Common ENT problems Flashcards
Purpose of the ear
Hearing and balance
Outer ear problems
Otitis externa Impacted wax Foreign bodies Trauma Tumours Cosmetic complaints
Middle ear problems
Glue ear Acute otitis media Perforated ear drums Retracted ear drums Cholesteatoma Trauma
Inner ear problems
Age related hearing loss
Noise induced hearing loss
Acoustic neuroma
Congenital hearing loss
Outer ear covers
Pinna to tympanic membrane
Middle ear covers
Tympanic membrane to oval window (where stapes goes in to inner ear)
Inner ear
Cochlea and vestibular system
Lobe, helix, tragus, antitragus, antihelix, contrabowl, ear canal
Pinna haematoma/ abscess
- cause
- symptoms
- treatment
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
Pure tone audiogram
To measure hearing
Lower down hearing gets worse
Anything below 20 is considered normal hearing
Conductive vs sensorineural hearing loss
Air conduction - e.g. though headphones
Bone conduction - played through bone
-suggests that inner ear isn’t working
Conductive vs sensorineural hearing loss
Air conduction - e.g. though headphones
-outer of middle ear problem
Bone conduction - played through bone
-suggests that inner ear isn’t working
Foreign body
Children usually
Be careful taking them out because one shot before pt might get frustrated
Swimmer’s ear
- cause
- symptoms
- treatment
Otitis externa Pseudomonas aerigonosa Can swell shut completely Symptoms: itchy, pus, tender Treatment: ear drops (antibiotic drops), can suck out gunk
Impacted wax
- symptoms
- cause
- treatment
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
Squamous cell carcinoma
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
Correction of protruding ears
Pinnaplasty
Score or suture cartilage back
Glue ear
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
Grommets
Tiny plastic tube sitting in air drum, stops hole closing up
Glue doesn’t come out
Infection can lead to pus coming out
Acute otitis media
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
Acute otitis media bacteriology
Strep. Pneumoniae (40%) Haemophilus influenzae (30%) Moraxella Catarrhalis (20%)
Chronic otitis media bacteriology
Gram –ve organisms
Staphylococci
Anaerobes eg. bacteroides fragilis
Mastoiditis
Urgent admission to hospital, will drain and give Abx
Abnormal acute otitis media eardrum and red inflamed mastoid bone
Complications of acute/ chronic ear infections: extracranial/ intratemporal
Mastoiditis Petrositis Labyrinthitis/Fistula Facial nerve paralysis Hearing loss
Complications of acute/ chronic ear infections: intracranial
*all very serious and require admission to hospital* Extradural/subdural/brain abscess Meningitis Sigmoid sinus thrombophlebitis Otic hydrocephalus
Complications of acute/ chronic ear infections: other
Otitis externa, pinna cellulitis and perchondritis
Traumatic perforation
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)
Cholesteatoma
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
Facial nerve palsy
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
Facial nerve palsy
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
Causes of vertigo
Benign paroxysmal positional vertigo
Labyrinthitis
Meniere’s syndrome/ disease
Occasionally stroke
Vertigo definition
Illusion of movement
-usually rotatory movement (room spinning)
Sudden sensorineural hearing loss
Suddenly gone deaf, can only hear ringing
Need urgent systemic dose of steroids (prednisolone)
Vestibular Schwannoma
- cause
- symptoms
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)
If inner ear stops working
Don’t have way of repairing balance
Inner ear regenerative medicine
The nose and sinuses - common problems
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
Function of the nose
Temperature regulator of air Moisture regulation Air filter Smell Immune defence Resonance
History: sinonasal symptoms
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
Nasal cavity anatomy
Septum, 3 sets of turbinates (see inferior turbinates if you looks up nose), adenoids
Sinuses anatomy
Ethmoid sinuses
Maxillary sinuses
Frontal sinuses
Sphenoid sinuses
Epistaxis
Little’s area most common
Pinching (pressure on little’s area) and tilt head forwards and sit quietly for 20 minutes with a tissue
Fractured nose
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
Saddle nose
Nose no longer supported
- characterized by a loss of height of the nose, because of the collapse of the bridge
Foreign body in nose
Removed by ENT specialists
Periorbital cellulitis
Resulting from sinus infections, especially ethmoid sinuses
Pus from sinuses have gone behind the eye
Refer to ENT ophthalmology
Nasal polyps
**
Treat medically, otherwise take them out
May open up the sinuses as well
If only on one side be more concerned - could be malignancy
Sinonasal tumours
Squamous cell carcinomas
Surgery to correct
Fairly rare
-can present as lump around nose or lump around eye
The pharynx: common problems
Tonsillitis and peritonsillar abscess Glandular fever -EBV Foreign bodies Ludwig’s angina Tumours causing upper airway obstruction
Tonsils grading
1-4
Tonsilitis
Exudate covering tonsils
-spots: bacterial
-covering: glandular fever
Swollen tonsils
Quinsy
Peritonsillar abscess
Big swollen area around tonsil
Dispaced uvula
Urgently send to ENT to be drained
Tonsil cancer
Unilateral abnormal large tonsil
Refer to ENT
Parapharyngeal infection
Further back than tonsil
Swollen
Refer urgently
Foreign bodies
E.g. swallowed a bone, dental bur
Ludwig’s angina
Infection tracked down to floor of mouth, swells up a lot
-careful of airway obstruction
-make sure airway is secured
Send to A&E
Tongue base cancer
Really bad pain - point exactly to it
-may radiate to ear
Endoscopy, look, feel
Confirm with MRI
The larynx: common problems
Epiglottitis and supraglottitis
Foreign bodies
Tumours causing upper airway obstruction
Epiglottitis
Big red and swollen
More common in children
Secure their airway
Expiratory stridor - A&E
Foreign body in trachea or bronchus
Pull it out
**
Presentation of laryngeal cancer
Hoarse voice Short of breath Stridor Pain Swallowing difficulty Neck lump Often smokers
The neck: common problems
Trauma Superficial infections Deep neck space infections Salivary gland swellings Thyroid swellings
The neck: superficial infections
Submandibular abscess
Ominous ENT symptoms
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
Ominous ulcerations
Non-healing ulcerations
Wait and watch for 2-3 weeks
Same physician
Proper biopsy
