ENT 1 Flashcards
Acute otitis media is extremely common in young children, with around half of children having three or more episodes by the age of 3 years.
What are the common causative agents?
(URTIs) typically precede otitis media as they disrupt the nasal microbiome
most infections are bacterial: Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
How does otitis media present?
recent viral URTI
fever
otalgia (children may tug their ear)
hearing loss
ear discharge may occur if the tympanic membrane perforates
What may you find on otoscopy of acute otitis media?
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope
What clinical criteria is commonly used for dx of otitis media?
acute onset of symptoms (otalgia or ear tugging)
presence of a middle ear effusion
inflammation of the tympanic membrane (erythema)
How can acute otitis media be managed?
generally a self-limiting condition that does not require antibiotics
good analgesia
advise to return if worse / not improved after 2 days
When should patients with otitis media receive abx?
Symptoms for > 4 days or not improving
Systemically unwell
Perforation and/or discharge in the canal
Younger than 2 years with bilateral otitis media
Immunocompromise or high risk of complications
What abx can be given for prolonged / complicated otitis media?
5-7 day course of amoxicillin is first-line
erythromycin or clarithromycin if pencillin allergic
What are the potential complications of acute otitis media?
mastoiditis
meningitis
brain abscess
facial nerve paralysis
Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses.
What are the most common causative agents?
Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses
What factors predispose to developing acute sinusitis?
nasal obstruction e.g. septal deviation or nasal polyps
recent local infection e.g. rhinitis or dental extraction
swimming/diving
smoking
What features may acute sinusitis present with?
facial pain: frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction
How can acute sinusitis be managed?
analgesia
intranasal decongestants or nasal saline
intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required
What is the ‘double sickening’?
when an initial viral sinusitis worsens due to secondary bacterial infection
Allergic rhinitis is an inflammatory disorder of the nose where the nose become sensitized to allergens.
How may it be classified?
seasonal
perennial
occupational
How may allergic rhinitis present?
sneezing
nasal pruritus
bilateral nasal obstruction
clear nasal discharge
post-nasal drip
How can allergic rhinitis be managed?
allergen avoidance
mild-to-moderate sxs:
oral or intranasal antihistamines
moderate-to-severe sxs:
intranasal corticosteroids
a short course of oral corticosteroids are occasionally needed to cover important life events
Short courses of topical nasal decongestants (e.g. oxymetazoline) can be used to control allergic rhinitis.
Why can longer courses not be prescribed?
increasing doses are required to achieve the same effect (tachyphylaxis)
rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal
Audiograms are usually the first-line investigation that is performed when a patient complains of hearing difficulties.
What are the rules for audiogram interpretation?
anything above the 20dB line is essentially normal
in sensorineural hearing loss both air and bone conduction are impaired
in conductive hearing loss only air conduction is impaired
in mixed hearing loss both air and bone conduction are impaired
Auricular haematomas are common in rugby players and wrestlers. How should these be managed?
prompt tx to avoid cauliflower ear
same-day assessment by ENT
incision and drainage has been shown to be superior to needle aspiration
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo.
What is the usual patient group?
average age of onset is 55 years and it is less common in younger patients
How does BPPV present?
vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
may be associated with nausea
each episode typically lasts 10-20 seconds
What is the clinical test for BPPV?
Dix-Hallpike manoeuvre
rapidly lower the patient to the supine position with an extended neck
a positive test recreates the symptoms of BPPV and induces rotatory nystagmus
BPPV has a good prognosis and usually resolves spontaneously after a few weeks to months.
Symptomatic relief may be gained by:
Epley manoeuvre (successful for 80%)
Vestibular rehabilitation exercises to do at home (e.g. Brandt-Daroff exercises)
Betahistine often prescribed but it tends to be of limited value
What does the Epley manoeuvre involve?
involves patient turning their head in a series of movements
specifically designed to use gravity to dislodge the crystals from the semi-circular canals
Black hairy tongue is relatively common condition which results from defective desquamation of the filiform papillae.
What are the predisposing factors?
poor oral hygiene
antibiotics
head and neck radiation
HIV
intravenous drug use
How should black hairy tongue be managed?
tongue should be swabbed to exclude Candida, if +ve then use topical antifungals
tongue scraping
Give some ddx for a neck lump
congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
inflammatory: reactive lymphadenopathy, lymphadenitis
neoplastic: lymphoma, thyroid tumour, salivary gland tumour
Branchial cysts are benign, developmental defects of the branchial arches.
How do they present?
present in late childhood or early adulthood
asymptomatic lateral neck lumps
usually located anterior to the sternocleidomastoid muscle
How do branchial cysts present on examination?
slowly enlarging
smooth, soft, fluctuant
non-tender
no transillumination
no movement on swallowing
a fistula may be seen
How can you investigate a branchial cyst?
consider and exclude malignancy
ultrasound
referral to ENT for fine-needle aspiration
What is a cholesteatoma?
a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction
most common in patients aged 10-20 years
What is the biggest risk factor for developing a cholesteatoma?
cleft palate (increases risk by 100 fold)
How do cholesteatomas present?
foul-smelling, non-resolving otorrhea
hearing loss
local invasion:
vertigo
facial nerve palsy
cerebellopontine angle syndrome
How can cholesteatomas be investigated and managed?
Otoscopy: ‘attic crust’ - seen in the uppermost part of the ear drum
Management: referred to ENT for consideration of surgical removal
What is chronic rhinosinusitis?
an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer
What factors predispose to developing chronic rhinosinusitis?
atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking