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ENT conditions Flashcards

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1
Q

Describe Bell’s palsy

A

Acute, unilateral facial nerve weakness or paralysis of rapid onset & unknown cause
Most common between 15 and 45 years of age

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2
Q

List the symptoms of Bell’s palsy

A

Rapid onset (<72 hours)
Facial muscle weakness involving the upper and lower parts of the face
Ear and postauricular region pain on the affected side
Difficulty chewing, dry mouth & changes in taste

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3
Q

List the complications of Bell’s palsy

A

Eye injury
Facial pain
Dry mouth
Intolerance to loud noises
Abnormal facial muscle contraction during voluntary movements

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4
Q

Describe the diagnosis of Bell’s palsy

A

Can be made when no other medical condition is found to be causing facial weakness/paralysis
Have the typical symptoms of Bell’s palsy
Atypical features of Bell’s palsy require referral for exclusion of an alternative diagnosis

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5
Q

List differentials of Bell’s palsy

A

Stroke – forehead will be spared
Brain tumour
Traumatic injury to the facial nerve
Infectious – herpes simplex, Lyme disease, otitis media

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6
Q

Describe the management of Bell’s palsy

A

Advice: prognosis is good -> most people recover within 3-4 months, keep affected eye lubricated, wear sunglasses when outdoors, tape eye closed if they can’t close it at night
Treatment (people presenting within 72 hours): consider prescribing prednisolone
Refer urgently if there are worrying symptoms

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7
Q

Describe benign paroxysmal positional vertigo (BPPV)

A

A disorder of the inner ear characterised by repeated episodes of positional vertigo (symptoms occur with changes in the position of the head)
Most common cause of vertigo in clinical practice, most commonly 50-70s females

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8
Q

List symptoms of BPPV

A

Symptoms are brought on by specific movements & positions of the head relative to gravity
Vertigo occurs in transient episodes (usually last less than one min)
N&V
Hearing NOT affected & tinnitus NOT a feature

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9
Q

Describe the diagnosis of BPPV

A

Relevant symptoms
Examination – likely to be normal at rest in a sitting position, positive Dix-Hallpike manoeuvre
Investigations not usually required

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10
Q

List differentials of BPPV

A

Vestibular neuritis
Labyrinthitis
Meniere’s disease

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11
Q

Describe the management of BPPV

A

Advice: most people recover over several weeks, even without treatment, simple repositioning manoeuvre, advise person not to drive when they are suffering vertigo
Management: offer a particle repositioning manoeuvre (Epley manoeuvre) -> ideally this should be done at the first presentation; consider suggesting Brandt-Daroff exercises which person can do at home
Follow up in 4 weeks if symptoms have not resolved

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12
Q

What is a cholesteatoma?

A

Abnormal sac of keratinising squamous epithelium & accumulation of keratin within the middle ear/mastoid air cell spaces which can become infected & erode neighbouring structures

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13
Q

List symptoms of a cholesteatoma

A

Recurrent/chronic purulent aural discharge, may be unresponsive to abx treatment
Hearing loss or tinnitus
Less common – otalgia, vertigo or facial nerve involvement

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14
Q

Describe the diagnosis of cholesteatoma

A

Relevant symptoms
If suspected, ask the person about any pre-existing ear disease/surgery
Examination (requires clear visualisation of the tympanic membrane) – ear discharge, deep retraction pocket in the tympanic membrane, crust/keratin in the upper part of the tympanic membrane

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15
Q

List differentials of cholesteatoma

A

Otitis media with effusion
Otitis externa
Tympanosclerosis

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16
Q

Describe the management of cholesteatoma

A

Arrange urgent referral to ENT – investigations carried out will include an audiology assessment and a CT scan
Prior to surgical treatment, aural discharge may be treated with topical abx (canal wall up mastoidectomy)
Emergency admission – facial nerve palsy/vertigo, other neurological symptoms/signs that could be associated with development of an intracranial abscess/meningitis

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17
Q

What is glandular fever?

