Disorders Of ENT

Question 1

The human ear:

Answer 1

The ear is split into 3 parts: external, middle and inner ear

Question 2

The inner ear:

Answer 2

The inner ear is located inside the skull- complex. The soft tissue in inner ear is made out of different types of cells and nerves. Which is all arranged in a pattern on a thin sheet of tissue. Large tubes filled with fluid surround the soft tissue of the inner ear
The inner ear also controls balance and hearing loss occurs when the inner ear is damaged

Question 3

Ear disorders:

Answer 3

Ear infections- most common in infants and young children

Tinnitus- roaring in ears, result from loud noises, medicines e.t.c.

Ménière’s disease- results of fluid problems in inner ear, symptoms include tinnitus and dizziness

Tumours

Some can result in hearing disorders and deafness

Question 4

Earwax: **

Answer 4

Earwax is a self cleaning agent- protective, lubricating and antibacterial properties- absence of this results in dry itchy ears

Ear canals mostly self cleaning

Question 5

When should ears be cleaned?

Answer 5

Under ideal circumstances, ear canals should never be cleaned.
Should be cleaned when enough ear wax gathers up to cause symptoms to avoid assessment by doctors: known as cerulean impaction
This condition causes these symptoms:
-earache
-partial hearing loss (progressive)
-tinnitus (ringing noises0
-itching, odour or discharge
-coughing

Question 6

Ear discharge:

Answer 6

Earwax, or cerumen, is the most common substance that drains from the ear canal. However, blood, pus or clear fluid may also drain from the ear canal.
Sign of infection or inflammation

Question 7

What is Ménière’s disease?

Answer 7

It’s caused by an increase in volume and pressure of the endolymph of the inner ear:
-Severe dizziness
-Tinnitus, noise, roaring, hissing or ringing in the ear
-Hearing loss that comes and goes and the feeling of ear pressure or pain.
-It usually affects just one ear.
It is a common cause of hearing loss.
-Don’t know the cause. Might be to do with the fluid levels or the mixing of fluids in the canals of the inner ear.
Symptoms occur suddenly and can happen as often as every day or as seldom as once a year.
An attack can be a combination of severe dizziness or vertigo, tinnitus and hearing loss lasting several hours.
No cure, may be able to control symptoms by changing your diet or taking medicine so that your body retains less fluid.
Severe cases may require surgery.

Question 8

Treatment of Ménière’s disease:

Answer 8

To lower the pressure within the inner ear include
-antihistamines
-anticholinergics
-steroids
-diuretics
Devices such as the Meniett, a safe method for reducing vertigo frequency for a majority of users.
The anti-herpes virus drug Acyclovir. Morphological changes to the inner ear of Ménière’s sufferers have also been found in which it was considered likely to have resulted from attack by a herpes simplex virus.

Surgery might be recommended - destruction of the balance part , Gentamycin injected into the middle ear which kills vestibular apparatus
Can also cut the nerve to balance portion of inner ear in a vestibular neurectomy, or the inner ear itself can be surgically removed

Question 9

Tinnitus symptoms:

Answer 9

Has many different causes but mainly results from ontologic disorders, same conditions that cause hearing loss
Most common cause is noise-induced hearing loss resulting from exposure to excessive or loud noises

Question 10

Causes of tinnitus:

Answer 10

But tinnitus, along with sudden onset hearing loss, may have no obvious external cause.

Ototoxic drugs can cause tinnitus, drugs which damage cochlea:

Aspirine
Nicotine
Chemotherapeutic agents
Some loop diuretics such as furosemide

Tinnitus may also be a symptom of other health problems, such as allergies, high or low blood pressure, tumours and problems in the heart, blood vessels, jaw and neck

Question 11

Treatments of tinnitus:

Answer 11

Finding the underlying problem.
Hearing aids, sound-masking devices
Lidocaine, benzodiazepines etc…
Surgery
Electrical stimulation

Question 12

Nose conditions:

Answer 12

Common cold, hay fever, nasal cancer, nose disorders, sinusitis

Question 13

Nose allergies:

Answer 13

Also called: Hypersensitivity
An allergy is a reaction of your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are
Pollen
Dust mites
Mold spores
Pet
food
Insect stings
Medicines

Question 14

Treatment of nose allergies:

Answer 14

Antihistamines acting on H1 receptors
Asthma and allergic reactions:

1. Antihistamines: for allergic rhinitis (“hay fever”) and other conditions such as hives.

Question 15

What are anti histamines?

Answer 15

“First generation, sedating:” these are known to cause drowsiness in some people

“Second generation, low-sedating or non-sedating:” these have much less chance of causing drowsiness

Question 16

Potential antihistamine side effects:

Answer 16

Dry mouth
Difficulty in urination (especially in men with prostate problems)
Constipation
Drowsiness
In some children: nightmares, unusual jumpiness, restlessness, irritability
These symptoms are much less common with the “second generation” antihistamines.

Question 17

What are decongestants?

Answer 17

They reduce nasal congestion and other symptoms to do with allergies
Work by constricting blood vessels, thereby decreasing the amount of fluid that leaks out into the lining of the nose which can cause congestion.
Available in liquid form, nasal spray and tablets.
Most of these are available over-the-counter as well as by prescription.
Very often antihistamines and decongestants are combined so that they may control more symptoms.

