5. ENT and General Practice Flashcards
List the ENT conditions studied, which can be adequately treated, unsupported, by a General Practitioner?
Wax Uncomplicated OM (Acute and Chronic) Simple URTI Certain FB only Minor Trauma
List the conditions studied, which are best treated on an elective ENT basis?
Otitis Externa Reluctant and Chronic Safe OM Hoarseness and Dysphagia (>2weeks = laryngoscopy) Neck Lumps Chronic Adenotonsillar hypertrophy Nasal Polyps
List the conditions studied, which require urgent/emergency ENT intervention?
Complicated OM, sinusitis, URTI Pediatric Upper Airway Problems All Abscesses All Trauma All FB All tumours Respiratory distress /stridor
Distinguish between complicated and uncomplicated Otitis Media?
Complicated = OM from which complications have developed, e.g. Mastoiditis
Distinguish between safe and unsafe chronic otitis media?
Safe = Perforation and can be managed by G.P.
Unsafe type = Kerattin formation in the attic region = ENT
What should a G.P. Be conscious of in the patient with otitis externa?
Looking out for signs of squamous cell carcinoma (canal mass, pain, hearing loss)
They may try antibiotics to treat OE but referal to outpatient ENT is the usual.
What intervention might be used in the context of stubborn wax impactation?
Micro Ear (Direct Vision and suction)
From what locations does referred oltagia often orginate? For each explain why?
Temporal-Mandibular Joint (teeth grinding, due to stres)
Parotid
Dental (due to shared innervation of trigemial)
Cervical Spine (Disc Degeneration)
Tongue Base (Glossopharyngeal Nerve)
What is the Ddx for presentation with loud tinnitus?
SNHL
How is facial nerve palsy (Bells) diagnosed?
Diagnosis of exclusion?
What constitutes “full facial palsy”?
All the facial muscles
What conditions are important to rule out in facial palsy?
Tumour of the Pons
Tumour of the Parotid
Scan (including skull base)
What is the usual course of a new bells palsy?
Most patients make a complete recovery?
What are the complications of a bells palsy?
Eye (Exposure Keratisits)
Swallowing (buccal mouth control)
Taste disturbance
What might be done by a G.P. to rule out viral involvement in Acute Otitis Media?
Hold of antibiotics for 24/Hrs
What are some of the characteristic of Glue ear?
Common in children
Usually painless
Appearance extremely variable
Drum can be sucked in by negative pressure
Sometimes honey appearance, sometimes golden.
What should be done before beginning ENT interventions for Glue Ear?
Must wait at least 3 month since 90% will resolve and 10% will not resolve w/o intervention.
What is the treatment for Glue ear which has not resolved after 3 months?
Tube 9grommet) inserted, which ventilates the middle ear giving it time to recover
The grommet falls out after around 9 months as the tympanic membrane seals itself.
Do audiogram + tympanometry
In adults always check Nasopharynx for carcinoma (effusion)
Medical Therapy
Distinguish between safe and unsafe Chronic Suppurative Otitis Media?
Perforation location…
Pars Tensa = Safe
Atticocoantral = Unsafe
What are the characteristics of chronic suppurative otitis media?
Otorrhoea
Polyps and granulation tissue, bleeding on contact (unsafe)
What is the Tx for chronic suppurative otitis media?
Aural Toiler
Surgery (repair of the ear drum) esp. if attic disease
(See flow chart)
How should polyps in the nasal cavity be treated?
Polyps bilateral → GP (steroids) → ENT if necessary
Unilateral Polyps → Urgent ENT
Septal Problems → Elective ENT
How should nasal trauma be treated?
The most minor might be treated by a G.P
Anything else ENT
In the case of a haemotoma must find or risk necrosis
What is the treatment for acute sinusitis?
Give Augmentin/Cefuroxime
Nasal Drop Steroids
What is the worry with infection of ethmoid sinus?
Spread to the eye.
What are the 4 phases of sinusitis?
Inciting Phase
Ostial Obstruction
Bacterial Phase
Ostiomeatal COMPLEX
Describe chandlers classification on the spread of sinusitis.
Orbital Cell Post Septal Cell Subperiosteal Abscess Orbital Abscess Cavernous Sinus Thrombosis
Outline the 8 divisions of the oral cavity for the purposes of an oral examination
- Ventral and dorsal tongue
- Hard Palate
- Upper and lower alveolus
- Floor of mouth
- Lips
- Buccal mucosa
Is peritonsillar abscess a form of tonsillitis?
A peritonsillar abscess (quinsy) is not a tonsillitis and is far more dangerous since can threaten the airway.
Uusally unilateral and there is swelling of the palate, complete distortion of the anatomy.
Treated with lancing with needle halfway between the uvula and the posterior molelar since you don’t want to hit the carotid which lies laterally.
What drug is C/I in peritonsillar abscess and why?
Augmentin
Should be avoided in infectious mononucleosis as is suspected since the occurrence of a morbilliform rash has been associated with this condition following the use of amoxicillin.
What are the indications for tonsillectomy?
Recurring definite tonsillitis (6py/4+attacks py for 2 years)
Quinsy (conservative = quinsey #2 )
Obstructive sleep apnoea (common in children as well)
Suspected malignancy.
What are the potential complications of tonsillectomy?
Bleeding primary or secondary
Secondary usually one week post op
Always requires readmission
Often settles with conservative management
Describe what is seen post-tonsillectomy?
Post tonsilectomey appearance
Prior to mucosalisation of the sloughs it will look pretty bad.
Eating and drinking helps to clear the debris
What is the difference between snoring and OSA
Snoring = vibration of soft tissue structures located in the upper airway (soft palate, uvula, tongue base, nasopharynx) and usually occurs during inspiration.
Sleep Apnoea: It is characterised by loud snoring with periods of cessation of breathing lasting 10 seconds or more followed by gasping and choking. These episodes continue throughout the night.
What is the Tx for obstructive sleep apnoea/snoring?
CPAP Uvulopalatopharyngoplasty or UPPP Laser assisted uvulopalatoplasty Adenotonsillectomy Septoplasty
