ENT Flashcards
Management of allergic rhinitis
Advice: diet, exercise, rest, don’t rub eyes, avoid decongestant nose drops, avoid allergens, bedding, carpets, keep pets outside, avoid chemical irritants
Oral/intranasal antihistamines
Oral/topical decongestants
Sodium chromoglycate intranasal or eye drops
Corticosteroids - in above forms too but good one is intranasal
LTRA
Immunotherapy
Triad of ménière’s disease and what are attacks preceded by
hearing loss, vertigo, tinnitus
fullness in the ear
Treating meniere’s attacks and prophylaxis
Prochlorperazine 25mg PR prophylaxis
Diazepam 5mg IV +/- prochloperazine
If persistent consider HCTZ 25mg PO OD
What is BPPV and features
Acute vertigo induced by changing head position - esp with tilting head backwards, changing from recumbent to sitting or turning to affected side
- recurs periodically for several days
- attacks brief, 10-60 s and subsides fast
- not accompanied by vomiting, tinnitus or deafness
How to diagnose BPPV
Hallpike manoeuvre - hold for 30s and observe for vertigo and nystagmus, there is latent period before symptoms
Hearing and vestibular function normal
Otitis media treatment adults
Analgesia Rest in warm room Nasal decongestants if nose congested antibiotics: amoxicillin 500mg TDS for 5 days treat associated conditions review and test hearing
if continuous discharging after 6 weeks, treat with topical steroid and antibiotics combination drops after ear toilet
Features, Red flags and Mx for cholesteatoma
Visible through perforation as white flakes/discharge/scab, it’s foul smelling and purulent
Meningitis type features
Cranial nerve deficits
Sensorineural hearing loss
Persistent deep ear pain
Need to refer because need surgical removal
Management of otitis externa
Aural toilet via suction and dry mopping
Dressing
Topical mixture of antibacterial anti fungal and anti steroid
Strong analgesia
Prevent scratching and water entry
How to treat impacted wax
If soft, use sodium bicarbonate drops to melt it and cotton mops to remove
If hard, need to remove manually using syringe or instrumentation
How to treat glue ear
Bromhexine elixir
If >3 months, hearing assessment and refer to ENT for Grommet (ventilation tube) inserted after myringotomy
Treatment of nasal polyps
Oral pred 50mg OD for 7 days, supplement with betamethasone spray simultaneously for 3 months
Antibiotics for purulent nasal discharge
Can refer to surgeon to remove polyp with mucosa of sinuses
Sinusitis diagnosis (viral) and treatment
Must have one of first two
- discolored nasal discharge
- nasal obstruction
- frontal headache
- reduced smell
Typically resolves in 7-10 days without treatment.
- oral analgesia
- saline nasal wash
- steam inhalation
- intranasal CS
- intranasal decongestants (<7 days)
Bacterial sinusitis diagnosis and treatment
If symptoms unchanged after 10 days or increasing after 5, bacterial infection if have at least 3 of
- discolored discharge
- severe local pain
- fever >38 C
- elevated ESR/CRP
- double sickening
Give amoxicillin 500MG TDS for 5 days or doxycycline
Chronic sinusitis diagnosis and treatment
Symptoms >12 weeks
Amoxicillin 500mg TDS for 10-14 days or hp to 6 weeks
The rest same as acute sinusitis
If ineffective, use nasal irrigation to remove stagnant mucus
If no response refer to surgeon, might need FESS
Or if orbital/facial cellulitis also need to refer
Complications of sinusitis
Orbital: ophthalmoplegia, diplopia, proptosis, impaired vision, orbital cellulitis
Subdural abscess
Osteomyelitis
