ENT Flashcards
Define Benign paroxysmal positional vertigo (BPPV)
peripheral vestibular disorder causing sudden short-lived episodes of vertigo elicited by certain head movements
Cause of BPPV
movement of otolith (crystals) from utricle + saccule => semi-circular canals causing movement of endolymph even when head has stopped moving.
Presenting symptoms of BPPV
- sudden severe episodic vertigo provoked by specific head movements
- nausea
- imbalance
- lightheadedness
Examination findings of BPPV
- normal neurological exam
- BUT positive DIX-HALLPIKE manoeuvre -sitting => supine positions => head tilted back and 45 degrees =>see nystagmus (eyes jumping) within 30s.
Investigations for BPPV
- Dix-hallpike maneouvre
- audiogram- exclude sensorineural hearing loss (meniere’s disease/ labrynthitis)
- MRI brain- exclude MS, tumours
Management for BPPV
- educate patient about condition and to continue exercise
- 3- position particle repositioning manoeuvre (PRM)
- if not- vestibular rehabilitation
define Meneiere’s
disorder of the inner ear causing sudden vertigo due to increased pressure and dilation of endolymphatic system
symptoms for Meniere’s
- spontaneous vertigo (20mins-12hours)
- tinitus
- ear fullness
- fluctuating sensorineural hearing loss
- nausea/vomiting
signs of Meniere’s
- nystagmus
- positive Romberg’s test (poor proprioception - ataxia is sensory in nature not cerebellar)
Risk factors for Meniere’s
- viral infections
- head trauma
- genetics
- autoimmune
- metabolic disturbances (changes to Na+/K+ in ear)
Management of Meniere’s disease
Severe => refer to hospital for IV labrynthite, fluids and nutrition
Medical:
- acute attacks => prochlorperazine- anti-emetic
- prevention => betahistine (anti-histamine)- anti-emetic, treats vertigo
MDT approach
- refer to ENT for diagnosis
- refer to audiology for hearing loss
Lifestyle:
- keep medication nearby, vertigo usually gets better with treatment and symptoms usually resolve within 24hrs
- caution of operating heavy mahcinery/ driving
- inform DVLA
define epistaxis
nose bleeds due to damage of vessels in nasal mucosa
- usually self-limiting
causes of epistaxis
- Nose trauma (picking/blowing nose, allergies /surgery)
- nasal polyps/ tumours (SCC)
- Hypertension/ atherosclerosis
- Haematological (leukaemia, haemophillia, thrombocytopenia)
- Environmental factors (low humidity, high altitude)
- Drugs (anticoagulants, antiplatelets)
- XS alcohol
- vascular causes (hereditary haemorrhagic telangiectasia/ Wegener’s granulomatosis
investigations for epistaxis
- rarely done
- FBC - Hb (anaemia)
- coagulation studies (clottting disorders)
Management of epistaxis
Acute epistaxis
- Lean forward, mouth open and hold nose for 10-15 mins
- if posterior bleed (profuse, bleeding from both nostrils => A&E)
- apply naseptin (antiseptic) to prevent re-bleeding
- after bleeding- advise to not heavy lift/pick nose for >24hrs
Recurrent epistaxis:
- topical antiseptic (naseptin- chlorohexidine + neomycin)- prevent crusting/vestibulitis
- nasal cautery
- referral to ENT
complications of epistaxis
- rare
- anaema
- hypovolaemia
define rhinosinusitis
- inflammation of nasal cavity + paranasal sinuses (frontal,nasal, ethmoid, maxillary sinuses) usually viral infection but can be followed by bacterial infection (uncommon)
- acute - symptoms <3 months
- chronic - symptoms >3 months
causes of rhinosinusitis
acute
- triggered by viral respiratory tract infection (influenza, RSV) =>followed by bacterial infection
- allergies, asthma, seasonal variation
- smoking
- CF
- anatomical obstruction (deviated nasal septum, nasal polyps, trauma, foreign body)
chronic
- inflammatory cause
- triggers: allergies, asthma, smoking, CF,
- immunocompromised
symptoms of rhinosinusitis
Adults:
- nasal blockage/nasal discharge + face pain (around sinuses)
- headache
- fever
- loss of smell
- cough
- red,tender, swollen cheeks/periorbital areas
Child:
- nasal blockage/ discoloured nasal discharge
- fever
- face pain / pressure
- cough
Examination => nasal inflammation, nasal disharge, mucosal oedema
Signs of bacterial infection
- discoloured discharge
- high fever
- followed a mild illness
investigations for rhinosinusitis
Differentials for rhinosinusitis
nasal blockage/discharge
- URTI
- tonsilitis
- tumour
- foreign body
face pain
- migraine
- giant cell/temporal arteritis
- dental pain
- temperomandibular disorders
- trigeminal neuralgia
management for rhinosinusitis
If signs of orbital/bone/neuro complications => hospital
AB use is not encouraged as bacterial infection is rare
Acute
- if symptoms <10 days - no further action needed, should resolve on own
- if > 10 days => high dose nasal corticosteroids + (backup antibiotics?)
- recurrent/ ABs don’t help => refer to ENT (rare)
Chronic
- avoid triggers, stop smoking
- nasal irrigation with saline
- high dose nasal corticosteroids
- refer to ENT
complications of rhinosinusitis
acute:
- Orbital complications — orbital cellulitis, orbital abscess, cavernous sinus thrombosis.
- Intracranial complications —meningitis, encephalitis, abscess, venous thrombosis.
- Bony complications — osteomyelitis.
- Progression to chronic sinusitis.
Chronic
- poor sleep, fatigue, depression
