflamed tonsils + uvula.
Bacteria:
Headache + abdo pain, fever.
Cervical lymphadenopathy
RED enlarged tonsils w/ white purulent exudate.

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17
Q

What is the CENTOR criteria?

A

Fever >38C (1)
Tonsillar exudate or swelling (1)
Cough absent (1) Cough present (0)
Cervical LN tenderness or swelling (1)

Score of 3 or more= likely to be group A β-haemolytic strep

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18
Q

Antibiotics for bacterial tonsilitis (if +ve swab for group A β-haemolytic strep)

A
  • Penicillin V or Erythromycin (10days)
  • Clarithromycin (if pen allergy)

NB: avoid amoxicillin, can cause rash in EBV cases.

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19
Q

Presentation of a peri-tonsillar abscess (quincy)

common complication of bacterial tonsilitis

A
  • Throbbing throat pain (U/L)
  • C/L deviation of uvula
  • Trismus
  • Reduced neck mobility
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20
Q

Where is the source of an anterior haemorrhage from Epistaxis?

A

(Mild) Source of bleeding is visible in majority of cases.

Usually from nasal septum at Little’s area where Kiesselbach’s plexus forms.

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21
Q

Where is the source of posterior haemorrhage from Epistaxis?

A

From deeper structures of the nose: large volume + risk of airway compromise.
More common in elderly.

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22
Q

What is nasal obstruction, headache, rhinorrhoea + anosmia a sign of in a young male patient?

A

Juvenile nasopharyngeal angiofibroma

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23
Q

Management of CSF Rhinorrhoea?

A
  1. Nasal discharge test +ve for glucose
  2. Send CSF sample to lab: B2 transferrin
  3. Conservative mx: bed rest, self resolves 7-10days
  4. Cover with abx + pneumococcal vaccine
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24
Q

What are the two subtypes of Otitis Externa?

A

a) Acute (<3wks, aka ‘Swimmer’s’ Ear), or Chronic (>3months, fungal)
b) Diffuse (affects skin + SC tissue), or Localised (eg infected hair follicle)

