1. Watch and wait, 12 wks arrange hearing test. (most resolve by themselves) 2. Steroid drops into nose. 3. Otovents balloon. 4. Grommets.

1. Saline douches, long term steroid drops 2. Surgery for polyps

ENT Flashcards by Toby Burn

Discharge first
pain
eac swelling-> close.

Otitis externa

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mx otitis externa

analgesia, warm flannel
topical acetic acid
antibiotic drops 
Ciprofloxacin drops -> Pseudomonas. , debridement w microsuction. 
(neomycin), steroids

popewick dressing.

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complications otitis externa

elderly/diabetic -> skull base osteomyelitis, facial cellulitis

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acute otitis media

red ejected bulging (w fluid) eardrum,
Pain then Mucinous discharge
palpate neck

Beware: diabetic, I.C, teenage, headache.

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complications otitis media

perforation - burst then heal. can become chronic if underlying eustatchian tube issue.
Effusion - glue ear
Mastoiditis - need admission -> CT (can form fistula, citelles abscess (anterior neck), Beszolds abscess (sternocleinomastoid) brain abscess, lateral sinus thrombosis.

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Mx otitis media

Analgesia antipyrexials 24-48h.
no d/c -> oral amoxicillin
d/c-> oral + topical
systemic - coamoxiclav.

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Loss of light reflex
conductive hearing loss
Pronunciation/language issues.

otitis media w effusion (glue ear)

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Mx Effusion

Watch and wait, 12 wks arrange hearing test. (most resolve by themselves)
Steroid drops into nose.
Otovents balloon.
Grommets.

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causes + Mx of perforation

infection
barotrauma
Chronic -> tympanosclerosis
Mx-Myringoplasty

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Cheesy gunky appearance above eardrum - dizziness

cholesteatoma
mx: surgical
can erode important structures, chronic infections, facial nerve palsy

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unilateral sensoneurinal hearing loss

vestibular schwannoma
Mx: MRI
neurosurgery

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Non allergic vs allergic rhinitis

allergic - mucosa swollen blue and pale
itchy, runny nose, seasonal, variable severity. allergic salute/crease.

Non allergic: constant, unvarying, black, thick mucus, pink appearance of nose.

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Classification of Allergic rhinitis

Intermittent:
<4 days per week
<4 weeks
Persistent:
>/=4days per week
>4weeks.

Mild: normal sleep
no impairment daily activities.
Mod severe: abnormal sleep, impairment school, work, sport, leisure.

dx: examination
skin prick testing
serum igE

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Mx AR

Mild, intermittent
Saline nasal douche, non sedating antihistamine (cetirizine/loratidine), allergen and irritant avoidance

Mod severe/intermittent
+IN steroid +/- LTRA

Mild persistent
+topical cromone/antihistamine

Mod severe persistent
+Immunotherapy

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Blocked nose
Facial pressure
hyposmia
swollen red mucosa
runny mucus for 12 weeks
endoscopy polyps

Rhinosinusitis

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Ix rhinosinusitis

Anterior rhinoscopy

CT -increased density in sinuses.

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Mx rhinosinusitis

Saline douches, long term steroid drops

2. Surgery for polyps

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Painful forehead/headache
maxillary pressure
purulent discharge
follow viral URTI

analgesia
saline douche/steroid spray
abx - PenV 500QDS
coamoxiclav if systemically unwell.

why are Nasal decongestants bad

cause rhinitis medica mentosa - blocked nasal cavity

- requires steroids/surgery.

RFs tonsil/oropharynx cancer

Smoking
HPV

Mx:

south east asian , nasopharynx lump

cancer - > refer urgent endoscopy.

HN cancer MDT - radiotherapy

voive change >3w
smoker
Alcohol

SCC larynx cancer
Ix: Flexible naso-laryngoscopy. 
-most often glottic region
best prognosis - hoarsenss early. 
Tx: surgery, radiotherapy, or combo, MDT

bunch of grapes/soap bubble

papillomatosis

-HPV

25yo lump moves on swallowing /tongue protrusion

Thyroiglossal cyst

dx USS
mx: sistrunks procedure

22yo smooth fluctuant swelling, 1/3 down anterior SCM

USS Cholesterol crystals Branchial cyst surgery

REd swollen ear , has otitis externa, piercing,

Perichondritis can -> temporal osteomyeleitis COamoxiclav if severe -> IV

foreign body

can leave in for days if u can see it remove , if pt compliant button battery emergency

facial palsy .

Ix: otoscopy ,TM + -vesicles EAC - Ramsay hunt Palpate parotid and neck Movement of facial muscles. Steroids + vaciclovir eye drops/patch ENT emergency clinic

facial nerve path

skull base -> middle ear cavity, temporal bone -> stylomastoid foramen -> parotid gland

``` sarcoid parotid enlargment anterior uveitis facial nerve palsy low grade fever ```

Heerfordt syndrome

RFs Bells palsy

Diabetes URTI Pregnancy

mass in parotid | facial nerve paralysis

Mucoepidermoid tumour

``` Painless well circumscribed swelling tail of parotid bilateral 10% male smoker 65 ```

Warthins tumour

Parotid tumours

80% benign 80% of benigns are pleomorphic adenomas young children - Haemangioma most common malignancy - mucoepidermoid carcinmoa - > lymph spread. PAIN, rapid growth, facial nerve palsy.

Facial nerve

motor to stapedius - hyperacusis | superficial petrosal branch -> lacrimation. Geniculate ganglion lesion - shirmers test.

recurrent ulcers, white + erythematous halo | ex smoker

apthous ulcers failure of ulcers to respond spontanouesly -> biopsy (exclude SCC) cmv, HSV, EBV, HIV

Apthous ulcers mx

Paracetamol NSAIDS topical anaesthetics

persistent Indurated ulcer, lateral tongue, smoking hx, | exophytic, submucosal mass.

squamous cell carcinoma. examine lNs Refer - max fax/onc , 2 w wait. -> biopsy

Recurrent laryngeal nerve pasly causes

``` Thyroid surgery Aortic aneurysm repair oesophageal cancer bronchial carcinoma Polio ```

trismus , unilateral swelling, sore throat, pyrexia, sepsis

``` quinsy group A strep Mx: IV benzylpenicllin +/- metronidazole. Incision and drainage with mosquito artery forceps/needle aspiration ``` 2 seprate episodes -> elective tonsilectomy

infectious mononucleosis mx

``` IV fluids Get LFTs Analgesia ?steroids Avoid contact sport 6 weks (hepatitis/splenomegaly -> bleed) ```

Infectious mononucleosis ix

Latex agglutination with paul bunnel antigen -> detect heterphile antibody. Monospot - most sensitive at 6weeks. better than paul bunnel.

Posterior epistaxis artery

``` Sphenopalatine artery (branch of internal maxilalry). Ligate with trans nasal endoscopic approach if nasal packing unsuccessful. ```

Epistaxis

Anterior: visible source. kisselbachs plexus. Posterior: profuse. sphenopalatine. ``` Mx: Sit forward. Pinch soft 20mins Cautery. (visible) Packing (non visble) Rapid rhino. Catheter. ```