ENT Flashcards
CN I: Olfactory nerve
Nerve type: sensory
Function: smell
exits skull via cribriform plate
palsy most commonly due to trauma to lateral/occipital regions, intracranial space occupying lesions
clinical features: anosmia
testing: identifying certain smells e.g. mint
CN II: Optic nerve
Nerve type: sensory
Function:
vision & afferent leg of pupillary light reflex
exits skull via optic canal
Causes of palsy: infection, tumours, ischaemic optic neuropathy, inflammation (MS), drugs (e.g. amiodarone, ethambutol)
clinical features:
impaired vision, ipsilateral blindness & absent direct pupillary light reflex
testing: visual fields, visual acuity, fundoscopy
CN III: Oculomotor nerve
Nerve type: somatic & parasympathetic motor
Function:
- eye movements (superior rectus (elevation/intorsion/adduction), inferior rectus (depression/extorsion),medial rectus (adduction), inferior oblique (extorsion/elevation/abduction)
- eyelid opening, pupillary constriction (efferent limb of pupillary light reflex), accommodation
exits skull via superior orbital fissure
Causes of palsy: strokes, MS, myasthenia gravis, aneurysms
clinical features:
down & out gaze, ptosis, weak adduction, horizontal diplopia, absent pupillary light reflex (both direct & indirect)
testing: ocular/extraoccular movements, pupillary response
NB parasympathetic fibres are on the outside so compression causes pupillary dilation before motor dysfunction
CN IV: Abducens nerve
Nerve type: motor
Function: eye movements (superior oblique (intorsion, depression, abduction))
exits skull via SOF
Causes of palsy: cavernous sinus thrombosis, microvascular damage
clinical features:
extortion of eye (inability to depress & adduct simultaneously) & diplopia (exacerbated on downward age e.g. going down stairs, reading)
testing: eye movements
CN V: Trigeminal nerve
Nerve type: sensory (V1/V2/V3) & motor (V3)
Function: facial sensation (V1 = ophthalmic, V2 = maxillary, V3 = mandibular), afferent limb of corneal reflex & jaw jerk reflex, muscle of mastication (V3)
exits skull via SOF (V1), foramen rotundum (V2), foramen ovale (V3)
Causes of palsy: cavernous sinus thrombosis, vascular compression
clinical features:
V1 = absent corneal reflex, loss of sensation to ipsilateral forehead
V2 = loss of sensation to ipsilateral midface
V3 = anaesthesia of lower 1/3 of face, anterior 2/3 of tongue, paresis of ipsilateral muscles of mastication & diminished jaw jerk reflex
testing: facial sensation, corneal reflex, jaw jerk, muscle of mastication
CN VI: Trochlear nerve
Nerve type: motor
Function: eye movements (lateral rectus = abduction)
exits skull via SOF
Causes of palsy: cavernous sinus thrombosis, diabetic neuropathy
clinical features:
horizontal diplopia worse when looking at far objects, esotropia (medial deviation of eye on neutral gaze), inability to abduct eye
testing: eye movements
NB most common ocular nerve plays
CN VII: Facial nerve
Nerve type: sensory, somatic & parasympathetic motor
Function:
taste (anterior 2/3 of tongue), sensation to tympanic membrane
muscles of facial expression, efferent limb of corneal reflex
salivation & lacrimation (submandibular/sublingual/lacrimal glands)
exits skull via internal acoustic meatus
clinical features:
flaccid paralysis of face, loss of taste, hyperacusis, loss of corneal reflex
testing: facial expression
CN VIII: Vestibulocochlear nerve
Nerve type: sensory
Function:
balance & equilibrium (vestibular)
hearing (cochlear)
exits skull via internal acoustic meatus
Causes of palsy:bacterial meningitis, lyme disease, acoustic neuroma, neurofibromatosis 2, basilar skull fracture
clinical features:
sensorineural hearing loss, vertigo, motion sickness, horizontal nystagmus
testing: audiometry (hearing test, Weber’s & Rhinnes)
CN IX: Glossopharyngeal nerve
