6&10 - ENT Flashcards
Otitis Externa
- S&S
- Mx
- Complications
Otitis Externa
- Itchy + discharge
- Avoid swimming
- Malignant OE -> Osteomyelitis (can spread)
ABx
Noise related hearing loss
- Three categories
- Mx
Noise-related hearing loss
- Occupational
Recreational
Accidental - Steroids
Hearing aids
Age related hearing loss
- Pattern
- Mx
Age-related hearing loss
- Higher frequencies lost (and conversation)
- Hearing aids
Reduced environmental noise
Cochlear implants
Acute Otitis Media
- Management
- 3-7/7 Analgesia
- ABx 10/7
Children: Amoxicillin 80mg
Adults: Co-amoxiclav 80-90mg - Tympanocentesis
Dry Tympanic Perforation
- Causes
- S&S
Dry Tympanic Perforation
Traumatic injury
- Sudden loud noise (can be very severe)
- Barotrauma
- Dislodged grommit
S&S
- Asymptomatic
- Conductive hearing loss/muffling
- Tinnitus
- Otalgia
Mastoiditis
- Hx
- Mx
- Red flags
Mastoiditis
Hx
- Otalgia
- Ear ‘Pushed forward’
- Rubor & Tumor
- Fever+Confusion+Meningism
Mx
- ABx IV -> PO (14/7)
- Aspiration/debridement/mastoidectomy
Red flags
- No improvement, Meningism, VST
Cholesteatoma Presentation
- Smelly otorrhoea
- Erythema
- Keratin/dead skin build upx
Referred Otalgia?
1 Nerves
2 Red flags
CNs:
- Trigeminal:
Dental abscess
Joint lesion (TMJ) - Facial:
Ramsay Hunt Syndrome? - Glosopharyngeal:
Tonsillectomy - Vagus:
Laryngeal cancer
Cricoid cancer
Otalgia red flags:
- Sudden hearing loss/pain
- Unilateral
- Pulsatile tinitus
- Repeated OE - ?Cholesteatoma?
Otitis media with effusion
- S&S
- Mx
‘Glue ear’
- Hearing loss
- Mild intermittent pain
- Fullness
- Popping
Mx
1. Active observation for 3/12
- Pure tone audiometry
+/-Tympanometry - Hearing aids
- Myringotomy
- Grommets and adenoidectomy
Congenital hearing loss
- Causes
- Mx
Congenital hearing loss
- Causes:
AD/AR/X-Linked
Rubella/Toxins/Pre-eclampsia/Anoxia - BSL & SALT
Hearing aid/implant
Thyroid nodule symptoms (5)
- Neck lump or mass when swallowing
- Pain
- Dyspnoea
- Horseness
- Thyrotoxicosis
Thyroid lump investigations?
- Exam
- TFTs
- USS and Radiodine
- Biopsy
Management of a thyroid lump:
- Non-malignant
- Asymptomatic
- Symptomatic
- Asymptomatic
- Malignant
- Thyrotoxicosis
Management of a thyroid lump:
- Non-malignant
- Asymptomatic
Monitor TFTs
- Symptomatic
Surgical removal
- Asymptomatic
- Malignant
- Removal - Thyrotoxicosis
- Radioactive iodine
Nasal fracture redflags
- Septal haematoma
- Battle’s sign (blood behind ear)
or bloody otorrhoea- Petrous fracture
- Peri-orbital ecchymosis (Panda eyes)
or cerebrospinal rhinorrhoea- anterial cranial fossa injury
- Neurological deficit (incl. Low GCS)
- CT
Nasal fracture management
- Conservative
- Displacement
- Complicated fracture
- PRICE
- Pain relief
- Raise/rest
- Ice
- Displaced
- Closed reduction
- Splinting
- Complicated
- Open surgical reduction
Alergic rhinitis management
- Reduce allergen contact
2. OTC antihistamines
Vestibular neuritis S&S (4)
- Severe continuous vertigo
- Fall to affected side
- N+V
- Nystagmus
- Osciloplasia (obects appear to jump, jiggle, or vibrate)
Vestibular neuritis test?
Head impulse test
- Pt focus eyes on examiner
- Examiner turn pt’s head
- If positive test, eyes move with head, then return
- If negative test, eyes remain fixed while head turns
Vestibular neuritis management?
