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ΩΩ 4 Bateman - Specialities + Endo + GI + Liver > ENT > Flashcards

ENT Flashcards

1
Q

Which nerve causes referred pain to the ear in sore throats/cold etc?

A

Glossopharyngeal nerve

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2
Q

Which of the three ossicles is in contact with the tympanic membrane?

A

Malleus

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3
Q

Which structure would be affected if the patient had an infection of the middle ear?

A

Cochlea

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4
Q

Which nerve does the shoulder shrug?

A

Accessory Nerve

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5
Q

Name these structures

A
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6
Q

What is a trismus?

A

Trismus is a motor disturbance of the trigeminal nerve.

In particular there is spasm of the masticatory muscles, with difficulty in opening the mouth - risus sardonicus or ‘lockjaw’ to the layperson

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7
Q

What are the different types of otitis externa?

A

Acute suppurative

Chronic suppurative

Serous / secretory

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8
Q

What are the causes of otitis media (acute supporative)?

A
  1. Common cold
  2. Acute tonsillitis
  3. Influenza
  4. Coryza - profuse discharge of the nose - of measles, scarlet fever, whooping cough.
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9
Q

What are the organisms for otitis media (acute supporative)?

A

URTI bacteria

Bacterial causes include:

  1. Strep pneumonia - 30%
  2. H. influenzae - 20%
  3. Moraxella catarrhalis - 20%
  4. Group A Strep and Staph aureus - 5%

Viral causes (less than 10%)

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10
Q

What are the symptoms of otitis media (acute supporative)?

A

Symptoms

  1. Earache, usually throbbing and severe
  2. Pyrexia up to 40 degrees - child may be flushed
  3. Otorrhoea will often be blood-stained - profuse and mucoid at first, later becomes thick and yellow
  4. Mucoid discharge: signifies tympanic membrane perforation, after which pain subsides

Signs

  1. Conductive deafness is always present, and may be accompanied by tinnitus
  2. Tympanic membrane signs depend on the stage of infection
  3. Loss of lustre
  4. Break-up of the light reflex
  5. Redness
  6. Impaired mobility of tympanic membrane
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11
Q

What is the diagnosis of otitis media (acute supporative)?

A
  1. Acoustic reflectometry
  2. Pneumatic otoscopy
  3. Portable tympanometry
  4. Professional tympanometry
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12
Q

What is the management of otitis media (acute suppurative)?

A
  1. Discussion and reassurance about the natural course of the illness
    • in children, 80% recover in around three days without antibiotics
  2. Pain relief
    • Paracetamol and ibuprofen have been shown to reduce earache
  3. Antibitoics
    • First choice: amoxicillin for 5 to 7 days
    • Penicillin allergy: clarithromycin for 5 to 7 days (but erythromycin is preferred if pregnant)
    • Second choice: co-amoxiclav
  4. If perforated
    • See children in 4 weeks and keep ear dry
    • Prescribe antibitoics if still looks infected
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13
Q

When should you consider antibiotics in otitis media (acute supporative)?

A
  1. Symptoms lasting more than 4 days or not improving
  2. Systemically unwell but not requiring admission
  3. Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  4. Younger than 2 years with bilateral otitis media
  5. Otitis media with perforation and/or discharge in the canal
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14
Q

What is otitis media (secretory)? (glue ear)

A

‘Secretory otitis media’, ‘otitis media with effusion (OME)’, or `glue ear’, is the accumulation of serous or mucoid fluid (but not mucopurulent fluid) in the middle ear cavity without signs and symptoms of an acute infection

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15
Q

What is the cause of otitis media (secretory)?

A

The aetiology of secretory otitis media is not fully understood.

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16
Q

What are the symptoms of otitis media (secretory)?

A

The highest incidence of glue ear is between the ages 2 and 5.

  1. Hearing impairment may be the only symptom
  2. Significant hearing loss may be observed in OME which is bilateral and has lasted for more than one month
  3. Speech or language development delay
  4. Behavioural problems
  5. Lack of concentration or attention
  6. Being withdrawn
  7. Ear rubbing, irritability or sleep disturbances in infants
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17
Q

What are the investigations for otitis media (secretory)?

A

Examine the ear with an otoscope
There are no signs of an acute inflammation

Evidence of middle ear effusion include:

  1. Abnormal colour of the tympanic membrane e.g. - yellow, amber, or blue
  2. Loss of light refelx
  3. Opacification of the membrane (except due to scarring)
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18
Q

What is the treatment for otitis media (secretory)?

