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Year 4 Additional Notes > ENT > Flashcards

ENT Flashcards

1
Q

Pathophysiology of acute otitis media

A

Viral- following a viral URTI

Bacterial- streptococcus pneumoniae, haemophilus influenzae, moraxella

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2
Q

Features of acute otitis media

A

Otalgia
Ear tugging/ anorexia/ irritability in children
Fever
Conductive hearing loss
Recent viral URTI (Coryzal symptoms)
Ear discharge if tympanic membrane bursts ie. One morning there is discharge on the pillow (perforation)

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3
Q

Otoscopy findings for acute otitis media

A

Bulging tympanic membrane if effusion present (loss of light reflex)
Opacification or erythema of TM
Perforation with purulent otorrhea
Decreased mobility if using a pneumatic otoscope

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4
Q

Management of acute otitis media

A

Generally self limiting and doesn’t require ABX
Seek medical advice if symptoms worsen or don’t improve after 3 days

Immediate ORAL ABX (not topical unless TM ruptured) if;
Symptoms last longer than 4 days or not improving
Systemically unwell but doesn’t need admission
Immunosuppression
Younger than 2 with bilateral otitis media
Otitis media with perforation and or discharge in the canal (including suppurative otitis media)

NB- ABX of choice is amoxicillin fir 5-7 days (erythromycin if allergy)

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5
Q

Sequelae of acute otitis media

A

Perforation- otorrhoea. Unresolved may develop into chronic suppurative otitis media (6 weeks)- need ABX
Glue ear (if an effusion develops and persists)
Hearing loss
Labyrinthitis
Mastoiditis
Meningitis
Brain abscess
Facial nerve paralysis

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6
Q

Infective agents in acute sinusitis

A

Streptococcus Pneumoniae
Haemophilus influenzae
Rhinoviruses

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7
Q

Features of sinusitis

A

Facial pain- frontal pressure worse when bending forward
Nasal discharge- thick and purulent
Nasal obstruction
Coryza- cough, sore throat

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8
Q

Management of acute sinusitis

A

Analgesia
Intranasal decongestants
Intransal corticosteroids if symptoms longer than 10 days
Oral ABX not normally required, unless severe presentation (Pen V)

NB- double sickening, where a viral sinusitis becomes a secondary bacterial infection

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9
Q

Features of allergic rhinitis

A

Sneezing
Bilateral nasal obstruction
Clear nasal discharge
Post nasal drip
Nasal pruritus

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10
Q

Management of allergic rhinitis

A

Allergen avoidance
Oral or intranasal antihistamines (CHLORPHENAMINE MALEATE)
Persistent- intranasal corticosteroids

NB- can use nasal decongestants (oxymetazoline), but don’t used for long as tachyphylaxis (becomes less effective) can be seen, and rebound hypertrophy of nasal mucosa may occur upon withdrawal (symptoms go then come back)

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11
Q

Auricular haematoma

A

Same day assessment by ENT
Incision and drainage

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12
Q

Features of BPPV

A

Vertigo triggered by change in head position- rolling over in bed, gazing upwards
Associated with nausea
10-20 seconds per episode
Positive Dix hallpike manoeuvre- patient experiences vertigo and rotator nystagmus

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13
Q

Management of BPPV

A

Good prognosis and usually resolves by itself
Epley manoeuvre (89% successful)
Vestibular rehabilitation- exercises the patient can do at home (Brandt-Daroff Exercises)
Betahistine is if limited value

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14
Q

Black hairy tongue

A

Defective desquamation of the piliform papillae (can be several colours)

Risks- poor oral hygiene, ABX, head and neck irradiation, HIV, IVDU

Swab tongue to exclude Candida

Management- tongue scraping, topical anti fungals if Candida

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15
Q

Branchial cyst features

A

Typically present in late childhood or early adulthood, usually anterior to the SCM

Unilateral
Slowly enlarging
Smooth, soft, fluctuate
Non tender
Fistula may be seen
No movement on swallowing
No trans illumination

Cholesterol crystals (even in young people)

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16
Q

Management of a branchial cyst

A

Consider/exclude (with tests) a malignancy
Refer to ENT
USS with FNA
Can be treated conservatively or surgically excised
ABX if they become infected

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17
Q

Cholesteatoma

A

Foul smelling, non resolving discharge
Hearing loss
If local invasion- vertigo, facial nerve palsy, cerebellopontine angle syndrome

