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ENT + Opthalmology > Common ENT problems > Flashcards

Common ENT problems Flashcards

1
Q

Purpose of the ear

A

Hearing and balance

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2
Q

Outer ear problems

A 
Otitis externa
Impacted wax
Foreign bodies
Trauma
Tumours
Cosmetic complaints
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3
Q

Middle ear problems

A 
Glue ear
Acute otitis media
Perforated ear drums
Retracted ear drums
Cholesteatoma
Trauma
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4
Q

Inner ear problems

A

Age related hearing loss
Noise induced hearing loss
Acoustic neuroma
Congenital hearing loss

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5
Q

Outer ear covers

A

Pinna to tympanic membrane

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6
Q

Middle ear covers

A

Tympanic membrane to oval window (where stapes goes in to inner ear)

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7
Q

Inner ear

A

Cochlea and vestibular system

Lobe, helix, tragus, antitragus, antihelix, contrabowl, ear canal

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8
Q

Pinna haematoma/ abscess

  • cause
  • symptoms
  • treatment
A

Blow to the ear, blood has collected between skin and lining of cartilage
Lifts skin and pericondrium
Can get infected, area is devascularised –> can lead to cauliflower ear
Treatment: treat as medical emergency, needs draining promptly

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9
Q

Pure tone audiogram

A

To measure hearing
Lower down hearing gets worse
Anything below 20 is considered normal hearing

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10
Q

Conductive vs sensorineural hearing loss

A

Air conduction - e.g. though headphones
Bone conduction - played through bone
-suggests that inner ear isn’t working

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11
Q

Conductive vs sensorineural hearing loss

A

Air conduction - e.g. though headphones
-outer of middle ear problem
Bone conduction - played through bone
-suggests that inner ear isn’t working

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12
Q

Foreign body

A

Children usually

Be careful taking them out because one shot before pt might get frustrated

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13
Q

Swimmer’s ear

  • cause
  • symptoms
  • treatment
A 
Otitis externa
Pseudomonas aerigonosa
Can swell shut completely
Symptoms: itchy, pus, tender
Treatment: ear drops (antibiotic drops), can suck out gunk
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14
Q

Impacted wax

  • symptoms
  • cause
  • treatment
A

Pushed up against ear drum
Causes some hearing loss
Caused by cotton buds or swimming
Suck it out by microsuction, soften it with olive oil or sodium bicarbonate drops

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15
Q

Squamous cell carcinoma

A

Wedge excision
Good aesthetic result, looks like you have a slightly smaller ear on one side
Look for knobbly bits or scabby areas, especially on helix

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16
Q

Correction of protruding ears

A

Pinnaplasty

Score or suture cartilage back

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17
Q

Glue ear

A

Otitis media with effusion
Middle ear fluid (behind eardrum)
Common in children
Hearing loss
Treatment: conservative, grommets, hearing aids
Left untreated, may interfere with speech development

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18
Q

Grommets

A

Tiny plastic tube sitting in air drum, stops hole closing up
Glue doesn’t come out
Infection can lead to pus coming out

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19
Q

Acute otitis media

A

Infection of middle ear
Build up of pus and fluid, pressure builds up and after 48/72hrs eardrum perforates, blood and pus come out
Gets better quite quickly afterward

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20
Q

Acute otitis media bacteriology

A 
Strep. Pneumoniae (40%)
Haemophilus influenzae (30%)
Moraxella Catarrhalis (20%)
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21
Q

Chronic otitis media bacteriology

A

Gram –ve organisms
Staphylococci
Anaerobes eg. bacteroides fragilis

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22
Q

Mastoiditis

A

Urgent admission to hospital, will drain and give Abx

Abnormal acute otitis media eardrum and red inflamed mastoid bone

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23
Q

Complications of acute/ chronic ear infections: extracranial/ intratemporal

A 
Mastoiditis
Petrositis
Labyrinthitis/Fistula
Facial nerve paralysis
Hearing loss
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24
Q

Complications of acute/ chronic ear infections: intracranial

A 
*all very serious and require admission to hospital*
Extradural/subdural/brain abscess
Meningitis
Sigmoid sinus thrombophlebitis
Otic hydrocephalus
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25
Q

Complications of acute/ chronic ear infections: other

A

Otitis externa, pinna cellulitis and perchondritis

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26
Q

Traumatic perforation

A

Due to infections (usually heals quite quickly), overenthusiastic cotton blood cleaning, trauma, post surgery
Normally don’t have to treat them
Can cause recurrent infections (don’t let any water near their ear)

27
Q

Cholesteatoma

A

Ball of skin invades ear drum, goes through middle ear, destroys balance systems, can destroy facial nerve and cause brain abscess and meningitis
History: persistent discharging ear (months or years)
Refer to ENT

28
Q

Facial nerve palsy

A

Unable to close eye on that side
Bell’s palsy (idiopathic, cause may be viral infection)
Cholesteoma, parotid gland tumour (check tonsil and parotid gland), other causes

29
Q

Facial nerve palsy

A

Unable to close eye on that side
Bell’s palsy (idiopathic, cause may be viral infection)
Cholesteoma, parotid gland tumour (check tonsil and parotid gland), other causes