A

Conservative

In children, 50% of cases will resolve spontaneously within 6 weeks.

Medical

Medical treatments used for this condition include decongestants and antibiotics

Surgical treatment
Adenoidectomy - if adenoid enlargement with post-nasal obstruction is present, the adenoids are removed

Myringotomy and grommet insertion

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19
Q

What is otitis externa?

A

Otitis externa is a diffuse inflammation of the skin lining the external auditory meatus.

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20
Q

Who are at risk of getting otitis externa?

A

Mediterranean ear” describes otitis externa which arises as a result of holidaying in hot climates where the patient tends to sweat and bathe more frequently.

commonly swimmers are more susceptible; hence the term “swimmer’s ear”

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21
Q

What are the causes of otitis externa?

What is the most common bug for otitis externa?

A
  1. Infection:
    Bacteria
    The vast majority of cases (98%) the cause is bacterial
    – Pseudomonas aeruginosa and Staphylococcus aureus, Other possible organisms include proteus and E.coli
    Fungi
    Candida, aspergillus
  2. Allergy
    Eczema; contact allergy to cosmetics, shampoos
  3. Iatrogenic
    Frequent ear syringing, especially when it causes trauma
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22
Q

What are the symptoms of otits externa?

A

Symptoms are of rapid onset (generally within 48 hours)

Scanty discharge
There are no mucous secreting glands in the external ear; profuse discharge suggests middle ear disease

Bacterial infection
Typically associated with scant white purulent discharge, which occasionally can be thick

Otalgia

Itch

Feeling of fullnessor hearing loss

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23
Q

What is needed for the dignosis of otitis externa?

A
  1. Rapid onset (generally within 48 hours) in the past 3 weeks

AND…
2. Symptoms of ear canal inflammation, which include:
Otalgia (often severe), itching, or fullness,
WITH OR WITHOUT hearing loss or jaw pain,

AND…
3. Signs of ear canal inflammation, which include:
tenderness of the tragus, pinna, or both
OR diffuse ear canal edema, erythema, or both
WITH OR WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin

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24
Q

What is the management of otitis externa?

A

Analgesia

Eardrops
e.g. containing antibiotic and anti-inflammatory:
Gentisone-HC contains gentamicin and hydrocortisone

Oral antibiotics
May occasionally be prescribed with topical treatment. Use flucloxacillin (if not penicillin allergic) unless pseudomonas is suspected when ciprofloxacin (or aminoglycoside) should be used

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25
Q

WHAT IS MALIGNANT OTITIS EXTERNA?

A
  1. Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics)
  2. most commonly caused by Pseudomonas aeruginosa
  3. Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
  4. Progresses to temporal bone osteomyelitis
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26
Q

What are the key features in a history for malignant otitis externa?

A
  1. Diabetes (90%) or immunosuppression (illness or treatment-related)
  2. Severe, unrelenting, deep-seated otalgia
  3. Temporal headaches
  4. Purulent otorrhea
  5. Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
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27
Q

What is the diagnosis of malignant otitis externa?

A

A CT scan is typically done

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28
Q

What is the management of malignant otitis externa?

A
  1. non-resolving otitis externa with worsening pain should be referred urgently to ENT
  2. Intravenous antibiotics that cover pseudomonal infections
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29
Q

What is leucoplakia?

A

Leucoplakia is a premalignant, white coloured thickening of the oral mucosa that cannot readily be scraped off. In the mouth the cheeks and the tongue are most often affected.

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30
Q

What are the causes of leucoplakia?

A

Sore teeth

Smoking

Spirits

Sepsis

Syphilis

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31
Q

How is leucoplakia different from candida?

A

Candida can be scraped off the tongue

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32
Q

What is the management for leucoplakia?

A

If leucoplakia is severe or extensive then the patient should be referred for dermatological opinion and biopsy.

If dysplasia is severe then this may necessitate surgical removal. Grafting may then be required.

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33
Q

What is a cystic hygroma?

A

This is a congenital lesion comprised of lymph-filled spaces which arise from an embryonic remnant of the jugular lymph sac.

It is not a true cyst but rather a lymphatic hamartoma which forms multilocular cyst-like spaces.

