ENT-Hugus

Question 1

Conductive hearing loss

1. Define
2. General tx:

Answer 1

dysfunction of external/middle ear

i.e obstruction, mid-ear effusion, scarring, ossicular disruption, otosclerosis (abn bone formation)

Generally corrected with medical or surgical therapy

Question 2

Sensorineural hearing loss

1. define
2. sx/sxs
3. tx

Answer 2

1. deterioration of cochlea or vesibulocochlear nerve Causes majority of hearing losses
2. difficulty distinguishing foreground voices against noisy backgrounds, loss of directionality of sound, perception that people mumble, difficulty when on phone
3. Generally permanent: depends on etiology

Question 3

Neural cause of hearing loss

1. Cause
2. risk factors
3. Tx

Answer 3

1. Lesions of cochlear nerve VIII or central pathway
2. MS, cerebrovasc disease, acoustic neuroma
3. Etiology dependent

Question 4

Sensory cause of hearing loss

1. cause
2. risk factors
3. tx

Answer 4

damage or deficiency of cochlea, usually loss of hair cells.

2. Presbycusis (age related) from degeneration of cochlea, noise trauma, otoxicity
3. hearing aids/implants

Question 5

Weber test

1. unilateral conductive hearing loss

vs

2. unilateral sensorineural hearing loss

Answer 5

Midline of head

1. sound lateralizes (is heard in) the bad ear
2. sounds lateralizes to good ear

Question 6

Rinne test

1. Conductive

vs.

2. Sensorineural

Answer 6

mastoid: infront of ear
1. BC>AC (bone conduction vs air conduction)
2. BC

Question 7

External ear hematoma

Answer 7

1. blunt trauma, blood accumulates in subperichondrial space and can compromise blood flow to cartilage. Neocartilage deposisted after 7-10 days
2. Immediate surgical evacuation with pressure dressing
3. Cauliflower ear (necrosis), infection

Question 8

What can be used to paralyze insect in ear before removal?

Answer 8

2% lidocaine

Question 9

Tinnitus

1. Define
2. theories
3. etiologies

Answer 9

1. ringing/buzzing sound or whooshing in case of pulsatile tinnitus
2. Middle ear pressure derangement, vascular d/o, neural firing.
3. High frequency sensorineural hearing loss, ototoxic meds, infxn, ischemia, acoustic neuroma

Question 10

Eustachian tube dysfxn (ETD)

1. Define
2. Risk factors

Answer 10

1. failure of ET to open properly (more common in kids due to the horizontal placement of tube vs in vertical in adults)
2. rhinitis, URI, sinusitis, chronic OM, bad anatomy

Question 11

ETD

1. sx/sxs
2. tx

Answer 11

1. fullness, pressure, otalgia(ear pain), tinnitus, mild acute hearing loss. Retracted TM, decreased mobility with insufflation
2. decongestants(short term) nasal spray, valsalva (long term)

Question 12

Barotrauma

1. define
2. risk factors
3. sxs/exam findings

Answer 12

1. caused by air/water pressure
2. flying, diving, explosions
3. Acute pain usually resolves in hours and mild/moderate hearing loss
   exam: hyperamia (excess blood supplying specific organ), edema, ecchymosis of mid ear mucosa, medial displacement of TM, fluid in mid ear, TM perforation in severe cases. Resolves on its own 2-3 weeks

Question 13

TM perforation

Answer 13

1. trauma, mid ear infxn
2. if trauma, 90% heal spontaneously, otherwise surgery. Keep ears dry
3. Ear infxn (chronic), CT temporal, likely need abx, tx with topical abx if otorrhea (drainage) present. Keep ears dry

Question 14

*AOM (acute otitis media)

1. MC age group?
2. risk factors?

Answer 14

1. most common reason for abx for kids. Boys>girls 6-24 months of age
2. day care, immune related, exposure to smoke

Question 15

AOM

1. define
2. pathophys
3. MC pathogens

Answer 15

1. acute infxn of mid ear fluid
2. pt has URI, inflamm edema of mucosa, eustachian tube obstruction, - midd ear pressure, build up secretions, accumulates in mid ear space- virus/bacteria enters space
3. Bacterial: strep pneumonia, h. influenza, m. catarrhalis
   viral: RSV, rhinovirus, influenza, adenovirus

Question 16

AOM

1. Clinical manifestation
2. tx

Answer 16

1. fever, irritated, restlessness, HA, ear pain, buldging/erythematous TM, HEARING LOSS, decreased mobility with pneumotoscopy
2. analgesics/ abx- Amoxicillin (if 2> or TM perf 10 day abx, otherwise 5-7)

