Review at 3 months with otoscopy, audiometry and tympanometry ``` May try autoinflation If persistent for >3/12 with symptoms: 3 years, first intervention - grommets >3 years, second intervention - grommets and adenoidectomy ``` If nasal syptoms, adenoidectomy may be considered earlier

ENT Investigations and Management Flashcards by William MacDonald

Tonsillitis investigations

None (throat swab not recommended)

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Bacterial tonsillitis criteria

Centor

Fever PAIN

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Bacterial tonsillitis management

Penicillin (clarithromycin if allergic)

If severe: IV fluids, IV antibiotics, steroids

Only need admission if can’t eat or drink

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Tonsillectomy criteria

Sore throats are due to tonsillitis
Episodes of sore throat are disabling and prevent normal functioning
7 or more in past year OR
5 or more each of the past 2 years OR
3 or more each of the past 3 years

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Peritonsillar abscess management

Aspiration and antibiotics

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Infectious mononucleosis investigations

Atypical lymphocytes in peripheral blood
+ve monospot/Paul-bunnel test (heterophile antibody tests)
Low CRP
EBV IgM

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Infectious mononucleosis management

Supportive management
Antibiotics in secondary bacterial infection
Maybe steroids if severe

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Glue ear investigations

“age appropriate hearing assessment”
Audiometry
Tympanometry

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Glue ear management

Review at 3 months with otoscopy, audiometry and tympanometry

May try autoinflation
If persistent for >3/12 with symptoms:
<3 years - grommets
>3 years, first intervention - grommets
>3 years, second intervention - grommets and adenoidectomy

If nasal syptoms, adenoidectomy may be considered earlier

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Referral criteria for OME

Bilateral OME for 3 months 
CHL>25dB
Speech/language problems
Developmental behavioural problems
Basically if symptoms persist

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Management of airway obstruction

ABCDE
Oxygen/heliox
Steroid
Nebulised adrenaline
Flexible fibre-optic endoscopy
ET tube (first line)
Emerency needle cricothyroidotomy (temporary measure pending tracheostomy, only works for 30-45 mins as CO2 builds up)
Tracheostomy

Treat underlying pathology

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What may you need to give before airway endoscopy?

General anaesthesis (gas - sevoflurane. IV - propofol, remifentanyl)

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Otitis externa management

Mild - acetic acid spray (Ear Calm) continuing 2 days after resolution
Moderate - sofradex or otomise (antibiotic and steroid) spray
Don’t swab

Severe - oral or IV antibiotics

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Otitis media management

Most will resolve without antibiotics
Consider if otorrhoea

1st line amoxicillin
2nd line clarithromycin

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Tympanic membrane perforation management

Nothing, usually heals spontaneously

Requires surgery if doesn’t heal (myringoplasty)

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Management of cholesteatoma

Mastoid surgery (mastoidectomy)

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Mastoiditis management

IV antbiotics
Middle ear drainage (myringotomy)
Mastoidectomy

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Otosclerosis investigation

Audiometry with masked bone conduction shows a dip at 2kHz (Cahart’s notch)

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Otosclerosis management

Stapedectomy

Or hearing aid

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Vestibular schwannoma investigation

MRI scan

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Septal haematoma management

Incision, drainage and packing

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Nasal fracture investigations

None - clinical diagnosis

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Nasal fracture management

Treat any symptoms
Reasses 5-7 days post-injury
Consider digital manipulation under anaesthetic within 3 weeks (10-14 days in handbook)

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Epistaxis first aid management

Local treatment
External pressure to nose
Ice
Cautery
Nasal packing

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Epistaxis specialist management

Resus on arrival if necessary Pressure, ice, topical vasoconstrictor with maybe local anaesthetic Remove clot (suction/nose blowing) Anterior rhinoscopy Cauterise vessel: silver nitrate/diathermy Use rapid rhino pack if bleeding continues

Management of epistaxis controlled with initial specialist management

Arrange admission if packed/poor social circumstances FBC, G&S (group and save) NO SEDATION

Management of epistaxis not controlled with initial specialist management

``` Arterial ligation Maybe embolisation (can cause stroke) ```

Management of CSF leak

Often settle spontaneously | Need repair if lasting for 10 days

Management of pinna haematoma

Aspiration OR Incision and drainage OR Pressure dressing No good evidence which technique is best

Management of pinna lacerations

Debridement Close (primary or reconstruction) Local anaesthetic Antibiotics if exposed cartilage

Temporal bone fracture investigation

Axial CT

Temporal bone fracture management

Often delayed as polytrauma Facial nerve decompression if no recovery and EMG studies CSF leak, most settle but need repair May need hearing restoration (hearing aid or ossiculoplasty)

Difference between immediate and delayed facial paralysis in temporal bone fracture

Immediate - disruption to facial nerve by fracture that can be treated. Delayed - likely swelling causing it which will improve with time

Management of sudden sensorineural hearing loss

Steroid Urgent referral to ENT If no improvement then intra-tympanic steroids

Foreign body in ear management

Can wait till urgent clinic Remove watch batteries immediately Drown live animals with oil which can be removed the next day

Management of neck injury that has not gone through the platysma

Just stitch it up

Neck trauma investigations