Nerve type: sensory & somatic/parasympathetic motor
Function:
taste (posterior 1/3 of tongue), afferent limb of gag reflex
carotid sinus/body (chemo & baroreceptors)
swallowing, innervates stylopharyngeus
salivation (parotid gland), sensation to posterior 1/3 of tongue/soft palate/upper pharynx
exits skull via jugular foramen
clinical features:
absent gag reflex, loss of carotid sinus reflex, sensory loss of back of mouth & upper throat, mild dysphagia
CN X: Vagus nerve
Nerve type: somatic/visceral sensory & somatic/parasympathetic motor
Function:
sensation (supraglottic region, larynx, trachea), couch reflex , efferent limb of gag reflex, swallowing (pharyngeal muscles) speech (laryngeal muscles via recurrent laryngeal nerve), SA & AV node innervation
exits skull via jugular foramen
Causes of palsy: trauma, diabetes inflammation
clinical features:
flaccid paralysis & ipsilateral lowing of soft palate, dysphagia, loss of gaga & cough reflex, uvuala deviation away from lesion, dysphonia (unilateral recurrent laryngeal) or aphonia (bilateral)
CN XI: Accessory nerve
Nerve type: motor
Function: head turn via sternocleidomastoid, shoulder elevation via trapezius
exits skull via jugular foramen
clinical features:
paresis, atrophy, asymmetry of sternocleidomastoid & trapezius, ipsilateral shoulder drooping & lateral winging of scapula
CN XII: Hypoglossal nerve
Nerve type: motor
Function: tongue protrusion (intrinsic & extrinsic muscled of tongue)
exits skull via hypoglossal canal
clinical features:
fasciculations & atrophy of tongue, tongue deviated towards lesion
Tonsillitis
an infection of the parenchyma of the palatine tonsils, frequently occurring i combination with inflammation of the pharynx = tonsilopharyngitis
common in children & young adults
Aetiology of tonsillitis
Viral (50-80%)
adenovirus, EBV, CMV,
Bacterial (15-30%) strep progenes (Group A strep)
NB viral = cough, bacterial = no cough
Presentation of tonsillitis
pain in throat/sore throat dysphagia fever lymphadenopathy headache tonsillar exudates tonsillar erythema tonsillar enlargement
Investigations for tonsillitis
throat culture
rapid streptococcal antigen test
Management of tonsillitis
Viral:
self limiting, supportive (antipyretics, analgesia)
Bacterial:
if confirmed on swab/antigen test or CENTOR score >3
5-10 day course of phenoxymethylpenicillin (erythromycin/clarithromycin if penicillin allergy)
Surgical:
tonsillectomy, if recurrent (≥5x in previous year) / chronic episodes
CENTOR criteria
The Centor criteria are: score 1 point for each
- presence of tonsillar exudate
- tender anterior cervical lymphadenopathy/lymphadenitis
- history of fever
- absence of cough
- age (<15 yrs = +1 point, >44 yrs = -1 point)
Abx indicated if CENTOR score >3
Peritonsillar abscess (Quinsy)
ENT emergency
usually in bacterial tonsillitis, seen in young adults & adolescents
presentation includes features of tonsillitis, drooling, severe throat pain, trismus, halitosis, ‘hot potato’ voice, contralateral uvula devotion, ↓ neck mobility
management:
1st line: needle aspiration or incision & drainage + Abx
2nd line: tonsillectomy, considered 6 weeks after
Acute otitis media (AOM)
a painful infection of the middle ear, generally secondary to a viral URTI as a bacterial superinfection e.g. due to strep pneumonia/H. influenzae/moraxella catarrhalis
very common in children (~80% experience AOM by age 3)
Presentation of Acute otitis media (AOM)
throbbing otalgia/earache
young children may be irritable & repeatedly touching/tugging at ear
hearing loss in affected ear
fever
otrohoea (if tympanic membrane perforated)
preceding URTI (coryza, rhinorrhoae etc)
Investigations of Acute otitis media (AOM)
Otoscopy (bulging tympanic membrane, opacification/erythema of tympanic membrane, visible perforation, purulent discharge from ear canal)
