ENT Flashcards
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
Which lymphoid tissues make up Waldeyer’s tonsillar ring
Adenoids
Tubal tonsils
Palatine tonsils
Lingual tonsils
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)
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
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
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
What are the complications of tonsillitis
Chronic tonsillitis
Peritonsillar abscess (Quinsy)
Otitis media
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis
Post-strep reactive arthritis
What is Quinsy
Aka peritonsillar abscess
Usually a complication of tonsillitis
Due to bacterial infection: group A strep, staph aureus, haemophilus influenzae
How might a patient with Quinsy present
Tonsillitis symptoms
Trismus (unable to open mouth)
Changes in voice
Swelling and erythema in area beside tonsils
What is the management for Quinsy
Refer to hospital urgently
Need incision and drainage
Antibiotics before and after surgery
Consider steroids (dexamethasone)
When should tonsillectomy be performed for tonsillitis
7+ in 1 year
5 per year for 2 years
3 per year for 3 years
Other than for tonsillitis, when should tonsillectomy be performed
2+ episodes of tonsillar abscess
Enlarged tonsils causing difficulty breathing or swallowing
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
What is otitis media
Inner ear infection
Bacteria enter from back of throat (through eustachian tube) following URTI
Common bacteria: haemophilus influenzae, staph aureus
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
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
What are the complications of otitis media
Otitis media with effusion
Hearing loss
Perforated eardrum
Recurrent infection
Mastoiditis
Abscess
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
