ENT + opthalmology Flashcards
(45 cards)
Acute otitis media on otoscopy?
Otoscopy reveals an inflamed tympanic membrane with an air-fluid level
For how long can otitis media be managed with symptom relief before abx are given (assuming vitals are stable)
48 to 72 hours and limit management to symptomatic relief.
Treatment of otitis media without systemic illness?
Azithromycin is an appropriate first-line treatment for patients with nonsevere illness
First line treatment in majority of pts with otitis media (temp less than 39, mild to moderate otalgia)
High-dose oral amoxicillin is the single most appropriate first-line therapy in the majority of patients with acute otitis media who have mild to moderate otalgia and a temperature < 39°C. It is effective against streptococci and has a narrow antibiotic spectrum of activity
In patients who have evidence of severe illness (moderate to severe otalgia or a fever >39°C) how should otitis media be managed?
In patients who have evidence of severe illness (moderate to severe otalgia or a fever >39°C) treatment should be initiated with high-dose amoxicillin/clavulanate,
What is malignant otitis externa?
malignant otitis externa, a rare, potentially life-threatening complication of otitis externa. The term refers to a form of osteomyelitis of the temporal bone and possibly the skull base, usually in those unable to clear the initial infection of the external auditory meatus due to underlying issues with the immune system such as diabetes or primary immunodeficiency. The symptoms are far more extreme than otitis externa, with patients usually showing signs of sepsis, headache, and agonising otalgia.
Common causative organism of malignant otitis externa?
Pseudomonas aeruginosa the main causative organism for the condition; it is also the pathogen most frequently implicated in diffuse otitis externa. Management of malignant otitis externa due to this pathogen will likely require IV antibiotics, as well as traditional management of co-existing sepsis. Surgery may be necessary if an abscess or localised collection is present due to the infection.
Red flags for throat lumps?
Patients with any cervical lymphadenopathy (unilateral or bilateral) should be referred to secondary care so that malignancy can be ruled out. Other red flags include slow-onset and persistent pain, voice changes, family history, or rapidly enlarging masses.
Referral to ENT for tympanostomy tube placement should be considered in which children?
Referral to ENT for tympanostomy tube placement should be considered in children who:
have 3 separate, well-documented episodes of acute otitis media (AOM) within 6 months
have ≥4 episodes within 1 year
have effusion that persists > 3 months
What commonly causes otitis externa (swimmers ear)
Causative organisms include pseudomonas aeruginosa, staphylococcus aureus, and occasionally other gram-negative rods. Patients with otitis externa typically present with external, localised ear pain, which is made worse with palpation of the tragus and external ear.
What is Ménièrs disease?
Ménière’s disease, a condition of unknown cause characterised by excessive pressure and progressive dilation of the endolymphatic system of the inner ear. Patients suffer from attacks of vertigo, tinnitus, hearing loss and a sensation of fullness, originally affecting one ear but becoming bilateral over time. Symptoms usually resolve after 10 years, but permanent hearing loss is possible.
Referral to an ENT consultant is needed to confirm the diagnosis. To reduce the severity of symptoms during attacks, buccal or intramuscular prochlorperazine can be given. Betahistine can help reduce the frequency of future attacks.
In which patients should antihistamines be avoided?
All oral antihistamines, even non sedative ones, should be avoided especially in the elderly who are more at risk of falls.
Management of hay fever without antihistamines?
some sodium cromoglycate eye drops and a nasal spray
First line management of excessive ear wax?
Put 2 to 3 drops of olive or almond oil in the ear twice a day
What is quinsy?
Peritonsillar abscess
Severe throat pain lateralising to one side
Uvula deviation
Warrents urgent ENT REF
Causes of epistaxis?
Trauma (most common)
Angiofibroma
Most common nose bleed and which area does it involve?
Anterior
Nasal septum
Kisselbach plexus
Arterial
Where does posterior epistaxis occur and which vessels are involved?
Nasopharynx
Woodruff plexus
Venous
Management of epistaxis?
- Pressure and ICE 20 mins
- Silver nitrateor heat cautery if can find source, if not anterior nasal packing
- Post nasal packing (foley catheter)
- Surgical ligation
What must be excluded with any nasal trauma?
Septal haematoma - interrupts blood supply to nasal septum causing necrosis and ultimately a saddle shaped deformity.
Check nasal patency and probe nasal septum - if fluctuant, mass viasbale or reduce patency think septal haematoma
Incise and drain within 24 hours
Management of nasal trauma where septal haemotoma is excluded?
Splint and book ENT OP appoitnment
Ménière’s disease triad of features and other clinical features?
- Episodic vertigo - lasting aprox 1 hour
- Unilateral hearing loss
- tinitus
Neasuea
What manouevere is used to diagnose BPPV?
Dix-Hallpike
What maouevere is used to manage BPPV?
Epley manoeuvre
