Ear, Nose & Throat Flashcards
Deafness/Hearing Loss
Definition
Pathogenesis
Presentation
Investigations
Differentials
Treatment
Definition -
Conductive: external ear problem, tympanic membrane or middle ear
Sensorineural:neurological problem, cochlea, auditory nerve, higher auditory processing pathways
Pathogenesis - Conductive = osteosclerosis, glue ear
Sensorineural = presbycusis, meniere’s, acoustic neuroma, drugs, noise discharge
Presentation - loss of hearing
Investigations - otoscope, Rivne’s and webber’s test
Differentials - cerumen impaction, foreign body, benign tumour, uncomplicated otitis externa
Treatment - reversal/treatment of cause, hearing aids, surgery
Tinnitus
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - perception of sound in the absence of any external auditory stimulus
Epidemiology - 1/3 of all people
Pathogenesis - otological, neurological (MS), hyperlipidaemia, hypothyroidism, psychogenic, vascular: arterial bruits, ototoxic medications: aspirin, NSAID
Presentation - ringing, buzzing, humming, hissing, clicking
Investigations - otoscope, Rivne’s, webber’s, FBC, TFT, Lipids, fasting glucose, MRI head, temporal bone CT, audiometry
Differentials - Ménière’s disease, acoustic neuroma, glomus tumour, otosclerosis, otitis media
Risk Factors - increased age, hearing loss, loud noise exposure, vestibular schwannoma
Treatment - hearing aids, masking device, treatment of underlying cause
Acute otitis media
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Treatment
Definition - infection of middle ear
Epidemiology - children, 6-18 months
Pathogenesis - viral URTI leading to bacterial infection: streptococcus pneumonia, non-typable haemophilia influenzae, mortadella catorhelis
Presentation - otalgia, fever
Investigations - otoscopy (bulging erythematous tympanic membrane with absent landmarks, perforation with purulent otorrhoea, acoustic reflectometry, bacterial culture of middle ear
Differentials - otitis media with effusion, myringitis, mastoiditis, cholesteatoma
Treatment - analgesia, antibiotic therapy: amoxicillin - possible delayed prescription
Otitis Externa
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Treatment
Definition - infection of external ear
Epidemiology - 10% lifetime incidence
Pathogenesis - bacterial infection: pseudomonas aeruginosa, staphylococcus aureus
Presentation - pain, itching, discharge
malignant: deep seated otalgia, temporal headaches, purulent otorrhoea, dysphagia/facial nerve dysfunction
Investigations - pneumatic otoscope, tympanometry, ear culture, microscopy
Differentials - acute otitis media, furunculosis, contact dermatitis of ear canal
Treatment - topical antibiotic ear drops: ciprofloxacin/amoxicillin, analgesia
If malignant: IV antibiotics + ENT referral
Vertigo
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - false sense of body/ environment moving
Epidemiology - 50-70 years, can occur at any age
Pathogenesis - primary/idiopathic
Secondary: head trauma, labyrinthitis, vestibular neuritis, Ménière’s disease, migraines, iatrogenic
Presentation - dizziness, hearing difficulty
Investigations - otoscopy, dix-hallpike manoevure, supine lateral head turns, brain MRI, audiogram
Differentials - meniere’s, vestibular neuritis, labyrinthitis, perilymphatic fistula, migraines, MS
Risk Factors - increased age, female, head trauma, vestibular neuritis, labyrinthitis
Treatment - repositioning manoeuvres
Tonsillitis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - infection of tonsils
Epidemiology - 5-15 years, 100 -1000 per year
Pathogenesis - usually viral: rhinovirus adenovirus, coronavirus, Epstein Barr virus
Bacterial: streptococcus pyogenes
Presentation - pharyngitis, fever, lymphadenopathy, white pustules on tonsils, sever throat pain, uvula deviation
Investigations - examination, throat culture, rapid strep antigen test
Differentials - infectious mononucleosis, epiglottis, peritonsilar abscess, retropharyngeal abscess
Risk Factors - school children
Treatment - paracetamol, consider antibiotics: V Penicillin, benzyl penicillin, amoxicillin/clauvanate
Epistaxis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - nose bleeding
Epidemiology - young and old, 60% incidence
Pathogenesis - littles area of anterior septum, location of kiesselbach plexus
Presentation - bleeding out of one or both nostrils
Investigations - FBC, Group and save, LFTs, CT of nasal sinuses, ECG
Differentials - haemoptysis, haematemesis
Risk Factors - age: more common in young and old, environment: cold, dry, low humidity, air temp variation, pressure, minor trauma
Treatment - Minor: pinch nostrils and lean forward for 20 mins
Major: A-E approach
Vasoconstrictor and local anaesthetic nasal spray
Sinusitis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation of paranasal sinuses
Epidemiology - 0.5-2% viral URTI progress to sinusitis
Pathogenesis - streptococcus pneumonia, haemophilus influenzae, rhinovirus, recent loc al infection, septal deviation
Presentation - facial pain, worse when leaning forward, nasal discharge, headache
Investigations - x-ray, CT sinuses with contrast, nasal endoscopy
Differentials - allergic rhinitis, migraine, adenoiditis
Risk Factors - viral URTI, allergic rhinitis, GORD
Treatment - analgesia, nasal saline, intranasal corticosteroids if >10 days of symptoms
Recurrent = surgical intervention
Nasal Polyps
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - loose connective tissue, oedema, inflammatory cells, glandular cells and capillaries
Epidemiology - 2-4% of general population
Pathogenesis - aetiology unknown, can be associated with adult onset eosinophilic asthma
Presentation - pain, irritation, reduced nasal breathing
Investigations - FBC with differentials, CT sinuses, anterior rhinos copy, nasal endoscopy, biopsy, nasal smear culture, IgE testing
Differentials - neoplasm, congenital lesions, foreign body
Risk Factors - asthma, aspirin sensitivity, allergic fungal rhino sinusitis
Treatment - intranasal corticosteroid, nasal saline irrigation, surgical polypectomy
Allergic Rhinitis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - IgE mediated inflammatory nasal condition
Epidemiology - 30% adults, 40% children
Pathogenesis - genetic, environmental component, genetic - 41 risk loci for allergic rhinitis
Presentation - sneezing, nasal pruritus, fatigue, irritation
Investigations - trial of therapeutic antihistamine or intranasal corticosteroid, allergy skin prick testing, in vitro specific IgE determination
Differentials - non-allergic rhinitis, acute sinusitis, chronic sinusitis, infectious rhinosinusitis
Risk Factors - Fx, age<20, western lifestyle, inadequate exposure to animals in early life
Treatment - intranasal corticosteroid, allergen avoidance, oral antihistamine/intranasal antihistamine
