Conditions Flashcards
What must be excluded in a nasal trauma?
- exclude septal haematoma
When should someone be reviewed in the ENT clinic post nasal fracture?
- 5-7 days
Complications of a nasal fracture?
- Epistaxis
- CSF leak
- Meningitis
- Anosmia
Treatment of a severe epistaxis?
- resusictate
- lignocaine + adrenaline
- remove clot
Systemic treatment for epistaxis?
- tranexamic acid
Treatment of a pinna haematoma?
- aspirate
- incision and drainage
Battle sign bruising may appear in what injury?
- temporal bone fracture
What is the most common classification of temporal bone fractures?
- longitudinal
What are causes of conductive hearing loss?
- fluid
- tympanic membrane perforation
- ossicular problem
Treatment of a sudden sensorineural hearing loss?
- steroids 1mg/kg
Zone 1 neck injury affects what area?
- trachea
- oesophagus
- thyroid
- thoracic duct
- subclavian
What can cause a deep neck space infection?
- extension of infection from tonsil or oropharynx into deeper tissue
Symptoms of a deep neck space infection?
- sore throat
- unwell
- previous URTI
- limited neck movement
Treatment of a deep neck space infection?
- Fluids
- IV antibiotics
- incision and drainage
Complication of a deep neck space infection?
- enters mediastinum
What sign will be seen on CT of sinuses during a facial trauma?
- tear drop sign
What is the most common LeFort fracture?
- Le Fort 1
What comprises Waldeyer’s ring?
- palatine tonsils
- adenoids
- inguinal tonsils
Histology of tonsil tissue?
- specialised squamous
Histology of adenoid tissue?
- ciliated pseudostratified columnar stratified squamous
- deep folds
Viral causes of acute tonsillitis?
- EBV
- Rhinovirus
- adenovirus
Bacterial causes of acute tonsillitis?
- s.pyogenes
- h. influenza
Bacterial symptoms of acute tonsillitis?
- systemic upset
- fever
- odynophagia
- lasts 1 week
Viral symptoms of acute tonsillitis?
- malaise
- sore throat
- 3-4days
High FEVERPAIN score treatment?
- penicillin 500mg 4 times daily for 10 days
When is tonsillectomy recommended?
- 7 or more infections a year
Peritonsillar abscess is also known as?
- quinsy
What causes a peritonsilar abscess?
- bacteria between muscle and tonsil and production of pus
Treatment of quinsy?
- aspiration and antibiotics
Glandular fever is also known as?
- infectious mononucleosis
What causes glandular fever?
- ebstein-barr virus
Signs of glandular fever?
- gross tonsillar enlargement
- cervical lymphadenopathy
Diagnosis of glandular fever?
- EBV IgM
- Low CRP
Management of glandular fever?
- antibitotics
- steroids
Signs of adenoid hyperplasia?
- mouth breathing
What is otitis media with effusion also known as?
- glue ear
What age group is most commonly affected by glue ear?
- children
What is glue ear?
- inflammation of the middle ear, fluid without the signs or symptoms of acute inflammation
Symptoms of glue ear?
- deafness
- speech delay
- behavioural changes
What would a tympanometry graph look in glue ear?
- flat
- bone conduction > air conduction
Treatment of glue ear?
- wait 3 months
- grommets
- adenoidectomy
- hearing aids
Glue ear is a __conductive/sensorineural__ hearing loss?
- conductive
Types of hearing loss?
- conductive
- sensorineural
- mixed
When would an adenoidectomy be considered in glue ear?
- having had 2 or 3 grommets
On audiometry the circles are what ear?
- right ear
On audiometer the crosses are what ear?
- left war
Otitis externa can present with __conductive/sensorineural__ hearing loss?
- conductive
Causes of otitis externa?
- water
- cotton buds
- skin conditions
Acute otitis media can present with __conductive/sensorineural__ hearing loss?
- conductive
Acute otitis media treatment?
- wait 3 or 4 days
- fail to resolve –> amoxicillin
Causes of chronic otitis media?
- cholesteatoma
- perforation
What is done prior to a grommet insertion?
- myringotomy
Treatment of perforation of the tympanic membrane?
- usually spontaneous recovery
Describe cholesteatoma?
- presence of keratin within the middle ear
- may erode surrounding bone
Cholesteatoma can present with __conductive/sensorineural__ hearing loss?
- conductive
Symptoms of cholesteatoma?
- conductive hearing loss
- discharge
Treatment of cholesteatoma?
- surgical excision
If cholesteatoma spreads superiorly it may cause?-
- brain abscess
- meningitis
Describe otosclerosis?
- genetic condition
- conductive hearing loss
- gradual fixation of the stapes foot plate
When is otosclerosis most prevalent?
- pregnancy
- HRT therapy
Treatment of otosclerosis?
- stapedectomy
Presbycusis an present with __conductive/sensorineural__ hearing loss?
- sensorineural
In presbycusis what frequency of soun is lost?
- high frequency
In presbycusis there is not a difference between bone and air conduction?
- true
Vestibular schwannoma can present with __conductive/sensorineural__ hearing loss?
- sensorineural hearing loss
What is vestibular schwannoma?
-Benign tumour arising in internal auditory meatus
Symptoms of vestibular schwannoma?
o Hearing loss (asymmetrical)
o Tinnitus
o Imbalance
Diagnosis of vestibular schwannoma?
- MRI
Symptom of vertigo?