Question 17

Chronic Otitis Media

1. define/cause
2. Sx
3. pathogen

Answer 17

1. chronic drainage from middle ear associated with TM perf. Often preceded by AOM that isnt diagnosed or treated properly
2. May have hearing loss, not usually painful, common in young kids <2
3. Psudomonas a., ptoteus, S aureus

Question 18

Chronic otitis media

1. exam findings
2. tx

Answer 18

1. TM perf+purulent discharge
2. Aural toilet (suction, dry mop, earwick, gentle syringe, to remove moisture and debris) + topical quinolone

Abx for 2 weeks: otoflaxin otic solution or ciprofloxacin otic solution

Question 19

Serous Otitis Media (SOM)

Answer 19

1. Collection of non infected fluid in mid ear. ETD prolonged period. Resultant negative pressure results in fluid
2. Hearing loss (conductive), speech/;anguage delay, tinnitus, “fullness” in ears
3. decongestant, myringotomy for chronic cases

Question 20

Otitis externa

Answer 20

1. “Swimmer’s ear”. Otalgia of ext ear, pruritus, hearing loss. Water expsoure, mechanical trauma
2. erythema and edema in ear canal with exudate.
   (tugging on ear elicit pain)
3. Pseudomona a, s epidermidis, s aureus
4. Cortisporin drops not to be used it TM perf.

or Cipro HC first line

Question 21

What is a common water loving bactera?

Answer 21

pseudomonas aeruginosa

Question 22

Cholesteatoma

1. Define/cause
2. sx
3. exam findings
4. tx

Answer 22

1. fast growing kertainized epithel tissue in mid ear can be chronically infected and erode into bone (can cause perm hearing loss).

Occurs d/t ET dysfunction (retraction pocket)

2. hearing loss, otorrhea (ear drainage), may be asympto.
3. whitish behind TM, chronic otorrhea
4. surgical removal + tympanoplasty

Question 23

Mastoiditis

1. define/pathogen causing
2. sx
3. tx

Answer 23

1. bacterial infxn of mastoid air cells (strep. pneumo, strep. pyogene, S. aureus ). Typically complication of AOM
2. postauricular tenderness, erythema, swelling, fever, otalgia, may be toxic
3. CT if unclear, culture, ENT consult, IV abx, surgery

Question 24

Vertigo

In different etiologies and their typical duration

Answer 24

“true spinning”- sign of vestibular disease.

Ex and durations:

BPPV (benign prox position vetigo)- seconds

Meniere’s disease- 30 min-12 hr

Labyrinthitis- days-weeks

Acoustic neuroma (nerve tumor)- days-weeks

otoxocity (chemo)- months

MS- months

Psychogenic- years

Question 25

BPPV 1. Define/duration 2. dx 3. tx

Answer 25

1. Common peripheral vertigo lasts only seconds. 2. dix-hallpile, torsional nystagmus test 3. Epley maneuver, meclizine, vestibular therapy

Question 26

Meniere's diease 1. Define 2. sx 3. dx 4. tx

Answer 26

1. Episodic vertigo, hearing loss, tinnitus, n/v. Endolympth pressure 2. Usually unilateral, wax/wane (+/-), N/V 3. Consider audiogram and MRI r/o others 4. CATS (caffeine, ETOH, tension, salt), low salt diet, diuretic, +/- surgery

Question 27

Labyrinthitis 1. define 2. sx 3. etiology 4. tx

Answer 27

1. acute onset of continous and severe vertigo may last days to a week. 2. May have hearing loss and tinnitus, N/V 3. often follows URI, otherwise unknown 4. vestibular suppressants

Question 28

Acoustic Neuroma 1. Cause 2. sx 3. dx/labs 4. tx

Answer 28

1. Tumor of CN VIII, cause of Sensorineural hearing loss (SNHL). 2. continous disequilibrium than episodic vertigo, unilateral hearing loss with deterioration of speech discrimination 3. gadonilium- enhanced MRI 4. Surgical excision- stereotactic radiation therapy

Question 29

allergic rhinitis

Answer 29

hay fever. pollens, dust, grasses. 2. \*\*pale and boggy nasal mucosa, +/- nasal polyps 3. nasal corticosteroids, flonase, antihistamines, decongestants.

Question 30

Nasal polyps 1. define 2. Triad? 3. tx

Answer 30

1. pale, edematous, mucosal covered masses, like grapes (in kids indicative of CF) 2. asthma, NSAID allergy, nasal polyps 3. topical streoids, surgery

Question 31

Epistaxis tx?

