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D3 > Ear, Nose and Throat > Flashcards

Ear, Nose and Throat Flashcards

1
Q

audiometry

A

Quantify loss and determine nature

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2
Q

Pure tone audiometry

A

headphones at different frequencies and strengths in soundproofed room

pt indicates when sound appears and siappears

mastoid vibrator - bone conduction threshold

threshold at different frequencies plotted to give audiogram

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3
Q

Tympanometry

A

Measures stiffness of ear drum
- evaluates middle ear function

flat tympanogram - mid ear fluid or perforation

Shifted tympanogram - +/- mid ear pressure

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4
Q

Evoked response audiometry

A

auditory stimulus w measurement of elicited brain response by surface electrode

used for neonatal screening if otoacoustic emission testing negative

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5
Q

Otitis Externa

A

Presentation (otalgia)

  • watery discharge
  • itchy
  • pain + tragal tenderness
Causes
 Moisture: e.g. swimming
 Trauma: e.g. fingernails
 Absence of wax
 Hearing aid

Organisms
 Mainly pseudomonas
 Staph aureus

Management
Aural toilet w drops
 Betamethasone for non-infected eczematous OE
 Betamethasone w neomycin
 Hydrocortisone w gentamicin
 Acidifying drops
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6
Q

Malignant Otitis Externa

A

Life-threatening infection which can > skull osteomyelitis
90% pt diabetic (or other immunocompromisation)

Presentation
 Severe otalgia which is worse @ night
 Copious otorrhoea
 Granulation tissue in the canal

Rx
 Surgical debrdement
 Systemic Abx

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7
Q

Bullous Myringhitis

A

 Painful haemorrhagic blisters on deep meatal skin and TM.

 Assoc. c¯ influenza infection

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8
Q

TMJ Dysfunction

A

Sx - otalgia (earache) - referred pain from auriculotemporal nerve

  • facial pain
  • joint clicking/popping
  • teeth-grinding (burxism)
  • stress (assw depression)

Signs
- joint tenderness exacerbated by lateral movement of open jaw

Ix - MRI

Mx - NSAIDs
- stabilising orthodontic occlusal prostheses

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9
Q

Otitis Media

Classification

A

Classification
 Acute: acute phase
 Glue ear / OME: effusion after symptom regression
 Chronic: effusion > 3mo if bilat or > 6mo if unilat
 Chronic suppurative OM: Ear discharge c¯ hearing
loss and evidence of central drum perforation.

Organisms

  • Viral
  • Pneumococcus
  • Haemophilus
  • Moraxella
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10
Q

Acute Otitis Media

A 
Presentation
 Usually children post viral URTI
 Rapid onset ear pain, tugging @ ear.
 Irritability, anorexia, vomiting
 Purulent discharge if drum perforates

o/e
 Bulging, red TM
 Fever

Rx
 Paracetamol: 15mg/kg
 Amoxicillin: may use delayed prescription

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11
Q

Acute Otitis Media Compliciations

A 
Intratemporal
 OME
 Perforation of TM
 Mastoiditis
 Facial N. palsy

Intracranial
 Meningitis / encephalitis
 Brain abscess
 Sub- / epi-dural abscess

Systemic
 Bacteraemia
 Septic arthritis
 IE

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12
Q

Otitis MEdia Externa (glue ear)

A

Presents

  • inattention at school
  • poor speech development
  • hearing impairment

O/E - retracted dull TM
- fluid level

Ix - audiometry flat tympanogram

Rx - usually resovles spontaneously
- consider grommets if persistent hearing loss
> SE infections, tympanosclerosis

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13
Q

Chronic Suppurative OM

A

Presentation - painless discharge and hearing

O/E - TM perforation

Rx - aural toilet
- abx/steroids ear drops

Complications - cholesteatoma

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14
Q

Mastoiditis

A

Middle-ear inflam > destruction of mastoid air cells + abscess formation

Presentation - fever, mastoid tenderness, protruding auricle

Imaging CT

Rx - IV abx
- myringotomy +/- mastoidectomy

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15
Q

Cholesteatoma

A

Locally destructive expansion of stratified squamous epithelium within middle ear