Attic crust seen on Otoscopy

Refer to ENT for surgical removal

Common in patients 10-20 years old

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18
Q

What is Chronic rhinosinusitis

A

Lasts 12 weeks or longer
Predisposing factors- atopy (hay fever, eczema), nasal obstruction (polyps), recent local infection, swimming, smoking

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19
Q

Features of rhinosinusitis

A

Facial pain (bending forward)
Nasal discharge- clear if allergic or vasomtor, thick and purulent if secondary infection
Nasal obstruction (mouth breathing)
Post nasal drip (chronic cough)

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20
Q

Management of chronic sinusitis

A

Conservative- Avoid allergen, Nasal irrigation with saline solution
Medical- Intranasal corticosteroids (polyps)
Surgery- Functional endoscopic sinus surgery (FESS) if persistent

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21
Q

Red flag sinusitis symptoms

A

Unilateral (one side/nasal cavity affected)
Persistence despite compliance with 3 months of treatment
Epistaxis alongside

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22
Q

Requirements for cochlear implants in adults

A

Completed a trial of appropriate hearing aids for at least 3 months Which they have received limited or no benefit from

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23
Q

Contraindications for a cochlear implant

A

Lesions of cranial nerve VIII or in brain stem causing deafness
Chronic infective otitis media, mastoid cavity, or tympanic membrane perforation
Cochlear aplasia

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24
Q

Features of IMPACTED ear wax

A

Pain
Conductive hearing loss
Tinnitus
Vertigo

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25
Q

Management of impacted wax

A

Ear drops (olive oil, sodium bicarbonate) for 1 week
Irrigation (ear syringing)

NB- don’t treat if perforation suspected or the patient has grommets

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26
Q

Gingival hyperplasia

A

Phenytoin
Calcium channel blockers
AML

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27
Q

Simple GINGIVITIS

A

Painless red swelling of the gum margin which bleeds on contact
Secondary to poor dental hygiene
Seek routine regular review by dentist, ABX not necessary

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28
Q

Acute necrotising ulcerative gingivitis

A

Similar to gingivitis, but very painful

Refer to dentist
Oral hygiene and stop smoking
Oral ABX eg. metronidazole for 3 days (can also use amoxicillin)
Chlorhexidine or hydrogen peroxide mouth wash
Simple analgesia

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29
Q

Management of epistaxis

A

If haemodynamically stable;

Sit forward and pinch cartilaginous area of nose firmly for 20 minutes (can use naseptin (chlorhexidine and neomycin) to reduce crusting- careful in peanut allergy)

If continues after 20 minutes;

Refer to hospital/ENT
Silver nitrate cautery if bleeding point visualised (one side of septum)
Packing if bleeding point cannot be identified

Haemodynamically unstable;

Admit to hospital
May need sphenopalatine ligation in theatre

NB- patient advice, don’t pick nose, heavy lifting, vigorous exercise, drinking alcohol or hot drinks as they may introduce a re-bleed

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30
Q

Causes of hoarseness

A

Voice overuse
Smoking
Reflux laryngitis/GORD
Laryngeal cancer

Lung cancer
Viral illness
Hypothyroidism
Reinkes oedema
Spasmodic dysphonia

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31
Q

Suspected laryngeal cancer

A

2 week wait referral for anyone with persistent or unexplained hoarseness (or a lump in the neck)
Nasal endoscopy to visualise vocal cords
CXR (exclude apical tumour)

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32
Q

What is laryngopharyngeal reflux (reflux laryngitis)

A

GORD causing inflammatory changes to the larynx
Common

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33
Q

Features of laryngopharyngeal reflux

A

70% have a sensation of lump in the throat (globus)- worse swallowing saliva than eating or drinking, felt in midline
Hoarseness
Chronic cough
Heartburn
Sore throat
External examination of neck normal
Posterior pharynx- erythematous

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34
Q

Investigations

A

Bedside examination of neck and throat
Observations
Bloods
Refer to ENT
Nasal endoscopy to visualise vocal cords

NB- if other red flags present/doesn’t resolve, may need to put on 2 week wait pathway

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35
Q

Management of laryngopharyngeal reflux

A

Lifestyle measures- avoid triggers such as fatty foods, caffeine, chocolate, alcohol
PPI
Sodium alginate liquids (Gaviscon)

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36
Q

Ludwig’s angina

A

Progressive cellulitis that invades the Flor of the mouth and soft tissues of the neck
Mainly from Odontogenic infections that spread into submandibular space