Weber’s/Rhinne’s test (conductive hearing loss)
consider culturing discharge
Management of Acute otitis media (AOM)
generally self limiting (~80%)
=pain relief & observation
Abx
1st line: amoxicillin (erythromycin if penicillin allergy)
indications for Abx
if >4 days of symptoms/no improvement, systemically unwell, bilateral AOM in <2y/o, perforation/discharge, immunocompromise
Indications for giving Abx in Acute otitis media (AOM)
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Otitis media with effusion (OME)
or glue ear
chronic mucoid/serous effusion in the tympanic cavity in the absence of infection lasting >3 months, though to be due to eustachian tube dysfunction causing fluid to accumulate
most common cause of hearing impairment in childhood, where it usually follow and episode of AOM
usually seen age 1-6 yrs
Risk factors for Otitis media with effusion (OME)
craniofacial malformations e.g. cleft palate
Down’s syndrome
allergic rhinitis
impaired ciliary motility e.g. cystic fibrosis
Presentation of Otitis media with effusion (OME)
hearing loss*
presents as mishearing, difficulty communicating in a group, needing thing to be repeated, excessively high TV volume
painless sensation of pressure
school progress may be impaired
easily missed in young children
Otitis media with effusion (OME) in adults
acute unilateral presentation in adults should trigger thoughts of nasopharyngeal carcinoma
Investigating Otitis media with effusion (OME)
hearing test (mild conductive hearing loss i.e. ↓20-40 dB)
Otitis media with effusion (OME) management
generally self limiting
1st line: active observation
2nd line surgery e.g. tympanovstomy tubes (grommets)
indications for surgery:
bilateral OME ≥3 months, hearing loss >30dB, developmental/educational difficulties
Chronic suppurative otitis media (CSOM)
chronic inflammation of the middle ear & mastoid cavity with persistent drainage from the middle ear through a perforated tympanic membrane lasting >6-12 weeks
generally caused by bacterial infection following perforated tympanic membrane e.g. due to recurrent AOM, trauma, tympanostomy
most common seen in those <15 y/o
Presentation of Chronic suppurative otitis media (CSOM)
painless recurrent otorrhoea conductive hearing loss no pain no fever perforated tympanic membrane on otoscopy
Complications of Chronic suppurative otitis media (CSOM)
cholesteatoma (keratinising epithelium growing into middle ear)
hearing loss may improve but may not fully recover
Management of Chronic suppurative otitis media (CSOM)
specialist (ENT) referral
topical Abx
rinsing/cleaning of ear
topical steroids
Infective labyrinthitis
inflammation/infection of the inner ear
frequently secondary to AOM, where it spreads through the road window
presents with severe vertigo, nausea, sensorineural hearing loss, nystagmus towards healthy ear
management with IV Abx, tympanostomy, glucocorticoids
Otitis externa
acute otitis external (AOE) is a diffuse inflammation of the external ear canal which may involve the pinna or tympanic membrane, also known as swimmers ear
Aetiology of otitis externa
most common bacterial infection e.g staph aureus, pseudomonas aeruginosa
fungal is less common, but usually aspergillum
non infectious e.g. seborrhoeic dermatitis or contact dermatitis
Risk factors for otitis externa
hot/humid climates swimming local trauma diabetes external auditory canal obstruction
Presentation of otitis externa
intense itching of external ear canal ear pain tender tragus ear canal swelling & erythema otorrhoea aural fullness conductive hearing loss
Management of otitis externa
1st line: topical Abx e.g. neomycin ± steroids
2nd line: ENT referral + systemic flucloxacillin + swab for culture
Perichondritis
infection of the tissue covering the cartilage of the pinna, usually after trauma e.g. piercing
