ENT Flashcards
1
Q
What are the 3 main bones of the middle ear?
A
Malleus - attaches to tympanic membrane, incus, stapes (attaches to oval window of inner ear)
2
Q
What is the function of the Eustachian tube?
A
Connects middle ear to the nasopharynx and equalises the pressure to that of the external auditory meatus (if dysfunction= negative pressure builds in middle ear)
3
Q
What makes up the bony labryinth (3) of the inner ear?
A
Semi-circular canals- involved in balance
Cochlear- houses the cochlear duct for hearing
Vestibule - balance
4
Q
What are some red flag questions to ask in a patient with a neck lump?
A
Weight loss, night sweats, fever Hard, fixed lump Dysphagia Otalgia Hoarseness Unilateral nasal congestion Epistaxis CN palsies
5
Q
What are 5 causes of neck lumps?
A
Malignancy- Lymphoma, squamous cell carcinoma, thyroid malignancy, carotid body tumours
Infective- reactive lymphadenopathy, abscess
Congenital - thyroglossal cyst (midline), branchial cyst (lateral), dermoid cyst (midline), salivary gland disease
Thyroid goitre - Hashimoto’s, Graves
Inflammatory- TB, sarcoidosis
6
Q
What type of carcinoma (histology) is most common in head and neck cancers?
A
Squamous cell carcinoma
7
Q
How would you investigate a SCC of head and neck?
A
Bloods- FBC, U&E, LFTs, CRP
Ultrasound
Flexible nasolaryngoscopy
8
Q
What are the signs/symptoms of lymphoma?
A
Lymphadenopathy - rubbery nodes + B symptoms- weight loss, night sweats, fever
9
Q
What are the two types of non-Hodgkin’s lymphoma and which type is more aggressive?
A
Low grade- follicular
High grade- diffuse B cell
High grade is more aggressive but can be cured. Compared to low grade- slow growing but incurable.
10
Q
What is a carotid body tumour?
A
Tumour of the paraganglionic cells of the carotid body
11
Q
How does a carotid body tumour present?
A
Painless, pulsatile neck lump with a bruit. Can’t move it up and down but can move it side to side
12
Q
How do you treat a carotid body tumour?
A
Active monitoring or surgical excision
13
Q
What is the typical age for a branchial cyst to present in?
A
Around 30s- if older, need to rule out thyroid/oesophageal cancer
14
Q
What is the branchial cyst?
A
Remnant of the branchial cleft from embyonic development
15
Q
How does a branchial cyst present?
A
Painless mass on lateral side of neck. no symptoms unless infected.
16
Q
How do you investigate a branchial cyst?
A
US. Aspirate for cytology- check it’s not metastasis from head and neck ca
17
Q
How do you treat a branchial cyst?
A
Surgical excision
18
Q
What is a thyroglossal cyst?
A
Remnant of the thyroglossal tract that should obliterate at birth
19
Q
What is the typical age group for a thyroglossal cyst to present in?
A
Children- around 5
20
Q
What are the symptoms and signs of a thyroglossal cyst? What can you ask the patient to do to help confirm a thyroglossal cyst?
A
Painless palpable lump in the midline
Can ask the patient to swallow and stick out their tongue- it will move on swallowing and tongue protrusion
21
Q
How do you investigate and treat a thyroglossal cyst?
A
TFTs
Ultrasound +/- aspiration
Tx: surgical
22
Q
A patient comes into your practice with painful lump under her jaw. She says the swelling and pain is particularly noticeable at meal times. The pain is severe but intermitten. What is the likely diagnosis?
A
Stones in salivary gland= sialolithiasis
Lump - submandibular stones are most common. painful mainly at meals.
23
Q
How do you treat Sialolithiasis?
A
Supportive
24
Q
What is the most common cause of acute sialadenitis?
A
Staphylcoccus
25
How does acute sialadenitis present? How would you treat?
Pain, swelling, purulent discharge, erythema. Treat with antibiotics.
26
What is the most common salivary gland tumour?
Parotid tumour. Most are benign
27
What is the most common type of parotid tumour?
Pleomorphic adenomas
28
How does a parotid tumour (plemomorphic adenoma) present?