-Sensation of movement, usually spinning, failing, being pushed
Verigo lasting seconds may indicate?
BPPV (Benign , paroxysmal positional vertigo)
Vertigo lasting hours may suggest?
- Meniere’s
Vertigo lasting days may suggest?
- vestibular neuritis
Semi-circular canals sense?
-Rotational acceleration
Saccule and utricle sense?
- linear acceleration
Head impulse test used to diagnose?
- vestibulo-ocular reflex
What causes bening paroxysmal positional vertigo?
-Otoconia from utricle are displaced into semicircular canals (typically the posterior)
Otoconia tends to fall into what semi-circular canal?
- posterior
When is Benign positional paroxysmal vertigo present?
- looking up
- rolling over in bed
What diagnoses BPPV?
- Dix Hallpike test
Treatment of BPPV?
- Epley manoeuvre
What is the name of the at home exercises a patient with BPPV can do?
- Brandt-daroff exercises
Vestibular neuronitis/labyrinthitis is vertigo lasting___
- days
Treatment of vestibular neuronitis
- Self-limiting
- Vestibular sedatives
- 3 days in bed, 3 weeks off work, off-balance for 3 months
Describe Meniere’s disease
- Endolymphatic hydrops
- Recurrent, spontaneous rotational vertigo
- 2 episodes >20mins
- New tinnitus
- Usually affects only one side
Hearing loss in Meniere’s disease?
- sensioneural
- affects low frequency hearing
Treatment of Meniere’s disease?
- Supportive during episodes
- Tinnitus therapy
- Hearing aids
- Salt restriction/ caffeine/alcohol stress
First line facial surgery healing technique?
-Healing by secondary intention
Low frequency hearing loss, fullness and tinnitus?
- Meniere’s disease
Vestibular schwannoma affects what nerve sheath?
- CN VIII
- Vestibulocochlear
Treatment of migraines?
- Lifestyle modification
- Triptans
- Propranolol or amitriptyline as prophylaxis
What drugs can be used in the prevention of migranes?
- propanolol or amitriptyling
Explain a type I hypersensitivity reaction?
- protein allergen in sensitied patient
- IgE on mast cell
- release of histamine and leukotrienes
Treatment of a stuffy nose?
- topical corticosteroids
- anti–histamine
- decongestant
- anti-cholinergic
- LTR blocker
Name an anti-cholinergic drug and its affect on the nose?
- ipratropium
- reduces nasal mucus
Symptoms of a blocked nose?
- blockages
- loss of smell
- discharge
- facial pain
What are the 2 broad causes of rhinitis?
- infective
- non-infective
What is the most common infective cause of rhinitis?
- viral
Non-infective causes of rhinitis?
- allergic
- non-allergic
What are intermittent causes of allergic rhinitis?
- grass pollen
- tree pollen
- fungal spores
What defines persistent allergic rhinitis?
- symptoms > 4 days per week
Treatment of allergic rhinitis?
- allergen avoidance
- nasal steroids
- antihistamines
- immunotherapy
What examinations may be conducted for allergic rhinitis?
- IgE bloods
- skin prick test
Treatment of nasal polyps?
- oral then topic steroids
- surgery
What is vasomotor rhinitis?
- drippy nose
- over 50s
- parasympathetic overdrive
Treatment of vasomotor rhinitis?
- ipratropium
Treatment of infective rhinitis?
- analgesics
- persistance > 10days –> antibiotics
Complications of sinusitis?
- orbital cellulitis
- meningitis
Complication of nasal trauma?
- septal haematoma
Causes of nasal blockage, non-infective?
- adenoid hypertrophy
- foreign body
- tumour
Causes of airway obstruction?
- inflammation
- foreign bodies
- trauma
- neoplastic
Why are children more prone to airway obstruction?
- large heads
- small nares
- neonates are nasal breathers
- narrow subglottis
Define stridor?
- high pitch harsh inspiratory noise
Define stertor?
- low pitch
- snoring sound
Causes of obstructive sleep apnoea in children?
- adenoid hypertrophy
- enlarged tonsils
Causes of epiglottitis?
- Influenza bacteria
Management of airway obstruction?
- resuscitation
- oxygen
- heliox
- steroid
- adrenaline
What is the most common cell type in head and neck cancer?
- squamous cell carcinoma
Most common site of head and neck cancer?
- larynx
Risk factors for head and neck cancer
- tobacco
- alcohol
- viruses (HPV and EBV)
Commonest head and neck cancer in south china?
- nasopharyngeal
- link to EBV
Symptoms of nasopharyngeal cancer due to EBV?
- Hearing changes due to glue ear
- lump in neck
Symptoms of head and neck cancer?
- dysphonia
- dysphagia
- odynophagia
Supra-glottic tumour may spread where?
- superior deep cervical nodes
Glottic tumours spread where?
- 95% stay on vocal cords
- minimum lymphatic drainage
Sub-glottic tumours spread where?
- paratracheal nodes
Diagnosis of head and neck tumours?
- USS/ FNA
- CT
- MRI
- PET
Treatment of early laryngeal cancer?
- transoral laser surgery
- radiotherapy
Treatment of late and advanced laryngeal cancers?
- partial or total laryngectomy
- chemo and radiotherapy
Malignant salivary gland pathology is associated with what size of gland?
- smaller glands = more chance of malignancy
Most common arterial branch to bleed in epistaxis?
- sphenopalatine
- branch of the external carotid
