Ear nose and throat Flashcards
Which vertigo conditions have..
Normal hearing
Hearing loss
Normal: BPPV, Vestibular neuronitis
Loss: Labyrinthitis, meniere’s, acoustic neuroma
How do BPPV and VN differ on…
Duration
History
Investigation
BPPV // VN
<60s // <72hrs
Head movement // Viral URTI
Dix-Hallpike // Head impulse
What is the treatment for
BPPV
Vestibular neuronitis
Epley
Prochlorperazine
How do you differentiate between labyrinthitis and Meniere’s in terms of duration and hisory?
How do you treat them?
Labyrinthitis: ~72hrs, viral and ear infections
Meniere’s: 20m to hours, Fullness and imbalance
Both get prochlorperazine + antihistamines
Meniere’s has beta-histine for prevention
Constant dizzyness with unilateral hearing loss and facial palsy indicates what?
How do you investigate and manage the condition?
Acoustic neuroma (vestibular schwanomma)
2WW for MRI
<3cm: Radiotherapy
>3cm: Surgical excision
What ear conditions cause pain?
Otitis externa
Otitis media
Mastoiditis
How can you differentiate between otitis externa, media and mastoiditis in terms of
Symptoms
History
Otoscopy
OE // AOM // Mastoiditis
Discharge and itchy // conductive hearing loss, fever // Severe pain, protruding ear, systemic unweel
Hx swimming // URTI // otitis media
red swollen, flaky canal // buldging tympanic membrane // possible perforation, ear discharge
How do you treat otitis externa?
1st: topical antibiotics (acetic acid) +/- steroid
+ oral abx/antifungals if spreading
Failsure: ENT referral
What do you do with a diabetic with deep ear pain, discharge and temporal headaches
Urgently refer for CT and IV antibiotics
Likely malignant otitis externa
What organisms typically cause malignant otitis externa?
Pseudomonas
What antibiotic is first line in otitis media and when should you give it?
Amoxicillin 5-7 days (macrolide if allergic)
Give if…
- >4 days
- systemically unwell without admission need
- Vulnerable (<2yrs, IC)
- Perforation or discharge in canal
-
What is the treatment for mastoiditis?
IV antibiotics
What are the complications of mastoiditis?
Meningitis
Hearing loss
Facial nerve palsy
How does cholesteatoma difer from otitis or mastoiditis?
Non painful
Smelly discharge
Conductive hearing loss
Hx cleft palate
What does the following show on otoscopy?
Attic crust (red arrow), bone (blue arrow)
Cholesteatoma
How do you manage cholesteatoma?
Refer to ENT for CT petrous bones
Painless conductive hearing loss in a young child indicates what and how do you treat it?
Glue ear
Grommet for 10 months
Adenoidectomy
How does presbycussis and otosclerosis compare in terms of…
Hearing loss
Age of onset
Tinnitus
Presbycussis // Otosclerosis
Bilateral conductive // Bilateral sensory
Increases with age // 20-40s, family history
Common // Uncommon
How do you confirm presbycusis?
-ve otoscopy, tympanometry and inflammatory markers
How can you tell if tonsillitis would benefit from antibiotics
CENTOR >=3 OR FeverPAIN >=4
Fever >38 degrees
Purulence
Acute onset (FeverPain)
Inflammation
No cough
For tonsilitis, what is the
Bacterial cause
Antibiotic therapy
Group A strep (pyogenes)
1st: Pen V (phenpen) 10 days (doxy, clarithromycin)
When would a tonsillectomy be considered?
7 bouts in 1yr
5 bouts in 2 yrs
3 bouts in 3 yrs
What is the management pathway for sinusitis
Conservative for 10 days
> 10 days, bacterial cause unlikely: Nasal spray
>10 days, bacterial cause likely: PhenPen
How is post-tonsillectomy bleeding managed?
6-8hrs: Theatre
5-10 days: Admit for IV antibiotics
How does mouth opening and uvula deviation play a role in sore throat
Trismus and deviation of uvula to one side indicates quinsy
Needs incision, drainage and IV antibiotics
How can you tell between anterior and posterior nosebleed clinically?
Posterior is more likely bilateral and profuse
Posterior is venous (Wooruff) while anterior is arterial (Kiesselbachs)
What is the management steps of nosebleed?
- Sit face forward and pinch cartilage for 20 mins
- Cauterise if visible, pack if fails
- Ligate/embolise
When do you admit for nosebleed?
Profuse, bilateral or non-visualised
Following nasal trauma, what is important to examine for?
Boggy septum
Boggy: Incise and drain haematoma <24hrs
Not: Splint + outpatient review
Sore throat with enlarged ant and posterior chains with raised WCC and ALT indicates what condition?
How do you investigate and treat it?
Infectious mononucleosis
2 week monospot
Conservative
Avoid heavy contact due to splenic rupture risk
What nature of nose symptoms are worrying?
Unilateral (eg mass leakage)
Urgent referral
