9: ENT B

Question 1

what is littles area

Answer 1

4 different arteries anastomose to form kesselbacks plexus
suppled blood to the anterior inferior septum
most common site of epitasis

Question 2

what are the function of conchae

Answer 2

increase surface area and create more turbulence for warm humidification and warming

Question 3

what is the function of the nose

Answer 3

warms up the air to prevent irritation of the throat/lungs
cribriform plate contains fibres of CN1
contains hairs to prevent debris entering the nose
helpful in phonation

Question 4

where do posterior nose bleeds tend to occur from

Answer 4

posterior ethmoid arteries

Question 5

how do you examine the nose

Answer 5

external nose - lesions, deformities, deviation
palpate the nasal bone and cartilage
assess air flow through each septum
use of otoscope and nasal speculum to visualise the internal nasal passage

Question 6

what are the three sensory inputs to the balance system

Answer 6

vestibular
visual
somatosensory

Question 7

what is the definition of vertigo

Answer 7

sensation that the room is spinning and the affect this has on their balance
symptom not diagnosis

Question 8

what is nystagmus

Answer 8

rhythmic, repetitive, involuntary movements of the eye

Question 9

what are the slow and fast phase of nystagmus

Answer 9

slow phase - causes eye to drift in certain direction
fast phase - brings eye back to central position

Question 10

what is acoustic neuroma

Answer 10

malignancy which arises from the Schwann cells of the inner ear
gradual/sudden onset unilateral sensorineural hearing loss
can also have persistent headaches, visual disturbances, changes to voice, dysphagia, or fascial nerve involvement

Question 11

what is the management of acoustic neuroma

Answer 11

start high dose steroids and urgent referral to ENT
gadolinium enhanced T1 weighted MRI is gold standard

Question 12

what are red flags for nasal fracture

Answer 12

uncontrolled epistaxis
CSF rhinorrhoea
signs of head injury
severe headache
visual disturbance

Question 13

how are nasal fractures managed

Answer 13

XR, CT if soft tissue or cranial injury suspected
if simple then it can be splinted and should heal in around 3 weeks. avoid sports during this time
if displaced will require correction
if correction isnt done within 2 weeks then it will have to be left for a couple months under general anaesthetic

Question 14

what is acute sinusitis

Answer 14

symptomatic inflammation of the paranasal sinuses lasting less than 12 weeks
often caused by viral URTI
fascial pain/pressure, pyrexia, and reduced sense of smell
children more likely to have coughing and coloured nasal discharge

Question 15

how is acute sinusitis managed

Answer 15

most resolve within 2-3 weeks
if they have more prolonged symptoms then consider high dose nasal steriods
considered bacterial sinusitis if severe local pain, pyrexia and marked deterioration after milder form of the pathology

Question 16

how is chronic sinusitis managed

Answer 16

control of underlying disease
smoking cessation
avoiding triggers
oral hygiene
conidere urgent referal if they have unilateral symptoms persisting 3 months despite treatment

Question 17

what is acute labyrinthitis

Answer 17

inner eat infection causing inflammation of the labyrinth
Hx of URTI
sensorineural hearing loss, tinnitus, N&V, vertigo
should resolve within 3 weeks
can give sedative, advise to avoid alcohol, and encourage sleep
if >6wks refer to ENT

Question 18

what is vestibular neuronitis

Answer 18

inflammation of the vestibular nerve
Hx of URTI
vestibular symptoms only - vertigo, N&V
should resolve within 3 weeks
can give labrynthine sedatives
if >6 wks refer to ENT

Question 19

what is allergic rhinitis

Answer 19

inflammation of the nasal mucosal lining
can be caused by acute infective rhinitis or allergic rhinitis
presents with congestion, rhinorrhoea, sneezing, post nasal drip, urticaria, itching, watery eyes

Question 20

how to manage allergic rhinitis

Answer 20

look for FHx of atopy
IgE test
percutaneous skin tests
main treatment is avoiding triggers
can also use antihistamines and saline rinse outs

Question 21

what are nasal polyps

Answer 21

fleshy, benign, outpouchings of nasal mucosa
typically billateral, and in over 40s
presents with blocked nose, mouth breathing, watery discharge, post nasal drip

Question 22

how are nasal polyps managed

Answer 22

nasal drops/ saline wash
if large and unresponsive then prednisolone
if no improvement in 10 weeks then surgical removal

Question 23

what is a deviated nasal septum

Answer 23

septum is displaced towards one side
congenital or trauma
presents with dry mouth/mouth breathing, congestion/pressure, snoring. can have recurrent sinusitis or otitis media
some reliefe from steriods or antihistamines
may require surgical resection

Question 24

what is a vestibular migrane

Answer 24

transient onset of vestibular symptoms
may have migraine
more common in women, worse near menstruation
track and void triggers
may need anti-sickness or talking therapies to cope
in severe cases then BBs or CCBs can be considered