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DPD 2020 > ENT surgery > Flashcards

ENT surgery Flashcards

Nose, Otology, Vestibular system and Paediatric A and E [tonsils, adenoids], (63 cards)

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1
Q

Chronic Rhinosinusitis

What is it- definition?

Associated symptoms

Treatment

A

Chronic Rhinosinusitis

What is it- definition?:
Constellation of symptoms
- nasal congestion bilaterally AND rhinorhhoea/post nasal drip
AND
Loss of smell/ cough [in children]
Facial pain 
For more than 3 months

Associated symptoms:
Nasal oedema/swelling
Nasal polyps

Treatment:

Intranasal steroids- MEDICAL TX IS DEFINITIVE

  • Flucticasone proprionate- less systemic
  • Betametasone proprionate- 60% systemic

Adjuncts:
- If too many polyps- obstructing path of intra nasal steroids
> Medical polypectomy- oral steroid short chours
> Surgery - remove polyps
then re administer intra nasal steroids

  • Sea salt- rinse nose- nasal steroid applies more easily
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2
Q

How do you investigate nasal polyp?

A

Naso endoscopy

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3
Q

What are the complications of nasal polpectomy?

A

Debriding eye

  • extra ocular fact
  • medial rectus
  • orbital bone

Injury to brain

V low risk- one in a thousand

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4
Q

What is the first/ most important step when assessing nasal trauma/suspected broken nose?

Why?

A

Septal haematoma

Cartilage of septum blood flow comes from overlying mucosa

Bilateral septal haematoma- separates cartilage and mucosa- devascularisation of nasal cartilage

If anterior perforation in septum- causes saddle nose

Drain immediately

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5
Q

Is a broken nose an ENT emergency?

A

No

Unless complicated

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6
Q

How do you treat a broken nose?

A

Leave- allow swelling to go down

ENT clinic- one week later

If still a problem:
Manipulation - surgery- push back to midline under anaesthesia- after three weeks

If still problem:
Septorhinoplasty- 9-12 months after injury

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7
Q

How common is rhinitis?

A

V common

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8
Q

How do you diagnose allergic rhinitis?

A

Positive allergy test- blood, skin prick tests

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9
Q

Symptoms of allergic rhinitis

A 
Watery eyes
Itchy sore throat
Runny nose- rhinorrhoea
Nasal congestion
Sneezing

No loss of smell, facial pain

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10
Q

How do you treat allergic rhinitis?

A

Antihistamines- intranasal

Intranasal corticosteroids

If still bad- oral antihistamine

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11
Q

What is a contraindication to intranasal corticosteroids?

A

Glaucoma

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12
Q

Why do a rhinoplasty?

A

Broken nose can cause deviated septum- blocking breathing

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13
Q

Nature of complications of rhinoplasty?

A

Long lasting

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14
Q

Purpose of eustachian tube

A

Brings fresh air into middle ear and equalises air pressure

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15
Q

What is otitis externa?

Aetiology/Causative organism

Risk factors/Precipitating factor

A

What is otitis externa?

Aetiology/Causative organism:
Staphyloccous- commensal
evolves to:
Klebsiella
E Coli
Pseudomonas- esp bad b/c
produces mucopolysaccharide biofilm- traps bacteria under it
Need to use vacuum to remove film before treating
Risk factors/Precipitating factor
- Water in ear- swimmer's ear
Break in skin
- Eczema
- Psoriasis
- Sebhorrhoeic dermatitis
- Using cotton bud to clear wax
- Contact dermatitis- shampoo, detergent etc
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16
Q

Otitis media- what is it?

Symptoms

Complication

A

Infection of middle ear- like an abscess behind tympanic membrane

Symptoms
Injected- inflamed blood vessels on ear drum
Pus
V painful- until pus drains
Grows bigger until causes perforated eardrum + discharged pus- relieving pain

Pus can also collect back into mastoid- mastoiditis

Can create a hole in mastoid- can become permanent and cause mastoid fistula

Can spread backwards - causing brain abscess

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17
Q

Causes of tympanic membrane perforation

A
  • Otitis media
  • Trauma- eg. blow to head
  • Barotrauma- sudden pressure changes
  • Cotton wool bud/foreign objects
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18
Q

Perforation prognosis

A
  • May either resolve
  • Or become permanent- not problem as long as kept clean and dry
  • Higher risk of infection
  • Middle ear infection v likely if large perforation + exposed to water
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19
Q

What is glue ear?