Painless lump behind the angle of the jaw
29
How does a malignant parotid neoplasm present?
Unilateral facial swelling, facial nerve palsy, cervical lymphadenopathy, painful
30
How would you investigate and treat a salivary gland tumour?
Ultrasound, aspiration + MRI (if malignant to stage)
| Tx: surgically excise
31
What is the type of salivary gland tumour common in elderly men (70s) who are smokers?
Warthin's tumour. can be managed conservatively.
32
What are the functions of the facial nerve?
Motor to muscles of facial expression and stapedius
Special sensory- taste to the anterior 2/3 of tongue
Parasympathetic- lacrimal glands, salivary glands
33
What are some causes of facial nerve palsy?
| What type of lesion causes forhead sparing?
Bell's palsy - LMN
Infection of facial nerve
Parotid tumours
Surgery to parotid causing nerve transaction
Temporal bone fracture
Stroke
UMN lesion causes forehead sparing - bilateral innervation
34
What is the most common cause of tonsilitis?
Viral- adenovirus, rhinovirus, influenza, EBV
| Bacterial cause - group A haemolytic strep
35
A 7 year old boy comes into your practice with a 4 day history painful throat. He says it really hurts to swallow and he feels unwell. His mother mentions he's been suffering from a cough and cold for a few days but not having any fevers. When you look in this throat, you see redness around the tonsils but no white stuff around it. What is the likely diagnosis? How will you decide whether antibiotics are indicated? Are they in this case?
```
Tonsillitis
Fever PAIN score
- Fever
-Purulence
-Attends rapidly within 3 days
-Inflamed tonsils
-No cough or coryza
His fever pain score is 2 (inflamed tonsils, no cough and coryza)- Abx not indicated.
```
36
What are the symptoms of tonsilitis?
Sore throat
Painful swallowing- odonyphagia, dysphagia
Earache
Malaise and headache
37
What are the signs of tonsilitis?
Bilateral enlarged tonsils with exudate
Bilateral cervical lymphadenopathy
'Hot potato'/thick voice
Fever
38
What investigations should you do in a patient presenting with tonsillitis?
FBC, U&Es (dehydration), CRP, monospot test (glandular fever screen), blood cultures if pyrexial
39
How do you treat viral tonsillitis? What antibiotic would you give if you suspected bacterial tonsillitis?
Reassure- will clear up in 7 days. Supportive- fluids, analgesia.
Phenoxymethylpenicillin (if penicillin allergic: erythromycin)
40
What antibiotic do you avoid giving in tonsillitis and glandular fever?
Ampicillin based eg. co-amoxiclav= can cause a rash in glandular fever
41
The same 7 year old patient with viral tonsillitis who you reassured and sent home with analgesia and advice for fluids has come back a week later with worsening sore throat. He says the pain is just on his left side and he is struggling to open his mouth for you to examine him. You eventually do as you see the uvula has been pushed to one side. What is the likely diagnosis and cause?
Quinsy- peritonsillar abscess caused by group A strep
| Sx: trismus, severe unilateral pain, 'hot potato' voice, deviated uvula - pushed away by abscess.
42
How do you investigate and treat a quinsy?
Bloods- FBC, U&Es, CRP.
Aspirate the quinsy and send for MC&S.
May have dexamethasone to reduce any swelling
Antibiotics- benzylpenicillin
43
What is globus pharyngeus?
Sensation of lump/discomfort in the throat with no obvious cause. Usually associated with reflux. Rule out serious pathology with flexible naso-endoscopy and then reassure and treat reflux.
44
What are common risk factors for tonsillar carcinoma?
Smoking, alcohol, HPV 16 and 18
45
What is the most common histological type of tonsillar carcinoma?
Squamous cell carcinoma
46
What symptoms and signs will you get with a tonsillar carcinoma?
```
Unilateral tonsillar swelling
Dysphagia
Sore throat
Lump in throat sensation
Referred otalgia
Cervical lymphadenopathy
Trismus
```
47
How will you investigate a suspected tonsillar carcinoma?
Bloods
Endoscopy + biopsy
Aspirate lymph nodes
MRI - staging
48
A 17 year old boy comes into your practice with a 3 day history of sore throat and low grade fever. On looking in his throat you see the tonsils are red and enlarged and there are some spots on his palate. You do a full examination and you notice he has splenomegaly present. What is test needed to diagnose this condition?
