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ENT Flashcards

(59 cards)

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1
Q

Otitis Externa Features

A

Ear pain
Discharge
Red swollen ear canal

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2
Q

Common causes of otitis externa

A

Staphylococcus aureus
Pseudomonas aeruginosa
Fungal infection

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3
Q

Management of otitis externa

A

Ear drop - combined topical abx and steroid drop e.g, gentamicin + prednisolone

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4
Q

When would you avoid using gentamicin in otitis externa and why

A

If there is tympanic membrane perforation

Due to risk of ototoxicity

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5
Q

What is malignant otitis externa?

A

Uncommon type of otitis externa where the infection commences in the soft tissues of the external auditory meatus, then progresses to involve the bony ear canal

It can progress to cause temporal bone osteomyelitis

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6
Q

What group of patients is malignant otitis externa most common?

A

Diabetics and Immunocompromised patients

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7
Q

What organism is the most common cause of malignant otitis externa?

A

Pseudomonas aeruginosa

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8
Q

Features of malignant otitis externa?

A

Severe, deep seated otalgia
Temporal headaches
Purulent otorrhea
Possibly facial nerve dysfunction

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9
Q

Management of malignant otitis externa

A

Urgent referral to ENT

IV abx - ciprofloxacin most common to cover pseudomonas

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10
Q

Features of otitis media

A 
Otalgia 
Fever
Hearing loss 
Recent viral URTI 
Ear discharge
Bulding tympanic membrane
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11
Q

When would you give antibiotics in otitis media

A 
If symptoms >4 days 
If pt unwell 
In Immunocompromised pts 
<2 years old with bilateral otitis media
If there is tympanic membrane perforation 
If there is discharge
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12
Q

What abx are used for otitis media

A

5-7 day course of amoxicillin (erythromycin if penicillin allergy)

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13
Q

What is a cholesteatoma?

A

Complication of otitis media

Non cancerous growth of keratin within pars flaccida (upper tympanic membrane)

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14
Q

Features of cholesteatoma

A

Foul smelling Non resolving discharge

Hearing loss

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15
Q

Management of cholesteatoma

A

Referral to ENT for surgical removal

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16
Q

What is the most common cause of conductive hearing loss

A

Ear wax

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17
Q

Causes of perforated tympanic membrane

A

Infection e.g, otitis media
Barotrauma
Direct trauma

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18
Q

Management of perforated tympanic membrane

A

Most cases will usually heal after 6-8 weeks
Avoid water in ear during this time
Amoxicillin - if caused by otitis media
Myringoplasty - if it does not heal by itself

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19
Q

What is otosclerosis?

A

Replacement of normal bone by vascular spongy bone - this causes fixation of the stapes at the oral window in the ear leading to hearing loss

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20
Q

What type of hearing loss does otosclerosis cause

A

Conductive

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21
Q

Risk factors for otosclerosis

A

Family history - as it is autosomal dominant condition

Pregnancy - may precipitate disease in those who are genetically predisposed

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22
Q

Features of otosclerosis

A 
Typically presents at age 20-40 
Conductive deafness 
Tinnitus 
Normal tympanic membrane 
Positive family history 
Symptoms improve with background noise
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23
Q

