ENT Flashcards
What are some causes of conductive hearing loss?
Pinna - atresia
External auditory canal - wax, FB, otitis externa, osteoma
Tympanic membrane - large perforation, tympanosclerotic plaque
Middle ear - OME, haemotympanum, cholesteatoma, otosclerosis
What tests can you perform in hearing loss?
Pure tone audiogram (subjective) and tympanogram (objective)
Free field hearing test
What are some causes of sensorineural hearing loss?
Inner ear - meningitis, cochlear aplasia, ototoxic medication, menieres, cochlear otosclerosis, noise induced hearing loss, presbycusis
Retrocochlear - cochlear nerve damage, IC lesions, IAM lesions
What is the commonest cause of sensorineural HL?
Age related HL - Presbycusis
Progressive bilateral degeneration due to loss of inner and outer hair cells.
Hearing impaired in background noise, may be described and sound is loud but not clear
What is characteristic of otosclerosis on an audiogram?
Carhart’s notch (dip in bone conduction)
Otosclerosis - abnormal bone growth at stapes so it may become fixed
What does conductive HL look like on a pure tone audiogram?
Air - bone gap
Reduction in air conduction compared to bone conduction
What does sensorineural HL look like on a pure tone audiogram?
Both are low
Most common cause - Presbycusis
What results can you get in a typanogram? (A, B, C)
Type A - normal middle ear
Type B - high volume - perforation, Low volume - middle ear effusion
Type C - Eustachian tube dysfunction
What decibels indicate normal hearing?
From - 10 to 20dB
What dB classifies mild - profound HL?
Mild = 20-40dB Moderate = 40-70dB Severe = 70-90dB Profound = 90-120dB
What might you present with in acute otitis media?
Rapid onset Otalgia, pyrexia
If perforates the pain eases and there is discharge
What commonly causes otitis media with effusion?
> 50% occur after AOM infection
Hearing loss, otalgia, ear fullness
common between 6 months and 4 years
Social problems - poor behaviour and listening, delay in speech and language, inattention
What is otitis externa?
Infection of the outer external auditory canal
Otalgia, discharge, ITCH
Commonly due to pseudomonas or candida
What is necrotising OE?
Aggressive and life threatening
Usually due to psuedomonas
Severe otalgia, keeps them awake at night, otorrhoea, ±facial/abducens palsy
Destruction of temporal bone and base of skull osteomyelitis
What is a cholesteatoma?
Build up or keratin debris in the middle ear
Dizziness, conductive hearing loss, ear pain and numbness, facial muscle weakness
Can lead to an infection - discharge
What is tinnitus?
A sound perceived for more than 5 minutes at a time, in the absence of any external acoustical or electrical stimulation of the ear and not occurring after loud sound exposure
Objective or Subjective
Intrusiveness depends on psychological state of pt
What is objective tinnitus?
Tinnitus audible to both the patient and examiner - somatosounds (AVM, glomus tumour, tympanic myoclonus)
What is Subjective tinnitus?
Tinnitus audible to only the patient - SNHL, Hyper-dynamic states (hyperthyroidism, pregnancy)
What symptoms must you have to diagnose Sinusitis in a patient presenting with facial pain?
Nasal blockage ± discharge
What are the red flags for sinonasal malignancy?
Unilateral symptoms, blood stained discharge, nasal obstruction, dental/orbital signs
Where do most nose bleeds originate?
Little’s area in the anterior septum - Kiesselbach’s plexus
What arteries make up Kiesselbach’s plexus?
Anterior ethmoidal (from internal carotid), Greater palatine, sphenopalatine* (from maxillary from external carotid) and Superior labial (from facial artery from the EC)
Why is it important to look for a septal haematoma (boggy cherry red swelling) after a nasal fracture?
Septal haematomas deprive the cartilage of its blood supply and can lead to ischaemic necrosis of the cartilage, perforation and then saddle nose deformity or can lead to a septal abscess
What is the difference between a tracheostomy and a laryngectomy?
Tracheostomy - Upper airway still patent
Laryngectomy - Larynx has been removed. Trachea is plugged into the front of the neck - no air from nose or mouth can reach the trachea