Monospot test done to diagnose glandular fever (EBV)
49
What investigations are done in a patient with suspected glandular fever?
Monospot
Bloods- FBC, LFTs - deranged, ESR/CRP, U&Es
US- if splenomegaly
50
What is the treatment for glandular fever?
Avoid contact sports and alcohol
| Paracetamol/ibuprofen for pain and fever and fluids (IV if can't swallow/dehydrated)
51
What complications can you get from glandular fever?
Obstruction of airway by very large tonsils
Splenic rupture
Autoimmune haemolytic anaemia- cold type
Pneumonia (infection spread to lungs)
52
What are the causes of vertigo? central and otologic
Central: stroke- posterior/cerebellar (acute onset), brain mets, MS, SOL, migraine
Otologic: BPV, Meniere's disease, vestibular neuronitis/viral labrynthitis
53
What is the cause of BPV?
Crystals in the semi-circular canals causing abnormal movement of endolymph and vertigo
54
Who are classically affected by BPV?
40-60 years old, elderly, rugby players
55
What are the classic symptoms and signs of BPV? (sx, onset, hearing loss, symptom duration)
Vertigo precipitated the same sudden movement eg moving head in bed, symptoms lasts seconds, nausea and vomiting. No hearing loss.
56
How can you diagnose BPV?
Dix Hallpike maneovre. If +ve= vertigo, nausea, and nystagmus
57
How can you treat BPV?
Epley maneouvre
58
What are the classic symptoms and signs of Meniere's disease? (sx, onset, hearing loss, symptom duration)
Unilateral sx: severe paroxysmal vertigo, sensorineural hearing loss, tinnitus
Gradual onset, symptoms can last minutes to hours.
59
What investigations should you do for a patient with Meniere's?
Otoscopy- normal
| Pure tone audiometry- sensorineural hearing loss
60
What is the treatment for Meniere's disease?
Prochlorperazine - acutely
Reduce salt in diet, avoid caffeine
Betahistine hydrochloride
If not controlled= surgery
61
What is usually the cause of vestibular neuronitis?
Viral infection preceeds- URTI
62
What are the symptoms and signs of vestibular neuronitis? (sx, onset, hearing loss, symptom duration)
```
Vertigo, nausea and vomiting
Sudden onset of severe symptoms, can last for days - classically confined to bed.
Horizontal nystagmus
No hearing loss
Takes a few weeks to fully resolve
```
63
How do you treat vestibular neuronitis?
Acutely: supportive- anti-emetics, fluids
| Vestibular rehab exercises
64
Do you get change in hearing/hearing loss in labrynthitis?
Yes
65
How do you treat viral labrynthitis?
Supportive- anti-emetics, prochlorperazine, fluids
66
What are some causes of conductive deafness?
Obstruction of ear canal- wax, foreign body, oedema, inflammation
Otitis media with effusion- popping, feeling of pressure
Tympanic membrane perforation- see on otoscopy. middle ear discharge.
Otosclerosis - abnormal remodelling of bone affecting stapes
Cholesteatoma- non-cancerous skin growth in ear- smelly discharge. (need CT)
67
What are some causes of sensorineural deafness? Bilateral and unilateral
Bilateral - age (presbyacusis), noise damage (+tinnitus), drugs- gentamicin, furosemide, chemotherapy, aspirin
Unilateral- Meniere's disease, Acoustic neuroma (asymetrical hearing loss + tinnitus- needs MRI),
Trauma , viral infections, stroke/TIA= sudden onset
68
What investigations would you do for deafness?
Pure tone audiometry
Rinne and Weber test
Tympanometry
69
What would be found on Rinne and Weber test in conductive deafness?
Normally: Rinne positive = they can hear the sound= air conduction >bone conduction
Rinne test= Rinne negative. bone conduction > air conduction (problem with sound getting through)
Weber test= hear better on the affected side (bad ear)
70
What would be found on Rinne and Weber test in sensorineural deafness?