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34
Q

What syndromes are cystic hygromas associated to?

A

Cystic hygromas of the neck in early fetal life are responsible for the webbed neck in Turner’s and Noonan’s syndromes.

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35
Q

Are are the features of a cystic hygroma?

A

Most occur in the base of the neck
Both in the anterior and the posterior triangle, and may extend up to the jaw, over the anterior chest wall, and down into the axilla. Rarely, it occurs alone in the axilla, pelvis, or groin.

It presents as a soft, fluctuant and highly transilluminable lump just beneath the skin. It may be lobular and usually is painless. It contains clear fluid and may be of any size.

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36
Q

What is the management for cystic hygromas?

A
  1. Surgery
    Surgical excision of all affected tissue, but this can be difficult because of infiltration of vital neck structures.
  2. Sclerosing agents e.g. doxycycline
    Can be injected directly into the cystic hygroma.
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37
Q

What is a branchial cyst?

A

This arises from embryonic remnants of the second branchial cleft in the neck.

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38
Q

What are the symptoms of a branchial cyst?

A

The cyst may enlarge during an upper respiratory tract infection and then persist.

In the acute stage, it may be tender.

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39
Q

What is the location of a branchial cyst?

A

It is most common in young adults where it presents as a smooth swelling in front of the anterior border of the sternomastoid at the junction of its upper and middle thirds.

The position is characteristic.

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40
Q

What are some investigations for branchial cyst?

A

The cyst may enlarge during an upper respiratory tract infection and then persist.

In the acute stage, it may be tender.

On examination

  1. It is usually fluctuant but does not transilluminate.
  2. It does not move on swallowing.
  3. Other enlarged lymph nodes are absent
  4. Contains cholesterol
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41
Q

What is the treatment for a branchial cyst?

A

Treatment is by excision.

Care must be taken not to damage the carotid vessels and internal jugular vein which usually lie deep to the swelling

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42
Q

What is a thyroglossal cyst?

A

The thyroid gland develops from the lower portion of the thyroglossal duct, which begins at the foramen caecum at the base of the tongue.

If a portion of this duct remains patent it can form a cyst - a thyroglossal cyst.

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43
Q

What is the location of thyroglossal cyst?

What age do they occur?

A

The cysts are usually found between the isthmus of the thyroid gland and the hyoid cartilage, or just above the hyoid cartilage.

They occur at any age but the majority are seen in patients between 15 and 30 years of age

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44
Q

What are the symptoms of a thyroglossal cyst?

A

Presentation is usually, as a painless, smooth, cystic, midline swelling in the region of the hyoid bone.

A thyroglossal cyst may become symptomatic if it becomes inflamed; resulting in pain and swelling.

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45
Q

What is seen on examination of a thyroglossal cyst?

A

On examination, the cyst rises as the patient swallows or protrudes their tongue because of its attachment to the tongue via the tract of thyroid descent.

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46
Q

What is the treatment of a thyroglossal cyst?

A

Often, it presents with infection requiring drainage prior to excision.

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47
Q

Where does pharyngeal cacner happen?

A

The nasopharynx (behind the nose)

The oropharynx, which includes the under surface of the soft palate, the base of the tongue and the tonsils

The hypopharynx (bottom part of the throat)

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48
Q

What are the symptoms associated with each location of pharyngeal cancer?

A

Nasopharynx
Most likely to cause a lump in the neck, but may also cause nasal obstruction, deafness and post-nasal discharge

Oropharynx
Common symptoms are a persistent sore throat, a lump in the mouth or throat, and otalgia

Hypopharynx
Problems with swallowing and ear pain are common symptoms and hoarseness is not uncommon

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49
Q

What are the risk factors for pharyngeal cancer?

A

The majority of upper airway tract (UAT) cancers are triggered by alcohol and tobacco, which together probably account for three-quarters of cases

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50
Q

What are the investigations for pharyngeal cancer?

A
  1. Ultrasound
  2. Fine-needle aspiration cytology or core biopsy for people with a neck lump that is suspected of being cancer of the upper aerodigestive tract
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51
Q

What is epistaxis?

A

Bleeding from the nose

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52
Q

What are the different classifications of epistaxis?

Where do these occur?

