ENT Flashcards
What typically preceeds acute otitis media
Viral URTI
causes of acute otitis media
viral or bacterial
S/s acute otitis media
- otalgia
- ear tugging
- fever
- URTI sx
Otoscopy findings in acute otitis media
- loss of light reflex due to bulging tympanic membrane
- middle ear effusion
- inflammation (erythema)
How is acute otitis media diagnosed
Clinical
Otoscopy
Management of acute otitis media
- generally self-limiting
- analgesia
- if abx indicated amoxicillin
- pen. allergy : clarithromycin/erythromycin
When are abx indicated in acute otitis media
- sx persist >4 days
- systemically unwell (not requiring admission)
- immunocompromised
- <2yo and bilateral otitis media
- perforation and/or discharge
sx of cerumen impaction
- Hearing loss
- Blocked ears
- Ear discomfort
- Feeling of fullness in ear
- Earache
- Tinnitus
cerumen impaction management
- removal not routinely needed
- ear drops if sx of hearing loss
- ear irrigation if sx persist
When should ear drops NOT BE USED
perforated tympanic membrane, active dermatitis, or active infection of the ear canal.
Causes of labyrinthitis
viral, bacterial or associated with systemic diseases
labyrinthitis
inner ear infection
labyrinthitis vs vestibular neuritis
vestibular neuritis : only the vestibular nerve is involved, hence there is no hearing impairment
labyrinthitis : both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment
sx of labyrinthitis
- vertigo
- n&v
- hearing loss
- tinnitus
- preceding or conceding URTI sx
signs of labyrinthitis
- sensorineural loss
- gait disturbance
- nystagmus
how is labyrinthitis diagnosed
clinical
management of labyrinthitis
- usually self-limiting
- prochlorperazine or antihistamines may help reduce the sensation of dizziness
otitis externa
inflammation (redness and swelling) of the external ear canal
sx of otitis externa
- ear pain
- itch
- discharge
common trigger of otitis externa
swimming
management of otitis externa
topical antibiotic or a combined topical antibiotic with a steroid
What should be done if otitis externa is not responding to initial treatment
ENT referral
Vertigo
false sensation that the body or environment is moving.
Which neurological finding may be found with vertigo
nystagmus
Main causes of vertigo
central : brain pathology - uncommon
peripheral : inner ear pathology
management of vertigo
- secondary care referral
- symptomatic drug tx: antihistamines e.g. prochlorperazine
chronic suppurative otitis media (CSOM)
Ear discharge persisting for more than 2 weeks, without ear pain or fever
chronic suppurative otitis media sx
persistent ear discharge
hearing loss
tinnitus
chronic suppurative otitis media management
ENT referral
What is mastoiditis
when an infection spreads from the middle to the mastoid air spaces of the temporal bone
s/s of mastoidits
- otalgia: severe, classically behind the ear
- fever
- swelling, erythema and tenderness over the mastoid process
- external ear may protrude forwards
how is mastoiditis diagnosed
clinical
CT if complications supected
complication of mastoiditis
- meningitis
- facial nerve palsy
- hearing loss
management of mastoiditis
IV abx
s/s menieres disease
- recurrent episodes of vertigo, tinnitus and hearing loss
- fullness / pressure in ear
- positive Romberg
management of menieres disease
- ENT specialist referral
- acute attacks: buccal or intramuscular prochlorperazine
- stop driving until sx controlled
how long do attacks last in menieres disease
present for at least 20 minutes, but typically last a few hours
What does barotrauma lead to
perforated tympanic membrane
sx of barotrauma
- hearing loss
- ear pain
- fullness in ear
What does positive and negative Rinnes test indicate
Positive : air conduction > bone conduction (normal)
Negative : bone conduction > air conduction (conductive hearing loss)
What is the webers test result in conductive and sensorineural hearing loss
conductive : lateralises to affected ear
sensorineural : lateralises to unaffected ear
How to manage hearing loss in primary care if all other causes have been treated/excluded
- ENT referral for audiological assessment