Malignant otits externa (necrotising otitis externa)
a necrotising inflammation of the external ear canal, i.e. an infection extending into the bony ear canal & deep soft tissue
95% of cases are due to pseudomonas aeruginosa
risk factors include poorly controlled diabetes, immunosuppression, elderly
Malignant otits externa (necrotising otitis externa)
a necrotising inflammation of the external ear canal, i.e. an infection extending into the bony ear canal & deep soft tissue
95% of cases are due to pseudomonas aeruginosa
risk factors include poorly controlled diabetes, immunosuppression, elderly
Malignant otitis externa presentation
typically elderly pt with poorly controlled diabetes
severe ear pain, erythematous/swollen periauricular soft tissue, otorrhoea,
may have facial nerve palsy
Complication of Malignant otitis externa
osteomyelitis of the skull base, which may cause intracranial expansion of the infection
Investigations for Malignant otitis externa
CT/MRI (identify bone destruction & intracranial expansion e.g. cranial abscess or venous sinus thrombosis)
biopsy (to distinguish from a tumour)
Treatment of Malignant otitis externa
IV Abx e.g. ciprofloxacin
high mortality even with treatment
Epistaxis
Nosebleeds
types:
Anterior (~90%), bleeding usually from Kiesselbach plexus located on anterioinferioir nasal septum (Little’s area) and anastomoses of the anterior ethmoidal/sphenopalatine/greater palatine/superioir labial arteries
Posterior (~10%), more dangerous, generally seen in older individuals, ↑ risk of airway compromise & aspiration, usually bleeding from both nostrils & blood running own throat
Causes of epistaxis
trauma including picking nose vascular malformations nasal septum defect (e.g. deviated septum) tumours bleeding disorders
Management of epistaxis
1) ABCDE assessment
2) sit upright with torso forward, squeeze cartilaginous part of nose for 20 minutes
3) Cautery with silver nitrate = 1st line if source of bleeding is visible use packing (nasal tampons, rapid rhino) if cautery not tolerated or source of bleeding not visible
4) if persistent epistaxis then artery embolisation/ligation
Sinusitis
inflammation of the mucous membranes of the paranasal sinuses, rarely occurring without concurrent inflammation of the nasal mucous (rhinitis) = rhinosinusitis
Type of sinusitis
Acute <4 weeks
subacute 4-12 weeks
chronic > 12 weeks
Aetiology of sinusitis
viral: very common e.g. rhinovirus, influenza, parainfluenza, adenovirus
bacterial: strep pneumonia, H. Influenzae
Risk factors for sinusitis
URTI
smoking
nasal obstruction e.g. septal deviation or nasal polyps
nasal foreign body
Presentation of sinusitis
facial pain (frontal pressure pain, worse on bending forward) nasal discharge (thick & purulent) nasal obstruction
Management of sinusitis
intranasal decongestants/nasal saline
intranasal corticosteroids (>10 days of symptoms)
if severe = oral Abx
if chronic consider intranasal saline washout
complications of sinusitis
preseptal/orbital cellulitis orbital abscess cavernous sinus thrombosis brain abscess subdural abscess (most common) osteomyelitis (especially of frontal bone = Pott's puffy tumour)
Rhinitis
inflammation & swelling of the nasal mucous membranes
can be allergic or non allergic
allergic rhinitis
acute/chronic rhinitis due to inhaled allergens causing a type I hypersensitivity reaction (IgE mediated), may be seasonal, occupational or perennial (throughout year)
most common form of rhinitis
presents with sneezing, bilateral nasal congestion, clear nasal discharge, post nasal drip, nasal pruritis
managed with allergen avoidance, oral/intranasal antihistamines, short course of decongestants e.g. oxyetazoline
Complications of intranasal decongestant use
prolonged use leads to tolerance meaning ↑ doses are needed to achieve the same affect & may cause rebound hypertrophy of the nasal mucosa when withdrawn