Classification

  • congenital
  • acquired 2ndary to attic perforation in chronic suppurative OM
Presentation 
- Foul smelling white discharge
- headache, pain
- CN involvement 
  > vertigo, deafness, facial paralysis

O/E - appears pearly white w surrounding inflammation

Mx - Surgery

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16
Q

Cholesteatoma Complications

A

Deafness (ossicle destruction)
Meningitis
Cerebral abscess

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17
Q

Tinnitus

A

Sensation of sound w/o external sound stimulation

Causes
Specific
 Meniere’s
 Acoustic neuroma
 Otosclerosis
 Noise-induced
 Head injury
 Hearing loss: e.g. presbyacusis

General
 ↑BP
 ↓Hb

Drugs
 Aspirin
 Aminoglycosides
 Loop diuretics
 EtOH
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18
Q

Tinnitus History

A

 Character: constant, pulsatile
 Unilateral: acoustic neuroma
 FH: otosclerosis
 Alleviating/exacerbating factors: worse @ night?

Associations
 Vertigo: Meniere’s, acoustic neuroma
 Deafness: Meniere’s, acoustic neuroma

Cause: head injury, noise, drugs, FH

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19
Q

Tinnitus Examination Ix Mx

A

Examination
 Otoscopy
 Tuning fork tests
 Pulse and BP

Ix
 Audiometry and tympanogram
 MRI if unilateral to exclude acoustic neuroma

Mx
 Treat any underlying causes
 Psych support: tinnitus retraining therapy
 Hypnotics @ night may help

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20
Q

Vertigo

Causes

A

Illusion of movement

Cause

Peripheral/vestibular

  • Meniere’s
  • BPV
  • Labyrinthitis
Central
- Acoustic neuroma
- MS
- vertebrobasilar insufficiency/stroke 
head injury
- inner ear syphilis 
Drugs (central/ototoxic)
 Gentamicin
 Loop diuretics
 Metronidazole
 Co-trimoxazole
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21
Q

Veritogo Hx + Examination + tests

A

Hx
 Is it true vertigo or just light-headedness?
> Which way are things moving?
 Timespan
 Assoc. symptoms: n/v, hearing loss, tinnitus, nystagmus

Examination and Tests
 Hearing
 Cranial nerves
 Cerebellum and gait
 Romberg’s +ve = vestibular or proprioception
 Hallpike manouvre
 Audiometry, calorimetry, LP, MRI
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22
Q

Meniere’s Disease

presentation

A

Dilatation of endolymph space of membranous labryrinth (endolymphatic oedema)

Presentation

  • Attacks occur in clusturs + last up to 12 hours
  • progressive SNHL (sensnorineural hearing loss)
  • vertigo + N/v
  • tinnitus
  • aural fullness
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23
Q

Meniere’s Disease

Ix Rx

A

Ix - audiometry shows low-freq SNHL which fluctuates

Rx
Medical - vertigo, cyclizine, betahistine

Surgical - gentamicin instillation via grommets
- Saccus decompression

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24
Q

Vestibular Neuronitis/Viral labyrinthitis

A

Presentation

  • following febrile illness (URTI)
  • sudden vomiting
  • severe vertigo exacerbated by head movement

Rx

  • Cyclizine
  • Improvement in days
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25
Q

Benign positional vertigo (BPV)

A

Displacement of otoliths in semicircular canals
- common after head injury

Presents
- sudden rotational vertigo for <30s
> provoked by head turning
- nystagmus

Causes

  • idiopathic
  • head injury
  • otosclerosis
  • post-viral

Dx - hallpike manoeuvre > upbeat torsional nystagmus

Rx

  • self-limiting
  • epley manoeuvre
  • betahistine - histamine analogue
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26
Q

