ENT Flashcards
1
Q
Describe the sensory innervation to the pinna?
A
- Upper lateral surface – CN V3 – Auriculotemporal nerve.
- Lower lateral surface and medial surface – C3 – Greater auricular nerve.
- Superior medial surface – C2/C3 – Lesser occipital nerve.
- Auricular branch of vagus – External Auditory Meatus
2
Q
How are lacerations managed?
A
- Mx: Simple primary closure of the skin with sutures after adequate cleaning
- Ensure that any exposed cartilage is covered with skin: if there is significant skin loss where primary closure will not be possible an opinion from a plastic reconstructive surgeon may be required.
3
Q
How are bites mx;d?
A
- Significant risk of infection from skin commensals, or oral commensals from the offending creature/person.
- Take an appropriate history to ascertain likely organisms involved in potential infection, and the wound must be left open.
- Mx: Wound irrigation and antibiotics.
4
Q
How are pinna haematomas mx’d
A
- Mx: Urgent drainage and pressure dressing application to prevent re-accumulation.
5
Q
What are tympanic membrane perforations and how are they mxd?
A
- Can be perforated by direct or indirect trauma, otitis media.
- SX: PAIN, conductive deafness
- Mx: Most perforations will heal by themselves - “watch and wait,” approach with the patients following water precautions
- If perforation does not heal > 6months – consider surgery:
- Myringoplasty: to repair the tympanic membrane if the perforation is causing problems.
6
Q
Describe haemotympanum trauma + its mx’d
A
- Ax: temporal bone fracture
- Examination: Can be seen through the tympanic membrane and is associated with a conductive hearing loss
- Mx: Conservative: it will settle with time.
- Pt should be followed up to ensure that there is no residual hearing loss from damage to the ossicles.
7
Q
How is ear wax mxd
A
- Sx: pain, conductive hearing loss, tinnitus, vertigo
- Mx: olive oil, sodium bicarbonate 5%. almond oil
- Treatment should not be given if a perforation is suspected or the patient has grommets.
- Primary care: syringing/ irrigation
8
Q
How does Otitis Externa present?
A
-
Presentation: painful discharging ear, itchiness, hearing muffled from the discharge present in the ear canal.
- Otoscopy: red, swollen, or eczematous canal
9
Q
What is malignant OE?
A
- Aggressive infection mainly seen in diabetics or immunocompromised patients
- Infection spreads from soft tissue of the ear canal into the bone (osteomyelitis)
- Significant mortality rate
- Sx:
- Chronic ear discharge
- Severe ear pain
- Cranial nerve palsies (most commonly CNVII).
10
Q
How is otitis externa mxd?
A
-
Topical abx (ciprofloxacin) +/- topical steroid
- Severe: PO flucloxacillin
- Ix: swabs
- Other:
- Microsuction of pus/debris
- Wick with aluminium acetate: help hold the canal open for topical treatment
- Mild: topical hydrocortisone + ear calm spray
11
Q
What is necrotizing OE?
A
- Aggresive + life threatening -> temporal bone destruction -> base of skull osteomyelitis
- Pt: otorrhea, severe otalgia, granulations in the floor of the EAC
- ? CN6+7 palsies as disease progresses
12
Q
How is OE mxd?
A
- Ix: swabs, MCS, biopsy of EAC to exclude SCC, CT scan
- Mx: topical abx (ciprofloxacin) +/- topical steroid
13
Q
What is acute otitis media?
A
- Acute otitis media (AOM) is an infection of the middle ear.
- Epithelium lining the middle ear is respiratory epithelium: pseudostratified columnar epithelium – is regarded as a continuation of the upper respiratory tract, and is therefore susceptible to a similar variety of pathogens.
- Common in childhood and is related to eustachian tube dysfunction.
- Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella species.
14
Q
How does acute otitis media present?
A
- Ear pain - in young children this may be evident by ear pulling.
- Discharge: tympanic membrane may rupture with the pus from the middle ear discharging into the ear canal.
- Fever
15
Q
How is acute OM mxd?
