Ear, Nose and throat conditions Flashcards
What is BPPV?
Benign paroxysmal positional vertigo - a peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements
What causes BPPV?
50-70% occurs without a known cause and is primary
Remainder termed secondary BPPV and associated with a range of underlying conditions
What are the possible underlying conditions for BPPV?
Head trauma Labyrinthitis Vestibular neuronitis Meniere's disease Migraines Ischaemic processes Iatrogenic causes
What are the risk factors for BPPV?
Age Female sex Head trauma Labyrinthitis Inner ear surgery Meniere's disease Otitis media Hypertension GCA Osteoporosis Intubation
What are the signs and symptoms of BPPV?
Specific provoking positions Brief duration of vertigo Episodic vertigo Severe and sudden vertigo Normal otological exam >50 Female sex Positional vertigo without nystagmus
What investigations are done for BPPV?
Dix hallpike manoeuvre
Supine lateral head turns
Audiogram
Brain MRI
What is Meniere’s disease?
Recurrent episodes of tinnitus, paroxysmal vertigo and unilateral fluctuating hearing loss
What causes meniere’s disease?
Unknown but results in over production of endolymph fluid or impaired absorption of endolymph fluid/
When is Meniere’s disease known as meniere’s syndrome?
When it is secondary to one of the known linked disorders
- Vasculitis
- RA
- SLE
What are the risk factors for Meniere’s disease?
Viral infection
Genetic predisposition
Autoimmune diseases (Vasculitis, RA, SLE)
What are the signs and symptoms of Meniere’s disease?
Recurrent vertigo lasting > 20 mins Fluctuating sensorineural hearing loss Tinnitus Sensed aural fullness Loss of balance to one side Headaches Nausea Vomiting
What are the investigations for Meniere’s disease?
No specific test
MRI
Electrocochleography
What is a thyroglossal cyst?
An epithelium-lined fluid filled sac found along the course of descent of the thyroid gland, resulting from incomplete closure of the thyroid’s migration path
What causes a thyroglossal cyst?
The thyroglossal duct is an embryonic remnant of the path of descent of the thyroid gland from the mouth down to its normal position in development.
The duct normally disappears in the 6th week, but if some tissue remains, it may develop a cyst
What are the risk factors for thyroglossal cyst?
Rare familial variants
What are the symptoms of thyroglossal cysts?
A swelling/lump in midline of anterior neck
Usually asymptomatic
May be tender or rapidly enlarge due to infection
What are the signs of thyroglossal cysts?
Midline, smooth, rounded swelling Typically found between thyroid notch and hyoid bone Moves upwards on protrusion of tongue Moves upwards when swallowing Can be transilluminated
What investigations are done for a thyroglossal cysts?
None needed if euthyroid
If cyst is suprahyoid, TFTs should be performed to exclude a lingual thyroid
Ultrasound/MRI
What is tonsillitis?
Infection/inflammation of the parenchyma of the tonsils leading to inflammation. Can be difficult to distinguish from viral pharyngitis
What causes tonsillitis?
Usually viral (e.g. cold or flu) Can be bacterial (Mainly strep. pyogenes)
What are the risk factors for tonsillitis?
Immune deficiency
Family history of tonsillitis or atopy
What are the symptoms of tonsillitis?
Pain in throat Painful swallowing Pain may be referred to ears Abdominal pain (in small children) Headache Loss of voice or changes in voice
What are the signs of tonsillitis?
Red throat
Swollen tonsils (white flecks of pus)
High temperature
Swollen lymph nodes
What are the classical streptococcal features?
Acute onset
Headache
Abdominal pain
Dysphagia
What can be seen on examination of the tonsils on someone with tonsillitis?
Intense erythema of tonsils and pharynx
Yellow exudate
Tender, enlarged anterior cervical glands
What are the investigations for tonsillitis?
Throat swabs and rapid antigen tests can be performed
Swabs may not be able to distinguish between infection and colonisation
