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ENT SB > Ear Disease and Adenotonsillar Disease > Flashcards

Ear Disease and Adenotonsillar Disease Flashcards

1
Q

In Rinner hearing test where is the tuning fork placed

A

behind the ear

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2
Q

in Weber hearing test where is the tuning fork placed

A

forehead

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3
Q

what tuning fork is used for testing hearing

A

512 Hz

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4
Q

what can be used to test pressure in the ears

A

tympanogram

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5
Q

what is a diagnostic test for many ear conditions

A

OTOENDOSCOPY

- endoscope in mid meatus

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6
Q

what are the 6 D’s of ear conditions

A 
Deafness
Discomfort
Discharge
Dizziness
Din Din (tinnitus)
Defective movement of face
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7
Q

what is central hearing loss

A

all other areas working but still do not hear. i.e. patient has had a stroke and now cannot hear.

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8
Q

where is the problem in conductive hearing loss

A

problem in either the ear drum, inner ear and canal causing hearing loss

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9
Q

where is the problem in sensorineural hearing loss

A

sensory - cochlear problem

neural - acoustic nerve problem

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10
Q

what nerves can cause earache

A 
V
VII
IX
X
C2, C3
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11
Q

what can cause otorrhoea/discharge from the ear

A

AOM
COM
CSF

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12
Q

what can be the cause of a defective facial movement

A

lower motor neurone

facial palsy

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13
Q

Hx of Otitis externa

A

minimal discharge - watery
very itchy
very painful
tragal tenderness

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14
Q

what organisms is the commonest cause of otitis externa

A

pseudomonas

2nd - staph aureus

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15
Q

complications for otitis externa

A

hearing loss

canal stenosis

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16
Q

Tx of otitis externa

A

Aural toilet

Anti-fungal drops e.g. Sofradex

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17
Q

Hx of AOM

A

rapid onset of pain
fever
irritability
viral UTI symptoms

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18
Q

Tx of AOM

A

analgesia

Amoxicillin 5 days but not always needed

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19
Q

what is otitis media with effusion also known as

A

Glue Ear

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20
Q

Sx of OME

A 
hearing impairment 
poor speech
language delay 
inattention 
poor behaviour
ear infections/URTI
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21
Q

Ex of OME

A

Retracted or bulging drum

Can look dull, grey or yellow

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22
Q

Ix of OME

A

Audiograms - looking for conductive hearing loss

Impedance audiometry - look for flat tympanogram

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23
Q

Tx of OME

A

Usually resolves over time
3 monthly review
Hearing aid - reserved for persistent bilateral OME
Surgery - if hearing loss, GROMMETS

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24
Q

what is COM

A

inflammation of middle ear fluid of several months duration

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25
Q

Sx of COM

A

hearing loss - if perforated ear drum
discharge (intermittently)
little pain

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26
Q

Tx of COM

A

Antibiotics therapy

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27
Q

can you get a congenital cholesteatoma

A

yes

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28
Q

Ix of ear problems

A

CT

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29
Q

what is the main function of tonsils

A

Trap bacteria and viruses on inhalation
Expose to immune system
Antibodiesproduced by the immune cells in the tissue
Help to prime immune system and help to prevent subsequent infections.

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30
Q

what is Waldeyer’s ring

A

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

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31
Q

what is Waldeyer’s composed of

A

Tonsils (Palatine Tonsil)
Adenoids (Pharyngeal Tonsil)
Lingual Tonsil

32
Q

histology of tonsils and adenoids

A

tonsils - Specialized squamous

adenoids - Ciliated pseudostratified columnar

33
Q

aetiology of acute tonsillitis

A

majority viral

  • EBV
  • Rhinovirus, Influenza, Parainfluenza, Enterovirus, Adenovirus

can be bacterial

  • strep pyogenes/GABHS (most common)
  • H. influenza
  • s. aureus
34
Q

Sx of viral tonsillitis

A 
Malaise
Sore throat, mild analgesia requirement
Temperature
Able to undertake near normal activity
Possible lymphadenopathy
Lasts 3-4 days
35
Q

Sx of bacterial tonsillitis

A 
Systemic upset,
Fever
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy
Lasts ~1 week, requires antibiotics to settle.
36
Q

what is centor criteria

A

History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough

37
Q

how is the score calculated in centor criteria

A

Age 44 subtract 1 point

0 or 1 points - No antibiotic
2 or 3 points - Should receive an antibiotic if symptoms progress
4 or 5 points - Treat empirically with an antibiotic

38
Q

Tx of tonsillitis

A

Viral
- supportive

Bacteria

  • Penicillin 10 days 500mg
  • Clarithromycin if allergic
39
Q

what is peritonsilar abscess a complication of and what is it

A

acute tonsillitis

bacteria between muscle and tonsil produce pus

40
Q

what is the classic history of peritonsilar abscess

A

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

41
Q

what is seen on examination of a peritonsilar abscess

A

Medial displacement of tonsil and uvula to contralateral side of the infection
Concavity of palate lost

