ENT Conditions and presentation Flashcards
Define acute epiglottiits
infection of the epiglottis (level of c3)
typically caused by HIB
what is the epiglottis (anatomy question)
small flap of tissue located at C3
Prevents entry of food in the trachea.
innvervated by the glossopharyngeal and hypoglossal nerves.
Case presentation: 5 year old presents to ED with drooling and leaning forward supporting himself (tripod poition)
epiglottis
signs and symptoms of epiglottitis (8)
- High fevers
- Appear ill or toxic
- . Intense throat pain swallowing, leading to drooling
- Soft inspiratory stridor
- . Rapid increase in respiratory difficulty over hours
- sit upright with an open mouth to optimize airway patency
- Minimal or absent cough
what is Croup?
Croup is inflammation of the trachea typically assoicated with seal (barking) cough
typically caused by parainfluenza virus
Peritonsillar abscess
pus-filled tissue at the back of the mouth, next to one of the tonsils
typically occurs when there is untreated tonsilitis.
signs and symptoms of croup
barking cough
inspiratory stridor
hoarseness.
signs and symptoms of pertitonsalar abcess
Severe throat pain
muffled “hot potato” voice,
drooling,
trismus (difficulty opening the mouth).
Signs and symptoms of Bacterial tracheitis
- Severe respiratory distress
- high fever
- purulent tracheal secretions
Bacterial tracheitis
secondary bacterial infection of the trachea
typically follow viral URTI
most often caused by the bacteria Staphylococcus aureus
Investigations for epiglottis
ONLY TO BE DONE BY SENIOR MEMBER OF STAFF DUE TO LARYNGOSPASM RISK
visualistation of the epiglottiis.
- cherry-red epiglottitis will be seen on endoscopy
- thumbprint sign will be seen on CXR
managment of epiglottitis
Do not examine or upset the child without senior support
- Securing the airway, possibly through endotracheal intubation, as a first priority
- Culturing and examination of the throat once the airway is secure
Administration of IV antibiotics, typically cefuroxime - IV antibiotics (e.g. ceftriaxone)
- Steroids (i.e. dexamethasone)
X-ray findings epiglottis
lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”.
- epiglottis looks like thumb pressed against the trachea
what is peritonsalar abcess aka?
quinsy
presentation of quinsy
severe throat pain
which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility
causes of quinsy
streptococcus pyogenes (group A strep) staphylococcus aureus
haemophilus influenzae.
managment of quinsy
REFER TO ENT
needle aspiration or surgical incision and drainage to remove the pus from the abscess.
broad-spectrum antibiotic such as co-amoxiclav would be an appropriate choice to cover the common causes,
Tonsilectomy should be considered to prevent future cases
note: some local guidelines suggest dexamethasone as well
-IV antibiotics and surgical drainage
Tonsilits
viral causes?
Inflammation of the tonsils
Typically caused by viral causes
- rhinovirus
- influenza
- parainfluenza
- can also be caused by staph Auerus
causes of tonisilits
Strep A is the most common cause
Streptococcus pneumoniae.
————————————————————–
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus
Waldeyer’s Tonsillar Ring
A ring of lymphoid tissue found in the throat
what are the complications of tonsilits?
Chronic tonsillitis
Peritonsillar abscess, also known as quinsy
Otitis media if the infection spreads to the inner ear (THINK STAPH)
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
managment of tonsilitis
Penicillin V (10 day course) (tastes bad, so kids may avoid it.
Clarithromycin is 1st line is pencillin allergy.
Tonsilectomy is contreversial
what is the centor criteria?
Estimates probability that pharyngitis is streptococcal, and suggests management course.
prescribing antibiotics if the Centor score is ≥ 3
streptococcal Pyrogenes is most common cause of tonsilitis
What is the FeverPain score?
- The FeverPAIN score for bacterial tonsilits
- of 2 – 3 gives a 34 – 40% probability
- 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:
Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
prescribe if FeverPAIN score is ≥ 4
complications of tonsilectomy
haemorrhage
post tonsilectomy haemorrhages- primary
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery.
It is managed by immediate return to theatre.
post tonsilectomy haemorrhages- secondary
5 and 10 days after surgery and is often associated with a wound infection.
Treatment admission and antibiotics.
Severe bleeding may require surgery.
Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
BPPV
Benign Paroxymal Positional Vertigo
- one of the most common causes of vertigo, typically due to middle ear
- triggered by change in head movement.
tests and managment of BPPV
Diagnosis- Dix-Haplike manouver
mangmEment- Eply manouver
cause of BPPV
cholelithiasis- accumulation of calcium deposits, known as , within the semicircular canals of the inner ear.
