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ENT - Lecture Flashcards

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1
Q

Broad aetiology of otalgia

A

External or middle ear pathology

Referred

  • CN5, 7, 9, 10
  • C2/3
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2
Q

Why is examination important

A

Drum condition is a good indicator of middle ear health
Patient is unlikely to have a normal drum with middle ear pathology
Inner ear conditions do not cause otalgia

Normal external ear examination = REFERRED PAIN

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3
Q

Specific aetiology of otalgia

A

Otological

  • Acute OM
  • Otitis externa
  • Furuncle
  • Necrotising otitis externa

Referred otalgia

  • Dental pathology
  • TMJ dysfunction
  • Cervical OA
  • Acute infections of the pharynx
  • Malignancy of the pharynx and/or larynx
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4
Q

TMJ dysfunction

A

Causes otalgia as TMJ is close to ear

Causes

  • Bruxism - Stress/anxiety
  • Malocclusion - Overbite or underbite

Management - Analgesia

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5
Q

Oropharyngeal malignancy red flags

A

Otalgia
Dysphagia
Dysphonia

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6
Q

Otitis externa aetiology

A

Bacterial - PSEUDOMONAS

Fungal - Otomycosis

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7
Q

Otitis external signs and symptoms

A

Pain
Discharge

Associated with eczema/dermatitis

O/E

  • Debris - White/creamy
  • Oedema
  • Stenosis
  • Fungal - Green mould or black dots
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8
Q

Otitis externa management

A

Topical abx - GENTAMICIN or CIPROFLOXACIN

Fungal - CLOTRIMAZOLE

Micro-suction to remove debris

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9
Q

Otits externa prevention

A

Stop touching
NO COTTON BUDS
Keep ears dry

Treat underlying skin condition

ACETIC ACID

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10
Q

Furuncle

A

STAPH AUREUS abscess on hair follicles

Pain - Cannot stand examination

Management

  • I+D
  • FLUCLOXACILLIN
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11
Q

Necrotising malignant otitis externa

A

Potentially fatal osteomyelitis of the EAM and bony tympanic plate

May spread along inferior surface of skull base

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12
Q

NMOE signs and symptoms

A

Typically older DM patients

Severe unremitting pain
Purulent discharge

Single or multiple cranial neuropathies - CN7

O/E - Granulations at the isthmus of the EAM

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13
Q

NMOE management and complications

A

Management - Refer to ENT for debridement

Complications

  • Meningitis
  • Cerebral abscess
  • Dural sinus thrombosis
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14
Q

Acute OM aetiology

A

Viral

  • RSV
  • Rhinovirus
  • Parainfluenza

Bacterial

  • Strep pneumoniae
  • Haemophilus influenza
  • Moraxella catarrhalis

CHILDREN HAVE SHORTER MORE HORIZONTAL EUSTACHIAN TUBES

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15
Q

Acute OM signs and symptoms

A

Preceding coryzal illness - Cough and rhinorrhoea

Pain
Deafness
Discharge

Systemic features - Fever and irritability

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16
Q

Acute OM examination findings

A

Middle ear inflammation

RED BULGING DRUM

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17
Q

Acute OM management

A

Self limiting - 48-72 hours
Abx do not affect outcome

Prescribe amoxicillin if…

  • Systemically unwell
  • Increasing pain
  • No improvement after 72 hours
  • Developing complication

Recurrent infections - Grommet insertion

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18
Q

Acute OM complications

A

Intracranial

  • Meningitis
  • Extradural, subdural, intracerebral abscess
  • Lateral sinus thrombosis

Extracranial

  • Mastoiditis
  • Petrositis
  • LMN - C7 palsy
  • Labyrinthitis
  • CHL or SNHL
  • TM perforation
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19
Q