Conductive Adult Hearing Loss

A

Impaired conduction between auricle and round window

External canal obstruction
 Wax
 Pus
 Foreign body

TM perforation
 Trauma
 Infection

Ossicle defects
 Otosclerosis
 Infection
 Trauma

Inadequate eustachian tube ventilation of middle ear

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27
Q

Sensorineural Adult Hearing Loss

A

Defects of cochlrea, cochlear Nerve or brain

Drugs

  • aminoglycosides
  • vancomycin

Post-infective

  • meningitis
  • measles
  • mumps
  • herpes

Misc

  • Meniere’s
  • Trauma
  • MS
  • CPA lesion (acoustic neuroma)
  • low B12
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28
Q

Acoustic Neuroma/Vestibular Schwannoma

A

Benign slow growing tumour of superior vestibular nerve

Acts as SOL > cerebellar pontine angle syndrome

assw NF2

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29
Q

Acoustic Neuroma/Vestibular Schwannoma

Presentation

A

 Slow onset, unilat SNHL, tinnitus ± vertigo
 Headache (↑ICP)
 CN palsies: 5,7 and 8
 Cerebellar signs

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30
Q

Acoustic Neuroma/Vestibular Schwannoma

Ix DDx Rx

A

Ix
 MRI of cerebellopontine angle
>MRI all pts. c¯ unilateral tinnitus / deafness
 PTA

Differential
 Meningioma
 Cerebellar astrocytoma
 Mets

Rx
 Gamma knife
 Surgery (risk of hearing loss)

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31
Q

Otosclerosis

A

AD fixation of stapes at oval window F>M

Presents

  • early adult life bilateral conductive deafness + tinnitus
  • HL improved in noisy places - Willis paracousis
  • worsened by pregnancy menstruation/menopause

Ix - PTA shows dip Caharts notch at 2kHz

Rx - hearing aid or stapes implant

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32
Q

Presbyacussis

A

Age related hearing loss

Presentation - >65y

  • bilateral slow onset
  • +/- tinnitus

Ix PTA

Rx - hearing aid

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33
Q

Congenital Hearing loss in Children

A

Conductive
 Anomalies of pinna, external auditory canal, TM or ossicles.
 Congenital cholesteatoma
 Pierre-Robin

SNHL
 AD - Waardenburgs: SNHL, heterochromia + telecanthus

AR
 Alport’s: SNHL + haematuria
 Jewell-Lange-Nielson: SNHL + long QT
 X-linked - Alport’s

Infections: CMV, rubella, HSV, toxo, GBS

Ototoxic drugs

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34
Q

Perinatal causes of hearing loss

A

anoxia
cerebral palsy
kernicterus
infection - meningitis

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35
Q

Acquired causes of hearing loss in children

A

OM/OME
infection - meningitis, measles
head injury

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36
Q

Universal Neonatal Hearing Tests

A

Detection + Mx of hearing loss before 6mo improves language

Tests

  • otoacoustic emissions
  • audiological
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37
Q

Congenital Anomalies

A

 1st and 2nd branchial arches form auricle while 1st
branchial groove forms external auditory canal.

 Malfusion → accessory tags/auricles and preauricular pits, fistulae or sinuses.

 Sinuses may get infected, mimicking a sebaceous
cyst.

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38
Q

Pinna Haematoma

A

Blunt trauma > subperichondrial haematoma

Can > ischaemic necrosis of cartilage + subsequent fibrosis > cauliflower ears

Mx - aspiration + firm packing to auricle contour

39
Q

Exostoses

A

Smooth symmetrical bony narrowing of external canals

Bony hypertrophy due to cold exposure
- from swimming/surfind

Sx - ASx unless narrowing occludes > conductive deaf

40
Q

Wax: Cerum Auris

A

Secreted in outer 3rd of canal to prevent maceration

Wax accumulation can > conductive deafness

Mx - suction under direct vision w microscope
- syringing after 1 wk softening wth oil

41
Q

Tympanic Membrane Perforation

causes

A

OM
Foreign Body
Barotrauma
Trauma

42
Q

Allergic Rhinosinusitis

A

Classification

  • seasonal (hay-fever)
  • perennial

T1HS IgE mediated inflam from allergen exposure > mediator release from mast cells

Allergens - pollen, house dust mites

Sx - sneezing, pruritis, rhinorrhoea

Signs - swollen, pale, boggy turbinates
- nasal polyps

Ix - skin prick testing to find allergens (not if prone to eczema
- RAST tests

43
Q

Allergic Rhinosinusitis Mx

A

Allergen Avoidance
 Regularly washing bedding (inc. toys) on high heat or
use acaricides.
 Avoid going outside when pollen count high.

