Ear and throat disease Flashcards
cause of dizzy patient
ENT cardiovascular metabolic anxiety neurological trauma migraine drug side effects
define dizziness
non specific feeling of vertigo, pre-syncope, disequilibrium
features of cardiac dizziness
lightheaded
palpitations
syncope
features of neurological dizziness
blackout visual disturbance paraesthesia weakness speech/swallow issues
features of vestibular dizziness
motion
spinning, fall, pushed
assoaicted symptoms with vertigo
hearing loss tinnitus aural pressure migraines sound/pressure indiced symptoms
dizzy rolling in bed?
BPPV
severe attack of dizziness lasting for hours with nausea and vomiting
vestibular neuritis
light sensitive and dizzy?
migraine
one ear feeling full and dizzy?
meniere’s disease
investigations to take for dizziness and vertigo?
blood pressure otoscopy neurological examination balance audiometry
what is the vestibulo-ocular reflex
focus eyes in distance, turning head causes deflection to allow eye focus
fluid shift in the horizontal VC deflects cupula to opposite side of turn and stimulates the left or right semi circular canal
leads to deflected eye movement
when the head turns right, the ___ horizontal canal is stimulated and the ___ is inhibited leading to eye movement on the ___ side
right
left
left
when the head turns left, the ___ horizontal canal is stimulated and the ___ is inhibited leading to eye movement on the ___ side
left
right
right
describe how nystagmus may occur in vestibular pathology
firing potential is lost on the affected side, with the other side being dominant. this leads to one side being the dominant in vestibulo-ocular reflex
this leads to nystagmus
what is the head impulse test
test vestibular-ocular reflex by rotating head and observing eye movement
use goggles to determine delay
cause of BPPV
trauma
ear surgery
idiopathic
pathophysiology of BPPV
otoconia from utricle is displaced into semicircular canal, usually posterior
presenting features of BPPV
vertigo on looking up, turning in bed, lying down, bending, rising, moving head quickly
how can BPPV be distinguished from vertebrobasillar insuffiency
difficulty speaking, swallow, weakness, numbness, visual disturbance
diagnostic test for BPPV
dix hallpike test sit up with enough room to lay down vertical/torsional geotropic nystagmus vertigo sick
best treatment for BPPV
epley manoeuvre
other management for BPPV
semont manoeuvre
brant-daroff exercises - 10 reps 3x a day for 1 weeek
features of vestibular neuronitis/labyrinthitis
prolonged vertigo for days
associated tinnitus
prodromal viral symptoms
management of vestibular neuronitis/labyrinthitis
self limiting
if prolonged then investigate
rehabilitate
3 days in bed, 3 weeks off work, 3 months off balance
features of meniere’s disease
fecurrent, spontaneous and rotational vertigo with 2 episodes >20 mins
new tinnitus
aural fullness
SNHL, low freq
management of meniere’s disease
supportive, intratympanic steroids, gentamicin, surgery, diuretics
tinnitus therapy
hearing aids
salt restriction, alcohol, caffeine, stress
what is a vestibular schwannoma, what symptoms may it cause and how is it diagnosed
rare, benign tumour of VIII sheath
imbalance, hearing loss with tinnitus
asymmetric hearing loss by MRI
management of migraine and vertigo
lifestyle - alcohol, caffeine, stress, citrus fruit, sleep
triptans
propranolol, amitriptyline
features associated wth migraine and vertigo?
ataxia vertigo phonophobia motion sickness hearing loss
what is otitis externa and what causes it
inflammation fo skin of ear canal
almost always infectrive - bacterial/fungal
caused by water, cotton buds, hearing aids, skin issues
in who is acuite otitis media more common
children
causes of OME in children
eustachian tube block or dysfunction
causes of OME in adults
nasopharyngeal carcinoma/lymphoma
rhinosinusitis
what is cholesteatoma, is it congenital or acquired, features
keratin in middle ear
hearing loss and discharge
usually acquired but can be congenital
complications of acuite otitis media/cholesteatoma
sensorineural hearing loss, tinnitus, vertigo, facial palsy
brain abscess or meningitis
venous sinus thrombosis
what is presbycusis and what frequency is the hearing loss
age related sensorineural hearing loss
high frequency
in who is otosclerosis more common
young women
pregnancy
familial
common cause of acute otitis media
preceding URTI in children
what makes up waldeyer’s ring
palatine tonsils
adenoid tonsils
lingual tonsil
histology of the tonsils
stratified squamous
crypts
adenoids formed of ciliated pseudostratified columnar
upper aerodigestive histology?
ciliated columnar respiratory type
squamous
histology of oral cavity, pharynx, vocal cords and oesophagus
squamous
pathogens in acute tonsillitis
EBV adenovirus rhinovirus enterovirus influenza and parainfluenza GAS , haemophilus influenzae, s aureus, strep pneumoniae
symptoms of viral tonsilitis
malise
sore throat
fever
possible lymphadenopathy <4days
symptoms of bacterial tonsilitis
around a week systemic upset fever lymphadenopathy odonophagia halitosis
management of tonsillitis
eat and drink rest OTC analgesia penicillin consider tonsillectomy steroids fluids
what is a peritonsillar abscess, what are the symptoms and management
pus production between tonsil and muscle
unolateral throat pain, odynophagia, medially displaced tonsil and uvula, trismus
aspirate, abx
signs of infectious mononucleosis
tonsillar enlargemnt with membranous exudate
cervical lymphadenopathy
palatal petechial haemorrhage
hepatosplenomegaly
disgnosis of infectious mononucleosis
atypical monocytes monospot paul bunnel test low CRP deranged LFTs
management of infectious mononucleosis
symptomatic
steroids if bad
abx, not amox
features of tonsillar obstructive hyperplasia
snoring
muffled voice
dysphagia
features of adenooid obstructive hyperplasia
mouth breathing
snoring
AOM/OME
hyponasal voice
features of chronic tonsilitis
chronic sore throat malodourus breath tonsilith peritonsillar oedema tender cervical lymphadenopathy
in who is OME more common
children males day care older siblings recurrent URTI
cause of OME
recurrent AOM or URTI premature craniofacial abnormality immune deficiency smoking day care allergy nutrition bottle feed seasonal
symptoms of OME
deafness behaviour issues poor school performance balance issues speech delay
diagnosis of OME
hx, otoscopy, tuning fork
audiometry and tympanometry
signs of OME on examiantion
TM retraction and reduced mobility and colour
visible middle ear fluid
management of OME
waiting, review at 3m with PTA, otoscope and tympanometry
if persistent refer
if <3, or >3 and first line - grommets
if >3 and 2nd line - grommets and adenoidectomy
complication of grommet insertion
infection early extrusion retention perforation swimming issues
