ENT Flashcards
When to give abx for acute OM
- symptoms >4 days or not improving
- systemically unwell
- immunocompromised/high risk of infection due to heart/kidney/liver/ neuromuscular disease
- <2 years and bilateral OM
- perforation/discharge in canal
antibiotic to give in acute OM
5 days amoxicillin
erythromycin/clarithromycin if allergic
when to consider antibiotic prophylaxis in acute OM
if 3+ infections in 6 months/4 in a year
what type of antibiotic to NOT use if tympanic membrane perforated
aminoglycosides (gentamicin)
cause of most mild to moderate hearing loss in children
conductive - secondary to otitis media
congenital infection which can cause sensorineural deafness
rubella
drugs which can cause sensorineural deafness in children
ahminoglycosides (gentamicin)
furosemide
maximum hearing loss in conductive hearing loss (might be more in sensorineural)
max 60 dB
audiometry results in presbycusis
bilateral high frequency hearing loss
inheritance pattern of otosclerosis
autosomal dominant - replacement of normal bone by vascular spongy bone
onset 20-40 years
features of otosclerosis
- conductive deafness
- tinnitus
- positive family history
management of otosclerosis
- hearing aids
- ?sodium fluoride/bisphosphonates
- surgery
features of Meniere’s disease
recurrent vertigo, tinnitus and sensorineural hearing loss
sensation of aural fullness/pressure
may have nystagmus/positive Romberg test
treatment of Meniere’s disease
prochlorperazine
antihistamines
CBT/relaxation therapy
ototoxic drugs
aminoglycosides
furosemide
aspirin
some cytotoxics
causes of vestibular neuritis
- usually - reactivation of latent HSV1
- autoimmune
- microvascular ischaemia
- following URTI
causes of labyrinthitis
mostly viral (following URTI in 50%)
which has hearing loss out of labyrinthitis and vestibular neuritis
labyrinthitis (vestibular Neuritis = No hearing loss)
drugs given for vertigo, N+V
prochlorperazine/ antihistamines
what increases the risk of cholesteatoma
cleft palate (100x)
non-cancerous growth of squamous epithelium
symptoms of cholesteatoma if local invasion
- vertigo
- facial nerve palsy
- cerebellopontine angle syndorme
sign of cholesteatoma on otoscopy
‘attic crust’ seen in uppermost part of ear drum
what counts for 90% of cerebellopontine angle tumours
acoustic neuroma / vestibular schwannoma
genetic condition associated with acoustic neuromas
neurofibromatosis type 2
investigation for acoustic neuroma
MRI cerebellopontine angle
presentation of acoustic neuroma
- vertigo, unilateral sensorineural hearing loss, unilateral tinnitus (CNVIII)
- absent corneal reflex (CNV)
- facial palsy (CNVII)
cause of anterior epistaxis
insult in Kiesselbach’s plexus
presentation of hereditary haemorrhagic telangiectasia
- autosomal dominant
- recurrent spontaneous nosebleeds
- AVM
tumour which can cause epistaxis
juvenile angiofibroma (benign tumour in adolescent males)
when are intranasal steroids recommended for acute sinusitis
if >10 days
when to refer sinusitis to ENT
3+ infections a year
how long is chronic sinusitis
> 12 weeks - check for polyps
what to check if nasal polyps in children
check for CF
usual pathogen causing tonsillitis
group A beta-haemolytic strep (strep pyogenes)
young child with tonsillitis complaining of abdo pain?
mesenteric adenines
when to give antibiotics in tonsillitis
- 3+ centor criteria
- unilateral peritonsilitis
- marked systemic upset
- increased risk e.g. immunodeficiency, rheumatic fever, >65 and significant medical history
- feverPAIN score 4/5
antibiotic to use in tonsillitis
phenoxymethylpenicillin
if penicillin allergic 5 days clarithromycin
erythromycin if pregnant and allergic
when to refer tonsillitis to ENT
- > 7 a year for 1 year
- 5 per year for 2 years
- 3 per year for 3 years
renal complication of tonsillitis
post-streptococcal glomerulonephritis
causes of laryngitis
- viruses
- trauma
- allergy
- GORD
when to refer laryngitis for laryngoscopy
if hoarse voice/voice change >3 weeks
type of most oral cavity/pharynx cancers
squamous cell (SCC)
risk factors for mouth cancer
- smoking
- HPV
- sunlight (lip melanoma)
when to urgently refer for oral cancer
- unexplained ulceration in oral cavity >3 weeks
- persistent unexplained lump in neck
1st line medication for trigeminal neuralgia
carbamazepine