Normally: Rinne positive = they can hear the sound= air conduction >bone conduction
Rinne test: Rinne positive. air conduction > bone conduction (no problems getting in - problem at cochlea)
Weber test= hear better on the good side (unaffected ear)
71
When would you suggest a cochlear implant as a treatment?
For profound sensorineural hearing loss
| In children with congenital deafness
72
What questions in the history would you like to ask a patient presenting with epistaxis?
Onset- when did it start?
How many times has it happened?
Volume- how much blood lost? teaspoon? cupful? Clots?
Which side did it start?
Anterior / posterior- does it run down the front or back of the throat?
Any trauma to nose?
Current medication- anticoagulants? HTN? previous nasal surgery?
Other symptoms- discharge, pain, crusting, weight loss, fever, night sweats
73
What is the most common site for epistaxis to come from?
Little's area- anterior part of septum
74
What are some causes of epistaxis?
```
Idiopathic
Trauma- injury, nose picking, surgery
Coagulopathies
Anticoagulants/antiplatelets
Hypertension
Cold weather
```
75
What investigations do you do for a patient with epistaxis?
Bloods- FBC, U&Es, clotting, cross-match/group & save, LFTs
May do rhinoscopy
76
How do you treat epistaxis?
1. Nasal pinching- the squish part and keep head forward. Ice cold packs. Adrenaline soaked gauze
2. Nasal cautery- silver nitrite sticks to Little's area- if can see the bleeding point
3. Anterior packing eg. rapid rhino
4. Posterior packing- using a Foley catheter
5. Surgical- cautery, emoblisation
(stop and reverse any anticoagulation)
77
What are the 4 sinuses?
Frontal
Maxillary
Ethmoid
Sphenoid- posterior, near pituitary gland
78
Patient presents with a headache that he describes as a dull throbbing pain in his forehead that is worse on bending forward. He says he has recently had a cold and a runny nose. What is the likely diagnosis?
Sinusitis
79
What are the 4 sinuses?
Frontal
Maxillary
Ethmoid
Sphenoid- posterior, near pituitary gland
80
Patient presents with a headache that he describes as a dull throbbing pain in his forehad that is worse on bending forward. He says he has recently had a cold and a runny nose. What is the likely diagnosis?
Sinusitis
81
What are some causes of sinusitis?
Viral- rhinovirus, parainfluenza
Bacterial - strep pneumoniae, H.influenza
Fungal
82
When would a CT of the sinuses be indicated?
Sinusitis >12 weeks with treatment
| Complications develop- meningitis, pre-orbital/orbital cellulitis, cavernous sinus thrombosis , abscess
83
How do you treat acute sinusitis?
```
Analgesia
Saline irrigation
Intranasal decongestant- for 1 week only
If symptoms last >5 days: intranasal steroids
If bacterial- Amoxicillin or doxycycline
```
84
When would a CT of the sinuses be indicated?
Sinusitis >12 weeks with treatment
| Complications develop- meningitis, pre-orbital/orbital cellulitis, cavernous sinus thrombosis
85
Name some other causes of facial pain?
Migraine, GCA, trigeminal neuralgia, dental abscess, TMJ dysfunction
86
How do you treat chronic sinusitis (with polyps and without polyps)?
Analgesia, decongestant, saline irrigation
Without polyps: NASAL steroids then spray
With polyps: ORAL steroids then nasal
Antibitoics- amoxicillin or doxycycline
87
How do you treat GCA?
Prednisolone 30mg
88
How do you treat trigeminal neuralgia?
Carbamazepine
If this fails- local nerve blocks
If this fails- surgery
89
What is the presentation of TMJ dysfunction?
Pain in jaw, radiating to deep ear, limited jaw movement
| Pain is worse on chewing
90
How do you treat TMJ dysfunction?
Bite raising appliance- rest the jaw, analgesia, jaw rest
91
What is the best analgesia to give for dental pain?
NSAIDs
92
How do you treat a dental abscess?
Drainage and Abx
93
What is the innervation to the larynx and vocal cords?
Vagus nerve
94
What are the two main branches of vagus nerve that provide innervation to the larynx and vocal cords and what are their functions?
Superior laryngeal nerve- motor to cricothyroid, sensory to vocal cords
Recurrent laryngeal nerve- motor to all muscles of larynx except cricothyroid, sensory to laryngeal mucosa
95
What are 5 causes of hoarseness?
