ENT Flashcards
Where is the problem is conductive hearing loss?
due to external / middle ear
Where is the problem is sensorineural hearing loss?
due to inner ear / CNVIII
Signs of CHL compared to normal on rinnes test?
Normal = air conduction > bone conduction
CHL = bone conduction > air conduction
Signs of CHL and SNHL compared to normal on weber test?
Normal =equal
CHL = lateralises to affected ear
SNHL = sound louder in normal ear
Common organisms of Acute Otitis Media and how does it happen?
URTI migrates to middle ear via eustachian tube
common organisms : strep pneumoniae and h.influenzae
When should Abx be given in Acute Otitis Media and what is given?
Symptoms for more than 4 days, under 2 years old, systemically unwell or perforation
Amoxicillin for 5-7 days
Acute Otitis Media
Common complications?
hearing loss
mastoiditis
CHOLESTEATOMA
symptoms?
foul smelling brown discharge
hearing loss
CHOLESTEATOMA
signs on otoscopy?
Otoscopy
‘attic crust’ - seen in the uppermost part of the ear drum
CHOLESTEATOMA
What congenital abnormality increases the risk?
Cleft palate increases the risk by 100 fold
CHOLESTEATOMA
What is it?
Growth of keratinising squamous epithelial cells trapped in skull base causing localised destruction
Otitis Externa
What is it commonly known as?
Symptoms?
Swimmers ear
SWIM DIP
Discharge
Itch
Pain
Otitis Externa
Common causing bacteria?
pseudomonas aeruginosa
staph aureus
Otitis Externa
Treatment?
topical antibiotic or a combined topical antibiotic with a steroid
if a pt fails to respond to tx refer to ENT
BPPV
Features?
vertigo triggered by change in head position associated with nausea lasting 10-20 seconds
BPPV
Cause?
canaliths (crystals) in semi-circular canals
BPPV
What test is a positive sign?
Hallpike manoeuvre
causes rotatory nystagmus
Symptomatic relief of BPPV?
Epley manoeuvre (successful in around 80% of cases)
Meniere’s Disease
features including Triad?
how long do episodes last and how long may someone have symptoms for?
Vertigo
Tinnitus
Sensorineural hearing loss
+ sensation of fullness in the ear
episodes lasting minutes to hours
resolve after 5-10 years
What causes Meniere’s Disease
Excessive pressure and progressive dilation of the endolymphatic system
What is Vestibular Neuronitis
cause of vertigo that often develops following a viral infection.
Features of Vestibular Neuronitis?
vertigo lasting hours - days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
Management of Vestibular neuronitis?
1st - vestibular rehabilitation exercises
2nd - a short oral course of prochlorperazine
Most common type of head and neck cancer?
Squamous cell carcinomas
how can vestibular neuritis be distinguished from Labyrinthitis
vestibular neuritis = the vestibular nerve is involved, hence there is no hearing impairment;
Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.
Features of Labyrinthitis?
Patients typically present with an acute onset of:
vertigo: not triggered by movement but exacerbated by movement
nausea and vomiting
hearing loss
tinnitus
preceding or concurrent symptoms of upper respiratory tract infection
What causes a Septal Haematoma and what happens if it is left untreated?
Trauma
untreated causes irreversible septal necrosis and ‘saddle nose’ deformity
Sign of Septal Haematoma
Feeling of nasal obstruction and classically, bilateral swelling arising from septum
Management of recurrent or chronic sinusitis?
avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
What to do if acute sinusitis lasts more than 10 days?
intranasal corticosteroids may be considered
Epistaxis
common location of bleeds?
Anterior (90%) - Klasselbach’s Plexus
Posterior - Woodnuffs Plexus
Epistaxis management?
1) Lean forward with mouth open and pinch cartilage for 20 mins
2) Cauterise bleeding if it can be visualised
3) Pack the nose if it can’t be visualised
4) Give topical antiseptic (Naseptin) if first aid measures successful