Neck swelling
Dysphagia
Fever

Airway management, IV antibiotics

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37
Q

What is malignant osteomyelitis

A

Uncommon form of otitis externa found in immunosuppressed individuals (90% diabetics)
Pseudomonas
Temporal bone osteomyelitides

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38
Q

Features of malignant osteomyelitis

A

Diabetes or immunosuppression
Severe unrelenting deep seated otalgia
Temporal headaches
Purulent otorrhoea
May have dysphagia, hoarseness, and or facial nerve dysfunction

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39
Q

Investigations for malignant otitis externa

A

Full ENT exam, observations, ear swab, diabetic screen
Otoscopy
Bloods- systemic dysfunction (ABG, FBC etc.)
CT Head (looking at bone)

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40
Q

Treatment of malignant Otis externa

A

Refer urgently to ENT (won’t know it’s malignant in primary care, but any one with non resolving OE with worsening pain should be referred)
IV ABX that cover pseudomonas (ciprofloxacin)
Surgical debridement if required

NB- you’ll know its otitis externa if it is in a T2DM patient and it has a very prolonged course

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41
Q

Mastoiditis

A

Complication of otitis media

Otalgia (behind the ear)
History of recurrent otitis media
Fever
Typically unwell patients
Swelling, erythema, tenderness over the mastoid process
External ear may protrude forward
Ear discharge may be present if eardrum has perforated

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42
Q

Features of Ménière’s disease

A

Recurrent episodes of vertigo, tinnitus, hearing loss (sensorineural)- vertigo usually prominent
Sensation of aural fullness or pressure
Nystagmus and positive Rhombergs test
Episodes last minutes to hours
Typically unilateral but symptoms can become bilateral
Drop attacks

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43
Q

Natural history of Ménière’s disease

A

Usually resolve after 5-10 years
Majority left with a degree of hearing loss
Psychological distress common

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44
Q

Investigations for Ménière’s disease

A

Observations, full ENT examination
Otoscopy
PTA
CT head (structural cause)

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45
Q

Management of Ménière’s disease

A

Inform DVLA (can’t drive until satisfactory control of Sx)
Acute attacks- buccal prochloperazine (may require admission)
Prevention- betahistine and vestibular rehabilitation exercises

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46
Q

Nasal polyps associations

A

Asthma
Aspirin sensitivity
Inective sinusitis
Cystic fibrosis
Kartageners syndrome
Churg Strauss syndrome

Asthma, aspirin sensitivity, nasal polyps triad- Samters triad

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47
Q

Management

A

Refer to ENT
Nasal corticosteroids will shrink them in 80% patients

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48
Q

Nasal septal haematoma features

A

Precipitated by trauma (even if minor)
Sensation of nasal obstruction
On examination- a bilateral, red swelling from the septum
Boggy on palpation (deviated septum’s will be firm)

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49
Q

Management of septal haematoma

A

Surgical drainage
IV ABX

NB- if not treated in 3-4 days, may get saddle nose deformity

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50
Q

Features of nasopharyngeal carcinoma

A

Otalgia
Unilateral serous otitis media (in an adult)
Nasal obstruction, discharge, and or epistaxis
Cranial nerve palsies III-VIb
Cervical lymphadenopathy

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51
Q

Causes of otitis externa

A

Infection- staph aureus, pseudomonas
Seborrhoeic dermatitis
Contact dermatitis
Recent swimming

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52
Q

Features of otitis externa

A

Ear pain, itch, discharge, tender Tragus
Otoscopy- red, swollen, eczematous canal, furuncle

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53
Q

Management of otitis externa

A

Don’t wet ear
Remove canal debris
Topical antibiotic (combined with steroid). Don’t use aminoglycoside (gentamicin,neomycin,streptomycin) if TM perforated
Ear wick if canal swollen
Failure to respond- refer to ENT

NB- oral ABX and swab if infection spreading or immunosuppression

54
Q

Otosclerosis

A

Autosomal dominant cause of conductive deafness
20-40 years, in women seen during times of hormonal change eg. Pregnancy

Conductive deafness
Tinnitus
Normal TM (10% have flamingo tinge- hyperaemia)
Positive FH

55
Q

Investigations for otosclerosis

A

Full ENT exam and observations
Otoscopy
PTA
Tympanometry- stiff TM/ reduced admittance