```
Malignancy: laryngeal carcinoma (SCC), thyroid carcinoma, lung cancer- compressing RLN
Benign: vocal cord nodules, cysts, polyps
Trauma: surgery, intubation
Iatrogenic: RLN palsy from surgery
Infection: laryngitis, candida
Vocal cord palsy
Muscle tension dysphonia
Hypothyroidism
```
96
A patient comes in complaining of hoarseness. This is usually at the end of the day or after he's spent the day shouting in work and being particularly stressed. He has no red flag symptoms including dysphagia, neck mass, weight loss. The hoarseness is not present all the time. You do a flexible naso-endoscopy which shows no abnormalities. You do full blood tests which show no abnormality. What is the next best step in management?
Reassure, get SALT team involved.
If reflux related- PPIs
This is muscle tension dysphonia- commonest cause but a diagnosis of exclusion .
97
What is the most common cause of hoarseness in professional singers?
Vocal cord nodules secondary to phonotrauma
98
What are the symptoms of vocal cord nodules?
Hoarseness, loss of vocal range while singing, voice fatigue
99
How are vocal cord nodules treated?
SALT team. If severe= surgery
100
Are vocal cord polpys unilateral or bilateral compared to vocal cord nodules?
Vocal cord polyps are unilateral
| Vocal cord nodules are bilateral
101
What are the two main risk factors for vocal cord polyps?
Smoking
| Vocal cord abuse
102
How do you treat vocal cord polyps?
They need surgical excision to exclude malignancy
103
A middle aged woman comes into your clinic complaining of hoarseness. You also notice she has quite a deep voice sounding like a man. On asking about her smoking history, she says she smokes 40 a day and has done for 10 years. What is the likely diagnosis and treatment?
Reinke's oedema- oedema of the vocal folds linked to smoking
Tx: smoking cessation and voice therapy
104
What is the causative organism of laryngeal papillomas?
herpes simplex virus 6 & 11
105
What is the treatment for laryngeal papillomas?
Surgical excision
106
A patient that you've seen for sometime now for a long difficult to control history of GORD presents now with hoarseness. He said it started a couple of weeks ago and he is still getting the burning sensation come up his throat. What will you see on flexible naso-endoscopy given the diagnosis?
FNE: erythema of the larynx
| This is reflux laryngitis due to GORD
107
How do you treat reflux laryngitis?
PPI + H.pylori treatment : amoxicillin + clarithromycin/ metronidazole
108
What are some causes of recurrent laryngeal nerve palsy?
```
Malignancy- thyroid cancer, lung cancer
Iatrogenic- head and neck, cardiothoracic surgery
Aortic aneurysm
Stroke
MS
```
109
What is the main investigation done if you suspect a RLN palsy?
CT skull to diaphragm- assess for pathology
110
What are some risk factors for laryngeal carcinoma?
Male, older age, smoking and alcohol, HPV 16 and 18, FMH
111
How do patients with laryngeal carcinoma present?
Hoarseness, referred otalgia, cough, cervical lymphadenopathy (lymphatic spread), stridor- if tumour obstructs, B symptoms
112
What is the most common histological type of laryngeal carcinoma?
Squamous cell carcinoma
113
How do you investigate laryngeal carcinoma?
CT or MRI of thorax- for TNM staging and for mets
Flexible naso-endoscopy and biopsy
Fine needle aspiration under USS for cervical lymph nodes
114
What are the options to treat laryngeal carcinoma?
Endoscopic resection- if early stage
Partial laryngectomy- if later stage
Chemo and radio- if later stage
115
What is the innervation to the ear? (4 CN and another) And where in the ear do they innervate?
Trigeminal nerve - sensory to all of face and motor to muscles of mastication
Facial nerve - supplies mainly outer- lobes and helix
Glossopharyngeal nerve- sensory to posterior 1/3 of tongue and pharynx including tonsils
Vagus nerve- sensory to larynx and pharynx, motor to vocal cords
Cervical plexus - C2,3
116
Why do you get referred otalgia in dental disease?
Trigeminal nerve- supplies sensory innervation to face and motor innervation to muscles of mastication. Since it also supplies teeth- referred pain in dental disease
117
Why do you get referred otalgia in oral disease eg. tonsillitis?