types of non allergic rhinitis
rhinitis medicamentosum:
rebound nasal congestion when discontinuing nasal decongestant, pts often use ↑dose/frequency to treat leading to vicious cycle
atrophic rhinitis:
chronic rhinitis associated with atrophy & sclerosis of the nasal mucosa
drug induced rhinitis:
e.g. snorting cocaine or ketamine
Epiglottitis
progressive inflammation of the epiglottis & supra glottis with the potential to cause airway compromise
caused by haemophilia infleuzae type B (Hib), has become rare since Hib vaccination
usually seen ages 2-5 yrs
Presentation of epiglottitis
acute onset
high fever, sore throat, dysphagia, odynophagia
tripod position, stridor, respiratory distress
muffled (‘hot potato’ voice)
drooling
Investigating epiglottitis
direct visualisation via laryngoscopy (must be airway trained/senior doctor)
lateral neck X-ray (thumb sign)
Management of epiglottitis
immediate senior & airway trained personnel involvement
DO NOT examine throat (using tongue depressor may cause obstruction)
IV/PO Abx
supplemental O2
airway management if indicated
Nasal polyps
associated with asthma cystic fibrosis, Kartengers
affect ~1% of adult population 2-4x more common in men
features include nasal obstruction, rhinorrhoea, sneezing, poor sense of taste & smell
NB unilateral nasal polyp should raise suspicion of cancer
management with ENT referral, topical steroids (↓ polyp size)
Nasal septum deviation
most common cause of nasal obstruction, usually due to direct trauma to nose/face or due to Marfan’s/Ehler-Danlos syndrome
features include recurrent sinusitis, facial pain, mouth breathing, ↓ wens of smell, repetitive sneezing, noisy breathing
managed with topical decongestants, steroid, antihistamines & surgery
Choanal atresia
congenital bony/membranous obstruction of the posterior nasal passage which can be unilateral/bilateral
associated with other abnormalities e.g. CHARGE syndrome
features:
if bilateral = obligate mouth breathing, cyanosis worse on feeding, noisy breathing, struggling with food intake
if unilateral: chronic rhinitis, congestion, rhinorrhoea
management surgical perforation (urgently if bilateral, or at 1-2y/o if unilateral)
Thyroglossal cyst
a remnant of the thyroglossal duct formed during embryonic development of the thyroid gland & normally regress before birth
2nd most common neck abnormality (~7% of population)
Presents as cyst present from birth, painless firm midline neck mass that elevates with swallowing & tongue protrusion
USS neck (evaluate cyst & confirm location of thyroid)
elctive surgical removal to treat
Brachial cyst
remand of the embryological 2nd brachial cleft/cervical sinus which normally regresses after birth
~20% of paediatric neck masses
presents as cyst diagnosed in late childhood/adolescence usually when cyst becomes infected, painless firm mass located lateral to midline usually anterior to SCM and does not move on swallowing
USS neck & CT/MRI (to plan surgery)
managed with surgical excision
Head & neck cancers
90% are squamous cell carcinomas
Risk factors for head & neck cancer
smoking heavy alcohol consumption poor dentition poor diet GORD HPV 16 +ve male gender
Cancer of the oral cavity
cancers of oral mucosa, tonsils, salivary glands & tongue, usually seen in males aged 55-60
present as dysphagia, non healing ulcers, halitosis, unusual bleeding in mouth, facial swelling, lymphadenopathy
biopsy & histopathology, panednoscopy (to assess extent of tumour), CT chest/abdo/pelvis (check for spread)
treat with surgical resection if local, or resection +radio/chemotherapy
Pharyngeal cancer
cancer of the oro/naso/hypopharynx, less common than other head & neck cancers, generally seen in males aged >50yrs
