ENT Flashcards
Meniere’s Disease presentation
episodic sudden onset vertigo
low frequency hearing loss
low frequency roaring tinnitus
sensation of fullness in ear
Meniere’s Disease pathophysiology
over production / impaired absorption of endolymph in inner ear
possibly: viral infection / autoimmunity / allergies
Meniere’s Disease investigation
Ref to ENT
- sensorineural HL
Meniere’s Disease management
No cure v Pressure: diet, thiazide diuretics Sx: antihistamines, benzo, phenothiazine, anticholinergics HL management: corticosteroids Intratympanic therapy Meniett device Rehabilitation therapy Inform DVLA (X driving - sudden onset vertigo)
Presbycusis pathophysiology
age related SN HL
progressie and irreversible damage to hair cells of organ of Corti > impaired hearing
Presbycusis clinical features
progressive BL HL (higher frequencies)
> 60 y/o
difficulty hearing
linked to depression + social isolation
Presbycusis investigations
pure tone audiometry
speech audiometry
Presbycusis management
hearing aids
speech to text
cochlear implants
family support
Mastoiditis pathophysiology and causes
infection of mastoid air cells surrounding middle + inner ear
- AOM / COM
- choleasteoma
- mastoid bone injury
Mastoiditis management
Abx
myringotomy
mastoidectomy
Mastoiditis complications
facial paralysis labrynthitis (n/v, vertigo) cerebral blood clots > headaches, visual changes cerebral abscess meningitis
Cholesteatoma features
abnormal growth of skin cells in middle ear / mastoid air cells > disruption of ossicles and tympanic membrane => hearing loss / tinnitus, purulent discharge, +/- TM perf
Cholesteatoma investigations
TM retraction pocket / perf crust / kertainisation mass behind TM purulent discharge Conductive HL + abnormal audiogram
Cholesteatoma management
routine ENT referral (semi-urgent) - surgery
Aural discharge: topical Abx
Acute sinusitis pathogen
aka rhinosinusitis
= viral URTI
Acute sinusitis features
<12 weeks presentation (> is chronic) nasal blockage discharge pain / headache cough discharge + oedema fever
acute sinusitis complications
polyps
cerebral abscess
meningitis
acute sinusitis management
consider Abx
symptomatic management
adv re natural course of infection
ENT ref if sev / atypical sx
chronic sinusitis management
IN corticosteroids
nasal irrigation
ENT ref if sev / atypical sx
LT Abx
thyrotoxicosis management
carbamazepine
beta blocks (sx)
surgery
radioactive iodine
how to differentiate vestibular neuritis and labrynthitis
both inflammation of vestibulocochlear nerve
vestibular neuritis = x tinnitus / HL
labrynthitis = tinnitus + HL
labrynthitis features
= inflammation of vestibulocochlear nerve due to viral / bac infection sev vertigo HL tinnitis nystagmus n/v anxiety malaise
Labrynthitis investigations
diagnosis of exclusion
= nystagmus, hearing + balance test, neurological examination
= complete history + viral URTI history
Labrynthitis management
typically self limiting 4-6 weeks
nausea: antihistamines + antiemetics
ref: vestibulocochlear rehabilitation
Allergic rhinitis pathophysiology
inflammatory condition of the URT
IgE associated response to environmental allergens
Nasal polyps management
IN corticosteroids
nasal saline irrigation
nasal polypectomy
Allergic rhinitis management
Allergen avoidance
antihistamines (oral / IN)
IN corticosteroids
LTRA
BPPV =
benign paroxysmal positional vertigo
BPPV pathophysiology and causes
= otoliths (abnormal crystals) > semicircular canals, movement disrupts laminar flow of endolymph and + follicular hair cells > interpreted as movement => vertigo
idiopathic, inner ear disorders, surgery
BPPV clinical features
dizziness + vertigo n/v nystagmus balance problems post sudden movement (temporary but sudden onset)
BPPV investigations
electronyastamography ie. record nystagmus
MRI (to detect other inner ear disorders)
BPPV management
spontaneous resolvement
- sx: antihistamines + antiemetics
- Canalith respositionning
- Epley maneuver
- change lifestyle (movements / sports / diet)
- soft collar support
- surgery = canal plugging
Nasal fracture complications
septal haematoma
req urgent drainage
Vestibulopathy pathophysiology
damage to inner ears
=> dizziness, imbalance, nausea, visual problems, hearing loss, high falls risk