Glossopharyngeal nerve (supplying posterior 1/3 of tongue and pharynx) and vagus nerve (supplying pharynx, larynx and vocal cords).
118
Why do you get referred otalgia in degenerative neck disease?
Cervical plexus- C2, C3
119
What are some otological causes and referred causes of otalgia?
Otological:
- Acute Otitis media
- Otitis externa
- Necrotising otitis externa
- Furuncle
Referred:
- TMJ dysfunction
- Tonsillitis/laryngitis
- Cervical arthritis
- Dental pathology
- Malignancy of pharynx and larynx (will have red flags- dysphagia, hoarseness, dysphonia + otalgia)
120
What questions would you want to ask in the history in a patient presenting with otalgia?
When did it start?
Where is the pain? Can they point to it?
What does the pain feel like? Sharp / dull?
Are there any other symptoms that go along with it? - discharge, vertigo, tinnitus, itching, change in hearing?
Is the pain always there or is it intermittent?
Is there anything that triggers the pain ?
Anything that makes it feel better? - any anaglesia?
Is it getting better or worse?
Any problems with dentition?
Any pain/problems with neck?
Recent colds/ illnesses?
Sore throat?
121
Why do you get otalgia in TMJ dysfunction?
Due to the proximity of the jaw joint to the ear
122
What are the common causes of TMJ dysfunction?
Teeth clenching, malocclusion
123
How can you feel for TMJ dysfunction on examination?
Put fingers over the jaw joint and ask them to open/close their mouth- can feel crepitus and pain
124
A patient comes into your practice complaining of ear pain. She says she has noticed some discharge and it is quite itchy. She is a big swimmer and goes every day for an hour. When you look in the ear you see some white debris. What is the most appropriate treatment for this condition?
Topical antibiotic - ciprofloxacin + topical steroid
| This is otitis externa
125
What is the commonest causative organism of otitis externa?
Pseudomonas (others= staph, fungal)
126
How does otitis externa present?
Itchy ear, otalgia, discharge
127
What can you see on otoscopy in a patient with otitis externa?
Debris in the ear canal- usually white
Oedema of the ear
If fungal- black debris
128
How do you treat otitis externa? (bacterial and fungal)
Topical antibiotic + steroid = clarithromycin
If lots of debris- microsuction to remove first
Fungal: clotrimazole
129
What is a furuncle?
Staphylcoccus abscess of the hair follicle
130
What are the symptoms of a furuncle?
Very tender ear- especially when pulling on the pinna or putting in otoscope
131
Would you see anything on otoscopy in a furuncle?
No - the ear is dry. If you see debris- suspect otitis externa
132
How do you treat a furuncle?
If the abscess if big- may need incision and drainage
| Oral flucloxacillin to treat the staph
133
What is happening in necrotising otitis externa?
Osteomyelitis of the temporal bone due to uncleared outer ear infection --> can lead to necrosis
134
What are some risk factors for necrotising otitis externa?
Immunocompromised, elderly, diabetic
135
What is the main causative organism of necrotising otitis externa?
Pseudomonas auerginosa
136
What are symptoms of necrotising otitis externa?
Severe, unremitting ear pain- out of proportion to normal otitis media/externa
Purulent discharge
Night pain
Not responsive to topical antibiotics
137
What can you see on otoscopy in necrotising otitis externa?
Granulation tissue, redness and swelling. If severe- bone can be exposed.
138
What complications can occur from necrotising otitis externa?
Facial nerve palsy
Spread and cause meningitis
Cerebral abscess
139
How do you investigate and treat necrotising otitis externa?
CT temporal bone (or MRI- gold standard)
Admit to hospital
Debridement of osteomyelitic bone
IV antibiotics for 6 weeks
140
A child has come into your GP practice with his mother. She says he has pain in his ear for a few days now and he keeps pulling on his ear. He has not been sleeping well and is irritable. She thinks he may have have a fever but he has had a cold for the last few days too with a runny nose and cough. When you look in the ear, it is red and inflamed and the ear drum is bulging. Given the likely diagnosis, what is the likely treatment?
Likely to be a viral cause of acute otitis media therefore reassurance and analgesia.
