ENT Flashcards
Difference in viral labyrinthitis and vestibular neuronitis?
Viral labyrinthitis = hearing loss as well as dizziness
What is a branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
What is a cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
What is a pharyngeal pouch?
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
What is a thyroglossal cyst?
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
Management of menieres?
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
Features of menieres disease?
recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years
Treatment for BPPV?
Epley manoeuvre
AC and BC tests results for conductive and sensorineural loss?
Sensorineural = AC > BC bilaterally, lateralise to other side to loss
Conductive BC > AC on affected side. lateralise to that side on webers
Centor criteria for red flag Sx of sore throat?
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
Treatment for otitis externa?
topical antibiotic or a combined topical antibiotic with a steroid. Antibiotic is often aminoglycoside. If the tympanic membrane is ruptured then an aminoglycoside is not used.
What drugs can cause tinnitus and hearing loss (ototoxicity).
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
Management of epistaxis
In order:
Adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help)
Topical adrenaline/local anaesthetic
Topical tranexamic acid
Nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter).
Surgical intervention (sphenopalatine artery ligation).
Symptoms of post nasal drip?
Bad breath, feeling of mucus in back of throat, chronic cough
May have erythematous throat
Features of ramsay hunt syndrome?
Auricular (ear) pain is often the first feature
Facial nerve palsy
Vesicular rash around the ear
Other features include vertigo and tinnitus
What is Ramsay hunt syndrome?
Caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
Management of Ramsay hunt syndrome?
oral aciclovir and corticosteroids are usually given
What is presbyacusis? What are the normal findings on examination of hearing?
Age related hearing loss
Bilateral sensorineural pattern hearing loss:
Bilateral impairment
High-frequency hearing loss
Downward-sloping pure tone thresholds
How long would a perforation have to be present (following otitis media) for a referral to ENT?
6 weeks
When should you refer a child with glue ear?
Symptoms are significantly affecting hearing, development or education.
Immediate referral in children with Downs syndrome or cleft palate
Persist beyond 6-12 weeks
Management of acute sensorineural hearing loss?
Acute sensorineural hearing loss is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI.
Start high dose oral steroids (60mg/day)
Management of allergic rhinitis?
Allergen avoidance
if the person has mild-to-moderate intermittent, or mild persistent symptoms:
- oral or intranasal antihistamines
If the person has moderate-to-severe persistent symptoms, or initial drug treatment is ineffective:
- intranasal corticosteroids
A short course of oral corticosteroids are occasionally needed to cover important life events
there may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline).
If you are treating a sore throat what antibiotics and for how long?
Either phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) should be given. Either a 7 or 10 day course should be given.
Management of adult glue ear?
2ww - ?posterior nasal space tumour
Chronic rhinosinusitis management? What if unilateral symptoms?
avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
If unilateral symptoms then 2ww
Indications for abx in otitis media?
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Management of patients with suspected menieres in primary care?
Referral to ENT for confirmation of diagnosis
BPPV Viral labyrithitis and Vestibular neuronitis and Menieres have what eye movement feature?
(Horizontal) nystagmus
Audiogram results for sensorineural and conductive hearing loss?
in sensorineural hearing loss both air and bone conduction are impaired
in conductive hearing loss only air conduction is impaired
Risk factors for glue ear?
Male sex
Siblings with glue ear
Higher incidence in Winter and Spring
Bottle feeding
Day care attendance
Parental smoking
Features of otosclerosis?
Onset is usually at 20-40 years - features include: conductive deafness tinnitus normal tympanic membrane* positive family history
Does menieres cause permanent hearing loss?
Usually it does cause mild hearing loss.
Management of acute sinusitis?
Analgesia
Intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited.
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days.
Oral antibiotics are not normally required but may be given for severe presentations.
How long would you leave otitis media before treating and what would you treat with?
Guidelines would advocate treatment after a delay of 2-3 days if there is no improvement in symptoms.
Oral amox
Unilateral or bilateral polyps is a red flag?
Unilateral
Management of black hairy tongue?
Tongue scraping
Topical antifungals if Candida
What can cause gigival hyperplasia?
phenytoin, ciclosporin, calcium channel blockers and AML
Management of vestibular neuronitis and viral labyrinthitis?
Vestibular Neuronitis:
Vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms.
Buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases.
A short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
Viral labyrinthitis:
Episodes are usually self-limiting.
Prochlorperazine or antihistamines may help reduce the sensation of dizziness
What is malignant otitis externa (features)?
Diabetes (90%) or immunosuppression (illness or treatment-related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
Treatment of malignant otitis externa?
Non-resolving otitis externa with worsening pain should be referred urgently to ENT.
Intravenous antibiotics that cover pseudomonal infections (Ciprofloxacin, cephalosporins, carbapenems, aminoglycosides - (?would be avoided here))
What is Siladenitis?
sialadenitis - inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.
What is lymphadenitis?
Enlargement of lymph glands due to inflammation (usually infection)
Features of trigeminal neuralgia?
Unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination
May be triggered by light touch, emotion
What medication is associated with nasal polyps?
Aspirin
Causes of bilateral parotid swelling?
viruses: mumps
sarcoidosis (associated with cough)
Sjogren’s syndrome
lymphoma
alcoholic liver disease
2ww rules for oral lesions?
Unexplained oral ulceration or mass persisting for greater than 3 weeks
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion
Common cause for repeated Otitis externa (not malignant)?
Candida