When the cholelithiasis dettach from the semicircular canals
stiumlation of the hairs = vertigo
Signs and symptoms of BPPV
Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards
may be associated with nausea
- lasts 10-20 seconds
Rotational vertigo lasting between 30 seconds to 1 minute
Absence of auditory symptoms
Recurrent episodes, often resolving naturally over weeks to months
Meniere’s disease
Meniere’s disease is a chronic condition which affectes the inner ear
primarily involves an abnormal buildup of fluid in the inner ear, known as endolymphatic hydrops. This causes change in balance and hearing.
episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the ear
What is the managment of anaphylaxis
A-E reponse
-intramuscular adrenaline 1:1,000
- oxygen
- fluids
adrenaline dose for < 6 months experiencing anaphylaxis
100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
adrenaline dose 6 months - 6 years
150 micrograms (0.15 ml 1 in 1,000)
adrenaline dose for 6-12 years
300 micrograms (0.3ml 1 in 1,000)
adrenaline dose Adult and child > 12 years
500 micrograms (0.5ml 1 in 1,000)
What is refractory anaphylaxis
defined as respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline
Managment of refactory adrenaline
IV fluids should be given for shock
expert help should be sought for consideration of an IV adrenaline infusion
Managment of refactory anaphylaxis after stabilisation
- non-sedating oral antihistamines, in preference to chlorphenamine
– Serum tryptase levels are sometimes taken in such patients as they remain elevated for up to 12 hours following an acute episode of anaphylaxi
- refer to allergy clinic
-Adrenaline injector should be givens an interim measure before the specialist allergy assessment (unless the reaction was drug-induced)
- patients should be prescribed two injectors
Chronic rhinosinusitis definition
inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.
factors which increase the likelihood of chronic rhinosinusitis
atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking
what are the features of chronic rhinosinusitis
- facial pain (typically frontal, wose on leaning forward).
- nasal discharge (usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
nasal obstruction: e.g. ‘mouth breathing’) - post-nasal drip: may produce chronic cough
Managment of chronic rhinosinusisitis
avoid allergen
intranasal corticosteroids
(150 to 352 mg)
nasal irrigation with saline solution
viral labyrinthitis
inflammation of the labyrinth which is typically caused by infection (e.g common cold)
symptoms of labyrinthitis
Vertigo (spinning sensation)
Nausea and vomiting
Dizziness
Balance problems
Hearing loss or changes in hearing
Tinnitus (ringing in the ears)
A feeling of fullness or pressure in the ear
Nystagmus (involuntary eye movements)
typically presentation occurs after illness, such as the common cold
labyrinthitis vs Vestibular neuronitis
- both are typically caused by viral infections
L is caused by common cold (rhinovirus) whereas VN is caused by herpes virus - VN is not typically assoicated with hearing loss, but L is
Labyrinthitis: Treatment for labyrinthitis often involves managing symptoms, such as medications for nausea and dizziness, corticosteroids to reduce inflammation, and vestibular rehabilitation exercises to improve balance and reduce dizziness. If hearing loss is significant, additional interventions such as hearing aids may be necessary.
Vestibular Neuronitis: Treatment for vestibular neuronitis also focuses on managing symptoms, typically with medications for nausea and dizziness and vestibular rehabilitation exercises. Corticosteroids may also be prescribed to reduce inflammation. Since vestibular neuronitis does not involve hearing loss, interventions specific to hearing impairment are not required.
Vestibular neuronitis
inflammation of the vestibular nerve, which is responsible for transmitting balance and spatial orientation information from the inner ear to the brain.
ototoxic medications (6 main classes of drug)
- Aminoglycoside antibiotics: e.g gentamicin
- Loop Diuretics: furosemide
-Chemotherapy Drugs: cisplatin, carboplatin - Salicylates: high doses of asprin
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): high doses of ibruprofen or naproxen
- Certain Antimalarial Drugs: Chloroquine and hydroxychloroquine
- Antidepressants: SSRIS (setraline)
Acoustic neuroma
- also known as a vestibular schwannoma
- noncancerous tumor that develops on the vestibular (balance) nerve, which connects the inner ear to the brain.
- generally a slow-growing and benign condition
Symptoms of acoustic neuroma
- gradual hearing loss
- tinnitus
- vertigo
- fullness in ear
- facial numbness or weakness on one side of the face, difficulty swallowing, and headaches.
Diagnostics of acoustic neuroma
-Audiology exam (sensoneural hearing loss)
- MRI with gadolinium contrast
treatment of acoustic neuroma
- observation (see the growth progression)
- radiotherapy: gamma knife, cyberknife
- surgery
who is affected by acoustic neuroma
- commonly diagnosed btween 30-60
- people with family hx of the condition
- people who have neurofibromatosis 2 (NF2)
- more common in females than males
- people who have greater exposure to radiation
rinne’s and webers
-rinne’s: differentiates sound transmission via air conduction from sound transmission via bone conduction
-Weber’s: differentiates which ear the sound is better/worst in
sensorineural hearing loss
Sensorineural hearing loss is a type of hearing loss that occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain.
Conductive hearing loss
Conductive hearing loss occurs when there is a problem conducting sound waves through the outer or middle ear. This type of hearing loss can result from various issues that interfere with the transmission of sound vibrations to the inner ear.