Ear nose and throat Flashcards
What criteria must someone meet according to NICE for consideration of tonsillectomy?
- Sore throats are due to tonsillitis (not upper respiratory infection)
- 7 episodes for 1 year, 5 episodes per year for episodes 2 years or 3 episodes per year for 3 years
- Episodes of sore throats must be disabling and prevent normal functioning
What are some other reasons for tonsillectomy?
- Recurrent febrile convulsions secondary to episodes of tonsillitis
2.Obstructive sleep apnea, stridor or dysphagia secondary to enlarged tonsils
- Peritonsillar abscess (quinsy) if unresponsive to standard treatment
Complications of tonsillectomy?
-Primary (<24 hours) haemorrhage 2-3%, pain
-Secondary (24 hours to 10 days) haemorrhage (most commonly due to infection, pain
Pain pattern post tonsillectomy
Pain increases up to 6 days following tonsillectomy
Haemorrhage post-tonsillectomy?
Assesed by ENT
Primary haemorrhage tonsilectomy?
Immediate return to theatre
Secondary haemorrhage tonsillectomy?
-Associated with wound infection
-Admission and antibiotics
-if severe immediate surgery
Nasal polyp associations?
Asthma, aspirin sensitivity, infective sinusitis, CF, Kartagener’s syndrome, churg-strauss syndrome
What is Samter’s triad?
Asthma, aspirin sensitivity and nasal polyposis
Features of nasal polyps
-Nasal obstruction
-Rhinorrhoea, sneezing
-Poor sense of taste and smell
What is an unusual feature nasal polyps that would require further investigation?
-Unilateral symptoms or bleeding
When to refer to ENT nasal polyps?
All patients with suspected nasal polyps should be referred to ENT for full examination
Management of nasal polyps?
-Intranasal corticosteroids are first line (if no malignancy is suspected)
-Surgical managed may be considered (FESS and polyectomy)
NOTE: intranasal corticosteroids shrink polyps in approx 80% of patients
What is the endolymphatic system responsible for?
-Regulating fluid balance
-Regulating function of structures that are involved in hearing and balance
What is endolymphatic system made up of?
-Part of inner ear made ducts and chambers filled with endolymph fluid
What is menieres disease?
-Chronic disorder of the inner ear that affects hearing and balance
WHat is thought to be the cause of meniere’s disease?
Abnormal buildup of endolymph fluid in the inner ear - this can interfere with normal functioning of auditory and vestibular systems
What happens in the endolymph system due to excess endolymph fluid?
Increase pressure because of excess fluid causes progressive dilatation of endolymphatic system
What are the features of menieres disease?
-Vertigo (most prominent)
-Tinnitus
-Sensorineural hearing lsos
-Aural fullness
-Nystagmus and positve romberg test
Unilateral or bilateral symptoms in menieres disease?
Typically unilateral but bilateral symptoms may occur after a number of years
Progression of meniere’s disease?
-Symptoms resolve in majority of patients after 5-10 years
-Can be left with a degree of hearing loss
What medication can be used in acute attacks of meniere’s disease?
Buccal or IM prochlorperazine
-In acute severe cases admission may be required
What medication can be used to used to help prevent meniere disease symptoms?
Betahistine
Chornic rhinosinustis?
Chronic inflammation of paranasal sinuses and nasal passage >12 weeks
Predisposing factors of chronic rhinosinustis?
-Atopy
-Nasal obstruction (polys, spetal deviation)
-Recent infection
-Swimming
-Smoking
Features of chronic rhinosinusitis
-Facial pain - frotnal pressure worse when bending forward
-Nasal discharge
-Nasal obstruction causing mouth breathing
-Post nasal drip causing cough
Management of recurrent sinusitis
-Avoid allegren
-Intranasal corticosteriod
-Nasal irrigation with saline solution
Red lfag symoptoims
