Ear, Nose And Throat Flashcards
What is a complication of pinna haematoma?
Cauliflower ear
Ischaemic necrosis and then fibrosis of the cartilage
What is the treatment for a Pinner haematoma?
Prompt drainage ideally within 24 hours
Ensure that other head injuries have been excluded and hearing mechanism is preserved
What are exostoses?
Irritation from cold wind and water exposure causes the bone surrounding the ear canal to develop smooth bilateral lumps of new bony growth which constrict the ear canal
Aka ‘Surfer’s ear’
What are the two main organisms that cause Otitis Externa?
Pseudomonas
Staphylococcus Aureus
What is bullous myringitis?
Very painful haemorrhagic blisters on deep meatal skin and the drum typically associated with influenza infection
What is malignant/necrotising otitis externa?
Aggressive, life-threatening infection of the external ear that can lead to temporary bone destruction and base-of-skull osteomyelitis. 90% are DM. Immuno suppression also a RF.
What is typically the organism that causes malignant/necrotising otitis externa?
Pseudomonas aeruginosa (Also proteus and klebsiella)
What is the treatment for malignant/necrotising otitis externa?
Surgical debridement, systemic antibiotics, specific immunoglobulins
Causes of discharge in ears?
Otitis externa - scanty watery
Otitis media - most common
Cholesteatoma - rare, often offensive discharge
CSF otorrhoea - CSF leaks may follow trauma
Typical symptoms of Otitis media?
Rapid onset of pain, fever +/- irritability, anorexia, vomiting
Often after a viral URTI
What are the common organisms that cause otitis media?
Pneumococcus, haemophilus, moraxella
What is the treatment for Otitis Media?
NSAIDs and analgesics
Systemic broad spectrum antibiotics if unwell - Amoxicillin
Decongenstants
Myringotomy and grommet insertion (if recurrent)
Adenoidectomy (if recurrent)
What is a Cholesteatoma?
cystic, inflammatory mass of keratinising stratified squamous epithelium which can go on to cause erosion of the middle-ear structures, the inner ear, and the surrounding temporal bone.
What is mastoiditis?
Middle ear inflammation leading to destruction of air cells in the mastoid bone +/- abscess formation
What is “glue ear”?
Otitis media with effusion
What is a pinna haematoma?
Bleeding into the external ear
Often due to trauma - Shearing forces can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage
What is the main mode of presentation of glue ear in children?
Parents notice a hearing impairment in 80% of cases
What would a tympanogram look like for a child with glue ear?
Low, Flat - acoustic impedance
Fluid in the middle ear makes the ear drum stiff, so most of the sound is reflected back to the probe.
What is the management for glue ear?
Usually resolves over time, often only needs reassurance and a 3 month review. Hearing aids or surgery considered if persistent bilateral OME
When would you consider treatment for OME?
If there is severe hearing loss, HL that’s causing significant problems with the child’s learning, development and social skills, Down’s syndrome or a cleft palate
How can childhood causes of deafness be classified?
A) congenital - central, conductive, SNHL,
B) perinatal and postnatal
What is Waardenburg syndrome?
A genetic disorder that causes deafness, white forelock, heterochromia iridis), white eye lashes, and wide-set inner corners of the eyes.
If an adult is found to have a sudden hearing loss, particularly if it is asymmetrical, what three things would you want to exclude?
Acoustic neuroma
Cholesteatoma
Effusion from nasophyngeal cancer
What is Ménière’s disease?
Excess accumulation of endolymph within the membranous labyrinth, causing progressive distension of the ducts. The resulting pressure fluctuations damage the thin membranes of the ear that detect balance and sound.
What is the presentation of Ménière’s disease?
Attacks occur in clusters and last up to 12h
Progressive SNHL
Vertigo and n/v
Tinnitus
Aural fullness
What is the most likely diagnosis for this presentation?
Attacks occur in clusters and last up to 12h, Progressive SNHL, Vertigo and n/v, Tinnitus, Aural fullness
Ménière’s disease
What is the most likely diagnosis?
Sudden vomiting and Severe vertigo exacerbated by head movement, following a febrile illness (eg. URTI)
Viral labyrinthitis
How does Viral Labyrinthitis present?
Sudden vomiting and Severe vertigo exacerbated by head movement, following a febrile illness (eg. URTI)
What is the management for viral labyrinthitis?
Cyclizine
Improves in days
What are the main classes of drugs that cause tinnitus?
Aminoglycoside antibiotics (gentamicin, streptomycin, neomycin)
Cytotoxic
Loop diuretics
What is the course of the facial nerve, intracranially?
Facial nucleus in pons, through the internal acoustic meatus, into the facial canal (gives off chorda tympani branch) exits via the stylomastoid foramen.
What is the course of the facial nerve extracranially?
Turns superiorly to run just anterior to the outer ear, gives off the post auricular branch, continues ant. and inf. into the parotid gland where it splits into its five branches.
What are the five terminal motor branches of the facial nerve?
Temporal Zygomatic Buccal Marginal mandibular Cervical
What is the chorda tympani nerve?
Branch of the facial nerve
Responsible for the taste innovation of the anterior 2/3 of the tongue
What are the main symptoms of Cholesteatoma?
Smelly white discharge lasting >6 weeks
Headache, pain
If CN involvement - vertigo, deafness, facial paralysis
What are the main complications of a Cholesteatoma?
