ENT Flashcards
sx of acute diffuse otitis externs
fever lymphadenopathy diffuse swelling variable pain, pruritus pain on moving ear and jaw impaired hearing
how do you manage acute otitis externaal
topical antibiotics SOFRADEX + topical steroid
Oral Fluclox or Gent if severe
why are children more likely to have otitis media
short horizontal and poorly functioning eustachian tubes
who is otitis media most common in
youong children,
male
cleft palate
downs
how does otitis media present
pain in the ear and fever
may have reduction in hearing
hat causes otitis media
a VIRAL infection whhich swells the eustachian tube
this blocks the middle ear fluid drainage
how do you manage otitis media
Oral amox 5 days if:
- more than 4 days of sx
- less than 2 yo and bilateral
- 1 perforation / discharge in canal
otherwise consider delayed / no prescription
what is a choleasteatoma
abnormal skin growth / cyst of epithelium in the middle ear
what causes choleasteatoma
congenital
due to perforation in chronic suppurative OM
sx choleasteatoma
EAR DISCHARGE (foul smelling white discharge)
OR
conductive hearing loss
may also have headache, pain, verttigo, facial paralysis
Who should you suspect choleasteatoma in
anyone with unexplained unilateral ear discharge not repsonsive to abx
how do you ix cholesteatoma
Otoscopy
or CT
how do you manage choleasteatoma
refer to ENT for surgery
what is tintinnus
sensation of sound WITHOUT external sound
causes of tintinnus
Vestibular system:
- menieres
- otosclerosis
Brain:
- acoustic neuromoaa
- head injury
General:
- noise induced
- presbycusis
drugs
- aspirin
- aminoglycosides
- loop diuretics
differentials for vertigvo
vestibular:
- menieres
- BPPV
- labirinthitis
Central:
- acoustic neuroma
- MS
- stroke
- head injury
- inner ear syphilis
Drugs:
- gentamicin
- loop diuretics
- metronidazole
- co-trimoxazole
what does Romberg +ve indicate?
vestibular or proprioceptive disorder
what is menieres diseasee
dilatation of endolymph spaces due to increaaed lymph fluid
how does menieres prsent
CLUSTERED ATTACKS last <12h aurala fullness / pressure vertigo, NV, nystagmus tintinnus
what ix for meenieres
audiometry,
mx menieres
cyclizine (to treat emesis)
betahistine (to treat vertfgo)
surgical : use grommets to give gentamicin; saccus decompression
vestibular neuronitis history
following a febrl history (URTI)
sudden vertigo and vomiting
exacerbated by eye movements
NO HEARING LOSS
what s the difference between vestibular neuronitis and labirinthitis
vestibular neuronitis : NO HEARING LOSS
labirinthitis: hearing loss
how do you manage vestibular neuronitis and labiritinthis
prochlorperazine
which maneuvre confirms BPPV?
Dix-Hallpike
which maneuvre treats BPPV
Epley maneuvre
causes of hearing loss in adults
Conductive (between auricle and round window)
- external ear obstruction (wax)
- TM perforation (trauma, infection)
- Ossicle defect (otosclerosis)
sensorineural (defect in cochlea, cochlear nerve or brain)
- Drugs (aminoglycosides, vancomycin)
- Infective (meningitis, measles, mumps, herpes)
- menieres, trauma, MS; CPA lesion, low B12
what is an acoustic neuroma
benign slow growing tumour of superior vestibular nerve
what condition is acoustic neuroma associated with
NF2
sx acoustic neuroma
slow onset unilateral SNHL tintinnus vertigo headache CN palsy (5,7,8) cerebellar signs
ix acoustic neutroma
MRI
otosclerosis aetiology
AUTOSOMAL DOMINANT
fixation of tapes at the oval window
S/S otosclerosis
begins in early adult lifwe bilateral conductive deafness tintinnus hearing loss improves with noise hearing loss worsens with pregnancy menstruation menopause
mx otosclerosis
hearing ads
stapes implant
mx allergic rhinosinusitis
mild sx: oral antihistamine (cetirizine) or intranasal antihistamine (azelastine) PRN
moderate-severe: Intranasal coorticosteroid
what is sinusitis
infection of the maxillary sinuses from viral URTI > may lead to secondary bacterial infection
may occur with pain, swelling and tenderness on front of face
how do you manage sinusitis
if sx <10 days, no antibiotics
sx > 10 days give high dose nasal corticossteroid for 14 days
abx if sx dont get better after 7 days
how do you manage nasal polyp
routiine referral to ENT medical therapy (topical betamethasone drops 4-6 weeks, followed by short course of oral steroids)
common pathogens causing otitis externa
Staph aureus
Pseudomonas aeroginosa
RF otitis externa
swimming in dirrty water
diabetes
old age
wax buildup
what is necrotising otitis externa
progression of otitis externa through ear canal > bon > across skull base
ESSENTIALLY CAUSES OSTEOMYELITIS into mastoid and temporal bones
sx necrotising otitiis external
severe pain in ear
exhudate
granulation tissue in ear
may cause CN palsy
how do you manage necrotising otitis externa
urgent ENT referral
ADMIT
CT head, IV ABx
what does TM look like in otitis media
red and bulging TM
loss of normal light reflex
perforation and pus
what is another name for glue ear?