A
  1. Anterior bleeding
    More common - seen in around 90% of cases

Occurs from Keisselbach’s plexus in a site known as the Little’s area
2. Posterior bleeding
Present in around 10% of cases

Woodruff plexus - Behind the posterior part of the middle turbinate

The posterior superior roof of the nasal cavity

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53
Q

What are the risk factors for epistaxis?

A
  1. A hot, dry indoor climate
    This causes the delicate nasal skin to crack
  2. Deviated nasal septum
    This alters airflow pattern and causes the skin on one side of the nasal septum to become dry
  3. Colds and allergies
    Upper respiratory tract infections and allergies increase the risk of bleeding.due to inflammation
  4. Irritant chemical exposure
  5. Medical causes
    Kidney failure, thrombocytopenia,hypertension, hereditary bleeding disorders (e.g.hemophilia)
  6. Anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
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54
Q

What are some local causes of epistaxis?

A
  1. Chronic sinusitis
  2. Irritants (cigarette smoke)
  3. Medications (e.g. topical corticosteroids)
  4. Rhinitis
  5. Trauma
  6. Nasal vessel degeneration
  7. Septal deviation and perforation
  8. Vascular malformation (e.g. telangiectasia
  9. Neoplastic
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55
Q

What are some systemic causes of epistaxis?

A
  1. Medication
    Warfarin
    Aspirin and other NSAIDS
  2. Haematological disorders
    Hereditary haemorrhagic telangiectasia
    Bleeding diatheses
    Leukaemia
  3. Liver disease (cirrhosis)
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56
Q

What are the investigations for epistaxis?

A

Examination
Nasal passage should be done with a Thudicum nasal speculum under adequate lighting to identify bleeding points

Laboratory studies are indicated in

  1. Patients with severe hemorrhage - full blood count, coagulation studies, blood typing and screening for possible transfusion
  2. Patients taking warfarin - full blood count, coagulation studies
  3. Patients with systemic conditions - investigations for hepatic or renal dysfunction
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57
Q

What is the treatment for epistaxis?

A
  1. First aid measures
  2. Cautery -using a silver nitrate stick
    Used in epistaxis that is refractory to first aid measures and if the bleeding site can be identified
  3. Nasal packing
    If bleeding continues despite cautery methods or if the bleeding point cannot be seen
    If nasal packing fails refer the patient to secondary care for further management
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58
Q

What is a red flag for recurrent nosebleeds?

A

Unilateral epistaxis - nasal cancer

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59
Q

What is a cholesteatoma?

A
  1. Are skin or stratified keratinising squamous epithelium growing in the middle ear
  2. They are a greasy-looking mass or accumulation of debris that is seen in a retraction pocket or perforation
  3. They often take the form of a cyst or pouch that sheds layers of old skin
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60
Q

What are the symptoms of a cholesteatoma?

A

Smelly (faecal) discharge and chronic drainage
Often presents as chronic otorrhea unresponsive to antibiotic therapy

Hearing loss
in 90 percent of patients there is conductive hearing loss caused by ossicular erosion

61
Q

What are the investigations for cholesteatoma?

A

Otoscopy

  1. Pearly, white, glistening debris occupying a perforation in the tympanic membrane - usually the pars flaccida
  2. Crusting in the uppermost part of the ear drum - the attic - beneath which lies a cholesteatoma

Tuning fork
Conductive hearing loss

62
Q

What is the treatment for a cholesteatoma?

A

Surgical Excision

63
Q

What is Meniere’s disease?

A

Meniere’s disease is a disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system.

64
Q

What is the cause of Meniere’s disease?

A
  1. The exact mechanism of the disease is controversial.
  2. Although Ménière’s disease is idiopathic, endolymphatic hydrops has been postulated as the cause of the disease
  3. The increased pressure causes rupture of the inner ear membranes and mixing of endolymph and perilymph which are biochemically dissimilar, having a high and a low potassium content, respectively.
  4. This causes acute vestibulo-cochlear failure, with sudden vertigo and deafness
65
Q

What are the symptoms of Meniere’s disease?

A

Periodic episodes of rotary vertigo or dizziness
Attacks occur intermittently, often in clusters.

  1. Fluctuating, progressive, unilateral or bilateral hearing loss
  2. Tinnitus
  3. A sensation of fullness or pressure in one or both ears
  4. Tumarkin attacks
  5. Nystagmus

NOT AFFECTED BY HEAD POSITION

66
Q

What are the investigations for Meniere’s disease?