56
Q

Management of otosclerosis

A

Conservative- Hearing aid
Surgical- Stapedectomy

57
Q

Investigations for parotid disease

A

Full ENT examination (neck lump), Observations
Nasal endoscopy (make sure nothing else is causing the swelling)
XRay to exclude calculus
USS guided FNA
MRI head and neck staging

58
Q

Management of a ruptured TM

A

No treatment, usually heal in 6-8 weeks
Don’t get wet, go scuba diving, get on plane
If following episode of OM- antibiotics, if barotrauma- conservative management
Myringoplasty performed if TM doesn’t heal itself

59
Q

Most common parotid neoplasm

A

Benign pleomorphic adenoma
Malignant transformation in 2-10%

60
Q

Post operative complications of tonsillectomy

A

Haemorrhage- need to be assessed by ENT. Immediate return to theatre (usually 6-8 hours after surgery). Get IV access and send bloods including an FBC, clotting screen, group and save and crossmatch. Fluids if necessary and keep NBM

Secondary haemorrhage occurs between 5-10 days after surgery and is associated with infection (may have fever, give ABX)

NB- Hydrogen peroxide gargle and Adrenalin soaked swab applied topically can be used to manage less severe bleeds

61
Q

Features of presbyacusis

A

Slow progressing history
Speech difficult to understand
Difficulty using telephone
Loss of directionality of sound
Worse symptoms in noisy environments

62
Q

Investigations for older age hearing loss

A

Otoscopy- normal
Tympanometry- normal middle ear function with hearing loss
Audiometry- bilateral sensorineural hearing loss
Blood tests including inflammatory markers

63
Q

Ramsay hunt syndrome features

A

Herpes zoster oticus- reactivation of varicella zoster virus in genticulate ganglion of 7th cranial nerve

Auricular pain
Facial nerve palsy
Vesicular rash around ear
Vertigo and tinnitus

64
Q

Management of Ramsay hunt syndrome

A

Oral aciclovir and corticosteroids

65
Q

Sore throat indication for ABX

A

Features of marked systemic upset
Unilateral peritonsilitis
History of rheumatic fever
Increased risk of infection eg. Immunosuppression (DM)
When 3 or more centor criteria/4 or more feverPAIN criteria are present

66
Q

Centor criteria

A

Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever
Absent cough

67
Q

FeverPAIN Criteria

A

Fever (38+)
Purulence (exudate)
Attend rapidly (3 days or less)
Severe,y inflamed tonsils
No cough or Coryza

68
Q

Antibiotics for sore throat

A

Pen V or clarithromycin (penicillin allergic)
7-10 day course

NB- can they take tablets if they have a sore throat?

69
Q

Sudden onset sensorineural hearing loss

A

The diagnosis is made when someone rapidly loses their hearing, and no conductive cause can be found.

Urgent referral to ENT
The majority are idiopathic
MRI- exclude vestibular schwannomas
High dose oral corticosteroids can be used by ENT

70
Q

Complications of thyroid surgery

A

Recurrent laryngeal nerve damage
Bleeding- laryngeal oedema
Hypocalcaemia

71
Q

Investigations for tinnitus

A

Full ENT exam
Observations
Otoscopy
PTA
Unilateral (asymmetrical) or bilateral and neuro Sx- MRI head
pulsating tinnitus- MR angiography

72
Q

Management of tinnitus

A

Investigate and treat underlying cause
Amplification devices- helpful if hearing loss (hearing aid) or adding background sounds to cancel it out
Psychological therapy and support groups

73
Q

Features if vestibular neuronitis

A

A cause of vertigo that develops following a viral infection

Recurrent vertigo attacks lasting hours or days
Nausea and vomiting
Horizontal nystagmus
No hearing loss or tinnitus

74
Q

Differentials for vestibular neuronitis

A

Viral labyrinthitis
Posterior circulation stroke- HiNTS exam can distinguish the 2

75
Q

Management of vestibular neuronitis

A

Short course of prochloperazine or an antihistamine (promethazine)
Vestibular rehabilitation exercises (chronic symptoms)- urgent referral to specialist if prochloperazine doesn’t work

76
Q

Features of labarynthtis

A

Vertigo- not triggered by movement, but made worse by it
Nausea and vomiting
Hearing loss (unilateral or bilateral)
Tinnitus
May have preceding or concurrent URTI
Horizontal nystagmus
Gait disturbance (towards affected side)

77
Q

Management of labyrinthitis

A

Usually self limiting
Prochloperazine or antihistamine (cyclizine) can help reduce dizzy sensations.

