ENT Flashcards
Allergic rhinitis
Cause; Sx 3; Mx 3; Review
Cause: Allergy/triggers, e.g. pollen, grass, house dust mite, animal hair, latex, etc
Sx: Rhinorrhea, sneezing, itchy noise
Mx…
Mild-moderate intermittent symptoms OR mild persistent symptoms:
- Intranasal antihistamines (eg azelastine) - FASTER ACTION AND MORE EFFECTIVE
- Non-sedating oral antihistamines (eg loratidine, cetirizine)
- Intranasal chromone (eg sodium cromoglycate) if antihistamines can’t be used
For moderate-severe persistent symptoms OR above not effective:
- Regular nasal corticosteroid (eg mometasone, fluticasone)
- Can use nasal drops instead if obstruction
Severe symptoms may need oral steroids (eg prednisolone)
Review…
After 2-4 weeks to assess efficacy of treatment
Nasal fracture
Sx; NAI; After
If Sx of septal haematoma —> immediate assessment!
Consider NAI in children
Later discussion about surgery depends on…
- Type of deformity
- Pt concern re shape
- Likelihood of recurrence, etc
Epistaxis
Types 2; Causes 4; Ix 2; Mx 3
Types:
- Anterior haemorrhage (usually Little’s area on septum)
- Posterior haemorrhage (usually more profuse, elderly, bleeding from deeper structures)
Causes:
- Trauma
- Antiplatelet/anticoagulation meds
- Clotting disorders
- Cocaine use
Ix - may need FBC and clotting profile
Mx:
- Sit upright, lean forwards, pinch bottom soft part of nose for 10-15 mins
- Consider nasal cautery (eg silver nitrate)
- May need packing
Nasal polyps
Sx 3; Consider 2; Ix 2; Mx med/surg
- arise from nasal mucosa, cause unknown
Sx:
- Nasal discharge
- Nasal blockage
- Snoring
Unilateral is presumed neoplastic until proven otherwise - may need biopsy
Think about CF in children
Ix:
May need nasendoscopy/CT via ENT
Mx:
Med - steroids
Surg - polypectomy/ethmoidectomy
Otitis externa
=; RFs 3; Sx 3; Exam 2; Mx 4
= Infection/inflammation (bacterial/fungal) of outer ear, including canal
RFs:
- Swimming
- Diabetes
- Humid conditions
Sx:
- Pain
- Itching
- Discharge
Exam:
- Pain on moving tragus
- Pre-auricular lymphadenopathy
Mx:
- Topical Abx (eg neomycin) if infected
- Topical steroids
- Debris removal
- Swab (eg if treatment failure or atypical appearance)
Otitis media
=; Sx 3; Exam 2; Mx 2
= Inflammation/infection of middle ear (bacterial/viral), commoner in children
Sx:
- Pain
- Fever
- Unwell
Exam:
- Red bulging TM
- Sometimes air-fluid level behind drum
Mx:
- Abx if… (first line amox 5-7 days)
- systemically unwell
- risk of complications
- bilateral in <2yo
- otorrhoea - Consider referral if recurrent OM
Eustachian Tube Dysfunction
=; Sx 3; Mx 2
= ET connects middle ear to nose, air/mucus usually pass through. Tube can block (eg due to infection/glue ear/rhinitis)
—> Sx:
- Muffled hearing
- Ear pain
- Vertigo
Mx:
- Usually settles in a few weeks
- Can be long-term - may need decongestants/steroids/antihistamines/surgery
Cholesteatoma
=; Sx 2; Exam 2
- unknown cause, dangerous due to local expansion
Sx:
- Smelly discharge
- Conductive hearing loss
Otoscopy:
- Pearly white debris
- Perforation
Acoustic neuroma
=; Sx 3 TRIAD; —>; consider
= benign, slow-growing tumour of 8th cranial nerve
Sx:
- Unilateral sensorineural hearing loss
- Vertigo
- Tinnitus
May lead to brainstem compression/raised ICP
If bilateral think of neurofibromatosis
Hearing loss
Conductive vs Sensorineural
Conductive = air —> ear conduction system affected
(Wax, OE/OM, FB, glue ear, otosclerosis)
Sensorineural = inner ear or neural pathways affected
(Infections - rubella, syphillis, mumps, etc -, acoustic neuroma, noise damage, ototoxic drugs, presbyacusis - age related)
Hearing loss tests
Rinne’s & Weber’s
Rinne’s = tuning fork on mastoid (bone), then in front of ear (air)
B > A = conductive deafness
A > B = sensorineural deafness or normal
Weber’s = tuning fork on centre of forehead…
Localises to normal side = sensorineural deafness
Localises to affected side = conductive deafness
Tinnitus
Med causes 4; Referral 5
Medication causes:
- Loop diuretics
- Aminoglycosides (e.g. gentamicin, amikacin, neomycin)
- Aspirin
- NSAIDs
Referral…
IMMEDIATE (i.e. admission)
- Acute vestibular symptoms e.g. vertigo
- Sudden onset neurological features e.g. facial weakness
- Suspected stroke
- High suicidal risk
- Sudden onset pulsatile tinnitus
- 2º to head injury
VERY URGENT (24 hours) - Tinnitus with hearing loss that develops suddenly (in 3 days) within last 30 days
URGENT (2 weeks)
- Distress affecting mental wellbeing
- Hearing loss developed more than 30 days ago
- Persistent otalgia or otorrhoea
Less urgent (based on local pathways) may include…
- Tinnitus that bother pt
- Persistent objective/pulsatile/unilateral
- Unilateral hearing loss
- Uncertain cause
If no referral indication, then…
Reassurance, treat underlying cause,
Sound enrichment/therapy
Vertigo
4
Classify by causes…
Central:
(Brainstem/cerebellum affected)
- Stroke, migraine, MS, acoustic neuroma, etc
Peripheral:
(Inner ear affected)
- BPPV (symptoms worse on moving head as fluid/particles shift) —> Dx w Hallpike manoeuvre; Rx w Epley manoeuvre
Infection/inflammation:
- Vestibular neuronitis (inflammation of vestibular nerve, e.g. due to viral infection) … no hearing loss; Symptomatic Rx eg buccal prochlorperazine & usually settles in a few weeks
- Labyrinthitis (=inflammation of the labyrinth AND vestibular nerve, e.g. due to viral infection) … hearing loss present; may need urgent ENT admission
Ménière’s disease (= progressive disorder of inner ear, unknown cause):
- Due to change in fluid volume of labyrinth
- Triad Sx “DVT” = deafness, vertigo, tinnitus
- ENT referral, r/o other causes eg audiometry/MRI, symptomatic treatment (acute and prophylaxis)
Sore throat: Centor criteria
4
= 3/4 —> 40-60% chance of group A beta-haemolytic strep so treat
- Tonsillar exudate
- Tender anterior cervical lymph nodes
- Absence of cough
- History of fever
Sore throat: FeverPAIN
- Fever
- Purulent
- Attending within 3 days
- Inflamed tonsils
- No cough
Score of 4 or 5 signifies higher bacterial risk