A

Meniere’s disease is a clinical diagnosis. Patients usually present with episodic dizziness. Acute episodes of vertigo should be differentiated from non-rotatory dizziness

  • *To exclude systemic conditions.**
  • Renal function, glucose - metabolic disturbances
  • FBC, ESR, CRP - infections
  • TFT - hormonal imbalances

For testing of hearing
Pure tone audiometry

ENG (electronystagmograph) or video nystagmography
May be performed to evaluate balance function

67
Q

What is the management for Meniere’s disease?

A
  1. Acute attacks:
    • ​​Buccal or intramuscular prochlorperazine. Admission is sometimes required
  2. Prevention:
    • ​​Betahistine and vestibular rehabilitation exercises may be of benefit
  3. ENT assessment is required to confirm the diagnosis
  4. Patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
68
Q

What is Ménière’s disease compared to Ménière’s syndrome?

A

Ménière’s disease is an idiopathic condition while

Ménière’s syndrome results secondary to various processes interfering with normal production or resorption of endolymph

69
Q

What is rhinosinusitis?

A

Rhinitis is inflammation of the lining of the nose.

70
Q

What are the causes of rhinosinusitis?

A

Allergic rhinitis
Seasonal (also called “hay fever”)
Caused by grass, tree pollen allergens, symptoms can seen during the same time each year

Perennial
Caused by house dust mites, symptoms occur right throughout the year

Occupational
Caused by allergens at workplace e.g.- flour allergy in a baker

Non-allergic rhinits
Streptococcus pneumoniae

71
Q

What are the symptoms of rhinosinusitis?

A

Itching, sneezing and watery nasal discharge

72
Q

What is the management of rhinosinusitis?

A

Acute <12w

  1. If not improving after 10 days prescribe high dose steroid spray (memetasone 200mcg BD 14d)
  2. If still not improving consider prescribing penicillin V (adult dose PO 500mg QDS 5d)

Chronic >12w

  1. Saline nasal irrigation
  2. Steroid nasal sprays
  3. FESS (functional endoscopic sinus surgery) to remove or correct obstructions.
73
Q

What is tonsillitits?

A

Acute tonsillitis is acute inflammation of the tonsils

74
Q

What are the signs and symptoms of tonsillitis?

A
  1. Sore throat
  2. Otalgia
  3. Headache and malaise

On examination:

  1. Patient is pyrexial
  2. Tonsils are enlarged and may be exuding pus from the tonsillar crypts - follicular tonsillitis
  3. Pharyngeal mucosa is inflamed
  4. Fetor - foul smell
  5. Cervical lymph nodes are enlarged and tender
75
Q

What is the management for tonsillitis?

A

Analgesia
Paracetamol and NSAIDs

90% of cases resolve in 7 days without treatment

​Consider antibiotics
If Centor score 3 or 4 OR FeverPAIN score 4 or 5

Phenoxymethylpenicillin
If allergic then clarithromycin

76
Q

What are the Centor and FeverPain criteria for?

A

Used to predict the likelihood of the patinet having Group A beta-haemolytic streptococcus

77
Q

What is on the Centor criteria?

A
78
Q

What is on the FeverPAIN criteria?

A
79
Q

What are the most common complications of tonsillitis?

A

Otitis media

Quinsy - peritonsillar abscess

80
Q

What are the indications for tonsillectomy?

A
  1. Absolute:
    • Biopsy in selected malignancy
  2. Relative:
    Tonsillectomy is recommended for recurrent severe sore throat in adults
    • Seven or more well documented, clinically significant, adequately treated sore throats in the preceding year or
    • Five or more such episodes in each of the preceding two years or
    • Three or more such episodes in each of the preceding three years
81
Q

WHAT IS A PLEOMORPHIC ADENOMA?

A

Pleomorphic adenoma (also known as a benign mixed tumour) is a benign tumour of the parotid gland. It is the most common tumour of the parotid gland and typically appears at the age of 40-60 years.

82
Q

What are the clinical feautres of a pleomorphic adenoma?

A
  1. gradual onset, painless unilateral swelling of the parotid gland
  2. typically movable on examination rather than fixed
83
Q

What is the management of a pleomorphic adenoma?

A
  1. surgical excision
84
Q

WHAT ARE SOME CAUSES OF VOICE HOARSENESS?