78
Q

Glue ear

A

Otitis media with effusion
Serous effusion in middle ear in absence of infection lasting longer than 3 months

79
Q

Features of glue ear

A

Painless sensation of pressure in affected ear
Conductive hearing loss
Speech and language impairment

80
Q

Otoscopy findings of glue ear

A

Air fluid level
Intact TM

81
Q

Management of glue ear

A

Pain relief, no speech impediment- monitor for 3 months
Surgical- grommets

82
Q

Unrelenting ear pain and diabetes

A

THINK MALIGNANT OTITIS EXTERNA

83
Q

Investigations for mastoiditis

A

Full ENT exam, ENT referral, admit to hospital, Otoscopy
Bloods- FBC UE LFT clotting ABG
Imaging- CT scan temporal bone

84
Q

Management of mastoiditis

A

Refer to ENT, analgesia
Empirical IV ABX
SUrgical- grommet insertion to facilitate drainage or in severe cases- mastoidectomy

85
Q

Oropharyngeal and laryngopharyngeal cancer

A

Local lymph node metastases causing enlarged cervical lymph nodes
Severe ear pain
Foreign body sensation, dysphagia, sore throat (persistent)
Dysphonia (muffled voice)

86
Q

Investigations for a neck lump

A

Observations, head and neck exam eg. Examine nasopharynx, oropharynx, oral cavity, refer to ENT
Bloods- FBC UE LFT CRP coagulation profile calcium ANA (SLE can cause lymphadenopathy)
Imaging- pan endoscopy and biopsy, USS with FNA

87
Q

Features of oral cavity cancer

A

Halitosis
Pain (earache)
Dysphagia
Non healing ulcer
Unusual bleeding in mouth
Facial swelling
Paralysis of part of face
Lymphadenopathy

88
Q

Question to ask in hoarseness history

A

GORD- reflux symptoms

89
Q

Features of nasal polyps

A

Post nasal drip
Bilateral nasal obstruction
Impaired olfactory functions

NB- refer if alarming features, then intranasal steroids, then surgery if that fails

90
Q

Causes of epistaxis

A

Nose picking
Foreign body
Intranasal drug use (corticosteroids, cocaine)
Nasal blunt force trauma

HHT
Anticoagulants

Allergic rhinitis
Nasopharyngeal carcinoma
Bleeding disorder- haemophilia, VWD
HTN
Vasculitis (Wegners)

91
Q

Causes of tonsillitis

A

Viral
Bacterial- group A strep, strep pneumoniae, haemophilus, staph aureus

92
Q

Features of tonsillitis

A

Sore throat
Fever
Pain on swallowing
Erythematous, large tonsils
Tonsillar exudate
Anterior cervical lymphadenopathy

93
Q

Complications of tonsillitis

A

Quinsy
Otitis media
Post strep glomerulonephritis
Post strep reactive arthritis

94
Q

Management of tonsillitis

A

Supportive- analgesia, fluids, safety net (pain not settled after 3 days, fever rises above 38.3)
Medical- if centor is 3+ or feverPAIN is 4+- ABX (pen V for 10 days, clarithromycin if penicillin allergy)
Surgery- tonsillectomy if 5 times a year for 3 years or 7 times a year for 2 years

95
Q

Quinsy (peritonsilar abscess) Features

A

Same Sx as tonsillitis
May also get;

Trismus
Change in voice (hot potato voice)
Deviation of uvula away from affected side
Swelling around the tonsils

96
Q

Management of quinsy

A

Supportive- refer to ENT, analgesia, fluids
Medical- ABX (co amoxiclav)
Surgical- incision and drainage

97
Q

Features of glandular fever

A

Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar lymph nodes
Splenomegaly
Palatial petechiae
Hepatitis (transient rise in ALT)

NB- itchy rash after taking amoxicillin or cephalosporin

98
Q

Investigations for glandular fever

A

Bedside- observations, full ENT exam
Bloods- FBC, UE, LFT CRP monospot test in 2nd week illness
Imaging- may need USS with FNA if concerned about malignancy

99
Q

Management of glandular fever

A

Supportive- analgesia, rest, avoid alcohol, increase fluids, avoid contact sports for 8 weeks

100
Q

Causes of epistaxis

A

HTN
Coagulopathy eg. Drug induced, VWD, haemophilia
Nasopharyng carcinoma
Trauma eg. Nose picking