A

Infection most commonly caused by EBV
Spread mainly through contact with saliva eg. kissing or sharing food and drink, spread during sexual contact
Lifelong latent carrier state
Most common aged 15-24 years

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18
Q

Describe the symptoms of glandular fever

A

Fever
Lymphadenopathy
Sore throat (usually severe)
Prodromal symptoms: lasts for several days & includes general malaise, fatigue, myalgia, chills
Non-specific rash

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19
Q

List complications of glandular fever

A

Upper airways obstruction
Splenic rupture
Neutropenia
Immunocompromised – may result in malignancies eg. Hodgkin’s lymphoma, nasopharyngeal carcinoma

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20
Q

List differentials of glandular fever

A

Streptococcal sore throat
Local infection or inflammation
Lymphoma or metastatic solid tumour
Cytomegalovirus primary infection

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21
Q

Describe the management of glandular fever

A

Use paracetamol and/or ibuprofen
Advice: symptoms usually last 2-4 weeks, exclusion from work/school is not necessary, return to normal activities as soon as possible
Advise the patient to seek urgent medical advice if:
- Develop stridor
- Difficulty swallowing/have signs of dehydration
- Become systemically very unwell
- Develop abdominal pain

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22
Q

What is Meniere’s disease?

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A

Disorder affecting the inner ear which can affect balance and hearing
Clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss & tinnitus, associated with a feeling of fullness in the affected ear
Unknown cause

23
Q

Describe the diagnosis of Meniere’s disease

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A

No specific diagnostic tests – based on presence of key clinical features
Definitive diagnosis requires all of the following:
1) Vertigo – at least two spontaneous episodes lasting 20 minutes to 12 hours
2) Fluctuating hearing, tinnitus and/or perception of aural fullness in affected ear
3) Hearing loss (sensorineural) confirmed by audiometry
Refer to ENT services to confirm the diagnosis of Meniere’s disease