1st Line
 Anti-histamines: cetirazine, desloratidine
 Or, beclometasone nasal spray
 Or, chromoglycate nasal spray (children)

2nd Line: intranasal steroids + anti-histamines

3rd Line: Zafirlukast

4rd Line: Immunotherapy
 Aim to induce desensitisation to allergen
 OD SL grass-pollen tablets → ↑ QOL in hay-fever
 Injection immunotherapy

Adjuvants
 Nasal decongestants: Pseudoephedrine, Otrivine

44
Q

Sinusitis

A

 Viruses → mucosal oedema and ↓ mucosal ciliary
actions → mucus retention ± 2O bacterial infection
 Acute: Pneumococcus, Haemophilus, Moraxella
 Chronic: S. aureus, anaerobes

Causes
 Majority are bacterial infection 2O to viral
 5% 2O to dental root infections
 Diving / swimming in infected water
 Anatomical susceptibility: deviated septum, polyps

Systemic Disease
 PCD / Kartagener’s
 Immunodeficiency

45
Q

Sinusitis Sx, Imaging

A

Symptoms

Pain
 Maxillary (cheek/teeth)
 Ethmoidal (between eyes)
 ↑ on bending / straining

Discharge: from nose → post-nasal drip c¯ foul taste

Nasal obstruction/congestion
Anosmia or cacosmia (bad smell w/o external source)
Systemic symptoms: e.g. fever

Imaging
 Nasendoscopy ± CT

46
Q

Sinusitis Mx

A

Acute / Single Episode
 Bed-rest, decongestants, analgesia
 Nasal douching and topical steroids
 Abx (e.g. clarithro) of uncertain benefit

Chronic / recurrent
 Usually a structural or drainage problem.
 Stop smoking + fluticasone nasal spray
 Functional Endoscopic Sinus Surgery
 If failed medical therapy
47
Q

Sinusitis Complications

A

 Mucoceles → pyoceles
 Orbital cellulits / abscess
 Osteomyelits – e.g. Staph in frontal bone

Intracranial infection
 Meningitis, encephalitis
 Abscess
 Cavernous sinus thrombosis.

48
Q

Nasal Polyps

Sites
Sx
Signs

A

M 40

Sites - Middle turbinates, middle meatus, ethmoids

Sx

  • Watery anterior rhinorrhoea
  • purulent post nasal drip
  • Nasal obstruction
  • sinusitis
  • headaches
  • snoring

Signs
- Mobile, pale, insensitive

49
Q

Nasal polyp associations

A

 Allergic / non-allergic rhinitis
 CF
 Aspirin hypersensitivity
 Asthma

50
Q

Single Unilateral Polyp

A

May be sign of rare sinister pathology

 Nasopharyngeal Ca
 Glioma
 Lymphoma
 Neuroblastoma
 Sarcoma

Do CT and get histology

51
Q

Nasal Polyp in children

A

Rare <10yrs old
 Must consider neoplasms and CF

Mx
 Drugs
 Betamathasone drops for 2/7
 Short course of oral steroids
 Endoscopic Polypectomy
52
Q

Fractured Nose

A

Anatomy

  • upper 1/3 of nose has bony support
  • lower 2/3 and septum cartilaginous
Hx
 Time of injury
 LOC
 CSF rhinorrhoea
 Epistaxis
 Previous nose injury
 Obstruction

Consider facial #, check for
 Teeth malocclusion
 Piplopia (orbital floor #)

53
Q

Fractured Nose

A

Ix - cartilaginous injury won’t show and radiographs don’t alter Mx

Mx

  • exclude septal haematoma
  • re-examine after 1 wk (decreased swelling)
  • reduction under GA w post-op splinting best w/i 2 weeks
54
Q

Septal Haematoma

A

Septal necrosis + nasal collapse if untreated
 Cartilage blood supply comes from mucosa

Boggy swelling and nasal obstruction

Needs evacuation under GA c¯ packing ± suturing.