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25
What organisms cause Otitis Externa?
Bacterial (90%): Staph aureus, Pseudomonas a Fungal: Aspergillus, Candida Also: irritants + inflammation.
26
Presentation of Otitis Externa?
Pruritic itchy ear Otalgia (esp on movement of tragus) Erythema + Oedema of ear canal + ear Mobile tympanic membrane
27
What is the presentation of Necrotising (malignant) otitis externa? (risk in DM/Immunocompromised)
90% caused by Psuedomonas. - Severe pain, exudate, oedema, micro-abscesses - Headache +/- facial nerve palsy - May spread to bone causing osteomyelitis death (if untreated)
28
How is necrotising OE managed?
URGENT admission + ENT referral. +ve swab PO + TOP Quinolones for 6-8wks (e.g. ciprofloxacin, oflaxacin)
29
What part of the ear is affected in Labyrinthitis (aka Vestibular Neuritis)?
Inflammation of the vestibular apparatus (nerve + labyrinth, VN sx are worse). The afferent input of the vestibular system is disturbed. Leads to a spectrum of balance + hearing problems.
30
What are some of the causes of Labyrinthitis? (infectious + vascular)
Viral: reactivation of HSV1 in vestibular ganglion, URTIs BActerial: rare but serious Vascular: Vertebro-basilar ischaemia
31
Presentation of Labyrinthitis?
- Sudden onset - Spontaneous + severe vertigo (constant, uncapacitating) - N&V - Nystagmus (Labyrinthitis: +/- tinnitus + hearing loss)
32
What are the components of a HINTS exam?
a) Head Impulse test (abnormal: saccades present) b) Nystagmus Type: discern if its unidirectional & consistent. c) Skew: typically vertical skew.
33
What does Nystagmus that changes on position indicate?
Indicates a central cause (i.e. Stroke/TIA). | such as fast phase to left when looking left, + vice versa
34
What results of a HINTS exam are markers of VN + labyrinthitis?
- Abnrmal head impulse test - Unidirectional nystagmus - No vertical skew
35
Management of Labyrinthitis/ VN?
- Emergency admission + ENT specialist (if sudden onset U/L heading loss) - Supportive mx + medication: Prochloperazine for dizziness
36
What surgery options are there to treat Labyrinthitis/VN with an underlying cause?
- Myringotomy: AOM w/effusion | - Mastoidectomy: mastoiditis/ cholesteatoma
37
What is Ramsay Hunt Syndrome? (aka Herpes Zoster Oticus)
Reactivation of VZV in CNVII. - Auricular pain (1st feature) - Facial nerve palsy - Vesicular rash around ear + tongue - Vertigo + tinnitus
38
What BPPV presentation?
- Gradual onset vertigo (triggered by head position) - Episodes last 10-20secs - +ve nystagmus! Epley Manoover
39
What is Meniere's disease?
Disorder of inner ear, characterised by excessive pressure + progressive dilation of endo-lymphatic system.
40
Clinical presentation of Meniere's disease?
Recurrent episodes (mins-hours) of: - Vertigo (1st + most prominent sx) - Tinnitus + hearing loss (sensorineural) - Sensation of aural fullness/ pressure - +ve nsytagmus/ +ve Romberg (n/b sx are typically U/L, but can develop into B/L)
41
Mx of Meniere's: a) Acute attacks? b) Prevention?
a) Buccal/IM Prochlorperazine | b) Betahistine + Vestibular Rehab exercise
42
What organism is Epiglottitis caused by?
Haemophilus Influenzae type B (HiB) | more common in travelling community as not as up to date on vaccines
43
Management of Epiglottitis?
- Intubate w/GA (dont examine throat) - Tracheostomy (if intubation fails) - Blood cultures + IV Abx after airway stabilised. - IV Cefuroxime or Cefotaxime
44
What prophylaxis is offered to the household of someone with Epiglottitis?
Rifampacin
45
What are Neurofibromatosis Type 1 and Type 2 associated with?
Type 1: can cause all tumour types + lead to deafness | Type 2: bilateral schwannomas
46
What is presbyacusis?
Age-related B/L hearing loss.
47
When would you do an urgent ENT referral for someone with hearing loss?
- Sudden unilateral hearing loss - Middle ear effusions - Focal neurology + cholesteatoma: malignant OE?
48
What is cholesteatoma? | not a tumour- made up of cholesterol
Independently growing collection of epidermis + cholesterol in the middle ear > potentially locally invasive > pressure + release of osteolytic enzymes can be destructive to bones of middle ear > can extend to mastoid.
49
What are the three causes of cholesteatoma? 1. Congenital 2. Primary 3. Secondary
1. Squamous epithelium trapped in temporal bone during embryogenesis > conductive hearing loss. 2. Chronic -ve middle ear pressure (eustachian tube dysfunction) > causes TM to retract > erosion of lateral wall of epitympanum > cholesteatoma. 3. Due to insult to TM > leading to implantation of squamous epithelium to TM > cholesteatoma
50
Symptoms of Cholesteatoma?
(vary according to size!) - Small: progressive conductive hearing loss. - Enlarging/Large: invades adjacent structures + leads to vertigo, headache, facial nerve palsy, tri neur.
51
What does an otoscope show with a Cholesteatoma?
-Attic lesion/crust seen in uppermost part of ear drum. (w/ retracted TM/ perforation)
52
Two types of excision management for cholesteatoma?
a) Tympanomastoidedectomy (open): more successful but more post-op SE. b) Tympanoplasty (closed): less post-op SE
53
What is an acoustic neuroma (aka Vestibular schwannoma)?
-Typically benign, slow-growing tumour of vestibulo-cochlear cerve (VIII), arising from Schwann cells of nerve sheaf. (most arise from vestibular portion rather than cochlear: therefore it is doubly misnamed: Schwannoma (not neuroma) and is from vestibular nerve (not auritory).)
54
Symptoms of acoustic neuroma are typically due to mass effect on CN. So what may be the clinical presentation?
- CNVIII: U/L hearing loss + tinnitus. Vertigo (late feature). - CNV: trigeminal neuralgia, absent corneal reflex. - CNVI: head tilted, defective horizontal gaze> HORIZONTAL diplopia. - CNVII (less common): facial palsy.
55
How do you diagnose/investigate an acoustic neuroma?
MRI cerebello-pontine angle.
56
Clinical presentation of Nasal Polyp?
- Nasal obstruction: mouth breathing, snoring. - Rhinorrhoea: watery, post-nasal drainage. - Sneezing.
57
Red flags of Nasal Polyps?
- U/L discharge/Sx | - Bleeding (consider neoplasm)
58
Presentation of Trigeminal Neuralgia?
- U/L shock-like pain paroxysms across CNV distribution. - Abrupt in onset/termination - Provoked by light touch - Nasolabial fold may act as trigger area. - Limited to one or more divisions of trigeminal
59
Management of Trigeminal Neuralgia?
- Carbamazepine (1st line) | - Failure to respond to Tx/ atypical features (e.g. <50yrs): refer to neurology!
60
Management of nasal polyps?
- Refer all pts to ENT for full examination + rhinoscopy. - TOP Beclomethasone 1% (shrinks polyp) - Anti-histamine if allergic rhinitis presents.

Year 5 Special Senses (2 decks)

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