How is it treated?

What can precipitate it? How does the precipitating factor change the presentation?

Who is it most common in and why?

A

Otitis media with effusion

Treatment:
Insertion of grommets- drain effusion and remove low pressure environment that caused effusion

Precipitated by:
Upper respiratory tract system

If due to URTI- usually bilateral
If unilateral- something compressing Eustacian tube- maybe cancer

Most common in children:
Eustacian tube less well developed

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20
Q

What can unilateral glue ear be a sign of?

A

Cancers

Usually precipitated by a cold

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21
Q

What is the problem with hearing aids?

A

Mechanically inefficient

Using lots of battery to transfer vibration

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22
Q

What is a BAHA?

A

Bone anchored hearing aid
Used when no middle ear bones [ossicular chain]
Causes vibration of bones in skull near cochlea- transmits to cochlea

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23
Q

What is an auditory brainstem implant?

A

Electrodes directly to brainstem
Experimental
Used if eighth nerve not working

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24
Q

What causes dizziness in ENT?

A

Vestibular system

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25
Bony labyrinth- what are the five parts?
Semicircular canals: Anterior Posterior Lateral Utricle Saccule - Gravity and linear acceleration
26
How do semi circular canals work?
Endolymph moves over hair cells when head moves | Opens ion channels- depolarises nerves
27
How do the utricle and saccule work?
Hair cells stimulated by gel containing otoliths Otoliths constantly activate hair cells- tell you if standing or lying down even when not moving
28
What is the vestibulospinal reflex?
Keeps head still while moving around | Allows to keep balance
29
What types of dizziness are there?
Vertigo- abnormal sensation of motion Light headedness- presyncope Spaced out- dissociation Unsteadiness/off balance- dysequilibrium
30
What are associated symptoms/signs of vertigo?
Nausea + Vomiting | Nystagmus
31
BPPV Cause Symptoms/signs Diagnosis Treatment
BPPV - otoliths get stuck in wrong place ``` Symptoms/signs Positional: Vertigo N + V Horizontal nystagmus Lasts for a few seconds ``` Diagnosis Dix Hallpike Treatment Epley maneouvre
32
Meniere's Symptoms
Meniere's Symptoms
33
Peripheral causes of vertigo
BPPV Meniere vestibular neuronitis/labrynthitis
34
Meniere's Symptoms Treatment
Meniere's ``` Symptoms Last up to an hour Vertigo Hearing loss- unilateral Tinnitus Ear fullness ``` ``` Treatment No cure Betahistine Intra tympanic steroid injection Balance therapy + physio Antiemetics ```
35
Time course of vertigo due to vestibular neuronitis/labyrinthitis
Resolves after infection is gone usually
36
What is the difference between vestibular neuronitis and labyrinthitis?
Vestibular neuronitis= affects nerve | Labyrinthis- affects utricle and saccule, SCC
37
Central causes of vertigo What indicates a central cause?
Vestibular migraine Brainstem, cerebellar, thalamic, cortical pathology Non- horizontal nystagmus
38
What are the types of tonsil disease?
- Acute tonsilitis - Recurrent tonsilitis - Malignancy- rare in children - Obstructive hyperplasia
39
What are the symptoms of tonsillitis?
``` > Prodrome- fever, malaise > Cervical lymphadenopathy- more than two cm/tender lymph nodes > Off school/work > Sore throat, odynophagia, dysphagia > Otalgia- ear pain ```
40
What are the causes of tonsillitis?
``` Viral- most common- adenovirus, enterovirus, EBV, RSV, CMV Bacterial: Strep pyogenes Strep pneumoniae [Haemophilus influenza] [Staph aureus] ```
41
Do you do throat swabs for tonsillitis?
Not really | If abscess, take pus
42
Can you clinically differentiate between viral and bacterial anitibiotics?
No
43
What is the treatment for tonsillitis?
Analgesia Penicillin- delayed prescription- give and let to take in seventy two hours if symptoms have not resolved Erythromycin
44