42
Q

what is a peritonsilar abscess also known as

A

quincy

43
Q

Tx of peritonsilar abscess

A

Aspiration

Antibiotics

44
Q

what is infectious mononeucleosis and what causes it

A

Glandular fever

EBV

45
Q

signs of Glandular fever

A 
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
46
Q

what is NOT prescribed in glandular fever and why

A

Ampicillin or amoxicillin

Can cause generalised macular rash

47
Q

features of chronic tonsillitis

A 
Chronic “sore throat”
“Malodorous breath”
Presence of tonsilliths
Peritonsillar erythema
Persistent tender cervical lymphadenopathy
48
Q

what are symptoms of obstructive adenoid hyperplasia

A

Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME

49
Q

what are symptoms of obstructive tonsil hyperplasia

A

Snoring and other symptoms of sleep disturbance
Muffled voice
?Dysphagia

50
Q

what can cause unilateral tonsillar enlargement

A

neoplastic

non-neoplastic

  • acute infective, chronic infective
  • hypertrophy, congenital
51
Q

what is OME/Glue ear

A

Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

52
Q

what is linked with OME

A

smoking households

recurrent URTI

53
Q

what is not a symptoms of OME

A

ear pain/otalgia

54
Q

signs of OME

A

TM retraction
Reduced TM mobility
Altered TM colour
Visible ME fluid/bubbles

55
Q

signs of AOM

A

ear drum bulging and red

56
Q

Tx of OME to begin with

A

“Watchful waiting”
60% resolved @ 1/12
90% resolved @ 3/12

Review @ 3/12

  • Otoscopy
  • PTA
  • Tympanometry
57
Q

Tx of OME after 3 months w/ symptoms of deafness, delay speech or poor balance

A

referral

3y/o first intervention
- grommets

> 3y/o second intervention
- grommets and adenoidectomy

58
Q

complications of grommets

A 
Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues
59
Q

what is important to find out in the history of dizziness

A 
Triggers?
Time Course?
Associated symptoms?
Precipitators?
Alleviating factors?
Medication? - alcohol can also make you dizzy
60
Q

common causes of dizziness

A

postural dizziness

side effect of medication

61
Q

what is BPPV

A

Benign Positional Paroxysmal Vertigo

commonest cause of vertigo looking up

62
Q

what causes BPPV

A

Head trauma, ear surgery, idiopathic

Otolith material from utricle displaced into semicircular canals. Most commonly in posterior SCC.

63
Q

Sx of BPPV

A

sudden rotational vertigo lasting more than 30 seconds by head-turning

NO tinnitus, headache, ataxia, facial numbness, dysphage

64
Q

when do BPPV get vertigo

A

looking up
turning in bed - often worse to one side
first lying down in bed at night
on first getting out of bed in the morning
bending forward
rising from bending
moving head quickly – often only in one direction

65
Q

Ix for BPPV

A

Hallpike’s Test

66
Q

Tx for BPPV

A

Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercise

67
Q

what is vestibular neuronitis

A

Prolonged vertigo (days)
No associated tinnitus or hearing loss
Probable viral aetiology
Viral prodromal symptoms

68
Q

what is labyrinthitis

A

Prolonged vertigo (days)
MAY be associated tinnitus or hearing loss
Probable viral aetiology
May be viral prodromal symptoms

69
Q

Tx for vestibular neuronitis/labyrinthitis

A

Supportive management

Generally self-limiting

70
Q

what is Meniere’s Disease

A

dilatation of the endolympahtic spaces of the membranous labyrinth cases vertigo

71
Q

Diagnosis of Meniere’s Disesase

A

History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)

Occurrence of or worsening of tinnitus on the affected side

Occurrence of aural fullness on the affected side

Documented SNHL on at least one occasion

Other causes excluded

72
Q

Sx of Meniere’s disease

A 
vertigo around 12 hours
nausea/vomiting
fullness in the ear 
uni/bi-lateral tinnitus
sensorineural deafness
73
Q

Mx of Meniere’s disease

A 
Supportive treatment during episodes
Tinnitus therapy
Hearing Aids
Prevention
Gentamicin/steroids

Surgery
- Grommet/Meniette

74
Q

what can make Meniere’s disease worse

A

Salt / Betahistine / caffeine / alcohol / stress

75
Q

what antibiotic can cause ear damage/hearing loss

A

Gentamicin

76
Q

Migrane + Vertigo dizziness

A 
Vertigo
Ataxia
Phonophobia (fear of loud noises)
Fluctuating Hearing loss
Motion sickness

ENT SB (9 decks)

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