55
Q

Epistaxis Causes

A

 80% unknown
 Trauma: nose-picking / #s
 Local infection: URTI

Pyogenic granuloma
 Overgrowth of tissue on Little’s area due to irritation or hormonal factors.

 Osler-Weber-Rendu / HHT
 Coagulopathy: Warfarin, NSAIDs, haemophilia, ↓plats,
vWD, ↑EtOH
 Neoplasm

56
Q

Epistaxis Initial Mx

A

Wear PPE

Assess for shock and manage accordingly

If not shocked
 Sit up, head tilted down
 Compress nasal cartilage for 15min.

If bleeding not controlled remove clots w suction or by
blowing and try to visualise bleed by rhinoscopy

57
Q

Anterior Epistaxis

A 
Usually septal haemorrhage: Little’s area /
Kisselbach’s plexus
 Ant. Ethmoidal A.
 Sphenopalatine A.
 Facial A.

Insert gauze soaked in vasoconstrictotr + LA
 Xylometazoline + 2% lignocaine
 5min

Bleeds can be cauterised w silver nitrate sticks

Persistent bleeds should be packed with Mericel pack
 Refer to ENT if this fails or if you can’t visualise
the bleeding point.
 They may insert a posterior pack or take pt. to
theatre for endoscopic control.

58
Q

Posterior/Major epistaxis

A

Posterior packing (+ anterior pack)
 Pass 18/18G Foley catheter through the nose
into nasopharynx, inflate w 10ml water and pull
forward until it lodges.
 Admit pt. and leave pack for ~48hrs.

Gold standard is endoscopic visualisation and direct control: e.g. by cautery or ligation.

59
Q

Epistaxis After bleed

A 
 Don’t pick nose
 Sit upright, out of the sun
 Avoid bending, lifting or straining
 Sneeze through mouth
 No hot food or drink
 Avoid EtOH and tobacco
60
Q

Osler-Weber-Rendu/HHT

A

AD 5 Genetic Subtypes

Features
- Telangiectasias in mucosae
 Recurrent spontaneous epistaxis
 GI bleed (usually painless)

  • Internal telangiectasias and AVM
     Lungs
     Liver
     Brain

Rarely
 Pulmonary HTN
 Colon polyps: may → CRC

61
Q

Tonsilitis Sx Signs Organisms

A

Symptoms
 Sore throat
 Fever, malaise

Signs
 Lymphadenopathy: esp. jugulodigastric node
 Inflamed tonsils and oropharynx
 Exudates

Organisms
 Viruses are most common (consider EBV)
 GAS: Pyogenes
 Staphs
 Moraxella
62
Q

Tonsilitis Mx

A

Swabbing superficial bacteria is irrelevant and can →
overdiagnosis.

Analgesia: Ibuprofen / Paracetamol ± Difflam gargle

Consider Abx only if ill: use Centor Criteria
 Pen V 250mg PO QDS (125mg TDS in children) or erythromycin for 5/7

NOT AMOXICILLIN → MACPAP RASH IN EBV

63
Q

Centor Criteria

A

Guideline for admin Abx in acute sore throat/tonsilitis/pharyngitis

1 point for

  1. Hx of fever
  2. Tonsillar exudates
  3. Tender anterior cervical adenopathy
  4. No cough

Mx
 0-1: no Abx (risk of strep infection <10%)
 2: consider rapid Ag test + Rx if +ve
 ≥3: Abx

64
Q

Tonsillectomy Indications

A

Recurrent tonsillitis if all the below criteria are met
 Caused by tonsillitis
 5+ episodes/yr
 Symptoms for >1yr
 Episodes are disabling and prevent normal
functioning

Airway obstruction: e.g. OSA in children

Quinsy

Suspicion of Ca: unilateral enlargement or ulceration

65
Q

Tonsillectomy method + complications

A

Cautery or cold steel..

