ENT common problems Flashcards
ear structures
pinna external auditory canal tympanic cavity with membrane vestibule cochlea
communication between middle ear and nasopharynx
eustation tube
ear symptoms history taking
hearing loss otalgia otorrhoea tinnitus vertigo concurrent nasal symptoms drug/family history
perichondritits
skin and soft tissue infection of the pinna
tx with IV Ab and analgesic
otitis externa
infection of external auditory canal
pseudomonas, staph aura
can have otalgia, otorrhoea, pruritus, heading loss
hepes zoster optics
acute facial palsy
otalgia
varicella like cutaneous lesions of the conch
otitis media with effusion/glue ear
persistent mucoid/serous middle ear effusion for more than 3 mns
symptoms of glue ear
hearing loss
recurrent infernos
delayed speech in children
acute Otitis media
infection/inflammation of the middle ear
either no supportive or supportive (no effusion vs with pus)
complications of acute otitis media
Extracranial
- TM perforation
- facial nerve palsy
- mastoiditis
- labyrinthitis
- petrositis
Intracranial complications
- meningitis
- extradural abscess
- subdural abscess
- intracerebral abscess
- lateral sinus thrombosis
chronic otitis media
Persistent or intermittent discharge through a pathological/abnormal TM (perforation, retraction pocket)
cholestaetoma
Destructive and expanding keratinised squamous cell debris (skin going inside middle ear, will carry on growing and spreading, destroy middle ear and can lead to the brain)
- congenital or acquired
what can cholesteatoma lead to - hearing loss (erosion of osicles)
- chronic ear discharge
- recurrent infections
- vertigo
- intracranial complications
acute mastoiditis
Infection of mastoid air cells as a complication of acute otitis media (spreads to the bone)
- mastoid tenderness
- pyrexia
- oedema and erythema of post auricular soft tissue
- antero-inferior displacement of pinna
benign paroxysmal positional vertigo
Brief intense episodes of rotatory vertigo lasting seconds triggered by head movements
- causes by misplaced otoconia in middle ear eg in bed turning, feel spinning but then it settles down
menieres
fluid imbalance in the inner eat
can lead to vertigo hearing loss and tinnitus
vestibular neuronitis labrinthitis
Inflammation of vestibular nerve (vestibular neuronitis) or inner ear (labyrinthic)
causes
- acute intense vertigo (dehabilitating) that lasts days/weeks followed by gradual recovery (via compensation by opposite inner ear)
main types of deafness
1) conductive
- obstacle to the passage of sound wave between external ear and cochlea
2) sensorineural
- fault in the cochlea (sensory) or cochlear nerve (neural)
- inner ear
sinuses in the face
maxillary
ethmoidal
frontal
sphenoid
what is in the nose and what does it do
turbinates
helps air flow- turbulent humidifies it
epistaxis
commonly from the Kisselbach plexus
causes of epistaxis
1) idiopathic
2) coagulopathy
3) rhinitis
4) trauma
- nose picking
- injury
- surgery
5) drugs
- aspirin
- warfarin
6) systemic diseases
- Wegener’s/sarcoidosis
7) neoplastic
management of epistaxis
1) first aid measures (compression 10-15 mins)
- at cartilage not bone
2) cautery (silver nitrate/bipolar)
3) nasal packing
- absorbable packs (nasopore) – not taken out
- haemostatic packs, flow seal
- balloon catheter
- posterior packs (folet catheter, rapid rhino/BIPP/Vaseline):
4) surgery (SPA or anterior ethmoid ligation)
5) interventional radiology
rhinosinusitis and nasal polyposis
Inflammation of the nose and paranasal sinuses
- nasal congestion or nasal discharge
- facial pain/pressure
- anosmia