30
Q

Causes of vertigo

A

Benign paroxysmal positional vertigo
Labyrinthitis
Meniere’s syndrome/ disease
Occasionally stroke

31
Q

Vertigo definition

A

Illusion of movement

-usually rotatory movement (room spinning)

32
Q

Sudden sensorineural hearing loss

A

Suddenly gone deaf, can only hear ringing

Need urgent systemic dose of steroids (prednisolone)

33
Q

Vestibular Schwannoma

  • cause
  • symptoms
A

Also called acoustic neuroma
Benign tumours that mainly happen on vestibular part of 8th cranial nerve which slowly expands
Ringing in that ear (unilateral tinnitus)

34
Q

If inner ear stops working

A

Don’t have way of repairing balance

Inner ear regenerative medicine

35
Q

The nose and sinuses - common problems

A 
Epistaxis
Foreign body
Nasal fractures
Septal haematoma
Septal deviation
Acute sinusitis
Rhinitis 
-Acute/Chronic
Chronic Rhinosinusitis
Nasal polyps
Cosmetic and functional nasal surgery
Sinonasal tumours
CSF leak
36
Q

Function of the nose

A 
Temperature regulator of air
Moisture regulation
Air filter
Smell
Immune defence
Resonance
37
Q

History: sinonasal symptoms

A 
Blockage/congestion               
Sense of smell/taste
Sneezing
Rhinorrhoea/post nasal drip
Nasal/ocular/palatal pruritis
Facial/sinus pain(infection) acute/recurrent/chronic
Snoring
?Bleeding – less common and maybe due to tumour
38
Q

Nasal cavity anatomy

A

Septum, 3 sets of turbinates (see inferior turbinates if you looks up nose), adenoids

39
Q

Sinuses anatomy

A

Ethmoid sinuses
Maxillary sinuses
Frontal sinuses
Sphenoid sinuses

40
Q

Epistaxis

A

Little’s area most common

Pinching (pressure on little’s area) and tilt head forwards and sit quietly for 20 minutes with a tissue

41
Q

Fractured nose

A

Standard practice: see them 7 days after when swelling has gone down
If significantly deviated, use LA or ?GA? and straigten
Can cause septal heamatoma
-blood collected between skin and cartilage
-devascularise the cartilage
-can cause septal perforation because it is devascularised
Can cause infection
Check for orbital/ maxillary/ skull fractures

42
Q

Saddle nose

A

Nose no longer supported

- characterized by a loss of height of the nose, because of the collapse of the bridge

43
Q

Foreign body in nose

A

Removed by ENT specialists

44
Q

Periorbital cellulitis

A

Resulting from sinus infections, especially ethmoid sinuses
Pus from sinuses have gone behind the eye
Refer to ENT ophthalmology

45
Q

Nasal polyps

A

**
Treat medically, otherwise take them out
May open up the sinuses as well
If only on one side be more concerned - could be malignancy

46
Q

Sinonasal tumours

A

Squamous cell carcinomas
Surgery to correct
Fairly rare
-can present as lump around nose or lump around eye

47
Q

The pharynx: common problems

A 
Tonsillitis and peritonsillar abscess
Glandular fever
-EBV
Foreign bodies
Ludwig’s angina
Tumours causing upper airway obstruction
48
Q

Tonsils grading

A

1-4

49
Q

Tonsilitis

A

Exudate covering tonsils
-spots: bacterial
-covering: glandular fever
Swollen tonsils

50
Q

Quinsy

A

Peritonsillar abscess
Big swollen area around tonsil
Dispaced uvula
Urgently send to ENT to be drained

51
Q

Tonsil cancer

A

Unilateral abnormal large tonsil

Refer to ENT

52
Q

Parapharyngeal infection

A

Further back than tonsil
Swollen
Refer urgently

53
Q

Foreign bodies

A

E.g. swallowed a bone, dental bur

54
Q

Ludwig’s angina

A

Infection tracked down to floor of mouth, swells up a lot
-careful of airway obstruction
-make sure airway is secured
Send to A&E

55
Q

Tongue base cancer

A

Really bad pain - point exactly to it
-may radiate to ear
Endoscopy, look, feel
Confirm with MRI

56
Q

The larynx: common problems

A

Epiglottitis and supraglottitis
Foreign bodies
Tumours causing upper airway obstruction

57
Q

Epiglottitis

A

Big red and swollen
More common in children
Secure their airway
Expiratory stridor - A&E

58
Q

Foreign body in trachea or bronchus

A

Pull it out

**

59
Q

Presentation of laryngeal cancer

A 
Hoarse voice
Short of breath
Stridor
Pain
Swallowing difficulty
Neck lump
Often smokers
60
Q

The neck: common problems

A 
Trauma
Superficial infections
Deep neck space infections
Salivary gland swellings
Thyroid swellings
61
Q

The neck: superficial infections

A

Submandibular abscess

62
Q

Ominous ENT symptoms

A 
Ulceration
Pain
Swallowing difficulties 
Weight loss
Unilateral secretion from nose
Glue ear in an adult
Bleeding
Hoarseness more than three weeks 
Neurological symptoms
Lump in neck
63
Q

Ominous ulcerations

A

Non-healing ulcerations
Wait and watch for 2-3 weeks
Same physician
Proper biopsy

ENT + Opthalmology (4 decks)

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