Ear, Nose and Throat Flashcards
When is referral to ENT needed for ear drum perforation?
After 6 weeks
What is the management of mastoiditis?
IV abx
NOTE: CT only if complications suspected
What is the management of otitis externa?
Topical abx +/- topical steroid
What are the criteria for tonsillectomy?
1) sore throats are due to tonsillitis (i.e. not recurrent URTI)
2) the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms)
3) the episodes of sore throat are disabling and prevent normal functioning
Other:
1) recurrent febrile convulsions secondary to episodes of tonsillitis
2) obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
3) peritonsillar abscess (quinsy) if unresponsive to standard treatment
What are the CENTOR score criteria?
1) presence of tonsillar exudate
2) tender anterior cervical 3)) lymphadenopathy or lymphadenitis
3) history of fever
4) absence of cough
What are the FeverPAIN criteria?
1) Fever over 38°C.
2) Purulence (pharyngeal/tonsillar exudate).
3) Attend rapidly (3 days or less)
4) Severely Inflamed tonsils
5) No cough or coryza
What is the antibiotic management of tonsillitis?
phenoxymethylpenicillin
pen allergic: clarithromycin
What are the features of an acoustic neuroma (AKA vestibular schwannoma)?
1) cranial nerve VIII: hearing loss, vertigo, tinnitus
2) cranial nerve V: absent corneal reflex
3) cranial nerve VII: facial palsy
NOTE: seen in NF2
What is the management of malignant otitis externa?
IV abx (ciprofloxacin)- abx to. cover pseudomonas
What is the management of nasal polyps?
All should be referred to ENT
Urgent- if unilateral or bleeding
What are the most common causative organisms of bacterial otitis media?
Streptococcus pneumonaie, Haemophilus influenzae
Moraxella catarrhalis
What is the management of Meniere’s disease?
1) acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
2) prevention: betahistine and vestibular rehabilitation exercises may be of benefit
3) Inform DVLA
What are causes of gingival hyperplasia?
phenytoin, ciclosporin, calcium channel blockers and AML
What is the manoeuvre used in the diagnosis of BPPV?
positive Dix-Hallpike manoeuvre
What is the manoeuvre used in the symptomatic relief of BPPV?
Epley manoeuvre
What are clinical signs of BPPV?
1) Vertigo triggered by head movement
2) May be associated nausea
3) Episodes last 10-20 seconds
What is the management of BPPV?
1) Epley manoeuvre
2) Vestibular rehabilitation, for example Brandt-Daroff exercises
3) Meds e.g. betahistine
What are the clinical features of Vestibular neuronitis?
1) recurrent vertigo attacks lasting hours or days
2) nausea and vomiting may be present
3) horizontal nystagmus is usually present
4) NO hearing loss or tinnitus
NOTE: often develops following a viral infection
What is the management of vestibular neuronitis?
If severe:
buccal or IM prochlorperazine
Less severe:
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
Chronic symptoms:
vestibular rehabilitation exercises
What are the clinical features of Viral labyrinthitis?
1) vertigo: not triggered by movement but exacerbated by movement
2) nausea and vomiting
3) hearing loss: may be unilateral or bilateral, with varying severity
4) tinnitus
5) preceding or concurrent symptoms of upper respiratory tract infection
What are the signs of Viral labyrinthitis?
1) spontaneous unidirectional horizontal nystagmus towards the unaffected side
2) sensorineural hearing loss: shown by Rinne’s test and Weber test
3) abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
4) gait disturbance: the patient may fall towards the affected side
What is the management of Viral labyrinthitis?
prochlorperazine or antihistamines may help reduce the sensation of dizziness
What are the clinical features of Ramsay Hunt syndrome?
1) auricular pain is often the first feature
2) facial nerve palsy
3) vesicular rash around the ear
4) other features include vertigo and tinnitus
What is the management of Ramsay Hunt syndrome?
Oral aciclovir and corticosteroids
What are the clinical features of Otosclerosis?
1) Onset is usually at 20-40 years
2) conductive deafness
3) tinnitus
4) tympanic membrane- only 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
5) positive family history
6) autosomal dominant
What is the management of Otosclerosis?
1) hearing aid
2) stapedectomy
What are the clinical features of Meniere’s disease?
1)recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
2) a sensation of aural fullness or pressure is now recognised as being common
3) nystagmus
4) a positive Romberg test
5) episodes last minutes to hours
6) typically symptoms are unilateral but bilateral symptoms may develop after a number of years
What is the management of Meniere’s?
1) ENT assessment is required to confirm the diagnosis
2) patients should inform the DVLA.
3) acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
4) prevention: betahistine and vestibular rehabilitation exercises may be of benefit
What are the clinical features of cholesteatoma?
Main features
1) foul-smelling, non-resolving discharge
2)hearing loss
Other features are determined by local invasion:
3) vertigo
4) facial nerve palsy
5) cerebellopontine angle syndrome
Otoscopy:
6) ‘attic crust’ - seen in the uppermost part of the ear drum
What is the management of Cholesteatoma?
patients are referred to ENT for consideration of surgical removal
What is the management of nasal poyps?
Intranasal steroids