``` FBC, G&S/cross matching AP/lateral neck x-ray (foreign body?) CXR (haemopneumothorax, emphysema) CT angiogram (vascular, pseudoaneurysm, laryngeal, aerodigestive tract) MR angiogram ```

Neck trauma management

Urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy Angiography - embolise

Deep space neck infection investigation

Deep space neck infection management

Fluid resus IV antibiotics Incision and drainage of neck space

Orbital blowout fracture investigation

CT sinuses (tear drop sign)

Orbital blowout fracture management

Conservative | Surgical repair of bony walls if: entrapment, large defect, significant enophthalmos

Le fort fracture investigation

Le fort fracture management

Surgery

Ageing cosmetic treatment ladder

``` Botulinum toxin Fillers Blepharoplasty Skin rejuvenation Face lift ```

Skin and soft tissue reconstruction options

Primary closure Healing by secondary intention Skin grafts Skin flaps

What is used to harvest skin in skin grafts?

Dermatome

Investigation for laryngeal cancer

Ultrasound and FNA Laryngoscopy and biopsy HPV status CT/MRI for staging

Investigation for salivary gland tumour

``` US FNA CT (staging) MRI (deep lobe) PET (metastatic nodes) ```

Minimally invasive technique for parotidectomy

Facelift approach

Indications of transoral robotic surgery

Tonsil cancer Laryngeal cancer Pharyngeal cancer Tongue cancer

Laryngeal cancer management

Radical radiotherapy for small tumours | Larger tumours treated with laryngectomy and block dissection of neck glands

Oropharyngeal cancer investigations

Forceps biopsy of lesion | CT/PET CT of neck

Orophayngeal cancer management

Surgery and radiotherapy (either first line in early cancer)

General management of salivary gland tumours

Surgery | Radiotherapy

Management of pleomorphic adenoma

Surgical removal

Management of warthins tumour

Partial parotidectomy

Management of mucoepidermoid carcinoma

Low grade - excision | High grade - excision and radiotherapy

Management of adenoid cystic carcinoma

Surgical excision and post-operative radiotherapy

Pain management where oral route no-longer an option

Syringe driver | Transdermal patch

Palliative management of stridor

Active sedation

Palliative management of major haemorrhage

Large doses of midazolam IM or IV | Don't leave patient alone

Rhinitis examination

Airway patency External nose Rhinoscopy

Allergic rhinitis management

Allergen avoidance Nasal irrigation 1. Intranasal antihistamine/oral antihistamine 2. Intranasal steroid

Nasal polyps management (commoner in non-allergic asthma)

Steroid drops for 6 weeks then long term nasal spray | If no better then endoscopic sinus surgery

Acute infective rhinosinusitis management

Analgesics and decongestants (98% are viral) | If persisting/worsening add antibiotic

Potential allergy testing

Skin prick tests RAST (IgE levels) (I don't think you do these unless clinical suspicion)

Vasomotor rhinitis management

Topical anticholinergic

Management of unilateral nasal discharge

Refer urgently In a young child it might be foreign body In adult it might be nasal or paranasal tumour

BPPV investigation

Dix-hallpike test

BPPV management

Epley manoeuvre Semont manoeuvre Brandt-Daroff exercises

Vestibular neuronitis/labyrinthitis management

Supportive management with vestibular sedatives Prolonged or atypical then may require further investigation Rehab exercises if prolonged

Menieres disease investigation

Audiometry

Menieres disease management

``` Supportive during episodes Tinnitus therapy Hearing aids Grommet insertion (meniette) Intratympanic steroid/gentamicin Surgery e.g. labyrinthectomy/vestibular nerve section ```

Diphtheria management

Antitoxin and supportive | Penicillin/erythromycin

Candida throat infection management

Nystatin or fluconazole

Malignant otitis (basically osteomyelitis) investigations

PV/CRP radiological imaging Biopsy and culture

Malignant otitis management

Ciprofloxacin PO or piperacillin/tazobactam IV

Fungal otitis externa management

Topical clotrimazole

Acute sinusitis management

1st line - phenoxymethypenicillin | 2nd line - doxycycline (not in children)

ENT Investigations and Management Flashcards

(80 cards)