141
How does acute otitis media present?
```
Usually in a child
Pain in the ear
Preceeding coryzal symptoms
Rubbing/tugging of the ear
Discharge - if TM rupture
Systemic- fever, irritability, poor sleep
Decreased hearing- if recurrent AOM
```
142
What are the likely causative pathogens of acute otitis media?
Viral- RSV, rhinovirus, parainfluenza
| Bacterial- strep pneum, H. influenza
143
When would you give antibiotics for acute otitis media? And what antibiotic would you give?
If symptoms not improving over 72 hours, decreased oral intake and increasingly unwell, developed any complications eg. meningitis, mastoiditis, TM perf, abscess
You would give amoxicillin
144
What signs may you get with mastoiditis?
Ear protrusion, swelling and redness of ear and mastoid region, systemically unwell
145
How do you treat mastoiditis?
Admit to hospital
NBM, IV fluids, analgesia, IV antibiotics
CT temporal bone
146
A little girl aged 4 years old has come into your practice with her mother. Her mother thinks she has noticed her daughter's hearing changed over the past few days. When you speak to the girl, she says she thinks she can't hear as well and her ear feels full all the time. You look in the ear and the eardrum is retracted and you can see fluid. What investigations would you do to confirm this diagnosis?
This is glue ear/otitis media with effusion
Pure tone audiometry- conductive deafness
Tympanometry - flat trace (ear drum doesnt move because fluid in ear)
147
What are some risk factors for glue ear/otitis media with effusion?
Older sibling, male, breastfeeding, day care attendance, parental smoking ,allergy, immune deficiency
148
What is the pathophysiology of glue ear/otitis media with effusion?
Adenoidal hypertrophy- obstructs the Eustachian tubes causing poor ventilation and recurrent infections.
149
What additional investigation would you do if it was an adult presenting with glue ear/otitis media with effusion , not a child ?
Flexible naso-endoscopy- look for nasopharyngeal tumour
150
How do you treat glue ear/otitis media with effusion in a child?
Active surveillance- usually clears up in 3 months
| If it doesnt- hearing aids/grommets
151
What are some causes of stridor?
Infections- supraglottitis, epiglottitis, croup, abscess
Anaphylaxis
Trauma- vocal cord palsy, laryngeal fracture
Malignancy- tumours of head and neck eg, laryngeal cancer, lymphoma mediastinal tumours compressing
Foreign body inahlation
Congenital- laryngomalacia
152
What questions would you want to ask (ENT specific) in the history in a patient with stridor?
```
When did it start?
Getting worse?
Associated symptoms?- drooling, fever, voice changes?
Any allergies?
Any medications recently started?
PMH- malignancy? reflux?
Red flags- dysphagia, weight loss, night sweats
Recent illnesses- ?abscess
```
153
How would you initially assess a patient with stridor?
A-->E
Airway- can they talk? Sit them forward and give them 15L oxygen.
Breathing- RR, oxygen sats, listen to their breath sounds, chest movements
Circulation- BP, pulse, CRT, heart sounds. Urine output, IV access and get bloods- FBC, U&E, CRP, LFTs, cultures, clotting. IV DEXAMETHASONE and IV ABX
Disability- glucose, AVPU, temperature, pupils.
Everything else- calves, abdo.
154
What imaging may you do after you've stabilised the patient?
CT neck and chest with contrast- find the cause.
155
What are the treatment options after you've done an A-E assessment of the patient?
1. Antibiotics + steroids and monitor
2. Intubate in theatre
3. Tracheostomy under local anaesthetic - foreign body, trauma, infection
156
How do you initially manage a patient with peri-orbital cellulitis?
ABCDE: airway- can they talk? Breathing- RR, oxygen sats, listen to chest. Circulation- BP, pulse, CRT, heart sounds, urine output. IV access and send off bloods. Disability- glucose, AVPU, temperature, pupils.
Assess for intracranial spread - do full neuro exam
NBM
IV fluids
IV antibiotics
Urgent opthal review
CT scan- IF not improving on Abx, neurological signs, fever >36 hours
157
What are some causes of peri-orbital cellultiis?
Infection of tear sac
Sinusitis spread to eye
Skin infection