Otitis media with effusion
SSx glue ear
reduced hearing (conductive) NO other problems
how do you ix glue ear, and what are findings
otoscopy (eardrum dull and retracted, fluid level visible()
audiometry (hearing test)
how do you manage glue ear
observe for 3 months
if persistent, refer to ENT
what is a dangerous complication of otitis media in children?
MASTOIDITIS
Explain mastoiditis pèresentation
inflamed mastoids> mastoid pain
discharge
swelling behinid ear, ear pushed forward
How do you manage mastoiditis
ADMIT
IV Abx
CT scan
may require incision and drainage
causes of epistaxis
LOCAL
- trauma (nose picking)
- URTI, allergy
- nasal polup
SYSTEMIC:
- GPA (wegener’s)
- coagulopathy
- hereditary haemorrhagic telangectasi
acute mx of epistaxis
sit up, lean forward, mouth open
Pinch soft area of nose (compress nasal cartilage)
Place ice on nose
mx if epistaxis takes longer than 15 minutes to respove
- remove clots, gauze, rhinoscopy
- visualise bleeding> CAUTERISE
- bleeing cannot be visualised > PACKING (anterior / posterior with foley)
- refer to ENT
2 key causes of tonsillitis
- group A beta haemolytic strep
- EBV (MONO)
what must you never give in suspected MONO
never give AMOXICILLIN
as it causes a widespread maculopapular rash
what score can you usee for tonsillitis, and what does it detect
CENTOR score
Each point scores 1:
- Tonsillar exhudate
- Tender anterior cervical lymphadenopathy
- Fever >38
- no cough
if score 3/4, there is up to 50% chance that it is due to bacteria > prescribe antibiotics + rapid strep test
sx tonsillitis
sore throat
fever
dysphagia, odynophagia
hoarness, rhinitis, fatigue, lethargy
what shows on ENT exam for tonsillitia
enlarged tonsils, white exhudates, cervical lymphadenopathy
when do you admit patient with tonsillitis
- pain not tolerated withh analgesia
- complete dysphagia
- difficulty breating
- clinically dehydrated
- QUINSY
what is QUINSY
PERI-TONSILLAR ABSCESS
how does quinsy present
unilateral tonsil swelling with deviated ubvula
needs drainage + admission + IV Abx
Mx of tonsillitis
Phenoxymethylpen 10 days (if indicated)
Clarythromycin if allergy
what is a complication of GAS tonsillitis (i.e. what can onsillitis progress to in children)
Group A strep can progress to SCARLET FEVER
how does Scarlet fever present
Sandpaper erythematous rash on neck and chest > sppreads to trunk and legs
Strawberry tongue
may later progress to rheumatic feber
mx of scarlet fever
phenooxymethylpenicillin
epiglottitis rf
UNVACCINATE child (as caused by H influenza)
presentation of epiglottitis
sitting forward drooling sore throat dysphagia STRIDOR
what is ludwigs angina
infction of submandibular space
how does ludwig angina present
neck swelling - WOODY AND HARD TO TOUCH
dysphagia
fever
drooling
what s age related heariing loss also called
presbycusis
describe presbycusis presentation
over 65 yo
bilateral
slow onset
may have tinnitusss
mx presbycusis
hearinig aiid
what does a unilateral polyp require
URGENT ENT REFERRAL
as it is a red flag sx
what must yoou do if TM rupture does not repair in 6-8 weeks
refer to ENT for MYRINGOPLASTY (repair of perforation)
describe the hearing loss type in presbycusis
BILAT HIGH FREQUENCY HEARING LOSS
where does most nosebleeding come from
the ANTERIOR nasal septum
how do you manage quincy
Admit
IV antibioticss + drainage
consider tonsillectomy in 6 weeks