101
Q

Sensorineural causes of hearing loss

A

Genetic
Presbyacusis
Vestibular schwannoma
Gentamicin, frusemide, aspirin, chemotherapy, quinine
Trauma
Noise-induced/excessive noise

102
Q

Conductive causes of hearing loss

A

Earwax
Foreign body
OE
OM
Otosclerosis
Cholesteatoma
Perforated TM
Exotosis (benign bony growth)

103
Q

Investigations for epistaxis

A

Bedside- full head and neck exam, nasal speculum, flexible nasoendoscopy
Bloods- FBC and clotting
Imaging- CT if worried about underlying pathology

104
Q

Investigations if suspecting impacted ear wax (or a conductive pathology)

A

Otoscopy, PTA, tympanometry

105
Q

Investigations for vertigo

A

Bedside- Otoscopy, neuro exam, cardiac exam (rule out cardiogenic syncope), Dix hallpike manoeuvre, PTA (cochlear disturbance), HINTS exam, Romberg’s
Imaging- MRI if want to rule out a central cause

106
Q

Mumps

A

Young adult
Parotid swelling and pancreatitis, orchiditis, reduced hearing, meningoencephalitis

107
Q

Vertebrobasilar ischaemia

A

Elderly patient dizzy on extending neck
Vascular risk factors/ history

108
Q

Causes of tinnitus

A

Idiopathic
Meniere’s disease
Labyrinthitis
Otosclerosis
Sudden onset sensorineural hearing loss
Presbycusis
Impacted ear wax
Drugs- Aspirin/NSAIDs, Aminoglycosides, Loop diuretics, Quinine
Otitis media
Noise exposure
MS
Trauma
Acoustic neuroma

NB- carotid bruit due to carotid artery stenosis or IIH can cause pulsatile tinnitus

109
Q

Conductive causes of rapid onset hearing loss (not associated with sudden sensorineural hearing loss (SSNHL))

A

Conductive causes of rapid-onset hearing loss (not classed as SSNHL) include:

Ear wax (or something else blocking the canal)
Infection (e.g., otitis media or otitis externa)
Fluid in the middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane

110
Q

Causes of SSNHL

A

Most cases (90%) of SSNHL are idiopathic, meaning no specific cause is found.

Other causes of SSNHL include:

Infection (e.g., meningitis, HIV and mumps)
Ménière’s disease
Ototoxic medications
Multiple sclerosis
Migraine
Stroke
Acoustic neuroma/ vestibular schwannoma
Cogan’s syndrome (a rare autoimmune condition causing inflammation of the eyes and inner ear)

NB- Audiometry is required to establish the diagnosis. A diagnosis of SSNHL requires a loss of at least 30 decibels in three consecutive frequencies on an audiogram.

MRI or CT head may be used if a stroke or acoustic neuroma are being considered.

111
Q

Management of SSNHL

A

Urgent referral to ENT
Steroids
Treat underlying cause if applicable

112
Q

Eustachian tube dysfunction

A

When the tube between the middle ear and throat is not functioning properly. The Eustachian tube is present mainly to equalise the air pressure in the middle ear and drain fluid from the middle ear.

Features;

Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus

113
Q

Investigations for eustachian tube dysfunction

A

Usually investigations aren’t necessary as a simple underlying cause can be identified. However further tests may be necessary;

Tympanometry (pressure in middle ear/ TM stiffness)
Audiometry
Nasopharyngoscopy (an endoscopic camera through the nose to the throat to inspect the Eustachian tube openings)
CT scan to assess for structural pathology

114
Q

Management of eustachian tube dysfunction

A

No treatment, waiting for it to resolve spontaneously (e.g., recovering from the viral URTI)
Valsalva manoeuvre (holding the nose and blowing into it to inflate the Eustachian tube)
Decongestant nasal sprays (short term only)
Antihistamines and a steroid nasal spray for allergies or rhinitis
Surgery (if persistent)- grommets or Balloon dilatation Eustachian tuboplasty

115
Q

HINTS exam

A

Normal HINTS (ie. negative), central cause of vertigo (so positive HINTS is reassuring)

NB- negative/normal HINTS is worrying

Nystagmus- central cause if vertical/bidirectional nystagmus

Vertical test if skew- central

116
Q

Nasal spray technique

A

Steroid nasal sprays are often misused, which means they will not be as effective. A good question to ask is, “do you taste the spray at the back of your throat after using it?” Tasting the spray means it has gone past the nasal mucosa and will not be as effective.

