ENT Flashcards
What is the function of the Eustachian tube?
Connect middle ear with nasopharynx, equalise pressure, drain mucus from middle ear, aerate middle ear.
A child present with otitis media with effusion. It has been ongoing for 10 days now, and the child is not getting any better. Obs include a temperature of 37.9C, the child looks in pain, pulling at ear. With regard to the Eustachian tube, why is it important to resolve this infection?
Not resolved = can lead to speech impediment and delay in language development or school performance
A man presents with a 3 day onset of facial pain, nasal discharge and headache. He has a recent PMH of a URTI. What is your diagnosis?
Acute Sinusitis
A child presents with acute otitis media. What might you find on examination?
Using otoscope, find a bulging, red/yellow/cloudy TM, potential perforation, some discharge in ear canal
A 1 year old child comes in to the GP surgery to see the on call doctor. His notes mention acute otitis media 6 days ago. His temperature is 39C. He is not acting himself. On examination he has neck stiffness and a non-blanching rash on his back. What are your next steps?
Arrange ambulance for immediate admission to Paeds A&E. Child may have meningitis - a complication of acute otitis media.
A woman may have BPPV after listening to her Hx. What manoeuvres would you carry out if comfortable to do so?
Dix-Hallpike, Epley
Describe the presentation of vestibular neuritis
Rotational vertigo which happens spontaneously, nausea, vomiting, balance problems, tinnitus, recent URTI
What are the causes of acute sinusitis?
Post- URTI
Tooth infection
How does acute sinusitis present
Frontal headache, facial pain, worse on movement , worse on bending, nasal discharge and +/- fever
What is chronic sinusitis?
Over 3 months or greater than 3 episodes of sinusitis in a year
How does chronic sinusitis present?
Over 3 months or greater than 3 episodes of sinusitis in a year
Post nasal drip, frontal headache, facial pain, blocked nose, PMH of nasal polyps
How do you treat acute sinusitis?
Supportive- analgesia, fluids, steam inhalation, decongestants
Abx if very severe- amoxicillin
How does acute Otitis media present?
Earache, fever, in kids, children- tugging ear, restlessness, poor feeding , cough, runny nose
How does acute otitis media look on a otoscope?
Red, yellow, cloudy TM; bulging TM, possible perforated, some discharge in ear canal
How do you treat acute otitis media?
Analgesia, safety net on worsening sx, Abx only needed if no improvement in symptoms within 3 days.
Abx- 5-7 day–> amoxicillin/erythromycin
What is the presentation of otitis media with effusion?
Hearing loss, aural fullness, crackling, popping tinnitus, aural pain, dizziness.
Children- the above + mishearing, lack of conc, impaired speech, impaired school progress, hx of URTI, ear infection
What are the otoscope findings for otitis media with effusion?
TM is yellow or amber, retracted, loss of cone of light, air bubbles
How do you treat otitis media with effusion
Watch and wait for 3 months, hearing tests 3 months apart with audiometry and tympanometry.
grommets after 3 months
How does Otitis externa present?
Itchy, severe ear pain, which is worse when more ear/otoscope inserted, discharge on pillow, tenderness on moving jaw, fever,
V serious cases–> loss of hearing, tender regional lymphadenitis
What are the otoscope findings in Otitis externa?
red, swollen ear canal, shedding of scaly skin in ear, pus in ear canal, discharge, inflamed eardrum
How do treat otitis externa?
Analgesia- oral paracetamol, ibuprofen, warm flannel, topical abx, topical acetic acid 2%.
Oral abx if swollen ear canal, celluitis beyond ear canal,
Flucloxacillin for 7 days, or erythromycin
Self care - no swimming! Keep dry. Use ear drops such as EarCalm
What is BPPV?
Benign paroxsymal positional vertigo.
Vertigo brought on by moving/changing positions. Vertigo <1 min
What are the symptoms of BPPV?
Vertigo lasts less than minute
Nausea and Vomitting
Light headless
How do you investigate BPPV?
Dix- Hallpike- diagnostic
Epley- helps relieve the dizziness
How do you manage BPPV?
Repositioning to help symptoms
Advise on safety e.g. driving, workplace, falls at home
What is vestibular neuritis?
Inflammation of inner ear labyrinth.
How does vestibular neuritis present?
Rotational vertigo happens spontaneously.