Question 18

Potential side effects of decongestants:

Answer 18

Nervousness
Lack of sleep
Increased blood pressure or heart rate
Rebound rhinitis- can occur with decongestant nasal spray if used more than 3-4 days in a row, leads to nasal congestion being more severe leads to becoming dependant on the medication
-swelling and mucous production in the lining of the nose and airways; caused by inflammation

Question 19

What are the different classes of medications that are used to treat allergies and asthma? (Prevents/reduces inflammation)

Answer 19

-mast cell stablizers
-corticosteroids
-anti-leukotrienes
-beta-agonist bronchodilators
-anti-cholinergic agents
-anti-IgE antibody

Question 20

What are mast cell stabilizers?

Answer 20

-non steroidal medications = help control inflammation by preventing the release of inflammatory chemicals
-include cromolyn and nedocromil and are available in various forms to treat allergic diseases; like rhinitis and asthma

Question 21

What are Corticosteroids?

Answer 21

-very different from the anabolic steroids that are misused by some athletes
-available in topical cream or ointments, nasal sprays, inhalers, pills and by injection

Question 22

What are oral corticosteroids?

Answer 22

-used to control severe asthma not stabilised by other medications
*short-term meds for asthma flare-ups, marked nasal congestion and at times for skin conditions
^side effects for short term use= weight gain, increased appetite, menstrual irregularities, muscle cramps, heartburn etc. *side effects do go once corticosteroids have stopped being taken
*long-term use side effects; ulcers, weight gain, cataracts, decreased density of the bones, thinner skin, easier bruising, high blood pressure etc.

Question 23

Inhaled corticosteroids;

Answer 23

-considered the most effective medications for long-term control of persistent asthma
-provide good control of asthma with minimal effect on the rest of the body at usual doses
*minor side effects= hoarseness and thrush (fungal infection of the mouth and throat)
*long term use in children= could potentially result in transiently reduced growth velocity- tends to be minimal

Question 24

Anti-leukotrienes:

Answer 24

-responsible for increasing inflammation= causing contraction of the airway muscle + swelling of the lining of the airways
-drugs primarily used to help gain control in patients with mild persistent asthma and in combo with inhaled corticosteroids in more moderate to severe disease
-also approved to treat allergic rhinitis

Question 25

Beta-agonist bronchodilators:

Answer 25

-relaxes the smooth muscle surrounding the bronchial tubes
-side effects; nervousness, increased heart rate, restlessness, insomnia and rare headaches

Question 26

Theophylline?

Answer 26

Been used for over 30 years to treat asthma; also known as dimethylxanthine- methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma
-available as tablets, capsules or intravenously
-blood levels should be monitored
-side effects; headaches, elevated heart rate, stomach issues

Question 27

Mechanism of action; theophylline

Answer 27

-theophylline is a competitive non selective phosphodiastrase inhibitor which;
*raises intracellular cAMP
*activates PKA
*inhibits TNF-alpha and inhibits leukotriene synthesis and reduces inflammation

Question 28

Non-selective adenosin receptor antagonist:

Answer 28

-antagonizing A1,A2 and A3 receptors= explains many of its cardiac and anti-asthmatic effects

Question 29

Anti-cholinergic agents-

Answer 29

-available in inhaled form
-can be used alone or combined with beta-agonist bronchodilators
-ipratropium= may be used for asthma treatment, official use= COPD
-cough and headache can be side effects

Question 30

Information about Anti-IgE antibody:

Answer 30

-omalizumab= approved as a new class of therapy for patients with moderate to severe persistent allergic asthma
-only approved for the use in treatment of asthma
-its an antibody that we all produce; causing symptoms such as: allergic diseases; allergic rhinitis= hayfever and asthma
-may reduce allergic reactions by binding free IgE so that the bound IgE cannot produce the allergic reaction

Question 31

Uses of Anti-IgE antibody-

Answer 31

-limited to patients with moderate to severe persistent allergic asthma who:
-are inadequately controlled with appropriate combination therapy
-complications due to inhaled or oral steroid use
-increases urgent care due to severe asthma exacerbations
-significant problems with daily activities
-don’t tolerate other meds usually prescribed to treat asthma

Question 32

Throat disorders (pharyngeal disorders)

Answer 32

-throat= tube that carries food to the oesophagus and air to the windpipe and larynx
-throat problems are common; sore throat= usually a viral infection is what causes it, other allergies; infection with strep bacteria, upward movement of the stomach acids into the oesophagus= gastric reflux
Other problems;
-tonsillitis- infection in the tonsils
-pharyngitis- inflammation of the pharynx cancer

Question 33

What is a strep throat? (Streptococcus pyogenes)

Answer 33

-bacterial throat infection that can make your throat feel sore and scratchy
-most sore throats are caused by viruses- usually goes away on its own
-if a strep throat is untreated= can cause complications such as kidney inflammation and rheumatic fever
^rheumatic fever= painful and inflamed joints, a rash and even damage to heart valves
-common between ages of 5-15

Question 34

Symptoms of strep throat:

Answer 34

-throat pain
-difficulty swallowing
-red + swollen tonsils = sometimes white patches + streaks of pus
-tiny red spots on the soft/hard palate
-swollen, tender lymph glands in the neck
-fever, headache, rash, stomach ache; sometimes nausea
^can also have these symptoms for a virus, tonsillitis or other illnesses therefore specific tests for strep throats are done

Question 35

Treatments for strep throat:

Answer 35

-antibiotics; oral antibiotic for kids= penicillin, amoxicillin, azithromycin, clarithromycin, clindamycin or cephalosporin
-penicillin; can be given as an injection
-stopping meds early= leads to recurrences and serious complications; rheumatic fever or kidney inflammation
-pain relievers= ibuprofen/paracetamol reduces fever and relieves throat pain
*Aspirin can’t be given to young children + teens