Answer 31

Nose bleed MC Kiesselbach's plexus (anterior septum) 2. pressure while leaning fwd 10 min. Vasocontrict nasal spray or silver nitrate cautery. Nasal packing, rhinorocket. 1-2 days. if on blood thinners - 5 days

Question 32

Bacteria that may cause sinusitus?

Answer 32

Strep pneumo, H influenza, M catarrhalis, Stap aureus

Question 33

Duration of: 1. acute rhinosinusitis 2. Subacute rhino 3. Chronic rhino 4. Recurrent acute rhino

Answer 33

1. \<4 weeks 2. 4-12 3. 12\< 4. 4 or more episodes

Question 34

Oral Candidas (thrush) 1. define 2. risk factors 3. sx 4. dx 5. tx

Answer 34

1. creamy white curd like patcches-scrapes off (Candida Albicans) 2. DM, abx, steroids, anemia, chemo 3. painful sore tongue/mouth/throat. 4. wet prep with KOH 5. Nystatin oral suspension, fluconazole

Question 35

Aphthous Ulcer 1. Define 2. Causes 3. Tx

Answer 35

1. Canker sore. 2-6 mm painful round ulcerations with peripheral rim of eythema and a central yellowish exudate. Uknown pathogens 2. physical (fever) or mental stress, diet 3. Heals on its own 1-3 weeks. Sx relief: oragel topical pain relief, topical steroids

Question 36

Oral herpes simplex 1. define 2. Risk factors 3. tx

Answer 36

1. HSV type 1 2. immunocompromised, trauma, stress 3. painful papules with vesicles that rupture 4. antivirals (Acyclovir)

Question 37

Leukoplakia 1. define 2. risk factors 3. tx

Answer 37

1. MC pre malignant lesion of oral caivty. white lesions cannot be removed by rubbing mucosa. Can be on tongue or buccal mucosa 2. Tobacco/ETOH use, dentures, aids 3. d/c use of tobacco and ETOH, bx may be needed for peristent lesion and surgical excision.

Question 38

Acute pharyngitis 1. Viral vs bacterial 2. dx 3. tx

Answer 38

1. 90% virus (coryza, lack exudate low grade fever, +/- LAD) \*10% bacterial (MC: group A strep) - complications scarlet/rheumatic fever, Glomerulonephritis (inflamm of kidney) 2. rapid strep, Centor criteria 3. OTC analgesics. Abx if bacterial 4. Penicillin, Amoxicillin for kids, Azithromycin if PNC allergy

Question 39

Describe Centor Criteria

Answer 39

Question 40

Mononucleosis 1. Name of virus 2. sx 3. labs to order

Answer 40

1. Epstein-Barr virus 2. fever, pharyngitis, LAD, malaise, HSM, odynophagia (diff swallowing) 3. Monospot, CBC, anti-EBV titers

Question 41

Peritonsillar Abscess 1. define 2. sx 3. tx

Answer 41

1. collection of pus b/w capsule of the palatine tonsil and pharyngeal muscles (GABHS and resp anaerobes) 2. trismus (locked jaw), fever, drooling, muffled voice, odynophagia, hot potato voice 3. Consult ENT, I&D, po abx/IV abx. +/- tonsillectomy

Question 42

Sialolithiasis 1. define/MC? 2. RF 3. sx 4. tx

Answer 42

1. stone formation in salivary gland duct. MC wharton's duct (see image) 2. dehydration and anticholingergic meds. 3. postprandial pain and/or swelling 4. hydration, OTCanalgesia, lemon drops (to salivate), surgery

Question 43

Sialadenitis 1. define 2. sx 3. tx

Answer 43

1. Infxn/inflamm of salivary gland d/t ductal obstruction. Bacterial (S Aureus) viral (Mumps) 2. pain/swelling with meals, purulent discharge may be massaged from duct, +/- systemic sx (fever) 3. warm compress, lemon drops, hydration, gland massage. Abx

Question 44

Laryngitis 1. define 2. sx 3. tx

Answer 44

1. usually viral, follows URI 2. Episodic Aphonia, hoarseness, no pain, dry cough 3. rest, hydration, humidification, abx not indicated!

Question 45

Epiglottitis 1. define/pathogen? 2. sx 3. tx

Answer 45

1. Bacterial H. Influenzae type B or viral 2. rapidly developing sore throat. Tripod position, dysphagia, drooling, fever, systemic toxicity, swollen cherry epiglottis 3. "thumb print" sign on xray 4. Maintain AIRWAY. Consutl ENT. IV abx