- hearing aids
When to urgently refer a patient with hearing loss
- Sudden onset (over 3 days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and all other causes excluded
- Unilateral hearing loss associated with focal neurology
- Hearing loss associated with head or neck injury
- Hearing loss associated with severe infection or Ramsay Hunt syndrome
- Rapidly progressive hearing loss
Causes of tympanic membrane perforation
- infection (most common)
- barotrauma
- direct trauma
management of tympanic membrane perforation
- self resolving in 6-8 weeks
- abx if following acute otitis media
- myringoplasty if not healing
most common infectious agents of acute sinusitis
Haemophilus influenzae
rhinovirus
Streptococcus pneumoniae
sx of acute sinusitis
- facial pain (worse on leaning forward)
- thick nasal discharge
management of acute sinusitis
- analgesia
- intranasal corticosteroids if sx > 10 days
- phenoxymethylpenicillin if severe presentations
How can allergic rhinitis be classified
- seasonal
- occupational
- perennial: symptoms occur throughout the year
sx of allergic rhinitis
- sneezing
- bilateral nasal obstruction
- clear nasal discharge
- post-nasal drip
- nasal pruritus
management of allergic rhinitis
- allergen avoidance
- mild-to-moderate : oral or intranasal antihistamines
- moderate-to-severe : regular intranasal corticosteroid
- tx failure : short-term intranasal decongestant
management of epistaxis
- haemodynamically stable pt : ask pt to sit with torso forward with mouth open & pinch the soft area of the nose firmly
- topical antiseptic preparation if above not effective
nasal cautery or nasal packing if above not effective
sx of nasal polyps
- nasal obstruction
- rhinorrhoea
- sneezing
- poor sense of taste and smell
which feature of nasal polyps is unusual and requires further investigation
unilateral nasal polyps or bleeding
management of nasal polyps
- ENT referral
- topical corticosteroids
how long do sx have to persist to be chronic sinusitis
12 weeks
management of chronic sinusitis
- nasal irrigation with saline solution
- course of intranasal corticosteroids
- specialist referral
Sx of tonsillitis
pharyngitis, fever, malaise and lymphadenopathy.
Most common pathogen causing tonsillitis
Streptococcus pyogenes
Appearance of tonsils in tonsillitis
Typically oedematous and yellow or white pustules
When is abx indicated in tonsillitis?
bacterial tonsillitis
Complication of bacterial tonsillitis
quinsy (peritonsilar abscess)
Tx for bacterial tonsillitis
phenoxymethylpenicillin
What is aphthous ulcer?
ulcer of oral mucosa
- avoid trigger
1st line for aphthous ulcer
Topical corticosteroid
What is oral herpes simplex?
cold sores
Management of cold sores
topical aciclovir
What is parotitis?
swelling of salivary glands
Features of quinsy
- severe throat pain, which lateralises to one side
- deviation of the uvula to the unaffected side
- trismus (difficulty opening the mouth)
- reduced neck mobility
Management of quinsy
Patients need urgent review by an ENT specialist.
Tx:
- needle aspiration or incision & drainage + intravenous antibiotics
- tonsillectomy should be considered to prevent recurrence
What is oral leukoplakia?
malignant disorder affecting the oral mucosa.
- white patch or plaque that develops in the oral cavity
Diagnosis of oral leukoplakia
diagnosis of exclusion
Biopsy
What is sialadenitis?
salivary gland infection
What is acoustic neuroma also known as?
Vestibular schwannoma
Features of acoustic neuroma
- vertigo
- sensorineual hearing loss
- unilateral tinnitus
- an absent corneal reflex.
Management of acoustic neuroma
referred urgently to ENT
- Surgery, radiotherapy or observation
Ix for acoustic neuroma
MRI of the cerebellopontine angle is the investigation of choice
2WWW Referral for oral cancer
Either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks
or
a persistent and unexplained lump in the neck.
Features of Nasopharyngeal carcinoma
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
Imaging for Nasopharyngeal carcinoma
Combined CT and MRI.
Tx for Nasopharyngeal carcinoma
Radiotherapy is first line therapy.