- Reassure - will settle over several weeks
- Buccal prochlorperazine (H2)
- Rapid vertigo relief
- Cyclizine (H2) IM
- Rapid vertigo relief
- Cyclizine PO
- N&V
Nasal polyps
- Ix
- DDs
Nasal polys
- Ix
- Endoscopy
- CT
- Biopsy - DDs
- Malignancy
- CF
Nasal polyps Mx
- Intra-nasal Steroids (fluticasone propionate 50mcg BD)
+ Nasal saline irrigation
( + Doxycycline 100mg OD 3-12/52 after 200mg 1/7) - Surgical polypectomy
+ Saline irrigatiion
+ Post op abx PO
What are distinguishing features of BPPV?
BPPV
- Only vertigo when moving
- Dix-Hallpike Manoeuvre (quick drop from 45° to -30°)
Management of BPPV?
BPPV
- Self limiting
1/3 resolve in 3 weeks
Majority resolve in 6 months - Epley manoeuvre
What are the symptoms of Vestibular Migraine?
- Migraine
Photophobia
Unilateral headache - Vestibular symptoms
Vertigo
Noise sensitivity
Vestibular Migraine Management
Vestibular migraine
- Lifestyle:
Regular patterns
Manage stress - Analgesia
Paracetamol
Ibuprofen
3. Triptans 5-Ht agonists Prevent CGRP [Caltcitonin gene-related peptide] ) Almotriptan 12.5mg Sumatriptan 50-100mg
- Antiemetics
Metoclopramide
Prochlorazapine
What is the indication for triptans and what is their mechanism?
- Triptans are 5-Ht agonists used in migraines
- They prevent CGRP [Caltcitonin gene-related peptide]
- Examples include:
Almotriptan 12.5mg
Sumatriptan 50-100mg
What antiemetics are used in migraines?
Metoclopramide
1 sachet at start
Next sachet at 2hrs
Maximum TDS)
Procholorperazine
PO 20mg initially
10 mg after 2 hours
IM 12.5mg
6hrs PO further dose
Labarynthitis S&S (4)
- Vertigo
Constant
Sudden
Severe - N&V
- Hearing loss &/or Tinitus
- Can follow URTI
Labarynthitis Ix
Labarynthitis
- Otoscopy
- Head impulse test
Turn head to side
Rapidly re-centre
Note eye-movements (lag?)
Labarynthitis Mx
Labarynthitis
- Reassure
- Days-weeks self-resolving
- Vertigo
Prochlorperazine
Anti-histamine
Cervical lymphadenopathy DDs and Mx
> 1cm - Get a Scan
- Viral Ifx
Reassure - Malignancy
Refer - Autoimmune + HIV
Refer
Septal Devation S&S
- Sleep apnoea
- Anosmia
- Infections
- Blocked nose/dry opposite nostril
- Pain
- Aesthetics
ENT Red Flags
- Unilateral nasal obstruction
Urgent referal - Trauma to nose
Look up nose same-day
?Septal haematoma - Unilteral hearing loss
?Stroke
?Neuritis
? Cerebellar schwannoma
Glossodynia DDx
Glossodynia differentials
- Infection
- Trauma
- Nerve damage
- Deficiency (B12, Iron, Zinc, Selenium)
Dry tympanic perforation
- Mx
Dry tympanic mx
- Self limiting (6-8/52)
- Keep dry
- Analgesia - Not healing or large
- Refer to otologist
- Myringoplasty/Tympanoplasty - If infected
- ABx
Acute sinusitis
- Mx
Acute sinusitis mx
- Supportive
- Rest and hydration
- Vitamin C ad Zinc - Analgesic/antipyretic
- Paracetamol/ibuprofen - Lavage
- Decongestant
- Oxymetazoline
- Pseudoephedrine - CST
- Mometasone - Ipratropium
Bacterial Sinusitis
- Mx
Bacterial Sinusitis
- ABx
- Co-Amox
- Clinda & Cefixime
- Doxy - ENT Referral
- Supportive
- Rest, fluids, lavage
- Analgesia/antipyrexial
- Decongestant, CST
Sinuses
- Four Sinuses
Sinuses
- Frontal
- Maxillary
- Ethmoidal
- Sphenoid
