Approach To ENT Complaint Flashcards
When do the frontal sinuses develop?
8-10 years of age
What can cause cobblestoning?
Inflammation or infection
Possibly allergies as well
What is allergic rhinitis?
Inflammation in the nose caused by an allergen characterized by sneezing, rhinorrhea (nasal discharge), and nasal obstruction
What is anterior epistaxis (nosebleeds)?
Most common nose bleed usually affects the vascular watershed area of the nasal septum (Kiesselbach’s plexus)
What is posterior epistaxis?
Less common
Usually this causes a more significant bleeding and affects the posterolateral branches of the sphenopalatine artery
What is tonsillitis?
Inflammation of the tonsils usually due to a specific bacterial or virus
What is infectious mononucleosis?
Illness caused by a virus called Epstein Barr virus and causes triad of fever, tonsillar pharyngitis (sore throat) and lymphadenopathy (enlarged LNs)
What is pharyngitis?
Inflammation of the pharynx with resulting sore throat
What are the most likely infectious causes for pharyngitis?
Viral and bacterial
What are common sx for viral pharyngitis?
Coryza (inflamed mucous membrane), conjunctivitis, malaise or fatigue, hoarseness, and low grade fever suggest the presence of viral pharyngitis
What causes streptococcal pharyngitis (strep throat)?
Group A beta hemolytic streptococcus
What are some sx of strep throat?
Sore throat, HA, fatigue, fever, body aches, nausea
Highest likelihood of group A beta hemolytic streptococcus (GABHS) if what?
Children 5-15, winter and early spring seasons, absence of cough, tender anterior cervical lymphadenopathy, tonsillar exudate, fever
What are labs to consider performing for pharyngitis?
Rapid Ag test or rapid strep Ag test (detects presence of strep)
Throat culture (throat swab)
Mono spot test (test for mononucleosis)
What are middle ear infections?
Acute otitis media (AOM)
Otitis media with effusion
What is otitis externa?
Outer ear infection
What is labyrinthitis?
Inner ear infection
What is acute OM?
Symptomatic inflammation of the middle ear that can be caused by bacteria or viruses
What is acute suppurative OM?
Acute OM with purulent material in the middle ear
What is OM with effusion (serous OM)?
Inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection
This may occur bc the fluid buildup persists after an ear infection has resolved
May also occur bc of SD or noninfectious blockage of the Eustachian tubes
What is chronic OM with effusion?
Occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection
Makes children susceptible to new ear infections and may affect hearing
What is chronic suppurative otitis media?
A persistent ear infection that often results in tearing or perforating of the eardrum
What will the ear look like with acute OM?
Often appears the TM is building
Erythematous
TM has reduced mobility when pneumatic otoscope is used
What will the ear look like with otitis media with effusion?
Fluid behind ear drum
Often follows AOM
Can last 3 months (if persists called chronic OM with effusion)
Can affect hearing esp if its chronic
Describe otitis externa
Can be caused by bacteria entering a small break in skin of canal
Pts may report drainage from ear
Usually associated with pain upon touching the external ear structures
What is otosclerosis?
Abnormal bone growth around stapes bone
Associated with progressive hearing loss beginning at ages 10-30
Marked hearing loss occurring during middle age
Affects more females than males
What are the two types of otosclerosis?
Conductive and sensory loss
What is conductive loss?
Ossicle sclerosis into a single immovable mass
What is sensory loss?
Otic capsule sclerosis
What is an abnormal Weber test?
If sound lateralizes to one ear it is either conduction loss in that ear or sensorineural loss in the opposite ear
What are some causes for conductive hearing loss?
Cerumen impaction, middle ear fluid, lack of movement of the ossicles, trauma, other causes of obstruction such as tumors
What are causes for sensorineural hearing loss?
Hereditary, Meniere disease, MS, trauma, ototoxic drugs, barotrauma, etc
What is rhinosinusitis/sinusitis?
Mucosal lining in the paranasal sinuses and nasal cavity becomes inflamed
Bacterial and viral causes
What are other causes for rhinosinusitis/sinusitis?
Dental infections and procedure, iatrogenic causes (sinus surgery, nasogastric tubes, etc), immunodeficiency, impaired ciliary motility, mechanical obstruction
What are signs and sx for rhinosinusitis/sinusitis?
Nasal discharge, sneezing, cough, nasal congestion, fever, Ha, pain and facial pressure
What is bacterial sinusitis?
Suspicion of acute bacterial sinusitis Double sickening (initially get slightly better than gets worse), purulent rhinorrhea, elevated ESR
When is acute bacterial rhinosinusitis indicated?
When signs or sx of acute rhinosinusitis persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory sx
What is croup (laryngotracheitis)?
Swelling of the larynx, trachea, bronchi causing inspiratory stridor and barking cough in children 6 mo to 3 years old
Causes: parainfluenza virus, influenza, respiratory syncytial virus
Hx: barking cough
Presentation: fever, nasal flaring, respiratory retractions, stridor
Can perform XR
What is epiglottitis?
Inflammation of the epiglottis and adjacent structures
Causes: haemophilus type B influenza, group A beta hemolytic streptococcus
Hx: rapid onset of sx, sore throat, muffled voice, drooling
Presentation: high grade fever, toxic appearance, child sitting or leaning forward
Consider lateral neck XR, elevated WBC
What is the most common cause of Eustachian tube dysfunction?
When the tube gets inflamed and mucus or fluid builds up
Causes include: flu, sinus infection, or allergies
Can cause vertigo
What is BBPV?
One of the MC causes of vertigo
Sudden sensation that youre spinning or that the inside of your head is spinning
Causes brief episodes of mild to intense dizziness
Triggered by specific changes in the position of your head
What is vestibular neuritis (inflammation of the nerve)?
Affects the branch associated with balance, resulting in dizziness or vertigo but no change in hearing
What is labyrinthitis?
Occurs when an infection affects both branches of the vestibulocochlear nerve resulting in hearing changes as well as dizziness or vertigo
Describe Meniere’s disease
Disorder of the inner ear that causes episodes in which you feel as if youre spinning (vertigo) and you have fluctuating hearing loss with a progressive permanent hearing loss, ringing of the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear
Affects one ear
Usually starts between ages 20-50
Which techniques can be used to diagnose BPPV?
Dix-Hallpike maneuver and Epley maneuver