Complications
 Reactive haemorrhage
 Tonsillar gag may damage teeth, TMJ or posterior
pharyngeal wall.
 Mortality is 1/30,000
66
Q

Strep throat complications

Peritonsillar Abscess

A

Quinsy
Typically occurs in adults

Symptoms
 Trismus
 Odonophagia: unable to swallow saliva
 Halitosis

Signs
 Tonsillitis
 Unilateral tonsillar enlargement
 Contralateral uvula displacement
 Cervical lymphadenopathy

Rx
 Admit
 IV Abx
 I&D under LA or tonsillectomy under GA

67
Q

Strep throat complications

Retropharyngeal Abscess

A

Rare

Presents

  • unwell child w stiff, extended neck who refuses to eat + drink
  • fails to improve w IV abx
  • unilateral swelling of tonsil of tonsil + neck

Ix

  • lateral neck XR show soft tissue swelling
  • CT from skull-base to diaphragm

Rx

  • IV abx
  • I+D (incision and drainage)
68
Q

Strep Throat Complications

Lemierre’s Syndrome

A

IJV thrombophlebitis c¯ septic embolization most
commonly affecting the lungs.

Organism: Fusobacterium necrophorum

Rx
 IV Abx: pen G, clinda, metro

69
Q

Strep Throat Complications

Scarlet Fever

A

12-48h after pharyngotonsillitis

Sandpaper like rash on chest, axillae or behind ears

Circumoral pallor

Strawberry tongue

Rx
- Start pen V/G and notify HPA

70
Q

Strep throat complications

Rheumatic Fever

A 
 Carditis
 Arthritis
 Subcutaneous nodules
 Erythema marginatum
 Sydenham’s chorea
71
Q

Strep throat complications

Post-Streptococcal glomerulonephritis

A

Malaise + smoky urine 1-2 weeks after a pharyngitis

72
Q

Larynx Function

A

 Phonation
 Positive thoracic pressure: inc. auto-PEEP
 Respiration
 Prevention of aspiration

73
Q

Laryngitis

A

Usually viral and self-limiting

2O bacterial infection may develop

Symptoms: pain hoarseness and fever

o/e: redness and swelling of the vocal cords

Rx: Supportive, Pen V if necessary

74
Q

Laryngeal Papilloma

A

Pedunculated vocal cord swellings caused by HPV

Present w hoarseness

Usually occur in children

Rx: laser removal

75
Q

Recurrent Laryngeal Nerve Palsy

A

Supplies all intrinsic muscles of the larynx except for
cricothyroideus.
 Ext. branch of sup laryngeal N.

Responsible for ab- and ad-uction of vocal folds

76
Q

Recurrent Laryngeal Nerve Palsy Sx

A

Hoarseness

Breathy voice w bovine cough

Repeated coughing from aspiration (↓ supraglottic
sensation)

Exertional dyspnoea (narrow glottis)

77
Q

Recurrent Laryngeal Nerve Causes

A

30% are cancers: larynx, thyroid, oesophagus,
hypopharynx, bronchus

25% iatrogenic: para- / thyroidectomy, carotid
endarterectomy

Other: aortic aneurysm, bulbar / pseudobulbar palsy

78
Q

Laryngeal Squamous Cell Cancer

A

Assw alcohol, smoking

Presentation
 Male smoker
 Progressive hoarseness → stridor
 Dys-/odono-phagia
 Wt. loss

Ix - laryngoscopy + biopsy (inc nodes)
- MRI staging

Mx - based on stage

  • radiotherapy
  • laryngectomy
79
Q

Laryngeal SCC

After total Laryngectomy

A

Pts have permanent tracheostomy

  • speech valve
  • electrolarynx
  • oesophageal speech (swallowed air)

Regular follow up for recurrence

80
Q

Laryngomalacia

Paeds airway issues

A

Immature and floppy aryepiglottic folds and glottis → laryngeal collapse on inspiration

Presentation
 Stridor: commonest cause in children
Presents w/i first wks of life.

Noticeable @ certain times
 Lying on back,
 Feeding
 Excited/upset

Problems can occur w concurrent laryngeal infections or w feeding.