Management of otosclerosis

A

Hearing aid

Stapedectomy

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24
Q

Causes of sudden-onset sensorineural hearing loss

Study These Flashcards
A

Idiopathic

Vestibular schwannoma

25
Management of sudden-onset sensorineural hearing loss
High dose prednisolone for 7 days
26
Causes of Vertigo and how to distinguish
Viral labyrinthitis - recent viral infection, hearing affected Vestibular neuronitis - recent viral infection, hearing okay BPPV - gradual onset, triggered by change in position Ménière’s disease - hearing loss, tinnitus, sense of fullness in ears Vertebrobasilar ischaemia - elderly pt, occurs on neck extension Acoustic neuroma - hearing loss, tinnitus, absent corneal reflex
27
What is meinere’s disease
Disorder of inner ear of unknown cause | Excessive pressure and progressive dilation of the endolymphatic system
28
Features of meneires disease
``` Unilateral Episodes lasting minutes to hours of: Vertigo Tinnitus Sensorineural hearing loss Feeling of fullness in ear ``` Pts will have: - Nystagmus - positive romberg’s test
29
Management of Ménière’s disease
Prevention of attacks - beta histone During attacks - buccal or IM prochlorperazine Must inform DVLA of diagnosis
30
Features of vestibular schwannoma
``` Unilateral: Vertigo Sensorineural hearing loss Tinnitus Absent corneal reflex Possible Facial palsy ```
31
Diagnosis of acoustic neuroma
MRI of the cerebellopontine angle
32
What is Ramsey hunt syndrome?
Reactivation of varicella zoster virus in the geniculate ganglion of the facial nerve
33
Features of Ramsey hunt syndrome
``` Ear pain Facial nerve palsy Vesicular rash around ear Vesicular lesions may be seen on anterior 2/3rds of the tongue and soft palate Vertigo Tinnitus ```
34
Management of Ramsey hunt syndrome
Oral aciclovir | Corticosteroids
35
Management of allergic rhinitis
Allergen avoidance Mild disease - Oral or intra nasal antihistamines Moderate disease - intra nasal corticosteroids Severe disease - oral corticosteroids
36
What are the common causative agents of rhinosinusitis
Streptococcus pneumoniae Haemophilis influenzae Rhino viruses
37
Definition of chronic Rhinosinusitis
Inflammation of paranasal sinuses and linings of nasal passages lasting >12 weeks
38
Risk factors for Rhinosinusitis
``` Hayfever or rhinitis Asthma Nasal obstruction e.g, septal deviation, nasal polyps Swimming Smoking ```
39
Features of Rhinosinusitis
Facial pain - typically a frontal pressure worse on bending forward Nasal discharge Nasal obstruction - e.g, mouth breathing Post nasal drip - may be producing a cough
40
Management of Rhinosinusitis
Intra nasal corticosteroids | Oral phenoxymethylpenicillin - for severe presentations
41
What population group are nasal polyps more common in?
Males
42
What is samter’s triad
Asthma Aspirin sensitivity Nasal polyposis
43
Clinical features of nasal polyps
Nasal obstruction Rhinorrhoea (runny nose) Poor sense of taste/smell Bilateral symptoms (unilateral nasal polyps is red flag sign for nasal pharyngeal cancer)
44
Management of nasal polyps
Bilateral - routine referral to ENT Unilateral - urgent referral to ENT Topical steroids are usually given to shrink polyps
45
CENTOR Criteria for tonsillitis
Tender cervical lymphadenopathy Tonsillar exudate Absence of cough Fever >38
46
Antibiotics given for tonsillitis
Phenoxymethylpenicillin - 7-10 day course | Erythromycin if penicillin allergy
47
Indications for tonsillectomy
All of the following: >5 episodes of sore throat in a year due to tonsillitis Symptoms present for >1 year Episodes are disabling and preventing normal functioning OR one of the following: Recurrent febrile convulsions due to tonsillitis Obstructive sleep apnea, stridor or dysphagia secondary to large tonsils Peritonsillar abscess
48
Complications of tonsillitis
Otitis media Quinsy/peritonsilar abscess Rheumatic fever and glomerulonephritis
49
Features of peritonsillar abscess
Severe unilateral throat pain Deviation of uvula to unaffected side Difficulty opening mouth
50
Management of quinsy
Urgent ENT referral Needle aspiration or incision and drainage IV abx
51
What are sialolithiasis
Calculi in the salivary glands or ducts
52
Features of sialolithiasis
Unilateral colicky pain and swelling on eating | Swelling of submandibular gland
53
What is sialadenitis
Inflammation of salivary gland secondary to obstruction by stone in the duct Caused by staph aureus infection Can cause foul taste in mouth as purulent discharge from duct drains into floor of mouth
54
Most common cause of parotid tumour
Pleomorphic adenoma
55
Which medications can cause ototoxicity
``` Gentamicin Quinine Furosemide Aspirin Some chemotherapy agents ```
56
What is glue ear?
Otitis media with effusion Where the Eustachian tube becomes blocked, which causes fluid to build up in the middle ear When the middle ear becomes full of fluid it can cause loss of hearing in that ear
57
Management of glue ear
Referral to audiometer - to help establish diagnosis and extent of hearing loss Usually resolves without treatment in 3 months Grommets can be inserted into tympanic membrane by ENT surgeons which allows fluid to drain out through the tympanic membrane into the ear canal (grommet usually fall out within a year)
58
Common site of epistaxis
Kiesselabachs plexus (littles area) - area that contains lots of blood vessels in the nose
59
Management of epistaxis
Sit up and head tilt forwards squeezing soft part of nose Nasal packing if it doesn’t stop Nasal cautery if it doesn’t stop

Year 5 (17 decks)

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