24
Q

List differentials of Meniere’s disease

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A

Acoustic neuroma
Multiple sclerosis
Perilymph fistula
Migraine
BPPV

25
Describe the management of Meniere’s disease
Advice – reassurance that vertigo significantly improves with treatment, acute attack will normally settle within 24 hours, don’t drive whilst dizzy Acute attack – hospital admission may be required for IV labyrinthine, use buccal/IM injection of prochlorperazine or IM injection of cyclizine to rapidly relieve N&V Prevention – trial of betahistine, if this does not work, refer to ENT
26
Describe otitis externa
Diffuse inflammation of the skin and sub-dermis of the external ear canal, which may also involve the pinna or tympanic membrane
27
Outline the types of otitis externa
1) Acute otitis externa is inflammation (< 6 weeks) typically caused by bacterial infection with Pseudomonas aeruginosa/staphylococcus aureus 2) Chronic otitis externa is inflammation (> 3 months) which may be caused by fungal infection with Aspergillus species or Candida albicans NB: malignant otitis externa is potentially life-threatening progressive infection of the external ear canal causing osteomyelitis of the temporal bone & adjacent structures
28
Describe the diagnosis of acute otitis externa
Usually rapid-onset within 48 hours: -itch of the ear canal -ear pain & tenderness of the tragus and/or pinna -ear discharge -hearing loss due to ear canal occlusion At least two typical signs: tenderness of tragus and/or pinna, ear canal is red & oedematous, typical membrane erythema, cellulitis of pinna and adjacent skin
29
Describe the diagnosis of chronic otitis externa
Typical symptoms: constant itch in the ear, mild discomfort or pain Typical signs: lack of ear wax in the external ear canal, dry scaly skin in the ear canal (often resulting in at least partial canal stenosis), conductive hearing loss
30
List differentials of otitis externa
Acute otitis media Foreign body in the ear Impacted ear wax Skin conditions – contact dermatitis, eczema, fungal skin infection
31
Describe the management of acute otitis externa
Self-care measures: avoid damage to external ear canal, keep ears clean and dry, over-the-counter ear drops/spray Manage underlying causes or risk factors Consider prescribing a topical antibiotic preparation with/without a topical corticosteroid for 7-14 days Arrange follow-up if symptoms don’t get better
32
Describe the management of chronic otitis externa
Analgesics Arrange ear swab & arrange treatment depending on the result Consider cleaning the external auditory canal Consider prescribing a topical ear preparation (if fungal = a topical antifungal preparation/clioquinol/corticosteroid)
33
What is acute otitis media?
Defined as the presence of inflammation in the middle ear, associated with an effusion & accompanied by the rapid onset of symptoms and signs of an ear infection Common condition caused by both viruses and bacteria
34
List complications of acute otitis media
Recurrence of infection Hearing loss Tympanic membrane perforation Rarely: mastoiditis, meningitis
35
List the symptoms of acute otitis media
Older children & adults: earache Younger children: holding, tugging & rubbing of ear & other non-specific symptoms eg. crying, fever and poor feeding
36
List the examination findings of acute otitis media
Tympanic membrane – red, yellow/cloudy tympanic membrane Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks & an air-fluid level behind the tympanic membrane (middle ear effusion) Perforation of the tympanic membrane and/or discharge in EAC
37
List differentials of acute otitis media
Otitis media with effusion (glue ear) Chronic suppurative otitis media Myringitis
38
Describe the management of acute otitis media
Advise the usual course of acute otitis media is about 3 days, but can be up to 1 week Paracetamol/ibuprofen for pain
39
What is chronic suppurative otitis media?
Chronic inflammation of the middle ear and mastoid cavity Presents with recurrent ear discharged through a tympanic perforation for at least 2 weeks Complication of acute otitis media
40
Describe the presentation of chronic suppurative otitis media (CSOM)
Ear discharge > 2 weeks, without ear pain or fever Hearing loss in affected ear History of AOM, ear trauma, glue ear & grommet insertion History of allergy, atopy, URTI Tinnitus and/or sensation of pressure in ear
41
List red flag symptoms in a person with CSOM
Headache Nystagmus Vertigo Fever Labyrinthitis Facial paralysis Swelling/tenderness behind the ear
42
List differential diagnoses of CSOM
Otitis externa ASOM Otitis media with effusion Foreign body
43
Describe the management of suspected CSOM
Any red flag symptoms – urgent assessment by ENT specialist Others: refer for ENT assessment (likely to involve abx, steroids, intensive cleaning) Advise to keep affected ear dry & dry mopping the affected ear will help to clean discharge from ear
44
What is otitis media with effusion?
Also known as ‘glue ear’ Characterised by a collection of fluid within the middle ear space without signs of acute inflammation Most common cause of hearing impairment in childhood
45
Describe the presentation of otitis media with effusion
History – hearing loss (mishearing, difficulty communicating in a group, asking for things to be repeated), mild intermittent ear pain with fullness, aural discharge, recurrent ear infections Examination – can be serous, mucoid or purulent & more likely if one or more of the following are present: abnormal colour of drum, loss of light reflex, opacification of drum, air bubbles or air/fluid level
46
List differentials diagnoses of otitis media with effusion
Acute otitis media Mastoiditis Otitis externa
47
Describe the management of otitis media with effusion
Active observation for 3 months is appropriate for most children, as spontaneous resolution is common -> during this time, re-evaluate signs and symptoms of the effusion & look for any complications -includes two hearing tests using pure tone audiometry at least 3 months apart & tympanometry
48
Describe mastoiditis
Inflammation of the mastoid air cells within the petrous temporal bone Complication of acute otitis media with infection spreading from the middle ear into the mastoid air cells -> abscess formation -> several life-threatening sequelae
49
Describe the typical presentation of mastoiditis
Children – ear pulling, ear pain, non-specific symptoms of systemic upset, persistent fever despite oral abx Adults – severe otalgia, otorrhoea, headache, hearing loss Examination – post-auricular erythema, tenderness, swelling; proptosed auricle, loss of post-auricular sulcus, evidence of sepsis
50
List the differential diagnoses of mastoiditis
Acute otitis media Post-auricular lymphadenopathy Cellulitis/perichondritis
51
What is vestibular neuronitis?
Disorder characterised by acute, isolated, spontaneous & prolonged vertigo of peripheral origin Due to inflammation of the vestibular nerve & often occurs after a viral infection
52
Describe the symptoms of vestibular neuronitis
Spontaneous onset of vertigo, nausea, vomiting & unsteadiness NO hearing loss, tinnitus and focal neurological signs
53
List differential diagnoses of vestibular neuronitis
BPPV Labyrinthitis (similar, but also involves tinnitus & hearing loss) Meniere’s disease Central causes eg. migraine, stroke, cerebellar tumour
54
Describe the management of vestibular neuronitis
Reassure the person that symptoms will usually settle over several weeks Advise that bed rest may be necessary if symptoms are particularly severe during the acute phase Advice on safety issues – not to drive when dizzy, inform employer if affects work, falls at home

Yr3 GP (4 decks)

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