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ENT > dizzy and ear disease revision > Flashcards

dizzy and ear disease revision Flashcards

1
Q

what are 5 ear related symptoms you should ask patients about?

A
  • discharge
  • otalgia
  • vertigo/dizziness
  • hearing loss
  • tinnitus
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2
Q
A

Allens test

Otscopy- looking in ear
Cranial nerve exam- exam balance and hearing nerve
Rhomborgs test- test of palance
Allens test- pulsation to the wrists

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3
Q
A

bone conduction and air conduction hearing loss no gap so it is sensorineural hearing loss

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4
Q
A

acute otitis media

-usually leave but if recurrent oral antibiotics

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5
Q

(bulging ear drum)

A

mastoiditis

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6
Q

(boy with mastoiditis)

A
  • if you think he is going to theatre and not improving them give oral antibiotics
  • if they have neural problems do a CT scan
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7
Q
A

cholesteatoma

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8
Q

what should be suspected in older patients with glue ear?

A

nasopharyngeal cancer

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9
Q
A

BPPV

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10
Q

what test diagnoses BPPV?

A

Dix-Hallpike

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11
Q

what are the manoeuvres to treat BPPV?

A
  • semont
  • Epley
  • Brandt daroff
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12
Q
A

vestibular neuritis

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13
Q

what parts does the temporal bone comprise of?

A

5 parts

  • squamous
  • zygomatic arch
  • styloid process
  • tympanic
  • petromastoid
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14
Q

what should be asked in the history if there is a suspected temporal fracture?

A
  • injury mechanism
  • hearing loss
  • facial palsy
  • vertigo
  • CSF leak
  • associated injuries
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15
Q

what is Battle sign a classic presentation of?

A

temporal fracture

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16
Q

what should be checked if there is a suspected temporal fracture?

A
  • Check condition of TM and ear canal
  • Assess facial nerve
  • Hearing test
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17
Q

How may you classify temporal fractures?

A
  • Longitudinal
  • transverse (transverse is worse)

Otic capsule involved (displacement of cochlear or vestibular apparatus so more chance of hearing loss, dizzyness and facial palsy)

Otic capsule spared (mild symptoms)

18
Q

which type of temporal fracture tends to have otic capsule involvement?

A

Transverse

19
Q

how may a patient present if a temporal fracture involves the otic capsule?

A
  • this would displace the cochlear or vestibular apparatus

- can present with hearing loss, dizziness and facial nerve palsy

20
Q

are transverse or longitudinal temporal skull fractures more common?

A

Longitudinal (80%) are more common than transverse (20%)

21
Q

what type of fracture does a lateral blow to the temporal bone usually cause?

A

longitudinal fracture

22
Q

How can a longitudinal temporal fracture present?

A
  • lateral blows
  • fracture line parallels the long axis of the petrous pyramid
  • bleeding from external canal due to laceration of skin and ear drum
  • Haemotympanum (blood in middle ear canal) (conductive deafness)
  • Vesicular chain disruption (conductive deafness)
  • facial palsy (20%)
  • CSF otorrhea
23
Q

what type of fracture does a frontal blow to the temporal bone usually cause?

A

transverse fracture

24
Q

how may a transverse temporal fracture present?

A
  • frontal blows
  • fracture at right angles to the long axis of the petrous pyramid
  • can cross internal acoustic meatus causing damage to the auditory and facial nerve
  • sensorineural hearing loss due to damage to 8th cranial nerve
  • facial nerve palsy (50%) and verigo
25
Q

what are some causes of conductive hearing loss?

A
  • fluid
  • TM perforation
  • ossicular problem
26
Q

what is the treatment for a temporal fracture?

A

Often lead by different teams

  • may need facial nerve decompression, if no recovery EMG studies
  • may need to manage CSF leak, most settle but may need repair
  • may need hearing restoration, either hearing aid or ossiculoplasty
27
Q

what should be done if there is a sudden sensorineural hearing loss?

A

EMERGENCY

Weber test- if it goes to the opposite ear (e.g. hearing loss on right hand side but Weber test goes to left hand side suggests sensorineural loss in right ear)

steroids 1mg/kg and consider intratympanic treatment

28
Q

how are foreign bodies stuck treated?

A

Can usually wait until urgent clinic for removal

  • Remove batteries immediately
  • Remove things that can swim immediately
  • if a live animal drown in oil and remove the next day
29
Q

what should be asked in a history of someone with neck trauma?

A
  • MOA
  • pain (location, nature, intensity, onset, radiation)
  • aerodigestive tract (dyspnoea, hoarseness, dysphonia, dysphasia, haemoptysis)
  • CNS problems (paraesthesias, weakness)
30
Q

how can neck trauma be categorised?

A

Zone I- from the Cricoid down
Zone II-Middle of the neck (least morbidity)
Zone III

31
Q

what does zone I in neck trauma include?

A 
From cricoid down
-trachea
-oesophagus
-thoracic duct
-thyroid
-spinal cord
vessels= brachiocephalic, subclavian, common carotid, thyrocervical trunk
32
Q

what does Zone II in neck trauma include?

A

Middle neck

  • larynx
  • hypopharynx
  • CNX, XI, XII
  • spinal cord

vessels= carotids, internal jugular

33
Q

what does Zone III in neck trauma include?

A

Pharynx
Cranial Nerves
Spinal cord

Vessels= carotid, IJV, vessels

34
Q

How do you manage neck trauma?

A

ABCDE

  • FBC, G&S/XM
  • AP/Lateral neck
  • CXR
  • CT angiogram
  • laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
35
Q

what is one of the most common causes of a deep neck space infection?

A

-extension of infection from tonsil or oropharynx into deeper tissues

36
Q

how may someone with a deep neck space infection present?

A
  • sore throat
  • unwell
  • limited neck movement
  • febrile
  • trismus
  • red/tender neck
37
Q

what is the management of deep space neck infection?

A
  • admit
  • IV access, bloods, fluid rehydration
  • IV antibiotics such as co amoxiclav or clindamycin
  • may need theatre for incision and drainage
38
Q

how does a maxillary fracture present?

A
  • Pain, Decreased visual acuity, Diplopia
  • Hypoaesthesia in infraorbital region
  • Periorbital ecchymosis
  • Oedema
  • Enopthalmos
  • Restriction of ocular movement
  • Bony step of orbital rim
39
Q

how does a maxillary fracture present on a CT of the sinuses?

A

teardrop sign

40
Q

what is the treatment for a maxillary fracture?

A

Conservative

Surgical repair of bony walls if: Entrapment / Large defect / Significant enophthlamos

ENT (33 decks)

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