Ear, Nose, and Throat Flashcards
viral sinusitis - sxs, dx, tx
common cold
Sxs: clear rhinorrhea, nasal congestion
- assoc. sx of H/A. cough, sneezing
- duration: < 10 days
PE: erythematous, engorged nasal mucosa
- non-purulent d/c (clear)
Tx: symptomatic
- saline nasal irrigation
- oral decongestion (pseudophedrine)
- nasal decongestant sprays (phenylephrine) - 3 day max for rebound swelling
bacterial sinusitis - acute, subacute, chronic
acute: >1 wk and <4 wk
subacute: 4-12 wks
chronic: > 12 wks
acute bacterial sinusitis - sxs, dx, tx
resulting secondary infection of mucous in sinuses due to stasis
sxs lasting > 10 days or worsening sxs after initial improvement
- facial PAIN
- PURULENT d/c
- fever
dx: clinical at first
- imaging if complications or not improving with ABX tx (CT prefered)
tx:
- AMOX: 7-10 days
- Macrolide (erythromycin, azithromycin) if PEN allergy
- Fluoroquinolones (Levaquin) if recent ABX or tx failure
Also supportive care w/ NSAIDS, etc.
chronic sinusitis
sinusitis lasting > 12 weeks
tx:
- intranasal corticosteroids (fluticasone)
- longer AMX tx: doxycycline (3 wls)
allergic rhinitis - sxs, tx
personal hx of atopy, seasonal
sxs: congestion, clear rhinorrhea
- EYE irritation (pruritus), sneezing
- cobble-stoning of posterior pharynx
- darkening under eyes
Tx:
- avoid allergen
- intranasal corticosteroids (delay onset of relief of 2 wks)
- OTC antihistmines in mean time
antihistamines - non-sedating vs. sedating
non-sedating (“-dine”)
- loradadine, fexafenadine
- hint: ok to dine
minimally sedating: cetirizine
sedating (“-mine”)
- brompheniramine, chlorpheniramine
- hint: sleep is mine
epistaxis - causes of anterior and posterior nasal cavity bleeds
nose bleed
- usually unilateral
Anterior nasal cavity (Kiesselbach plexus)
- causes: trauma, forceful blowing, rhinitis, dryness
- tx: direct pressure (nose clamp) and lean forward
- also cautery, packing
Posterior nasal cavity bleed
- assoc. w/ HTN, atherosclerosis
- tx: posterior packing referred to ENT
foreign body
occurs in PEDS to adults who are developmentally disabled
sxs:
- unilateral purulent nasal d/c
- foul smelling odor
- sneezing, bleeding, pain, mouth breathing
tx: removal, refer to ENT
nasal polyps
pale, boggy nasal mass (“grape-like” structure)
- commonly seen in pts w/ allergic rhinitis, aspirin sensitivity, asthma
Sxs:
- unilateral
- NOT sensitive to probing (vs. a foreign body that would be sensitive)
Tx:
- topical corticosteroids (1-3 mo)
- short-course oral steroids follow by topical nasal corticosteroids (severe)
- CT is not improving - surgery
aphthous ulcers - definition, duration, sxs, tx
canker sore
- common, found on non-keratinized mucosal surface
- painful, shallow ulcerations surrounded by red hallow
- last 7-10 days (painful), heal in 1-3 wks
risks: stress, acidic foods
tx: supportive
- topical corticosteroids (orabase = triamcinolone acetonide in adhesive base)
oral herpes simplex - definition, cause, sxs, tx
cold sores
- prodromal: tingling
- small vesicles, rupture, scab formation
- primary infection more severe
- recurrent on vermilion border (mild, self-limited)
- cause: HSV-1 > HSV-2
risks: stress, infection, trauma, sun exposure
tx:
- none or antiviral topical cream (acyclovir)
- first episode: systemic antiviral (acyclovir, valacyclovir)
Note: prevention of frequency recurrence: suppressive therapy w/ valacyclovir QD 5-7 yrs
oral candidiasis (thrush)
painful, intermittent sores in mouth
- creamy white patches over red mucosa
- CAN BY RUBBED OFF
risks: dentures, immune-compromised, recent steroids or ABX
- can be initial manifestation of HIV
dx:
- clinical
- biopsy if unclear (spores on wet prep)
tx:
- -azole (7 days)
- clotrimazole troches
- nystatin mouth rinse
oral leukoplakia - sxs, risks, dx, tx
white lesions caused by chronic irritation (dentures, tobacco)
- CANNOT be scraped off
- may be dysplasia or early squamous cell CA (ETOH or tobacco risks for SCC)
dx: biopsy or scraping
tx:
- ENT, surgical removal possible
acute pharyngitis - viral vs. bacterial
sore throat (common) - viral vs. bacterial key to identify strep and tx to avoid complications
viral:
