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General practice 2023 > Ear and ENT > Flashcards

Ear and ENT Flashcards

1
Q

anatomy of the ear

A
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2
Q

a membrane in acte otitis media might look

A

opaque
inflamed
bulging

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3
Q

typical history of acute otitis media

A

acute onset of pain (may be difficult to tell in young children)
fever
concurrent URRTI symptoms common

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4
Q

treatment for acute otitis media

A

antibiotics ??
more likely to help in bilateral OM in age <2
recommended in aboriginal children due to high prevalence of complications
symptomatic management is reasonable in non-severe cases
analgesia

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5
Q

otitis media with effusion

A

persisting middle ear effusion, follows acute otitis media or accompanies rhinitis/sinusitis
best confirmed by pneumotoscopy or tympanometry
painless, sometimes causes hearing loss
often resolves spontaneously within <3 months

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6
Q

when is hearing testing needed

A

if persists >3 months

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7
Q

when is ENT consult needed

A

bilateral hearing loss >30dB or
speech delay, educational impairment or behavioural difficulties

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8
Q

grommets are also called

A

tympanovstomy tubes
ventilation tubes

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9
Q

a grommet is

A

a small plastic tube, narrower in its middle than its ends
inserted surgically to maintain a hole in the tympanum

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10
Q

main indicators for grommet are

A

recurrent otitis media
otitis media with effusion

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11
Q

possible adverse effects of grommets

A

anaesthetic risks, ear discharge, persisting perforation, tympanosclerosis

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12
Q

chronic suppurative otitis media

A

chronic bacterial infection of the middle ear with persistent drainage of mucous from the middle ear via perforation

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13
Q

chronic suppurative otitis media may occur following

A

acute otitis media

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14
Q

chronic suppurative otitis media is especially common in

A

resource poor settings internationally
in remote aboriginal communities

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15
Q

chronic suppurative otitis media is an important cause of

A

conductive hearing loss

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16
Q

treatment of chronic suppurative otitis media

A

ear cleaning (aural toilet) - dry mopping with tissue spears or dilute butadiene washout
topical antibiotic

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17
Q

what sort of antibiotic is best for chronic suppurative otitis media

A

topical antibiotics are better
best evidence is for fluroquinolones which are also not ototoxic (unlike some other topical antibiotics)

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18
Q

perforation

A

may follow otitis media or trauma
often causes some hearing loss depending on extent of perforation

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19
Q

perforation prognosis

A

often heals spontaneously in absence of infection, especially in childhood

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20
Q

treatment for persistent perforation

A

tympanoplasty is a surgical option
involves grafting other tissue over the perforation

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21
Q

cholesteatoma

A

not actually a malignancy
expanding mass of keratinising squamous epithelium
potentially locally destructive including to ossicular chain
can lead to permanent hearing loss or vertigo

22
Q

treatment for cholesteatoma

A

needs surgery - only option

23
Q

is cholesteatoma a malignancy

A

no

24
Q

cholesteatoma can cause

A

can lead to permanent hearing loss or vertigo

25
Q

tympanosclerosis

A

local opacity or scarring of tympanum often seen after past perforation/grommets
commonly seen
often has little or no effect on hearing
often no treatment needed

26
Q

what does otitis externally look like

A
27
Q

acute otitis externa is due to

A

acute otitis exterrna is due to infection of the external auditory canal

28
Q

chronic otitis externa is due to

A

is due to dermatological disease

29
Q

acute otitis extra is characterised by

A

acute onset of ear pain, sometimes with discharge

30
Q

risk factors for acute otitis externa

A

moisture (commonly swimming)
ear trauma or irritation
pre-existing skin disease in canal

31
Q

causative agents of acute otitis externa

A

usually bacterial
pseudomonas most common
followed by staphylococcus species
about 10% fungal

32
Q

treatment for acute otitis externa

A

aminoglycoside + anti fungal + steroid drops often used, only considered safe if there is an intact tympanum
quinolone-based drops considered safe in setting of tympanic perforation

33
Q

if acute otitis externa does not respond to initial treatment

A

consider swab for microscopy and culture

34
Q

if the acute otitis externa is severe

A

consider
oral antibiotics if there is a spreading infection
with if very swollen canal (to allow entry for medicines)
referral to ENT for canal cleaning (microscopic toilet)

35
Q

with treatment, symptoms of acute otitis externa should last

A

6 days on average

36
Q

what is an exostoses

A

benign bony overgrowth of external ear canal
associated with repeated water exposure - ‘surfer’s ear’

37
Q

treatment for exostoses

A

usually of no consequence unless leading to frequent occlusion or infection (can then be treated surgically)

38
Q

symptoms of wax impaction

A

hearing loss
pain, tinnitus, vertigo
diagnosis is usually obvious on examination but beware pathology behind the wax

39
Q

treatment for wax impaction

A
  • drops
  • syringing
  • manual removal by a specialist
40
Q

drops for wax impacting

A

water based or oil based
not effective and uncertain evidence base

41
Q

syringing for wax impaction

A

contraindications include current infection, perforation, grommets, recent trauma, past ear surgery

42
Q

risks of syringing

A

small (1/1000?) risk of perforation
stop irrigation if severe pain or vertigo and have ENT review

43
Q

hearing loss presentations in children

A

low threshold for audiometry/referral

44
Q

sudden idiopathic sensorineural hearing loss

A

often spontaneously improves but not always
high dose steroids are standard of care
refer urgently to an ENT

45
Q

things to look for on throat examination

A

symmetry
tonsil size
tonsil inflammation or exudate (tonsil crypts are normal finding)
pharyngeal inflammation +/- lymphoid hyperplasia
ulcers
plaques
dentition

46
Q

when is antibiotics recommended for sore throats

A

scarlet fever or rheumatic fever
some guidelines suggest antibiotics for tonsillitis if criteria are met

47
Q

peritonsillar abscess

A

aka. quinsy
presents with severe unilateral throat pain, high fever, perhaps change in voice or truisms

48
Q

treatment for peritonsillar abscess

A

surgical - emergency
plus penicillin

49
Q

mouth ulcers

A

often viral/idiopathic
beware malignancy in ulcer persisting >2 weeks especially in the setting of risk factors eg. smoking, chewing tobacco, alcohol

50
Q

hoarseness

A

commonly post viral
also benign nodules with overuse e.g in singers
beware malignancy - refer to ENT if hoarseness lasts >3 weeks and red flags present

51
Q

red flags in voice hoarseness

A

significant smoking history
otalgia
dysphagia/odynophagia
stridor
haemoptysis
fevers/night sweats /weight loss
neck mass

52
Q

which hand do you use to hold an otoscope

A

right hand for right ear
left hand for left ear

General practice 2023 (32 decks)

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