What are the differentials for tonsillitis?
``` Infectious mononucleosis Malignancy - Lymphoma, leukaemia carcinoma Diphtheria- almost wiped out Scarlet fever Agranulocytosis ```
45
What is obstructive hyperplasia?
Tonsils are so big that they affect breathing ``` On a spectrum from: Mouth breathing Snoring Sleep disordered breathing Upper airways resistance syndrome Complete sleep apnea ```
46
What are the symptoms of obstructive hyperplasia? What are the investigations?
Symptoms: Day time somnolence, decreased attention, school performance Daytime chronic mouth breathing Daytime dysphagia and failure to thrive Snoring Restless sleep Investigations: Sleep study-polysomnography- oxygen and carbon dioxide levels Sleep video diary over a month If surgery - check for perioperative issues- post op HDU
47
What other conditions can compound obstructive hyperplasia in children and increase likelihood of sleep apnea?
Down's syndrome Cranio facial problems [reduced oral airway, set back jaw]- Pierre Robin, Treacher Collins Neuromuscular disorders
48
What are the complications of severe obstructive sleep apnoea?
``` Cardio and resp complications: Pulmonary hypertension Cor pulmonale Dysrhythmia Heart failure ``` Intracranial hypertension
49
What does unilateral tonsil enlargement suggest?
Can either be true enlargement or apparent enlargement [Tonsil displaced medially by abscess/mass] Often non neoplastic Can be neoplastic- unlikely in small children, but investigate in teenagers, and adults
50
What are non neoplastic causes of unilateral tonsillar enlargement?
Hypertrophy Acute infection Chronic infection- TB, actinomycosis, congenital syphilis Congenital- teratoma, haemangioma, lymphangioma, cystic hygroma
51
What are neoplastic causes of unilateral tonsillar enlargement?
Benign papillomas Lymphomas Squamous cell carcinoma
52
What are the types of adenoid disease?
Acute adenoiditis Recurrent adenoiditis Obstructive hyperplasia Malignancy [adults]
53
What is adenoid facies?
Overbite Long face Crowded incisors Associated with increased risk of adenoid disease
54
What are the symptoms of adenoid disease?
Obstruction related: - Snoring - Mouth breathing - Hyponasality Discharge related: - Rhinorrhoea - Post nasal drip - Nocturnal cough
55
What investigations do you do for adenoid disease?
Nasendoscopy [rarely in children] Posterior rhinoscopy - rarely done Lateral neck X ray- rarely done- [only useful if history and exam contradictory, and quality often compromised due to poor positioning of child due to poor cooperation'
56
What are the indications for tonsillectomy?
> Recurrent or chronic tonsillitis - 7 episodes in 3 year - 5 in 2 years - 3 in 3 years > Obstructive sleep apnea- hypertrophy > Peritonsilar abscess + tonsillitis In adults - Very last resort for tonsiloliths/halitosis - Unilateral tonsillar enlargement- if malignancy
57
What are the indications for adenoidectomy?
Obstruction - chronic nasal obstruction/mouth breathing - Obstructive sleep apnea/sleep disordered breathing - Speech problems Infection - Recurrent/chronic adenoiditis - Recurrent/chronic glue ear
58
What do you consider about palate before doing an adenoidectomy?
``` Bifid uvula- submucosal cleft palate Cleft palate- if weak palate and take out adenoid- food up nose when swallow Midline muscle diastasis Velopharyngeal insufficiency Neuromuscular disease ```
59
Techniques for tonsillectomy?
``` Guillotine Cold steel Electrodissection- diathermy Laser dissection Microdebridement Coblation ``` ALL EQUALLY EFFECTIVE
60
Techniques for adenoidectomy?
Curretage Suction diathermy Laser ablation Microdebridement ALL EQUALLY EFFECTIVE
61
What are the contraindications for adenoidectomy?
Overt or submucous cleft palate Neuromuscular abnormalities- impaired palatal function [both of these cause food to come out of nose if adenoid removed] Anaemia/haemostasis disorders
62
What is an active middle ear implant?
Directly stimulates stapes
63
What is an acoustic neuroma/vestibular schwannoma?
Benign tumour of CNVIII

DPD 2020 (48 decks)

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