ENT Flashcards by Aneesa Sheikh

What is tonsillitis

Inflammation of the tonsils (mainly palatine)

Usually due to viral infection

Bacterial causes: group A strep, strep pneumoniae, haemophilus influenzae, staphylococcus aureus

Peak ages: 5-10, 15-20

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Which lymphoid tissues make up Waldeyer’s tonsillar ring

Adenoids

Tubal tonsils

Palatine tonsils

Lingual tonsils

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How might a patient with tonsillitis present

Fever

Sore throat

Pain swallowing

Non-specific symptoms in children: fever, poor oral intake, headaches, vomiting, abdominal pain

See red, enlarged tonsils (may have white patches of exudate)

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What is the centor criteria

Estimates probability that tonsillitis is due to bacterial infection (will need antibiotics)

Score 3+ is significant

Fever > 38

Tonsillar exudate

Absent cough

Tender anterior cervical lymph nodes

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What is the FeverPAIN score

Estimates probability that tonsillitis is due to bacterial infection (will need antibiotics)

Score 4+ is significant

Fever during previous 24 hours

Pus on tonsils

Attended within 3 days of symptom onset

Inflamed tonsils

No cough or coryza

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What is the management for tonsillitis

Educate

Safety netting (return if not settled in 3 days, fever > 38.3)

Simple analgesia

Consider antibiotics (penicillin V for 10 days, or clarithromycin)

Consider delayed prescription

Admit if: immunocompromised, systemically unwell, dehydrated, stridor, respiratory distress, peritonsillar abscess, cellulitis

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What are the complications of tonsillitis

Chronic tonsillitis

Peritonsillar abscess (Quinsy)

Otitis media

Scarlet fever

Rheumatic fever

Post-strep glomerulonephritis

Post-strep reactive arthritis

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What is Quinsy

Aka peritonsillar abscess

Usually a complication of tonsillitis

Due to bacterial infection: group A strep, staph aureus, haemophilus influenzae

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How might a patient with Quinsy present

Tonsillitis symptoms

Trismus (unable to open mouth)

Changes in voice

Swelling and erythema in area beside tonsils

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What is the management for Quinsy

Refer to hospital urgently

Need incision and drainage

Antibiotics before and after surgery

Consider steroids (dexamethasone)

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When should tonsillectomy be performed for tonsillitis

7+ in 1 year

5 per year for 2 years

3 per year for 3 years

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Other than for tonsillitis, when should tonsillectomy be performed

2+ episodes of tonsillar abscess

Enlarged tonsils causing difficulty breathing or swallowing

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What are the complications of tonsillectomy

Pain

Sore throat

Damage to teeth

Infection

Post-tonsillar bleeding (up to 2 weeks after surgery, can be life threatening due to aspiration of blood, consider intubation if severe)

Risk of anaesthetic

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What is otitis media

Inner ear infection

Bacteria enter from back of throat (through eustachian tube) following URTI

Common bacteria: haemophilus influenzae, staph aureus

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How might otitis media present

Ear pain

Reduced hearing

General URTI symptoms

Balance issues/vertigo (if vestibular system affected)

Discharge (if tympanic membrane ruptured)

Infants: fever, vomiting, irritability, lethargy, poor feeding

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What is the management for otitis media

Consider admission (< 3 months temp > 38, 3-6 months temp > 39)

Usually resolves without antibiotics

Simple analgesia

Immediate antibiotic prescription: significant comorbidities, < 2 with bilateral infection, discharge

Delayed prescription

Amoxicillin for 5 days

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What are the complications of otitis media

Otitis media with effusion

Hearing loss

Perforated eardrum

Recurrent infection

Mastoiditis

Abscess

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What is glue ear

Otitis media with effusion

Middle ear filled with fluid

Get hearing loss

Eustachian tube becomes blocked

How might the ear look on examination of a patient with glue ear

Dull tympanic membrane

Air bubbles

Visible fluid level

What is the management for glue ear

Refer for audiometry (establish extent of hearing loss)

Usually resolves without treatment (in 3 months)

Grommets (fall out within a year)

What are the congenital causes of hearing loss

Maternal infection (rubella, cytomegalovirus)

Genetic deafness

Associated syndromes (Down’s)

What are the perinatal causes of hearing loss

Prematurity

Hypoxia during/after birth

What are the postnatal causes of hearing loss

Jaundice

Meningitis

Encephalitis

Otitis media

Glue ear

Chemotherapy

Where do nosebleeds usually come from

Kiesselbach’s plexus (Little’s area)

Usually unilateral

What are the triggers for nose bleeds

Nose picking Colds Vigorous nose blowing Trauma Changes in weather

What is the management for nosebleeds

Usually spontaneously resolve If recurrent, look for underlying cause Tilt head forward Squeeze soft part of nose for 10-15 mins Nasal packing Nasal cautery (silver nitrate) Naseptin (QDS for 10 days, reduces crusting)

What is a cleft lip

Split or open section of upper lip At any point along top lip Can extend as high as nose

What is a cleft palate

Defect in hard or soft palate Opening between mouth and nasal cavity

What is the management for cleft lip/palate

Refer to cleft lip service Specially shaped bottles and teats Surgical correction (lip at 3 months, palate at 6-12 months)

What are the complications of cleft lip/palate

Problems feeding Difficulty swallowing Speech issues Social impact Increased risk of: hearing problems, ear infections, glue ear

What is tongue tie

Aka ankyloglossia Baby born with short and tight lingual frenulum Not able to extend tongue out of mouth (difficult to latch on) Presents with poor feeding

What is the management for tongue tie

If mild, monitor Frenotomy (cut through tongue tie, can be in clinic)

What is a cystic hygroma

Malformation of lymphatic system Get a cyst filled with lymphatic fluid Usually in posterior triangle on left Seen on antenatal scanning, baby checking, incidentally

What are the key features of cystic hygroma

Can be very large Soft Non-tender Transilluminates

What is the management for cystic hygroma

Small and not causing issues, watch and wait Aspiration Surgical removal Sclerotherapy

What are the complications of cystic hygromas

Difficulty feeding Issues with swallowing Difficulty breathing If infected: red, hot, tender

What is a thyroglossal cyst

Part of thyroglossal duct (where thyroid gland migrates) persists, can fill with fluid

What are the features of a thyroglossal cyst

In midline Mobile Tended Soft Fluctuant Move up and down when moving tongue or swallowing

What are the investigations for thyroglossal cyst

Ultrasound CT

What is the management for thyroglossal duct cyst

Surgical removal

What is a branchial cyst

Congenital abnormality Second branchial cleft doesn't form properly Have space surrounding epithelial tissue in lateral neck (can be filled with fluid) Usually presents after age 10

What are the features of a branchial cyst

Round, soft, cystic swelling Between angle of jaw and SCM Transilluminates

What is the management for a branchial cyst

If recurrent infections, surgical excision