Can worsen as the day goes on
Nausea and vomitting
Balance affected
Recent URTI
How is vestibular neuritis management?
Reassure, symptoms get better within few days
Bed rest
Safety issues
If symptoms of nausea and vom–> buccal prochlorperazine or oral if severe
What is Mernieres disease?
Spontaneous vertigo Tinitus Fluctuating SN hearing loss Aural fullness Balance problems Postural instability
How do you investigate Mernieres disease?
Refer ENT to confirm diagnosis
Refer if no improvement in 5-7 days
How do you treat Mernieres?
Admit if sx are severe
Refer to ENT, audiology
Reassure will mostly settle within 24 hrs
Prochlorperazine for nausea or antihistamine.
To prevent further attacks, trial betahistine
What symptoms can ear wax cause?
Hearing loss Blocked ears discomfort earache itchiness
How do you treat earwax?
Soften it using sodium bicarb, olive oil–> use 3-4x daily for 3-5 days
Ear irrigation
Microsuction
What is presbycusis?
Gradual hearing loss in older people, difficulty understanding speech, tinnitus
What is otosclerosis?
Gradual onset of hearing loss in patients between 30-50 Bilateral usually, unilateral is rare Fhx of hearing loss Speaking softly Hearing better in noisy surroundings
What are the investigations in otosclerosis?
Conductive pattern in Rinne’s and Webers audiometry, CT scan
How do you treat otosclerosis?
Refer to ENT, bilateral hearing aids, surgery to remove part of stapes
What are the symptoms of cholesteatoma?
Discharge from the ear Hearing loss Tinnitus If advanced: Otalgia Vertigo facial N involvement
What are the otoscopic findings of cholesteatoma?
Deep retraction pocket TM, crust/ keratin in upper TM, TM perforation
How do you treat cholesteatoma?
referral for surgery. If infection is present, treat for OE or OM
Presentation of tonsillitis
Fever
Sore throat
Pain on swallowing
tonsillar exudate
Indicates viral tonsillitis rather than bacterial?
Coryzal symptoms and cough= viral
Examination findings in tonsillitis?
Inflamed tonsils
White on the tonsils
Fever
Management of tonsillitis?
Self limiting- conservative: analgesia, water, rest
If no change in 5 days, abx: erythromycin or penicillin for 5-10 days
Scoring system for an acute sore throat?
FeverPAIN
Complications of tonsillitis?
Peritonsillar abscess
Glandular fever
Presentation of glandular fever?
Fever
Enlarged lymph nodes
Sore throat
general malaise
Investigations for glandular fever?
Blood test for EBV
Management of glandular fever?
Conservative
If cannot swallow fluids - admit to hospital
Complication of glandular fever?
Splenic rupture
Presentation of tonsillar tumour?
Elderly
Sore throat for >1 month
Difficulty swallowing
Management for tonsillar tumour?
Refer to ENT
Presentation of laryngitis?
Sore throat Fever Pain using voice Hoarseness Hx of URTI
Management of laryngitis?
Conservative- rest, fluids and analgesia, self limiting, resolves 1-2 weeks
Rarely abx if bacterial infection is suspected
Presentation of vocal chord nodules?
hoarseness
repetitive use of voice e.g. singer
Presentation of laryngeal cancer?
Hoarseness Neck lump difficulty swallowing Pain 45yrs and over hx of smoking/ alcohol excess
Presentation of croup?
young children barking cough usually at night difficulty breathing mild fever sometimes stridor
Management of croup?
usually self limiting- give dexamethosone
May need hospital admission for O2
Examination findings in croup?
Increased RR
Clear chest
No cyanosis
Normal O2 sats
Presentation of epiglottitis?
Stridor Sniffing position drooling v unwell fever Hx of bacterial infection
Management of epiglottitis?
Straight to hospital for IV abx
Presentation of branchial cyst in adults?
Painless cyst on anterior border of SCM
Smooth
Usually noticed after URTI
Examination findings of branchial cyst?
Does not move on swallowing
management of branchial cyst?
refer to ENT
Presentation of thyroglossal cyst?
Midline cyst
Smooth
May be inflamed- tender with localised swelling
Examination findings for thyroglossal cyst?
Moves with tongue protrusion
Management of thyroglossal cyst?