presents as enlarged lymph nodes, severe air pain, dysphagia, sore throat, foreign body sensation, recurrent otitis media & conductive hearing loss, epistaxis
investigate with panendoscopy, biopsy, MRI/CT (to check infiltration into surrounding structure)
Managed with surgery ± radio/chemo therapy
NB nasopharyngeal cancer usually not SCC
Laryngeal cancer
cancers of supraglottis, glottis, subglottis, 2nd most common head & neck cancer, usually seen in males age 40-70
presents with hoarseness, change in voice, foreign body sensation, dyspnoea, dysphagia, stridor, aspiration
investigate with direct laryngoscopy, CT/MRI or USS neck
Management with radiotherapy/transednoscpopic laser resection if early, larynectomy if advanced
Reineke’s oedema
benign build up of fluid in the lamina propria of the true vocal cords, looks like a sac-like fluid filled vocal cords
due to irritation & inflammation secondary to smoking
presents with deep/low pitched voice,rough voice, dysphonia, bilaterally swollen vocal cords on laryngoscopy
managed with smoking cessation & voice therpay
Laryngeal papillomatosis/recurrent respiratory papillomatosis (RRP)
being tumour of the laryngeal epithelium caused by HPV infection (the 6&11)
presents as white exophylic cauliflower like lesion located in the larynx/trachea/vocal cords which may cause dysphonia, hoarseness, stridor
should be surgical removed but may reoccur
Laryngopharyngeal reflux (LPR)
inflammatory changes of the larynx/pharynx secondary to GORD, common
presents with globes (felt in midline, worse on swallowing), hoarseness, chronic cough, dysphagia, heart burn
managed with lifestyle changes, PPIs or alginates e.g. gaviscon
Laryngopharyngeal reflux (LPR)
inflammatory changes of the larynx/pharynx secondary to GORD, common
presents with globus (felt in midline, worse on swallowing), hoarseness, chronic cough, dysphagia, heart burn
managed with lifestyle changes, PPIs or alginates e.g. gaviscon
Laryngitis
inflammation of the larynx
acute: <3 wks, usually viral ± bacterial superinfection
chronic >3 wks, usually GORD related or smoking related
Presentation of laryngitis
hoarseness of voice, dysphonia, dry cough, stridor, fever, dysphagia, lymphadenopathy, globus, sore throat
mainly clinical diagnosis, consider laryngoscopy (shows oedema, eryhtma, or cobble stoning (if GORD))
Management of laryngitis
vocal rest smoking cessation speech therapy humidification Abx for bacterial superinfection
Foreign nasal body
mostly young children (<2.5yrs)
presents as unilateral nasal obstruction, epistaxis or mould smelling purulent rhinorrhoea
nasal cavity inspection (otoscope) or flexible fiberoptic endoscopy
removal via positive pressure, forceps or endoscopy
Foreign bodies in the ear
usually seen in children (older children/adults will know something is i their ear)
may present as ear pain, deafness, ↓hearing or discharge
visualise on otoscopy
remove with forceps (if insect should kill insect first)
Swallowed foreign bodies
generally seen in children <5yrs
coins = most common object to swallow, items like button batteries are very dangerous
presents with vomiting, choking, refusal to eat, blood stained saliva, drooling, wheezing, respiratory distress
investigate with plain CXR or endoscopy
managed by endoscopic removal or if in stomach waiting for it to pass in stool
Obstructive sleep apnoea (OSA)
characterised by episodes of complete/partial upper airway obstruction during sleep
most common breathing related sleep disorder, 2x more common in men
Risk factors for OSA
obesity adenotonsillar hypertrophy (in children) nasal septum deviation nasal polyps macroglossia family history Down's syndrome
Presentation of OSA
excessive snoring
reports of apnoea (from sleep partner/parents)
day time somnolence
restless sleep
frequent waking
mouth breathing
impaired cognitive function (poor concentration)