A
  1. voice overuse
  2. smoking
  3. viral illness
  4. hypothyroidism
  5. gastro-oesophageal reflux
  6. laryngeal cancer
  7. lung cancer
85
Q

What are the investigations for voice hoarseness?

A

When investigating patients with hoarseness a chest x-ray should be considered to exclude apical lung lesions.

86
Q

What pathway should a patinet be referred if they are suspected laryngeal cancer?

A
  1. A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
    • persistent unexplained hoarseness or
    • An unexplained lump in the neck.
87
Q

WHAT IS MASTOIDITIS?

A

Mastoiditis typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone.

88
Q

What are the features of mastoiditis?

A
  1. Otalgia: severe, classically behind the ear
  2. There may be a history of recurrent otitis media
  3. fever
  4. the patient is typically very unwell
  5. swelling, erythema and tenderness over the mastoid process
  6. the external ear may protrude forwards
  7. ear discharge may be present if the eardrum has perforated
89
Q

What is the diagnosis of mastoiditis?

A
  1. Clinically
  2. Can use CT
90
Q

What is the management of mastoiditis?

A

IV antibiotics

91
Q

What are the complications of mastoiditis?

A
  1. facial nerve palsy
  2. hearing loss
  3. meningitis
92
Q

WHAT IS RAMSAY HUNT SYNDROME?

A

Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

93
Q

What are the features of Ramsay Hunt syndrome?

A
  1. auricular pain is often the first feature
  2. facial nerve palsy
  3. vesicular rash around the ear
  4. other features include vertigo and tinnitus
94
Q

What is the management of Ramsay Hunt syndrome?

A
  1. Oral aciclovir and corticosteroids are usually given
95
Q

WHAT IS ACUTE SINUSITIS?

A

Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses. The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

96
Q

What are the features of acute sinusitis?

A
  1. Facial pain
  2. typically frontal pressure pain which is worse on bending forward
  3. nasal discharge: usually thick and purulent
  4. nasal obstruction
97
Q

What is the management of acute sinusitis?

A
  1. Analgesia
  2. Intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
  3. NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
  4. oral antibiotics are not normally required but may be given for severe presentations.
  5. The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
98
Q

What is a featute of acute sinusitis were a person seems to be getting better but then declines?

A
  1. ‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
99
Q

WHAT IS A PHARYNGEAL POUCH?

A

A pharyngeal pouch (also known as Zenker’s diverticulum) is a posteromedial diverticulum through Killian’s dehiscence. Killian’s dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles. It is more common in older patients and is 5 times more common in men

100
Q

What are the features of a pharyngeal pouch?

A
  1. Dysphagia
  2. regurgitation
  3. aspiration
  4. neck swelling which gurgles on palpation
  5. halitosis
101
Q

What is the investigations of pharyngeal pouch?

A

barium swallow combined with dynamic video fluoroscopy

102
Q

What is the management of a pharyngeal pouch?

A

Surgery

103
Q

WHAT IS BENIGN PAROXYSMAL POSITIONAL VERTIGO?

A

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo encountered.

It is characterised by the sudden onset of dizziness and vertigo triggered by changes in head position.

The average age of onset is 55 years and it is less common in younger patients.

104
Q

What is the causes of BPPV symptoms?

A
  1. Displacement of an otolith with the semicircular cancals
  2. Causes abnormal movement with the canals, giving vertigo
105
Q

What are the features of benign paroxysmal vertigo?

A
  1. Vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
  2. May be associated with nausea
  3. Each episode typically lasts 10-20 seconds
  4. Positive Dix-Hallpike manoeuvre, indicated by:
    • Patient experiences vertigo
    • Rotatory nystagmus
106
Q

What is the management of benign paroxysmal vertigo?

A
  1. Epley manoeuvre (successful in around 80% of cases)
  2. teaching the patient exercises they can do themselves at home, termed vestibular rehabilitation, for example Brandt-Daroff exercises
  3. Medication is often prescribed (e.g. Betahistine) but it tends to be of limited value.
107
Q

WHAT ARE THE ASSOCIATIONS WITH A NASAL POLYP?

A
  1. asthma (particularly late-onset asthma)
  2. aspirin sensitivity
  3. infective sinusitis
  4. cystic fibrosis
  5. Kartagener’s syndrome
  6. Churg-Strauss syndrome
108
Q

What is the association of asthma, aspirin sensitivity and nasal polyposis known as?