Mx
 Usually no Rx required but severe cases may warrant surgery

81
Q

Epiglottitis

Paeds Airway Issues

A 
Symptoms
 Sudden onset
 Continuous stridor
 Drooling
 Toxic

Pathogens: haemophilus, GAS

Rx
 Don’t examine throat
 Consult w anaesthetists and ENT surgeons
 O2 + nebulised adrenaline
 IV dexamethasone
 Cefotaxime
 Take to theatre to secure airway by intubation

82
Q

Foreign Body

Paeds airway issues

A

 Sudden onset stridor in a previously normal child.
 Back slaps and abdominal thrusts.
 Needle cricothyrotomy in children
 Can only exclude foreign body in bronchus by
bronchoscopy

83
Q

Subglottic Stenosis

paeds airway issues

A

 Subglottis is narrowest part of respiratory tract in children.

Symptoms: stridor, FTT

Causes
 Prolonged intubation
 Congenital abnormalities

Rx
 Mild: conservative
 Severe: Tracheostomy or partial tracheal resection

84
Q

Bell’s Palsy

path + features

A

Inflammatory oedema f CN7 in narrow facial canal

  • probs viral origin (HSV1)
  • 75% of facial nerve palsies

Features
 Sudden onset: e.g. overnight

Complete, unilateral facial weakness in 24-72h
 Failure of eye closure (Bell’s Sign) → dryness and conjunctivitis
 Drooling, speech difficulty

Numbness or pain around ear

↓ taste (ageusia)

Hyperacusis: stapedius palsy

85
Q

Bell’s Palsy Ix Mx

A

Ix
 Serology: Borrelia or VZV Abs
 MRI: SOL, stroke, MS
 LP

Mx

  • protect eyes (dark glasses, artificial tears, tape closed at night)
  • give prednisolone w/i 72h >60mg PO for 5 days followed by tapering
  • valciclovir if zoster suspected
  • plastic surgery may helpif no recovery
86
Q

Bell’s Palsy Prognosis

A

Incomplete paralysis usually recovers completely w/i wks.

With complete lesions:

80% full recovery
20% delayed recovery or permanent
neurological / cosmetic abnormalities.

87
Q

Bell’s Palsy Complications

A

Synkinesis: e.g. blinking causes up-turning of mouth

Crocodile tears: eating stimulates unilateral lacrimation, not salivation

88
Q

Ramsay Hunt Syndrome

path + Features

A

Reactivation of VZV in geniculate ganglion of CNVII

Features

  • preceding ear pain or stiff neck
  • vesicular rash in auditory canal (+/- TM, pinna, tongue, hard palate)
  • no rash is zoster sine herpete
  • ipsilateral facial weakness, aguesia, hyperacusis
  • may affect CN7 > vertigo, tinnitus, deafness
89
Q

Ramsay Hunt Syndrome

A

Mx - valaciclovir + prednisolone w/i 72h

Prognosis

  • treated w/i 72h 75% recovery
  • otherwise 1/3 recovery, 1/3 partial, 1/3 poor
90
Q

Other facial palsy

not bell’s, ramsay hunt

A

 Bilateral symptoms (Lyme, GBS, leukaemia,
sarcoid)
 UMN signs: sparing of frontalis and orbicularis oculi
 Other CN palsies (but seen in 8% of Bell’s)
 Limb weakness
 Rashes

91
Q

Intracranial lesions and facial palsy

A

Vascular, MS, SOL (space occupying lesion)
 Motor cortex → UMN signs
 Brainstem nuclei → LMN signs

Cerebello-pontine angle lesion
 May be accompanied by 5th, 6th, and 8th CN
palsies

92
Q

Intratemporal/infratemporal lesions + facial palsy

A

Intratemporal lesions

Otitis media
Cholesteatoma
Ramsay Hunt

Infratemporal lesions

  • parotid tumours
  • trauma
93
Q

Systemic facial nerve palsy

A

Peripheral neuropathy
 Demyelinating: GBS
 Axonal: DM, Lyme, HIV, Sarcoid

Pseudopalsy: MG, botulism

D3 (14 decks)

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