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ENT > Ear Disease > Flashcards

Ear Disease Flashcards

1
Q

A bone-gap in the audiogram indicates what

A

Conductive hearing loss

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2
Q

Ear discomfort can involve which nerves (5)

A

1) CN V 2) CN VII 3) CN IX 4) CN X 5) C2, C3 roots

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3
Q

Discharge from the ear (otorrhoea) can be due to what (3)

A

1) AOM 2) COM 3) CSF

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4
Q

Otitis externa is present in which group typically

A

Swimmers

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5
Q

Otitis externa will be a slow/rapid onset pain?

A

Rapid (<48 hours).

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6
Q

Otitis externa can cause what type of hearing loss

A

Conductive

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7
Q

What is the 1st line investigation in otitis externa?

A

Otoscopy

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8
Q

Should otitis externa be swabbed?

A

No

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9
Q

What is the main therapy for otitis externa?

A

Aural toilet (cleaning). If bacterial: ofloxacin drops. If fungal: topical antifungals (e.g. clotrimazole).

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10
Q

Secondary investigation in otitis externa?

A

CT (rule out malignant otitis externa)

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11
Q

What does this otoscopy indicate?

A

Otitis externa

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12
Q

Otitis media patients tend to be young/old. What are the common symptoms?

A

Young. Acute ear pain, irritability and sleep disturbance.

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13
Q

“Day care attendance” and “older siblings sick” is buzzword for what

A

Acute Otitis Media

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14
Q

What infection type is associated with AOM?

A

Upper respiratory tract

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15
Q

How is AOM diagnosed?

A

Otoscopy (bulging tympanic membrane) + history (URTI).

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16
Q

What’s the guidance around antibiotic prescription and AOM?

A

No antibiotics generally needed (as they will only reduce symptom duration by 1 day). If there is significant otorrhoea present, amoxicillin 500mg TDS is given (clarithromycin if allergic).

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17
Q

What is considered “chronic” otitis media?

A

>3 episodes in 6 months OR >5 episodes in 12 months

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18
Q

If severe, AOM can develop into what

A

Otitis media with effusion (can perforate TM)

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19
Q

What does this otoscopy show?

A

AOM

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20
Q

What does this otoscopy show?

A

Cholesteatoma

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21
Q

OME is also called…

A

Glue ear

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22
Q

How is glue ear treated?

A

Observe for 3 months.

If unchanged, if there is hearing loss ocnsider Groment insertion.

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23
Q

What does this otoscopy show?

A

OME

24
Q

T/F: Cholesteatoma has no serious complications beside conductive hearing loss.

A

False - can erode into the bone.

25
Q

What’s the gold standard investigation for diagnosing cholesteatoma?

A

Diffusion-weighted MRI

26
Q

How is cholesteatoma treated?

A

Surgery to remove

27
Q

Waldeyer’s Ring is composed of which tonsils

A

Palatine, pharyngeal (adenoids) and lingual

28
Q

Which epithelium covers the adenoids?

A

Ciliated pseudostratified columnar

29
Q

Most common cause of acute tonsillitis

A

Virus (mainly rhinovirus, influenza)

30
Q

Important bacteria to consider in acute tonsillitis

A

Group-A beta haemolytic strep (S. pyogenes) as they can cause rheumatic fever and glomerluonephritis

31
Q

Is throat swabbing recommended to diagnose acute tonsillitis?

A

No (pathogen recovery poor)

32
Q

Spot Diagnosis

A

Acute tonsillitis

33
Q

Most common bacterial isolates in tonsillitis

A

S. pyogenes, H. influenzae, S. pneumoniae

34
Q

How can viral and bacterial sore throats be differentiated?

A

Bacterial tends to last 1 week (viral only 3-4 days).

Bacterial tends to be more severe where the patient cannot work (viral tends to be near-normal QoL)

35
Q

What is the Centor Criteria

A

A system used to differentiate bacterial from viral infection.

1) History of fever
2) Tonsillar exudates
3) Tender anterior cervical lymph nodes
4) Absence of cough
5) Age <15

36
Q

What Centor scores should receive an antibiotic?

A

4 or more empircal

2-3 give an antibiotic if symptoms worsen

37
Q

How is tonsillitis treated?

A

Supportively (hot tea, rest, OTC analgesia).

Antibiotics if Centor indicated (penicillin 500mg QID or clarithromycin if allergic)

38
Q

T/F: Tonsillectomy is routine in tonsillitis patients.

A

False - only done if there have been >7 treated sore throats in the past year

39
Q

Peritonsillar abscess is a classical complication of what condition

A

Acute tonsillitis

40
Q

Triad of peritonsillar abscess

A

1) Unilateral throat pain and odynophagia
2) Trismus (spasm of jaw muscles)
3) 3-7 days of preceding tonsillitis

41
Q

How is quinsy treated

A

Aspiration & antibiotics (benzylpenicillin PO)

42
Q

Cause of IM

A

EBV

43
Q

Spot diagnosis: A patient presents with marked cervical lymphadenopathy, palatal petechia haemorrhages and gross tonsilar enlargement with a membranous exudate

A

Glandular Fever

44
Q

Serious complication of IM

A

Hepato-splenomegaly

45
Q

How is IM diagnosed

A

Atypical lymphocytes, +MonoSpot test, EBV IgM in clotted blood

46
Q

How is IM managed?

A

Symptom relief.

Do NOT prescribe amoxicillin/ampicillin (can cause a generalised macular rash)

47
Q

Which drug should be avoided at all costs in EBV infection?

A

Amoxicillin

48
Q

Hyperplasia of which tonsils gives snoring?

A

Palatine tonsils

49
Q

Hyperplasia of which tonsils can give a hyponasal voice?

A

Adenoids

50
Q

T/F: Enlarged tonsils without symptoms need to be treated.

A

False

51
Q

T/F: Glue ear/ AOM presents with signs of acute inflammation.

A

False - differentiates from AOM (where there is inflammation of the middle ear)

52
Q

Otitis Media with Effusion is a cause of earache. T/F?

A

False

53
Q

OME is a cause of hearing loss.

A

True.

54
Q

OME can be triggered by what

A

Day care, household smoking, recurrent URTI, recurrent AOM

55
Q

Air Bone gap suggests what

A

Conductive Hearing loss

56
Q

How is OME treated?

A

Watchful waiting for 3 months

If persistent treatment depends upon age:

  • <3 years old OR first-line therapy = Grommet insertion
  • >3 years OR 2nd line therapy = Grommets AND adenoidectomy
    nb: if nasal symptoms are present, adenoidectomy may be considered earlier on.
57
Q

Investigations in OME

A

Otoscopy, tuning fork tests, audiometry, tympanometry

ENT (7 decks)

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