A

Samter’s triad

109
Q

What is the treatment for nasal polyps?

A
  1. All patients with suspected nasal polyps should be referred to ENT for a full examination
    • Unilateral nasal polyps are a red flag
  2. Topical corticosteroids shrink polyp size in around 80% of patients
110
Q

WHAT ARE THE SYMPTOMS OF EAR WAX?

A
  1. pain
  2. conductive hearing loss
  3. tinnitus
  4. vertigo
111
Q

What is the treatment for ear wax provided they don’t have a perforated ear drum or grommets?

A
  1. olive oil
  2. sodium bicarbonate 5%
  3. almond oil
112
Q

WHAT ARE THE FEATURES OF VESTIBULAR NEURONITIS?

A
  1. Recent viral infection
  2. Recurrent vertigo attacks lasting hours or days
  3. NO HEARING LOSSSSSS
113
Q

What is the treatment for vestibular neuronitis?

A
  1. Buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
  2. A short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
  3. vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
114
Q

WHAT ARE THE FEATURES OF LABYRINTHITIS?

A
  1. Recent viral infection
  2. Sudden onset
  3. Nausea and vomiting
  4. Hearing may be affected
115
Q

WHAT IS A NASOPHARYNGEAL CARCINOMA?

A
  1. Squamous cell carcinoma of the nasopharynx
  2. Rare in most parts of the world, apart from individuals from Southern China
  3. Associated with Epstein Barr virus infection
116
Q

What are the presenting features of a nasopharyngeal carcinoma?

A

Systemic

  1. Cervical lymphadenopathy

Local

  1. Otalgia
  2. Unilateral serous otitis media
  3. Nasal obstruction, discharge and/ or epistaxis
  4. Cranial nerve palsies e.g. III-VI
117
Q

What is the imaging for nasopharyngeal carcinoma?

A

Combined CT and MRI

118
Q

What is the treatment for nasopharyngeal carcinoma?

A

Radiotherapy

119
Q

WHAT ARE THE COMPLICATIONS AFTER A TONSILLECTOMY?

A
  1. Haemorrhage
  2. Pain
120
Q

What is the treatment for complications post tonsillectomy?

A
  1. Haemorrhage is a feared complication following tonsillectomy. All post-tonsillectomy haemorrhages should be assessed by ENT.
  2. Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
  3. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
121
Q

WHAT DOES WEBER’S TEST SHOW YOU?

A
  1. In unilateral Sensorineural deafness, sound is localised to the Superior/unaffected side
  2. In unilateral Conductive deafness, sound is localised to the Crap/affected side
122
Q

What does Rinne test tell you?

A
  1. ‘positive test’: air conduction (AC) is normally better than bone conduction (BC)
  2. ‘negative test’: if BC > AC then conductive deafness
  3. Air conduction > bone conduction = sensorineural hearing loss
123
Q

WHAT ARE THE CONDITIONS CUASING CONDUCTIVE HEARING LOSS?

A
  1. Exotosis
  2. Cholesteatoma
  3. Perforated eardrum
  4. Ear wax
124
Q

What are the conditions causing sensorineural hearing loss?

A
  1. Acoustic neuromas
  2. Age-related hearing loss
  3. Noise-related hearing loss
125
Q

WHAT IS THE TREATMENT FOR A PERFORATED EARDRUM?

A
  1. Watch and wait - if persists beyond 6 weeks then ENT referral
  2. Myringoplasy
126
Q

WHAT IS BARRETT’S OESOPHAGUS?

A

Barrett’s refers to the metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium. There is an increased risk of oesophageal adenocarcinoma, estimated at 50-100 fold

127
Q

What are the risk factors for barrett’s oesophagus?

A
  1. gastro-oesophageal reflux disease (GORD) is the single strongest risk factor
  2. male gender (7:1 ratio)
  3. smoking
  4. central obesity
128
Q

What is the management of barrett’s oesophagus?

A
  1. Endoscopic surveillance with biopsies
  2. high-dose proton pump inhibitor: whilst this is commonly used in patients with Barrett’s the evidence base that this reduces the change of progression to dysplasia or induces regression of the lesion is limited

Endoscopic surveillance

  1. for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

If dysplasia of any grade is identified endoscopic intervention is offered. Options include:

  1. Endoscopic mucosal resection
  2. Radiofrequency ablation
129
Q

What are the features of nasal septal haemotoma?