- cough, rhinorrhea w/ no tonsillar exudate
bacterial (Centor Criteria):
- fever, tender ant. cervical nodes, NO cough, tonsillar exudate/petechiae, severe
- score determines ABX treatment (Pen V for adults, Amox for kids) vs. culture vs. symptomatic
complications of strep pharyngitis
antibody people make to group A strep can recognize normal protein on heart valves and attack it (think it’s foreign)
- rheumatic fever (myocarditis)
Post-strep: complexes between antibody and strep antigens deposit in the kidney = glomerulonephritis
scarlet fever: bright red rash
local abscess formation
GAS pharyngitis - tx
PEN V: adults
- if PEN allergy use macrolide: erythromycin or azithromycin
Note: Amox: kids (tastes better, only BID)
NOTE: do not Rx amox if possibly EBV (mono) - RASH
mononucleosis (EBV) - sxs and tx
sxs:
- adenopathy
- tonsillar exudate
- YOUNG ADULT
- ORGANOMEGALY
1/3 of pts w/ EBV also have secondary GA/B strep pharyngitis
Tx: must AVOID AMOX
peritonsillar abscess - sxs, PE, dx, tx
infection that penetrate tonsillar capsule and invades surrounding tissue
sxs:
- severe sore throat, odynophagia, trismus (lock jaw), muffled voice (“hot potato”)
PE: medial deviation of soft palate and uvula
Dx: clinical; needle aspiration to confirm
Tx:
- ABX: IV Amox in ED, PO Amox, Augmentin, Clindamcin
- needle aspiration, I&D are controversial
dental abscess - sxs, dx, tx
deep infection in periodontal tissue around tooth
- usually from untreated dental caries
Dx: clinical
Tx: refer to dentist for I&D, tooth extraction
- ABX (PEN), NSAIDS
complication: can get deep neck infection (Ludwig angina)
- emergency (airway compromise)
- tx: PEN and Flagyl (IV)
epiglottitis - sxs, dx, tx
upper airway inflammation and obstruction
- can occur at any age
- most common in diabetic pts
sxs: rapidly developing SORE THROAT
- odynophagia (painful swallow) out of proportion to exam
- fever, drooling, voice change, sniffing position (try to get air in)
Dx: clinical
- thumbprint sign on lateral neck x-ray
Tx:
- ADMIT (airway obs)
- IV ABX (broad spectrum cephalosporin)
- corticosteroids
- prophylactic intubation may occur (PEDS)
laryngitis - sxs, tx, cancer hints
most common cause of HOARSENESS
- occurs 1 wk following URI
- difficulty talking
- cough
- usually viral
Tx: conservative
- rest, fluids
Laryngeal squamous cell carcinoma
- new, persistent hoarsness (> 2wks) & smoker
- pain, hemoptysis, issue swallowing
- dx: laryngoscopy and biopsy
- tx: radiation, surgery, chemo (if advanced)
sialadenitis - definition and cause / location
inflammation of salivary gland - most common parotid (cause: MUMPS; location: inner cheek near maxilla 2nd molar) and submandibular (cause: stones; location: under tongue)
- ductal obstruction leads to salivary stasis and infection
sialadenitis - presentation, tx
occurs in setting of dehydration or chronic illness (Sjogren syndrome)
- acute swelling of gland
- postprandial pain
Tx:
- ABX (PO Augmentin; IV nafcillin)
- inc. salivary flow: hydration, sucking on lemon drops
parotitis - cause, sxs, dx, tx
cause: MUMPS (paramyxovirus)
- often occurs in dorms, sports teams
sxs:
- prodromal sxs: malaise, HA, anorexia, fever
- swelling of parotid gland area
- earache, jaw tenderness, ear lobe lifted forward
dx: clinical (can confirm w/ labs)
tx: supportive care
- isolation (5 days); recovery 1-2 wks
hematoma of external ear - cause, sxs, dx, tx
cause: trauma or blunt force to ear
sxs: tender auricle, fluctuant collection of blood, ecchymosis
dx: clinical
tx:
- drain and packing
- referral to ENT if lasting >1 wk
complication: cauliflower ear
hearing impairment - 3 types
conductive: problem of external or middle ear affects sound getting to inner ear
- cause: obstruction (cerumen impaction), infection
- tx: correctable w/ medical or surgical tx
sensory (sensorineural): due to cochlear deterioration
- gradual, high frequency loss, occurs w/ aging (presbyacusis), noise, trauma
- tx: NOT correctable, but can be stabilized or prevented
neural: lesions of nerve or neural pathway in CNS
- acoustic neuroma, MS
hearing impairment - testing
Weber: test for lateralization
- normal: heard equal in both ears
