ENT Flashcards by Majayda Islam

otalgia
+ some children may tug or rub their ear
recent URTI
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea

acute otitis media

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management of acute otitis media

usually conservative - analgesia

in some exceptions/severe cases = amoxicillin is given for 5-7 days
eg if prolonged for 4 days, if immunocompromised or have a lot of systemic symptoms

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pain
conductive hearing loss
tinnitus
vertigo

cerumen impaction

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management of cerumen impaction

Initial management of earwax includes ear drops for 3–5 days initially, to soften wax.

If symptoms persist, ear irrigation can be considered, providing that there are no contraindications.

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Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
vertigo

labyrinthitis

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labyrinthitis

antiemetics or antihistamines

prochlorperazine or cyclizine

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ear pain, itch, discharge

otoscopy: red, swollen, or eczematous canal

otitis externa

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management of otitis externa

topical antibiotic or a combined topical antibiotic with a steroid
ciprofloxacin in diabetics
second line = flucloxacillin
analgesia for any pain

failure to respond to treatment = ENT referral

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dizziness triggered by head movement ~10-20
room is spinning around them/still objects moving
associated nausea

Benign paroxysmal peripheral vertigo

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diagnosis of BPPV

positive Dix Hallpike manoeuvre - rotatory nystagmus and vertigo)

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management of BPPV

epley manoeuvre
betahistine

vestibular rehabilitation (brandt-Daroff exercises)

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severe deep otalgia
temporal headaches
purulent otorrhoea
facial palsy

more common in elderly and diabetics

malignant otitis externa

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Ix for malignant otitis externa

CT scan

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management of malignancy otitis externa

IV Abx = ciprofloxacin

non-resolving otalgia = ENT referral

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severe otalgia behind the ear 
fever 
swelling and erythema 
tenderness over the mastoid process 
external ear protrudes forward

mastoiditis

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management of mastoiditis

managed in hospital

usually IV broad spec antibiotics (Cefixime) for 1-2 days and then 1-2 weeks of oral ABx

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‘glue ear’

usually 3-6year olds

chronic otitis media

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management of chronic otitis media

offer otovent devices
myringotomy and insert grommets
recurrent = adenoidectomy

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keratinising epithelium in the middle ear

usually longstanding eustachian tube dysfunction

cholesteatoma

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cholesteatoma management

refer to ENT if suspected

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vertigo 
tinnitus 
sensorineural hearing loss
nystagmus 
usually unilateral 
aural fullness/pressure

meniere’s disease

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management of meniere’s disease

confirm diagnosis at ENT
pt to inform DVLA

acute attacks = buccal/IM prochlorperazine

prevention/prophylaxis = betahistine and vestibular rehabilitation

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hearing loss
vertigo
tinnitus
absent corneal reflex

acoustic neuroma

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management of acoustic neuroma

ENT referral

Management is with either surgery, radiotherapy or observation.

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Ix of choice for acoustic neuroma

MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important

hearing loss may have some discharge recent history of infection or trauma loud noisy work/concert

perforated TM

management of perforated TM

no treatment is needed in the majority of cases as the tympanic membrane will usually heal 4-6 weeks myringoplasty may be performed if the tympanic membrane does not heal by itself advise to keep the ear dry

facial pain - frontal pressure worsens it (leaning forward) nasal discharge nasal obstruction/congestion some may have a low-grade fever and coryzal symptoms recent infection/cold

acute sinusitis

management of acute sinusitis

analgesia and intranasal decongestants/nasal saline intranasal corticosteroids if persists for 10days+ severe cases - ABx = phenoxymethyl-penicillin or co-amoxiclav

management of epistaxis | persistence for 10-15mins

first aid measures = sit with torso forward and mouth open whilst pinch cartilaginous area firmly if unsuccessful consider topical antiseptic = naseptin if persists for cautery & packing for a visualised anterior nosebleed - anaesthetic spray and packing needed for this

nasal obstruction rhinorrhea and sneezing poor sense of smell/taste more common in men and also in children/elderly

nasal polyps

management of nasal polyps

referral to ENT & topical corticosteroids

``` sneezing clear nasal discharge bilateral nasal obstruction/congestion post-nasal drip nasal pruritus ```

allergic rhinitis

management of allergic rhinitis

oral/intranasal antihistamines intranasal corticosteroids and general allergen avoidance