Refer to ENT
Presentation of epistaxis
Nosebleeds
hx of trauma? hx of infection
Investigations in epistaxis?
If recurrent/regular FBC to check for anaemia
Examination in epistaxis?
Look into nose
Management for epistaxis?
Acute- hold soft part of nose and lean forward
If recurrent- cauterise or nasal packing
If bleeding from posterior part- admit to hospital
Self care advice- no blowing or picking nose, no hot drinks or alcohol and no lying flat
Presentation of nasal polyps?
Snoring post nasal drip blocked nose stuffy nose Fix of asthma
Examination for nasal polyps?
Look up nose- bilateral smooth polyps
Unilateral/ irregula-?malignancy
Management for nasal polyps?
Nasal spray- steroid
Abx if discharge
Presentation of septal haematoma?
Pain
associated fracture/ recent nasal trauma
Examination of septal haematoma?
Look into nasal passages - see bilateral soft bulging of the septum.
management of septal haematoma?
Refer to ENT
Presentation of allergic rhinitis?
Itchy nose/eyes/throat Sneezing red eyes Nasal congestion bilateral Hx of atopy?
Management for allergy rhinitis?
Self care- NHS leaflets
OTC nasal spry
Antihistamine
Sever- corticosteroids intranasally for periods of exposure
Presentation common cold?
Sore throat, Rhinorrhoea, cough, hoarse voice, general malaise Onset is 1-2days and rapid Fever, headache, loss of taste/smell, pressure in ears/sinuses
Examination of common cold?
Examine for viral spread to other organs
facial pain? sinusitis
chesty cough, asthma? LRTI
ear pain/dishcarge? acute otitis media
Management of common cold?
Adequate fluids, rest, analgesia, anti-pyretic. Steam inhalation, gargling salt water, vapour rubs.
Follow up if symptoms worsen after 5 days or persist after 7-14days.
Presentation fo deviated nasal septum?
Secondary to injury
May also present with external deformity
Unilateral nasal blockage
Management of deviated nasal septum
Treat mucosal swelling as if rhinitis. Not helped? Refer to ENT for surgery
Presentation of septal perforation?
Bleeding, crusting
Pain/discomfort
Recent Hx of trauma, nose picking , malignancy
Substance misuse - cocaine
Management of septal perforation?
Refer if features of malignancy
Treat symptomatically - vaseline, and antiseptic nasal spray for crusting
Refer for surgery if symptomatic treatment not helping
Presentation of snoring/sleep apnoea
Sleeping in the day Snoring Witnessed brreathing pauses Gasping or choking when sleeping Unrefreshed sleep Unexplained morning headache Wakes up in the night Nocturia Obese, depressed, HTN, stroke
What examinations would you do for sleep apnoea?
BMI, BP
Examine for COPD signs, jaw abnormalities, nasopharyngeal obstruction,
check neck circumference
Management for sleep apnoea
Referral to sleep clinic
Referral to paeds ENT if a child with adenotonsillar hypertrophy or regular snoring at night.
Manage weight, lifestyle.
NHS leaflets of sleep apnoea
Presentation of nose fracture?
Pain, swelling, redness Crack/crunch when touch nose Hard to breathe through nose Shape of nose changed Bruising under eyes, cut on nose, nosebleeds
Management of nose fracture?
Advise ice pack, analgesia, treat nosebleeds, keep head upright when lying down, strong painkillers
Refer if not getting better
Presentation of non-allergic rhinitis?
Blocked nose
sneezing
irritation of nose
loss of smell
Management of non-allergic rhinitis?
Rinsing nasal passafe
Nasal spray with steroids
Why are tinnitus and hearing loss NOT a feature of vestibular neuronitis?
As cochlea and cochlear nerve not affected
If a pt presents with vertigo, tinnitus and hearing loss which 2 diagnosis should you consider?
Labrinthitis
Mernieres disease
Compare labyrinthitis and vestibular neuronitis in terms of hearing loss
Labyrinthitis - hearing loss
Vestibular neuronitis - no hearing loss
If vertigo is present as a symptom what is important to explore?
If central (brain) or peripheral (inner ear) cause Neuro signs - central, urgent management e.g. posterior circulation infarction (stroke)
What is typical triad of mernieres?
Hearing loss
Vertigo
Tinnitus
(Can get fullness in ear)