Investigating OSA
Polysomnography (1st line)
Epworth sleepiness scale
Management of OSA
weight loss, sleep hygiene, lateral sleeping position
CPAP
surgical removal of tonsils/adenoids in children
Vertigo
dizziness is a general, non specific term to indicate the sense of disorientation
vertigo is a type of dizziness & refers to the false sensation that oneself or the surroundings are moving/spinning
due to mismatch of vestibular, visual & somatosensory systems
Causes of vertigo
cerebral:
CVD, migraine, MS, acoustic neuroma, alcohol intoxication
Vestibular:
vestibular neuritis, viral labyrinthitis, BPPV, Meniers, motion sickness, ototoxicity (e.g. gentamicin), HZV (ramsay hunt syndrome)
Benign paroxysmal positional vertigo (BPPV) presentation
gradual onset, triggers by change in head position, episodes lasts 10-20secs
Meniere’s disease presentation
hearing loss, tinnitus & sensation of pressure/fullness in one/both ears
nystagmus
Vertebrobasillar ischaemia
elderly pts, presents with dizziness on extension of neck
acoustic neuroma presentation
hearing loss, vertigo, tinnitus ± absent corneal reflex/facial nerve palsy
if bilateral then neurofibromatosis 2
Investigating vertigo
Romberg's test Dix-Hallpike manoeuvre head impulse test CT/MRI audiometry vestibular function
Laryngeal nerve palsy/vocal cord paralysis
clinical features depend if one or 2 cords are affected & position of chords, due to injury of one/both recurrent laryngeal nerves
unilateral: hoarseness
bilateral: dysphonia, stridor, snoring, breathing problems
treatment: voice therapy, surgery
Benign lesions of the vocal cords
present as hoarseness
include:
vocal cord nodules (bilateral), treated with voice therapy
polyps of vocal folds (unilateral), treated with excision to exclude malignancy
Voice overuse/misuse
common in professions such as acting/singing/teaching
may lead to being lesions such as nodules (singers nodules) or cysts
treated with voice therapy or surgery
Labyrinthitis
inflammatory disorder of the membranes of the labyrinth affecting both vestibular & cochlear organs, usually preceded by URTI
may be viral (most common), bacterial or associated with systemic disease
usually seen age 40-70
Presentation of labyrinthitis
acute onset vertigo (not triggered by movement but exacerbated by movement)
hearing loss*
nausea&vomiting, tinnitus
spontaneous unidirectional horizontal nystagmus towards unaffected side, sensorineural hearing loss
Vestibular neuritis
inflammation of the vestibular nerve, usually follows a viral illness
Presentation of vestibular neuritis
recurrent vertigo attacks lasting hours to days, nausea & vomiting, horizontal nystagmus
NO hearing loss or tinnitus (unlike labyrinthitits)
Management of vestibular neuritis
vestibular rehabilitation exercises
Cholesteatoma
presence of keratinising squamous cell epithelium within the middle ear or in other pneumatised areas of the temporal bone, the epithelium exhibits independent growth leading to expansion & reabsorption of underlying bone
risk ↑ 100x with cleft palate
presentation of cholesteatoma
painless otorhhoea (scant but foul smelling discharge from affected ear)
conductive hearing loss (painless)
retraction pocket/attic crust seen on otoscopy
Pleomorphic adenoma
commonest tumour of parotid glands
Slow growing, lobular, and not well encapsulated
Normal Webers & Rhinnes test
Rhinnes:
Air conduction > bone conduction bilaterally
Webers:
equal on both sides, no lateralisation, stays in midline
Conductive hearing loss Webers & Rhinnes test
Rhinnes:
Bone conduction > air conduction in affected ear
Air conduction > bone conduction in unaffected ear
Webers:
Lateralises to affected ear
Sensorineural hearing loss Webers & Rhinnes test
Rhinnes:
Air conduction > bone conduction bilaterally
Webers:
Lateralises to unaffected ear