``` facial pain nasal discharge nasal obstruction - mouth breathing post nasal drip - chronic cough usually ongoing for 12 weeks ```

chronic sinusitis

management of chronic sinusitis

intranasal corticosteroids nasal irrigation with saline solution allergen avoidance

``` otalgia unilateral serous otitis externa nasal obstruction, discharge of epistaxis cranial nerve (3-6) palsies cervical lymphadenopathy ```

Nasopharyngeal/oral cancers

Ix for Nasopharyngeal/oral cancers

combined CT & MRI

management of Nasopharyngeal/oral cancers

radiotherapy first line

itchy feeling in the the throat, painful/sore and dysphagia

acute pharyngitis

``` inflamed/swollen/enlarged tonsils white exudate may be seen on the top of tonsils erythematous tonsils enlarged lymph nodes low grade fever dysphagia sore throat ```

acute tonsillitis

Scoring FEVERpain & Centor criteria for tonsillitis

centor = tonsillar exudate, tender anterior cervical lymphadenopathy, hx of fever and absence of a cough = 3-4 = 32-56% likely ``` feverpain = fever >38° purulent exudate acute onset - within 3 days severely inflamed tonsils no cough/coryza ``` = 4-5 = 62-65% likely

management of tonsilitis

paracetamol/ibuprofen antibiotics not routinely indicated if require Abx = penicillin 7-10 day course or clarithromycin (systemic upset, unilateral tonsillitis, hx of rheumatic fever, immunocompromised, 3+ on centor score)

``` acute rapid onset stridor drooling tripod position - leaning forward with neck extended muffled/hoarse voice blue skin/lips ```

epiglottitis

Ix epiglottitis

thumb print/sign on X-ray

Management of epiglottitis

immediate senior involvement - emergency airway support from anaesthetist oxygen and IV Abx

severe sore throat pain - lateralises to one side deviation of uvula to unaffected side trismus = difficulty opening mouth reduced neck mobility hx of tonsillitis

Quinsy/peritonsillar abscess

management of quinsy

urgent review by ENT specialist needle aspiration/Incision and drainage IV Abx potential tonsillectomy to prevent recurrence

plaque like lesion cannot be rubbed away bright white sharply defined patches more common in males and smokers usually in 50s-70s

oral leukoplakia

Ix/management oral leukoplakia

Biopsies are usually performed to exclude alternative diagnoses

prodromal itching, pain and tingling in the lower mouth initially vesicles collapse into ulcers often manifest as a result of recent illness/under stress, immunocompromised

Oral herpes simplex

management of oral herpes simplex

topical antivirals (aciclovir) use as soon as symptoms begin - usually 5 days (can also use chlorhexidine mouthwash) topical pain relief

usually preceding malaise, fever and headaches can also have myalgia bilateral swelling of parotid glands - near the ear

parotitis

Ix for parotitis

Salivary IgM against mumps

management of parotitis

mainly supportive - analgesia, fluids and bed rest Prevention = MMR vaccine

white patches on oral mucosa | can be wiped off - reveals a erythematous/bleeding base

oral candidiasis

management of oral candidiasis

topical fluconazole | advise good oral hygiene

clearly defined, painful, shallow, rounded ulcers can be caused by trauma, stress, food allergies and hormonal changes

aphthous ulcer

diagnosis of aphthous ulcer

usually diagnosis of exclusion need to rule out = HSV, carcinoma, IBD or autoimmune disease

management of aphthous ulcer

saline mouthwash topical corticosteroids avoid picking

painful enlarged salivary gland fever decreased salivary secretion purulent drainage from duct orifice

sialadenitis

management of sialadenitis

hot/cold compress & massage aggressive hydration analgesia lemon drops = promotes salivation

sore throat lymphadenopathy in the anterior/posterior triangles) pyrexia/fever sore throat/coryza splenomegaly hepatitis palatal petechiae

glandular fever / infectious mononucleosis

diagnosis of glandular fever

``` maculopapular rash with amoxicillin use monospot test (2nd week of symptoms) ```

management of glandular fever

conservative management | avoid contact sports for 8 weeks (avoid ruptured spleen)

Pain (toothache) which can quickly become worse. It can be severe and throbbing. Swelling of the gum, which can be tender. Swelling of the face malaise/temperature

dental abscess

management of dental abscess

analgesia | refer to dentist to drain the abscess (lancing)