Head and Neck Flashcards by Tilly Walker

What is acute otitis externa, and how is it managed?

Inflammation of the ear canal causing:

Otalgia and pruritus (itching)
Discharge
Hearing loss

Antibiotics (gentamicin topical drops)

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What is otitis media, and how is it managed?

Inflammation of the middle ear causing:

Otalgia
Hearing loss
Fever

Antibiotics

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What is a cholesteatoma, what are the complications and how is it managed?

A mass of keratin which grows in a pocket, producing smelly discharge

Hearing loss, facial paralysis, meningitis, intra-cranial abscess

Mastoid surgery

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What is glue ear, and how is it managed?

Otitis media with effusion

Treat with grommet if >3months duration and beginning to cause pain and hearing loss

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What does a negative rinne test mean?

Bone conduction is better than air conduction - this is abnormal and is caused by conductive hearing loss

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What causes conductive hearing loss?

Wax, otosclerosis, otitis media, glue ear

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What causes sensorinueral hearing loss?

Genetics, infection, drugs (gentamicin), congenital infection, acquired, presbyacusis

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What is presbyacusis?

Loss of acuity for high frequency sounds, starting before 30 years old.

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What types of hearing aids can you get for:

a) conductive loss?
b) sensorineural loss?

a) bone conduction hearing aid

b) cochlear implant (direct stimulation of cochlear nerve)

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What investigations should be done for hearing loss?

Webers, Rinnes
Otoacoustic emissions, audiometry
Tympanogram (for CHL)

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What is tinnitus?

Ringing or buzzing in the ears

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What is the definition of vertigo?

An illusion of movement, often rotatory, which worsens with movement

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What is the definition of disequilibrium?

Being off balance

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What is the definition of pre syncope?

Feeling lightheaded or faint

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What are some central and peripheral causes of vertigo?

Central - MS, stroke, migraine

Peripheral - BPPV, Meniere’s, vestibular neuronitis, motion sickness, trauma, ototoxic drugs

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What is BPPV?

Vertigo and nausea lasting seconds, associated with head turning.
Caused by debris moving around in the semicircular canal

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How is BPPV diagnosed?

Nystagmus on performing the Hallpike manoeuvre (hands on ears and lie patient down)

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How can BPPV be managed?

Epley manoeuvre to clear the debris

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What is acute labyrinthitis (vestibular neuronitis)?

Temporary infection of the vestibular nerve causing:

Vertigo lasting days
Nausea and vomiting
Balance problems

Sometimes follows a viral URTI

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How is acute labyrinthitis managed?

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It is self-limiting so manage with reassurance and sedation

What is Meniere’s disease?

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Recurrent attacks of vertigo lasting hours accompanied with fluctuating hearing loss and tinnitus, due to increased pressure in the labryinth

How is Menieres disease managed?

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Bed rest and reassurance during attacks

Antihistamine if prolonged

What is an acoustic neuroma?

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A Schwannoma arising from the vestibular nerve, presenting with unilateral hearing loss and subsequent vertigo, then damage to other ipsilateral cranial nerves.

What is herpes zoster?

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Herpetic eruption of the external auditory meatus causing:

Facial palsy
Deafness
Tinnitus
Vertigo

What are the red flags for a sino-nasal malignancy?

Bloody discharge Unilateral nasal blockage Pain Loose teeth

What causes nasal polyps?

Chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders

What is the classical presentation of sinusitis?

Dull, constant ache over the sinuses Post-nasal drip Pain worse on bending over Coryzal symptoms

What is the classical presentation of giant cell arteritis?

Form of vasculitis in >50 yo causing... Headache and scalp tenderness Jaw claudication Sudden unilateral blindness (amaurosis fugax)

How should GCA be managed?

1. Investigate ESR, CRP (both raised) and USS | 2. Start prednisolone immediately to prevent blindness

What is TMJ syndrome?

Pain and dysfunction of the muscles of mastication

A man has a neck lump which moves with swallowing but not tongue protrusion. What is the diagnosis?

Thyroid enlargement

A man has a neck lump which moves with swallowing and tongue protrusion. What is the diagnosis?

Thyroglossal cyst (linked to the back of the tongue)

A man has a neck lump which does not move with swallowing. What is the diagnosis?

Dermoid cyst | Chondrome

What investigations should be done for a neck lump?

Bloods: TFTs, thyroid autoantibodies Imaging: USS, CT Biopsy: fine needle aspiration, excision biopsy

What is sialolothiasis?

Salivary stones

What is sialadenitis?

Infection of the salivary glands

What is sialadenosis?

Non-infectious enlargement of the salivary glands

Where are salivary stones most common, and what are the symptoms?

Submandibular gland - causes intermittent colicky pain before and after eating

A man comes in with dry eyes, dry mouth and a swollen parotid gland. He has a history of T1DM. What is the diagnosis?

Sjorgens syndrome

What is the main type of head and neck cancer?

Squamous cell carcinoma (particularly tonsils)

What are the risk factors for head and neck cancer?

HPV, EBV, radiation exposure, smoking, alcohol, GORD, poor dentition, betal nut

What are the symptoms of head and neck cancer?

Mass in the neck Neck pain Bleeding from the mouth Sinus congestion, especially with nasopharyngeal carcinoma Bad breath Sore tongue Painless ulcer or sores in the mouth that do not heal White, red or dark patches in the mouth that will not go away Earache Unusual bleeding or numbness in the mouth Lump in the lip, mouth or gums Enlarged lymph glands in the neck Slurring of speech (if the cancer is affecting the tongue) Hoarse voice which persists for more than six weeks Sore throat which persists for more than six weeks Difficulty swallowing food Change in diet or weight loss

What can cause an enlarge salivary gland?

Acute - mumps, HIV Recurrent - salivary stones Chronic - autoimmune (hypothyroidism, sjorgens) Fixed - tumour, sarcoid, amyloid, Wegeners syndrome, idiopathic

Where is the most common site of salivary gland tumour?

Parotid (80%)

How can head and neck pathology be investigated?

Bloods: TFTs, thyroglobulin Imaging: USS, barium swallow, CT neck, MRI, PET-CT (these are mostly for cancer staging) Special: Flexible nasendoscopy

What is the most common cause of facial nerve palsy?

Idiopathic Bell's palsy - often caused by a virus

How can you differentiate stroke from bells palsy?

Stroke - UMN lesion so there will be forehead sparing | Bell's - LMN lesion

How is Bell's palsy managed?

Prednisolone and protect the eye from drying out

What are the DDs for facial nerve palsy?

``` Bell's palsy Ramsay-hunt syndrome (VZV herpes zoster reactivation) Meningitis Viruses Stroke, tumour, MS Acoustic neuroma Diabetes GBS Parotid tumours Otitis media ```

Head and Neck Flashcards

(49 cards)