Ramsay-Hunt syndrome presentation

A

HERPES ZOSTER OTICUS

Severe pain
Vesicles on TM/pinna
Facial nerve palsy
Hearing loss

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20
Q

Ramsay-Hunt syndrome investigations

A

HERPES ZOSTER OTICUS

Check for corneal reflex
PCR for VZV
Pure tone audiogram
Grade the palsy

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21
Q

Ramsay-Hunt syndrome management

A

Corticosteroids
ACYCLOVIR

Eye protection

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22
Q

Vertigo

A

Hallucination of movement

Manifestation of inner ear dysfunction

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23
Q

BPPV

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A

Benign positional paroxysmal vertigo

Positional rotational vertigo that lasts seconds

Management - EPLEY MANEUVER

24
Q

Meniere’s disease

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A

Episodic vertigo lasting minutes or hours

Associated with…

  • Hearing loss
  • Tinnitus
  • Aural fullness
25
Meniere's disease management
Salt restriction Betahistine HCL- SERC Anti-emetics Chemical labyrinthectomy
26
Sinusitis signs and symptoms
Post-coryzal - Nasal congestion Lasting days - Often recurrent Dull throbbing pain and pressure - Worse on bending forward - Forehead - Cheeks - Between the eyes - Occipital
27
Acute sinusitis management
Analgesia - Sufficient for 80% cases Intranasal decongestion - After 1 week Saline irrigation Consider intranasal steroid therapy if severe or prolonged Antibiotics if bacterial or co-morbidity Refer to hospital if suspected cranial involvement OPD referral to ENT if >3 abx courses in 1 year
28
Acute sinusitis antibiotics
Amoxicillin Penicillin Doxycycline, erythromycin, clarithromycin No improvement in 48 hours - Consider co-amox or azithromycin
29
Chronic sinusitis management
Intranasal steroid Prolonged antibiotic course - Macrolide Referral to ENT... - Intranasal polypectomy - Septal correction - Functional endoscopic sinus surgery
30
Atypical facial pain signs and symptoms
Vague history Changing symptoms Unresponsive to various medications History of depression or psychological disturbance
31
Atypical facial pain management
Amitriptyline Gabapentin Pregabalin
32
Epistaxis aetiology
Idiopathic Coagulopathy Rhinitis Trauma Neoplastic - Juvenile angiofibroma Drugs - Aspirin or warfarin Chronic granulomatous disease - Wegener's - Sarcoid
33
Epistaxis management
ABC Anterior and posterior rhinoscopy - Identify bleeding source Nasal cautery - Silver nitrate Nasal packing - Anterior - Merocel or BIPP - Posterior - Foley catheter
34
Epistaxis surgical management
Examination under GA - Ligation of artery Anterior ethmoid Sphenopalatine Carotid Angiography and embolisation
35
Tonsillitis aetiology
Viral - Adenovirus - Rhinovirus - H. Influenza - RSV - EBV - 1-10% Bacterial - Strep pyogenes - Staph aureus - Strep pneumoniae - Mycoplasma plenumoniae - Chlamydia pneumoniae
36
CENTOR criteria
Cervical lymphadenopathy Exudate No cough Temperature < 15 (+1 point) > 44 (-1 point) 0-1 points - No abx or culture 2-3 - Culture ± abx 4-5 - Abx therapy
37
Fever PAIN score
Fever Purulence Attend within 3 days of symptom onset Inflamed tonsils No cough or coryza 0-1 points - No abx 2-3 points - Consider delayed prescription 4-5 points - Consider abx
38
Bacterial tonsillitis management
Analgesia Penicillin V Erythromycin or clarithromycin Rehydration Admit if severe
39
Tonsillitis complications
``` Rheumatic fever Glomerulonephritis Scarlet fever Quinsy Retropharyngeal abscess ```
40
Tonsillitis investigations
Throat swab Monospot test EBV serology - IgG or IgM FBC
41
Tonsillectomy indications
> 7 episodes of bacterial tonsillitis in 12 months 5 episodes in each of last 2 years 3 episodes in each of last 3 years Peritonsillar abscess Suspected malignancy Sleep disordered breathing - Obstructive sleep apnoea
42
Thyroglossal cyst
More common in patients < 20 Usually midline - Between isthmus of thyroid and hyoid bone Moves upwards with protrusion of tongue Painful if infected
43
Reactive lymphadenopathy
Most common cause of neck swellings History of local infection or generalised viral illness
44
Lymphoma
Rubbery painless lymphadenopathy Night sweats Splenomegaly Pain on drinking alcohol - UNCOMMON
45
Thyroid swelling
May present with thyroid symptoms Moves upwards on swallowing
46
Pharyngeal pouch
More common in older men Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles Usually not visible May present as a midline lump in the neck that gurgles on palpation Dysphagia Regurgitation Aspiration Chronic cough
47
Cystic hygroma
Congenital lesion - Lymphangioma Classically the left side of the neck Mostly evident at birth 90% present before 2 years of age
48
Branchial cyst
Oval mobile cystic mass Between sternocleidomastoid and pharynx Failure of obliteration of second branchial cleft Usually present in early adulthood
49
Cervical rib
More common in adult females | 10% develop thoracic outlet syndrome
50
Carotid aneurysm
Pulsatile lateral neck mass | Doesn't move on swallowing
51
Types of hearing loss
CHL - Disease affecting outer/middle ear SNHL - Disease affecting cochlea or CN8 Mixed - Disease affecting both
52
Normal hearing physiology
Sound waves travel through EAC Stimulate cochlear nerve Air conduction > Bone conduction
53
Conductive hearing loss pathophysiology
Decreased transmission of sound to cochlea via air conduction
54
Sensorineural hearing loss pathophysiology
Sound is transmitted normally to the inner ear
55
CHL aetiology
Obstruction of EAC Perforation of TM Discontinuity of ossicular chain - Infection or trauma Fixation of ossicular chain - Otosclerosis
56
Progressive SNHL aetiology
Bilateral - Presbyacusis - Drug ototoxicity - Noise damage Unilateral - Meniere's disease - Endolymphatic hydrops - Acoustic neuroma
57
Sudden SNHL aetiology
Trauma Impaired vascular flow (CVA) Acoustic neuroma Barotrauma and leakage of perilymph fluid from inner ear Viral infections - Mumps - Measles - VZV

3B (23 decks)

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