Flashcards in Procedures and Imaging Deck (40)
Purpose of X-ray in ENT?
- detect sinusitis (can help confirm)
- detect fluid in sinuses
- detect polyps
Indications for X-ray?
- pain and pressure in face, especially lowering head
- when clinical sxs need supportive evidence to make the dx
Different types of X-ray for ENT?
-water's view, waters projection: posterioranterior radiographic view of the skull made with orbitomeatal line at angle of 37 degrees from the plane of the film, to show the orbits and maxillary sinuses
- maxillary sinus: a frontal view of maxillary sinuses, orbits. nasal structures. and zygomas, permits direct comparison of sides
What can you detect on x-ray?
- croup (steeple sign)
- retropharyngeal abscess (imaging test of choie is CT scan of neck)
When is CT use preferred?
- good for bone involvement, better than x-ray
- sensitive to bone destruction: trauma, infection
- sensitive to inflammatory changes: retropharyngeal abscess. ludwig's angina
- preferable to MRI for scanning larynx for neck nodes, tumor volume, cartilage sclerosis, and destruction
CT of sinuses is useful for?
- gives further info about certain tumors of nasal cavity and sinuses
- can provide impt info about sinus and nasal obstruction
- able to detect sinuses that are filled with fluid
- can detect if sinus membranes are thickened
- assist with dx of sinusitis
when is a MRI useful?
- valuable in demonstrating soft tissue involvement
- sensitive enough to evaluate mucous membranes
- can distinguish tumor from inflammation and inspissated mucus
- useful if malignancy suspected (acoustic neuroma)
Indications for throat swab and culture?
- sore throat
- fever of unknown origin
- chronic carriers with recurrent infection
Indications for nose swab and culture?
- nasal or sinus infections
- carriers of pathogenic bacteria
What pathogens are identified by throat cultures?
-- Bordatella pertussis
- streptococci, esp b-hemolytic strep
- meningococci, corynebacterium diptheriae
Nasal cultures are used to ID what bacteria?
- staph aureus
nasopharyngeal swabs are used to ID what bacteria?
Difference b/t nasal and nasopharyngeal swab?
- nasopharyngeal: in deeper, more delicate swab that is flexible
Rapid strep test use?
- posterior pharyngeal swab
- has an antiserum against group A strep
- very accurate w/o cultures
- takes about 5 minutes to perform
- if negative, and sxs consistent with GAS, culture should be done
- culture will take at least 2 days
- if culture is negative, no strep infection exists
Diff methods of testing throat culture?
- diff media:
chocolate, strep-specific, other agar
- may quickly gram stain bacteria and initiate therapy based on whether gm + (blue) or - (red).
Cerumen disimpaction method?
- if cerumen can be removed using curette or otoloop, this is safest method, and usually only mildly uncomfortable to pt
- Ear canal is much less sensitive along top compared to bottom
When shouldn't you do ear irrigation on a pt?
- if pt has hx of ruptured TM or has FB such as insect in ear (possibility of having ruptured TM)
Tx of epistaxis?
- topical vasoconstrictors/analgesics
- direct pressure
- silver nitrate cautery
When should you use topical vasoconstrictors? Types?
- ongoing bleeding
- inhaled afrin
- cotton balls soaked in Epi and lidocaine
Direct pressure for epistaxis?
- tape 2 tongue blades together and leave in place for up to 20 minutes
Nasal cautery use? Method?
- after 20 min of direct pressure:
remove cotton balls, gently evacuate clot by suction or gentle nose blowing
- inspect nare with nasal speculum
- if ongoing bleeding is seen apply a silver nitrate stick to site for 10 sec then roll it over surrounding area
(have to be able to see source of bleed)
- don't cauterize both sides of nasal septum at same time becuase of risk of septal perforation
- must be able to directly visualize the bleeding area
- apply abx ointment over cauterized area
Most cases of epistaxis occur where?
- anterior part of nose
Posterior nasal packing should be done by whom?
- experienced physician or ENT doc
Anterior nasal packing utensils?
- gauze: petroleum soaked
- commercial nasal tampon: rhino rocket, mercel
Nasal packing follow up? Result if packing too tight?
- f/u reqd w/in 24 hrs
- leave in place for 48 hrs usually
- may cause necrosis if packing too tight
- may develop sinusitis, otitis media, or TSS
Use of pneumatic otoscopy?
- normal light reflex from tympanic membrane provides info regarding middle ear fxn
- degree of mobility of TM using pneumatic otoscopy or tympanometry is more helpful
- movement is best visualized in posterosuperior quadrant of ear drum
Procedure of pneumatic otoscopy?
- insert otoscope far enoguh to create good seal, this prevents air leakage b/t speculum and ear canal wall
- gently squeeze bulb on otoscope to create positive pressure on tympanic membrane and observe degree of tympanic membrane mobility
- release bulb to create negative pressure on TM and observe degree of TM mobility
Interpretation of pneumatic otoscopy?
- increased mobility: may be caused by atrophy, previous perforation or tympanostomy tube
- absent or decreased mobility of TM may be caused by:
acute otitis media, scarring
What is audiometry?
- formal measurement of hearing
- it involves the presentation of tones or speech to each ear
- a range of frequencies is used, and the pt's pattern of response is analyzed
- pt raise hands in response to sound or in case of children, CPA is used
- can also test speech recognition
- measurement is usually performed using an audiometer by an audiologist (non medical healthcare professional specializing in eval and rehab of people with hearing loss)