The technique involves:

Tilting the head slightly forward
Using the left hand to spray into the right nostril, and vice versa (this directs the spray slightly away from the septum)
NOT sniffing hard during the spray
Very gently inhaling through the nose after the spray

117
Q

Causes of lymphadenopathy

A

Reactive lymph nodes (e.g., swelling caused by viral upper respiratory tract infections, dental infection or tonsillitis)
Infected lymph nodes (e.g., tuberculosis, HIV or infectious mononucleosis)
Inflammatory conditions (e.g., systemic lupus erythematosus or sarcoidosis)
Malignancy (e.g., lymphoma, leukaemia or metastasis)

118
Q

Carotid body tumours

A

Slow growing lump
In the upper anterior triangle of the neck (near the angle of the mandible)
Painless
Pulsatile
Associated with a bruit on auscultation
Mobile side-to-side but not up and down
If it presses on vagus nerve- Horners syndrome

119
Q

What medication can be used to treat some head and neck cancers

A

Cetuximab is an example of a monoclonal antibody. It may also be used to treat bowel cancer. It targets epidermal growth factor receptor

120
Q

Glossitis

A

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure

NB- can be atrophic/desquamative/folded etc.

121
Q

Angioedema (tongue)

A

Allergic reactions
ACE inhibitors
C1 esterase inhibitor deficiency (hereditary angioedema)

122
Q

Oral candidiasis

A

Inhaled corticosteroids (particularly with poor technique, not using a spacer and not rinsing with water afterwards)
Antibiotics (disrupt the normal bacterial flora giving candida a chance to thrive)
Diabetes
Immunodeficiency (consider HIV)
Smoking

Management;

Miconazole gel
Nystatin suspension
Fluconazole tablets (in severe or recurrent cases)

123
Q

Strawberry tongue

A

A strawberry tongue appearance occurs when the tongue becomes swollen and red, and the papillae become enlarged, white and prominent.

Scarlet fever
Kawasaki disease

124
Q

Leukoplakia

A

Leukoplakia is characterised by white patches in the mouth, often on the tongue or insides of the cheeks (buccal mucosa). It is a precancerous condition, meaning it increases the risk of squamous cell carcinoma of the mouth.

The patches are asymptomatic, irregular and slightly raised. They are fixed in place, meaning they cannot be scraped off.

They may require a biopsy to exclude abnormal cells (dysplasia) or cancer. Management involves stopping smoking, reducing alcohol intake, close monitoring and potentially laser removal or surgical excision.

125
Q

Erythroplakia

A

Erythroplakia is similar to leukoplakia, except the lesions are red. Erythroleukoplakia refers to lesions that are a mixture of red and white. Both erythroplakia and erythroleukoplakia are associated with a high risk of squamous cell carcinoma and should be referred urgently to exclude cancer.

126
Q

Lichen planus

A

An autoimmune condition that causes localised chronic inflammation of the skin. The skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.

Often affects the mucosal membranes, including the mouth. Often it only affects the mouth.

NB- oral hygiene, stopping smoking and topical steroids.

127
Q

Aphthous ulcer

A

Idiopathic
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Coeliac disease
Behçet disease
Vitamin deficiency (e.g., iron, B12, folate and vitamin D)
HIV

Usually heal within 2 weeks- longer than 3+ 2 week wait pathway

Management- either Topical bonjela, lidocaine, or steroids

128
Q

Unilateral middle ear effusion

A

Urgent referral to ENT in adults (could be nasopharyngeal carcinoma)

129
Q

Investigations for suspected acoustic neuroma

A

Bedside- full ENT assessment, PTA
Bloods
Imaging- gadolinium-enhanced MRI head scan

130
Q

Motion sickness

A

Management
the BNF recommends hyoscine (e.g. transdermal patch) as being the most effective treatment. Use is limited due to side-effects
non-sedating antihistamines such as cyclizine or cinnarizine are recommended in preference to sedating preparation such as promethazine

131
Q

Patient snoring/making airway noises/unconscious

A

Head tilt chin lift jaw thrust
Then insert oropharyngeal airway (nasopharyngeal is contraindicated in basal skull fracture)

132
Q

Glue ear and Down’s syndrome/cleft palate

A

Refer to ENT

Year 4 Additional Notes (17 decks)

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