A
  1. may be precipitated by relatively minor trauma
  2. the sensation of nasal obstruction is the most common symptom
  3. pain and rhinorrhoea are also seen
  4. on examination, classically a bilateral, red swelling arising from the nasal septum
  5. this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm
130
Q

WHAT IS THE TREATMENT OF A NASAL SEPTAL HAEMATOMA?

A

Urgent ENT referral

  1. Surgical drainage
  2. IV antibitoics
131
Q

WHAT IS THE TREATMENT FOR SUDDEN-ONSET SENSORINEURAL HEARING LOSS?

A

High-dose oral corticosteroids are used by ENT for all cases of SSNHL.

132
Q

WHAT DOES BLUNT TRAUMA WITH ASSOCIATED HYPHEMA PUT YOU AT RISK OF?

A

Glaucoma

133
Q

MOUTH ULCERS LONGER THAN HOW LONG MUST BE REFERRED TO ORAL SURGERY?

A

3 weeks

134
Q

WHAT IS OTOSCLEROSIS?

A
  1. Otosclerosis describes the replacement of normal bone by vascular spongy bone.
  2. It causes a progressive conductive deafness due to fixation of the stapes at the oval window.
  3. Otosclerosis is autosomal dominant and typically affects young adults
135
Q

What are the features of otosclerosis?

A
  1. conductive deafness
  2. tinnitus
  3. normal tympanic membrane*
  4. positive family history
136
Q

What is the management of otosclerosis?

A
  1. hearing aid
  2. stapedectomy
137
Q

WHAT IS A PERITONSILLAR ABSCESS (QUINSY)?

A

A peritonsillar abscess typically develops as a complication of bacterial tonsillitis.

138
Q

What are the features of a peritonsillar abscess?

A
  1. severe throat pain, which lateralises to one side
  2. deviation of the uvula to the unaffected side
  3. trismus (difficulty opening the mouth)
  4. reduced neck mobility
139
Q

What is the management of a peritonsillar abscess (quinsy)?

A
  1. Patients need urgent review by an ENT specialist.
  2. Management
    • needle aspiration or incision & drainage + intravenous antibiotics
    • tonsillectomy should be considered to prevent recurrence
140
Q

WHAT IS PRESBYCUSIS?

A

Presbycusis is a type of sensorineural hearing loss that affects elderly individuals. Typically, high-frequency hearing is affected bilaterally, which can lead to conversational difficulties, particularly in noisy environments.

141
Q

What are the investigations for presbycusis?

A
  1. Otoscopy: Normal, to rule out otosclerosis, cholesteatoma and conductive hearing loss (Foreign body, impacted wax etc.)
  2. Tympanometry: Normal middle ear function with hearing loss (Type A)
  3. Audiometry: Bilateral sensorineural pattern hearing loss
  4. Blood tests including inflammatory markers and specific antibodies: Normal
142
Q

WHAT IS PREAURICULAR SINUS?

A
  1. Small epithelial defect anterior to the left ear
  2. Produce foul mselling discharge
143
Q

WHICH RECURRENT LARYNGEAL NERVE IS MORE SUSCEPTALBE TO DAMAGE AND WHY?

A

Left, has a longer course, therefore, more susceptable to damage

144
Q

What are the fives parts of the facial nerve?

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical
145
Q

WHAT IS INFECTIOUS MONONUCLEOSIS?

A
  1. Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4) in 90% of cases. Less frequent causes include cytomegalovirus and HHV-6. It is most common in adolescents and young adults.
146
Q

What are the symptoms of infectious mononucleosis?

A
  1. sore throat
  2. lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
  3. pyrexia
147
Q

What are some other features of infectious mononucleosis?

A
  1. malaise, anorexia, headache
  2. palatal petechiae
  3. splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
  4. hepatitis, transient rise in ALT
  5. lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
  6. haemolytic anaemia secondary to cold agglutins (IgM)
  7. a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
148
Q

What are the investigations for infectious mononucleosis?

A
  1. heterophil antibody test (Monospot test) - NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.
149
Q

What is the managemnet of infectious mononucleosis>

A
  1. rest during the early stages, drink plenty of fluid, avoid alcohol
  2. simple analgesia for any aches or pains
  3. consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

ΩΩ 4 Bateman - Specialities + Endo + GI + Liver (6 decks)

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