Rinne: compares air conduction and bone conduction
- normal: air conduction heard longer than bone conduction
conductive loss:
- Weber lateralizes to impaired ear
- Rinne shows BC>AC in impaired ear
sensorineural loss:
- Weber lateralizes to better ear
- Rinne shows AC>BC in both ears
cerumen impaction
obstruction of canal by cerumen
- hearing loss (unilateral)
- itchy, painful
tx: removal
- ear drops (debrox)
- curette
- irrigation
eustachian tube dysfunction
normally closed and opens only during yawn or swallow
dysfunction: air trapped in middle ear causes negative pressure
- usually from viral URI or allergy
sxs: fullness, hearing fluctuation, discomfort w/ barometric changes
tx: systemic and intranasal decongestants
- pseudoephedrine
- oxymetazoline spray
barotrauma - definition, sxs, tx
injury caused by changes in atmospheric pressure
- occurs w/ eustachian tube dysfunction during air travel, diving, altitude change
sxs: pain, hearing loss
tx:
- decongestants prior to episode
- swallow, yawn
- myringotomy (small eardrum perforation) if severe
tympanic membrane perforation - cause
causes: trauma to middle ear, pressure changes, chronic otitis media, iatrogenic (during foreign body removal)
sxs:
- sudden ear pain that suddenly gets better
- see tear on otoscopic exam
tx:
- most heal spontaneously
- ENT can follow
- avoid water exposure (swimming, etc.)
- ABX - only if caused by AOM
cholesteatoma
trapped skin from eustachian tube dysfx causes white mass behind TM
- will keep growing so much remove
- key: differentiate from tympanosclerosis (scar from PE tubes) - benign
tx: REFER!
- surgical removal
mastoiditis
inflammation of mastoid air cells inside mastoid process
- occurs weeks after otitis media that was inadequately treated
- more common in kids
sxs: postauricular pain, erythema, fever, forward auricular displacement
dx: clinical
tx: IV ABX (cefazolin)
- myringotomy (TM incision for drain/culture)
- surgical drainage or mastoidectomy (w/ med failure)
tinnitus
perceived sound in absence of exogenous sound source
- often indicates sensorineural hearing loss
dx:
- non-pulsatile: audiometry to r/o hearing loss
- unilateral: MRI to r/o vestibular schwannoma
- Pulsatile: MRA and venography to r/o vascular lesion
tx:
- avoid: excessive noise, ototoxic agents, trauma
- find and treat cause
vertigo - definition and hx components
sensation of motion when there is no motion or only small motion (exaggerated)
- spinning, tumbling, falling
History differentiates peripheral vs. central
- duration of episodes
- associated hearing loss
- triggers: ETOH, stress, high salt diet (Meniere dz)
vertigo - peripheral vs. central causes
- limit to those on blueprint
peripheral:
- labyrinthitis
- Meniere disease
- Benign positional vertigo (Dicks-Hallpike) (not on blue print)
mixed central and peripheral:
- vestibular schwannoma
- migraine, infection (not on blue print)
central: MS, seizures, Wernicke encephalopathy
- none on blue print
peripheral vertigo - origin, sxs
otologic origin
sxs:
- sudden onset
- tinnitus and hearing loss
- N/V
- horizontal nystagmus w/ rotary component
- unidirectional
- suppressed by visual fixation
central vertigo - sxs
CNS origin
sxs:
- gradual onset
- NO auditory sxs
- nonfatiguable vertical nystagmus
- NOT suppressed by visual fixation
Meniere’s disease - definition, 4 clinical findings, PE, tx
increased volume of endolymph (fluid) in ear causes pressure changes
4 findings:
- episodic vertigo: minutes to hours
- hearing loss
- tinnitus: low pitched blowing
- unilateral aural pressure
PE:
- horizontal nystagmus
- unilateral hearing loss
tx: lower pressure
- low salt diet
- diuretics
sx relief w/ meclizine or valium
labyrinthitis - clinical findings, cause, tx
peripheral vertigo:
- acute onset, continuous, severe
- lasts days to weeks
- hearing loss, tinnitus
- takes weeks to improve
cause: unknown, following URI
Tx: bed rest
acoustic neuroma - 8th CN schwannoma - definition, sxs, dx, tx
common intracranial tumor
- BENIGN
sxs:
- unilateral hearing loss
- dec. speech discrimination
- continuous disequilibrium
dx: MRI
tx: depends on patient’s age and tumor size