A
- Conservative: 24-48h settles on its own. Watch and wait
- Immediate abx prescription: PO amoxicillin 2nd: erythromycin. Give if:
- Immunocompromised
- Bilateral AOM <2 yo
- Perforation
- Systemically unwell
- Surgery: grommet insertion
16
Q
What is the diagnostic criteria of AOM?
A
- Acute sx onset: otalgia/ ear tugging
- Middle ear effusion
- Inflammation of the tympanic membrane
17
Q
How does a cholesteotoma arise? What are its complications?
A
- Pathophysiology: acquired – chronic –ve middle ear pressure, from Eustachian tube dysfunction -> retraction pocket
-
Complications: destruction of ossicles, semicircular canals (vertigo) and cochlea (sensorineural hearing loss)
- Facial nerve palsies
- Erosion into intracranial cavity: meningitis, intracranial abscesses and sinus thrombosis
- RFs: acute OM, Eustachian tube dysfunction, and prior otological surgery
18
Q
How does cholesteotoma appear on otoscopy?
A
- Pearly, keratinized, or waxy mass in the attic region is seen on otoscopy
- Atic crust
19
Q
What are the ix’s and mx for cholesteotoma?
A
- Ix: otoscopy, PTA, CT scan of petrous part of temporal bone
- Mx:
- Surgery: mastoidectomy – cholesteotoma removed and mastoid cleaned out
- Ossicles reconstruction depending on the extent of damage
20
Q
What is otitis media with effusion?
A
- Fluid is present in the middle ear with an intact tympanic membrane
- Related to eustachian tube dysfunction.
- Children
- Adults: (especially unilateral) : v important to look at the post nasal space as tumours in this area can cause eustachian tube dysfunction -> OME
- Not painful but the middle ear may become infected which will lead to an acute otitis media which is painful.
21
Q
What are some the RFs for glue ear?
A
- Bottle fed, Paternal smoking
- Atopy (e.g eczema, asthma
- Genetic disorders/ Mucociliary disorders, CF, PCD
- Craniofacial disorders e.g. DS
22
Q
What are some of the clinical fx of otitis media with effusion (glue ear)?
A
- On otoscopy: Bulging retracted tympanic membrane which can appear dull, grey or yellow
- Loss of light reflex ? bubble
- CHL-> can cause speech/ developmental delay
- Pressure in ear
- Sometimes: disequilibrium + vertigo
23
Q
How is otitis media with effusion ixd and mxd?
A
Ix
- Tympanogram: Flat (Type B) Tracing with normal canal volume
- Pure tone audiogram: CHL
- Sometimes FNE
Mx
- Conservative – most cases settle within 3 months - Hearing aid
-
Surgery - for prolonged hearing loss causing significant problems
- Myringotomy +/- Grommets (ventilation tubes) +/- Adenoidectomy
24
Q
What is otosclerosis?
A
- Cause: genetic and environmental
- Genetic: In families - autosomal dominant transmission.
- Mature bone is gradually replaced with woven bone
- Sx develop as the stapes footplate becomes fixed to the oval window.
- Causes bilateral hearing loss
25
Q
Describe the presentation of otosclerosis?
A
- 2x F>M
- Progressive hearing loss (bilateral), tinnitus, improved hearing in noisy surroundings during early stages of disease
- Family History
26
Q
What examination and ixs are used for otosclerosis?
A
Examination: Most commonly normal
- Rarely pink hue to the tympanic membrane – Schwartze’s sign
Investigations
- Tympanogram - Normal type A trace
- PTA - Conductive hearing loss: characteristic “Carhart notch” at 2kHz
27
Q
What are the central and peripheral causes of vertigo?
A
- Central causes: Stroke,Migraine, Neoplasms, Demyelination eg. MS, Drugs
- Peripheral causes: BPPV, Ménière’s disease, Vestibular Neuronitis
28
Q
What is BPPV + its pathophysiology?
A
- Vertigo occurring with particular head movements, which is benign in nature, and lasts a short amount of time, typically seconds
- Pathophysiology: otoliths (crystals) in the semicircular canals (most commonly posterior) causing abnormal stimulation of the hair cells giving a hallucination of movement i.e. vertigo
45
Q
What are the different sites of draining for paranasal sinuses?
A
