ENT Flashcards
What is BPPV?
benign paroxysmal vertigo which is a common cause of recurrent episodes of vertigo, triggered by head movement
- peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain
How does BPPV present?
- variety of head movements can trigger attacks e.g. turning over in bed
- symptoms settle after 20-60 seconds
- episodes occur over several weeks and then resolve but can reoccur weeks or months later
- no hearing loss or tinnitus
How can we diagnose BPPV?
- Dix-Hallpike manoeuvre - patient upright on couch with head turned at 45 degrees, rapidly lower the patient backwards until head is having over couch extending 20-30 degrees, look for nystagmus in the eyes, repeat on other side
How can we treat BPPV?
- idea is to move the crystals in the semi-circular canal into a position that doesn’t disrupt endolymph flow
- do the Dix-Hallpike manoeuvre but at the end, move the head to 90 degrees in the opposite direction, have the patient lie sideways with the legs off and position head so they’re looking at floor, get them to sit up and position the head in the central position with the neck flexed at 45 degrees, with the chin towards the chest.
What is Meniere’s disease?
long-term inner ear disorder that causes recurrent attacks of vertigo and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear
What is the triad of symptoms found in Meniere’s disease?
Hearing loss, vertigo, tinnitus
How does Meniere’s disease present?
- usually 40-50 year old with unilateral episodes of vertigo, hearing loss and tinnitus
- vertigo comes in episodes lasting 20 minutes to several hours, come in clusters over several weeks, no real triggers
- hearing loss fluctuates at first but then becomes more permanent, unilateral and low frequencies affected
- tinnitus initially occurs with the vertigo but then becomes more permanent
- fullness in ear, unexplained falls without loss of consciousness, imbalance
How is Meniere’s disease diagnosed?
- based on clinical signs and symptoms
- audiology assessment to evaluate hearing loss
How is Meniere’s managed?
- manage symptoms during attack and prophylaxis
- Acute: prochlorperazine, antihistamines
Prophylaxis: betahistine
What are the causes of tonsillitis?
- usually viral
- if bacterial then: group A streptococcus, streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis, staphylococcus aureus
Which tonsils are usually infected?
palatine tonsils
How does tonsillitis present?
- sore throat
- fever (above 38)
- pain on swallowing
Examination findings for tonsillitis
- red, inflamed and enlarged tonsils with or without exudates
- possibly anterior cervical lymphadenopathy
How can we distinguish between viral and bacterial tonsillitis?
- Centor Criteria - 3 or more means 40-60% chance it’s bacterial
- fever over 38
- tonsillar exudates
- no cough
- tender anterior cervical lymph nodes - FeverPAIN score - 2-3 = 34-40% chance, 4-5 = 62-65% chance
- Fever in past 24 hours
- Pus on tonsils
- Attended within 3 days of symptoms
- Inflamed tonsils
- No cough or coryza
How should tonsillitis be managed?
- consider admission if the patient is immunocompromised, systemically unwell, dehydrated, has stridor, respiratory distress or cellulitis
- calculate the centor criteria or FeverPAIN score
- safety net if it hasn’t settles after 3 days or fever rises above 38.3
- consider antibiotics if centor 3 or more or FeverPAIN 4 or more
- Penicillin V for a 10-day course
- Clarithromycin if allergy