Deafness
Meningitis
Cerebral abscess
What is the commonest cancer of the larynx?
Squamous cell carcinoma
What are the main presenting features of laryngeal SCC?
Progressive hoarseness - stridor
Dys-/Odono-phagia
Wt loss
(Male smoker)
What is the most likely diagnosis?
Unilateral hearing loss, tinnitus, a blocked stuffy nose
Nasophyngeal carcinoma
What are the possible symptoms of a nasophyngeal carcinoma?
Lump in the neck Hearing loss usually unilateral Tinnitus A blocked or stuffy nose Nosebleeds
What is the most commonest parotid tumour?
Pleiomorphic Adenoma (80%)
What are the causes of a parotid tumour?
Benign: 1) pleiomorphic adenoma and 2)Adenolymphoma (Warthin’s)
Malignant: 1) mucoepidermoid and 2) Adenoid cystic
When would you suspect a parotid tumour might be malignant?
CN VII palsy and fast growing
What is the most useful initial investigation of a neck lump?
Needle aspiration
What are nasal polyps often associated with?
Allergic/non-allergic rhinitis
CF
Aspirin hypersensitivity
Asthma
What is Samter’s triad?
Asthma Aspirin sensitivity Nasal polyps (4th - hyperplastic sinusitis) Now called Aspirin exacerbated respiratory disease (AERD)
What are the three bones of the middle ear?
malleus, incus and stapes
What is mastoiditis?
When otitis media spreads into the mastoid air cells. Due to their porous nature, they are a suitable site for pathogenic replication.
What is the main complication of mastoiditis?
The mastoid process itself can get infected, and this can spread to the middle cranial fossa, and into the brain, causing meningitis.
How do you treat mastoiditis?
pus must be drained from the air cells. When doing so, care must be taken not the damage the nearby facial nerve.
What are the two main functions of the inner ear?
To convert mechanical signals from the middle ear into electrical signals, which can transfer information to the auditory pathway in the brain.
To maintain balance by detecting position and motion.
What are the two openings of the inner ear to the middle ear?
The oval window lies between the middle ear and the vestibule,
The round window separates the middle ear from the scala tympani (part of the cochlear duct
What makes up the vestibular apparatus?
The semicircular ducts, saccule and utricle
What are the two main causes of perforation of the tympanic membrane?
Trauma and infection
What are the three areas of the pharynx (superior to inferior)?
Nasopharynx
Oropharynx
Laryngopharynx
What is Presbycusis?
Progressive and irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degeneration of the cochlea and associated structures.
HL is most marked in the higher frequencies
What is Otosclerosis?
Autosomal dominant, replacement of normal bone by vascular spongey bone. Onset usually at 20-40 years.
Gives conductive HL and tinnitus with a positive family Hx
What is the most likely diagnosis?
61 year old, two week Hx sharp, stabbing pain over right cheekbone.
‘V severe’, ‘spasms,
Can be triggered by shaving and eating. Subsides after a minute.
Trigeminal Neuralgia
What is the first line management for trigeminal neuralgia?
Carbamazepine
What are the main complications of tonsillitis?
Otitis media
Quinsy
Rarely - rheumatic fever and glomerulonephritis
What criteria needs to be met for a tonsillectomy to be considered?
Sore throats due to tonsillitis (not URTI)
5 or more episodes a year
Symptoms occurring for at least a year
Episodes are disabling and prevent normal function
What is a quinsy?
Complication of tonsillitis
Peritonsillar abscess - collection of pus beside the tonsil
ENT emergency
What is the most likely diagnosis?
Dysphagia, halitosis
Small fluctuate swelling on the left side of the neck which gurgles when palpated
Pharyngeal pouch
What is the most likely diagnosis?
44 year old woman with neck swelling. Systemically well.
O/E midline, non-tender neck swelling which moves upwards when she swallows
Goitre
What is the most likely diagnosis?
Newborn baby
Large swelling on the L side of neck
O/E soft, fluctuant, highly transilluminable lump, noted just beneath the skin
Cystic hygroma
What are the characteristic features of lymphoma?
Rubbery, painless lymphadenopathy
May be associated with night sweats and splenomegaly
What are the characteristic features of a thyroglossal cyst?
Common in
What are the characteristic features of a cystic hygroma?
Congenital lymphatic lesion typically found in the neck, classically on the L side
Most evident at birth, 90% present before 2 yrs
What are the characteristic features of a branchial cyst?
Oval, mobile cystic mass
Develops between the sternocleidomastoid muscle and the pharynx
Due to failure of obliteration of the second branchial cleft in embryonic development
What is Hodgkin’s lymphoma?
Malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell
What are Reed-Sternberg cells?
Found in Hodgkin’s lymphoma
Large, often bi-nucleated cells with prominent nucleoli (two mirror-image nuclei/owl eyes)
What is the management for Bell’s palsy?
Prednisolone 1mg/kg for 10 days within 72 hours of onset
Eye care - consider artificial tears and eye lubricants
What are the characteristic features of BPPV (Benign paroxysmal positional vertigo)?
Vertigo triggered by change in head position
May be associated with nausea
Each episode typically lasts 10-20 seconds
In facial palsy, food accumulates in the mouth due to paralysis of which muscle?
Buccinator
