9: ENT B Flashcards
what is littles area
4 different arteries anastomose to form kesselbacks plexus
suppled blood to the anterior inferior septum
most common site of epitasis
what are the function of conchae
increase surface area and create more turbulence for warm humidification and warming
what is the function of the nose
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
where do posterior nose bleeds tend to occur from
posterior ethmoid arteries
how do you examine the nose
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
what are the three sensory inputs to the balance system
vestibular
visual
somatosensory
what is the definition of vertigo
sensation that the room is spinning and the affect this has on their balance
symptom not diagnosis
what is nystagmus
rhythmic, repetitive, involuntary movements of the eye
what are the slow and fast phase of nystagmus
slow phase - causes eye to drift in certain direction
fast phase - brings eye back to central position
what is acoustic neuroma
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
what is the management of acoustic neuroma
start high dose steroids and urgent referral to ENT
gadolinium enhanced T1 weighted MRI is gold standard
what are red flags for nasal fracture
uncontrolled epistaxis
CSF rhinorrhoea
signs of head injury
severe headache
visual disturbance
how are nasal fractures managed
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
what is acute sinusitis
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
how is acute sinusitis managed
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
how is chronic sinusitis managed
control of underlying disease
smoking cessation
avoiding triggers
oral hygiene
conidere urgent referal if they have unilateral symptoms persisting 3 months despite treatment
what is acute labyrinthitis
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
what is vestibular neuronitis
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
what is allergic rhinitis
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
how to manage allergic rhinitis
look for FHx of atopy
IgE test
percutaneous skin tests
main treatment is avoiding triggers
can also use antihistamines and saline rinse outs
what are nasal polyps
fleshy, benign, outpouchings of nasal mucosa
typically billateral, and in over 40s
presents with blocked nose, mouth breathing, watery discharge, post nasal drip
how are nasal polyps managed
nasal drops/ saline wash
if large and unresponsive then prednisolone
if no improvement in 10 weeks then surgical removal
what is a deviated nasal septum
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
what is a vestibular migrane
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
