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3B > ENT - Lecture > Flashcards

ENT - Lecture Flashcards

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

A

Benign positional paroxysmal vertigo

Positional rotational vertigo that lasts seconds

Management - EPLEY MANEUVER

24
Q

Meniere’s disease

A

Episodic vertigo lasting minutes or hours

Associated with…

  • Hearing loss
  • Tinnitus
  • Aural fullness
25
Q

Meniere’s disease management

A

Salt restriction

Betahistine HCL- SERC
Anti-emetics

Chemical labyrinthectomy

26
Q

Sinusitis signs and symptoms

A

Post-coryzal - Nasal congestion
Lasting days - Often recurrent

Dull throbbing pain and pressure - Worse on bending forward

  • Forehead
  • Cheeks
  • Between the eyes
  • Occipital
27
Q

Acute sinusitis management

A

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
Q

Acute sinusitis antibiotics

A

Amoxicillin
Penicillin
Doxycycline, erythromycin, clarithromycin

No improvement in 48 hours - Consider co-amox or azithromycin

29
Q

Chronic sinusitis management

A

Intranasal steroid
Prolonged antibiotic course - Macrolide

Referral to ENT…

  • Intranasal polypectomy
  • Septal correction
  • Functional endoscopic sinus surgery
30
Q

Atypical facial pain signs and symptoms

A

Vague history
Changing symptoms
Unresponsive to various medications
History of depression or psychological disturbance

31
Q

Atypical facial pain management

A

Amitriptyline
Gabapentin
Pregabalin

32
Q

Epistaxis aetiology

A

Idiopathic
Coagulopathy
Rhinitis
Trauma

Neoplastic - Juvenile angiofibroma

Drugs - Aspirin or warfarin

Chronic granulomatous disease

  • Wegener’s
  • Sarcoid
33
Q

Epistaxis management

A

ABC

Anterior and posterior rhinoscopy - Identify bleeding source

Nasal cautery - Silver nitrate

Nasal packing

  • Anterior - Merocel or BIPP
  • Posterior - Foley catheter
34
Q

Epistaxis surgical management

A

Examination under GA - Ligation of artery

Anterior ethmoid
Sphenopalatine
Carotid

Angiography and embolisation

35
Q

Tonsillitis aetiology

A

Viral

  • Adenovirus
  • Rhinovirus
  • H. Influenza
  • RSV
  • EBV - 1-10%

Bacterial

  • Strep pyogenes
  • Staph aureus
  • Strep pneumoniae
  • Mycoplasma plenumoniae
  • Chlamydia pneumoniae
36
Q

CENTOR criteria

A

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
Q

Fever PAIN score

A

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
Q

Bacterial tonsillitis management

A

Analgesia

Penicillin V
Erythromycin or clarithromycin

Rehydration
Admit if severe

39
Q

Tonsillitis complications

A 
Rheumatic fever 
Glomerulonephritis 
Scarlet fever 
Quinsy 
Retropharyngeal abscess
40
Q

Tonsillitis investigations

A

Throat swab
Monospot test
EBV serology - IgG or IgM
FBC

41
Q

Tonsillectomy indications

A

> 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
Q

Thyroglossal cyst

A

More common in patients < 20

Usually midline - Between isthmus of thyroid and hyoid bone

Moves upwards with protrusion of tongue

Painful if infected

43
Q

Reactive lymphadenopathy

A

Most common cause of neck swellings

History of local infection or generalised viral illness

44
Q

Lymphoma

A

Rubbery painless lymphadenopathy

Night sweats
Splenomegaly

Pain on drinking alcohol - UNCOMMON

45
Q

Thyroid swelling

A

May present with thyroid symptoms

Moves upwards on swallowing

46
Q

Pharyngeal pouch

A

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
Q

Cystic hygroma

A

Congenital lesion - Lymphangioma

Classically the left side of the neck

Mostly evident at birth
90% present before 2 years of age

48
Q

Branchial cyst

A

Oval mobile cystic mass
Between sternocleidomastoid and pharynx

Failure of obliteration of second branchial cleft

Usually present in early adulthood

49
Q

Cervical rib

A

More common in adult females

10% develop thoracic outlet syndrome

50
Q

Carotid aneurysm

A

Pulsatile lateral neck mass

Doesn’t move on swallowing

51
Q

Types of hearing loss

A

CHL - Disease affecting outer/middle ear
SNHL - Disease affecting cochlea or CN8
Mixed - Disease affecting both

52
Q

Normal hearing physiology

A

Sound waves travel through EAC
Stimulate cochlear nerve

Air conduction > Bone conduction

53
Q

Conductive hearing loss pathophysiology

A

Decreased transmission of sound to cochlea via air conduction

54
Q

Sensorineural hearing loss pathophysiology

A

Sound is transmitted normally to the inner ear

55
Q

CHL aetiology

A

Obstruction of EAC
Perforation of TM
Discontinuity of ossicular chain - Infection or trauma
Fixation of ossicular chain - Otosclerosis

56
Q

Progressive SNHL aetiology

A

Bilateral

  • Presbyacusis
  • Drug ototoxicity
  • Noise damage

Unilateral

  • Meniere’s disease - Endolymphatic hydrops
  • Acoustic neuroma
57
Q

Sudden SNHL aetiology

A

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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