ENT Flashcards
Conductive hearing loss test
Rinne - if bone louder than air
Acute otitis media signs
Otalgia malaise Bulging tympanic membrane Eustachian tube migration of URTI RSV, bacteria include s.pneumoniae Self resolves - abx if severe Consider grommets in children comp. perforated ear drum and discharge
Otitis media with effusion
Hearing loss almsot exclusively in children Glue ear non-infective 50% cleared in 3 months if not, hearing aids/grommets NO abx Otoscopy - dull tympanic membrane, light reflex reflected upwards or absent light reflex
Chronic Otitis Media
Aural toilet - washing out the ear canal
Topical antibiotics/steroids - allow the perforation to heal
If the perforation is not healing/is too large to heal, can surgically repair it. This is called myringoplasty and involves taking cartilage from the tragus and using that to fill the space
comp. mastoiditis and hearing loss, facial nerve palsy
Cholesteatoma
destructive, hyperproliferating growth of keratinazing squamous epithelial cells
Otorrhoea - chronic, brown in colour without otalgia or fever
Conductive hearing loss - if damages the ossicles
Senosorineural hearing loss
Dizziness - damage to the semicircular canals
Facial nerve palsy - invasion of cranial nerve VII
CT and surgical removal
‘pearly white/grey appearance’ on otoscopy with painless, brown discharge
Otitis Externa
otalgia, otorrhoea with a swollen, erythematous ear
pseudomonas aeruginosa
Topical antibiotics (prolonged and IV if necrotising) and steroid
Vertigo - BPPV
Test?
Treatment?
Dix-Hallpike for test
Epley manouevre for clearance
Vertigo - Meniere’s Disease
Triad?
Length of vertigo?
Treatment?
Triad - vertigo, tinnitus and sensorineural hearing loss
Episodes last minutes to hours
Usually self resolves, may require steroid/ abx injections
Vertigo - vestibular neuronitis
Why
Length
Treatnebt
Often URTI
Lasts days
elf resovles usually
Referred ear pain - nerves
CN V
Disease of the teeth
TMJ disease (temporomandibular joint) eg. excessive grinding of the teeth
Parotid gland disease
CN VII
Herpez zoster infection
Bell’s Palsy
CN IX
Disease of the throat such as tonsillitis, pharyngitis
Oropharyngeal malignancy such as cancer of the tongue
Cervical nerves
Cervical arthritis
Rhinosinusitis
Rhinorrhoea (runny nose)
Nasal congestion
Reduced sense of smell
Facial pain/headache
Infection - This is most likely viral and common organisms include rhinovirus, RSV, parainfluenza virus. Can also be bacterial; s. pneumoniae and H. influenza
Allergy - This is an IgE mediated Type 1 hypersensitivity reaction. This is one of the symptoms of ‘hayfever’ and is more common in those with asthma and eczema
Other triggers - This can be cigarette smoke, environmental changes (such as cold or dry air), pollution, exercise
Tonsillitis definition
Infection of the palatine tonsils
pain, fever, dysphagia and cough
a frequency of more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms), referral to an ear, nose, and throat specialist is advised as this cohort may benefit from tonsillectomy.
FeverPAIN
Centor
Quinsy
Comp of bacterial tonsillitis
deviating the uvula away
Trismus (difficulty fully opening the jaw), unilateral symptoms and a ‘hot potato’ voice
Admission, IV abx, drainage
ENT cancers
RF
Inv
fine needle aspiration
Epistaxis
Anterior or posterior plexus - 90% anterior (Little’s area)
Greater palantine artery in older
Epistaxis emergency management
A-E Pinch cartilage, 20 mins Cauterise with silver nitrate Pack nose anterior (rapid rhino) or posterior (foley catheter) depending on where bleed is - tamponades may require surgical ligation
Emergency airway obstruction - causes
Cancers
Oropharyngeal
Laryngeal
Base of tongue
Infections
Epiglottitis
Deep neck space infections
Foreign body
Mostly seen in children
Emergency airway obstruction - red flags
Stridor/Stertor
Cyanosis
Agitation
Respiratory distress
Wheeze
Decreased breath sounds on auscultation
Emergency airway obstruction - management
Call for help
Nebulised adrenaline/salbutamol
Intubation
tracheostomy
Emergency- epiglottitis
supraglottic tissue infection
Haemophilus Influenza type B infection usually
Emergency - epiglottitis
Key symptoms
Management
3 D’s are the key symptoms:
Drooling
Distressed
Dysphagia
IV abx
Laryngoscopy - lateral neck radiograph
O2, Steroids - dex, 0.08-0.3 mg/kg/day
Conductive hearing loss test
Rinne - if bone louder than air
Vertebrobasilar ischaemia
Elderly patient
Dizziness on extension of neck
Acoustic neuroma
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2
Viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Reactive lymphadenopathy
By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness
Lymphoma characteristics
Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly
Thyroid swelling
May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing
Thyroglossal cyst
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
Pharyngeal pouch
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
Cystic hygroma
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
Branchial cyst
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Cervical rib
More common in adult females
Around 10% develop thoracic outlet syndrome
Carotid aneurysm
Pulsatile lateral neck mass which doesn’t move on swallowing
Ramsay Hunt syndrome
(herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Management
oral aciclovir and corticosteroids are usually given
Alport’s syndrome
Hearing loss, famiyl history, progressive decline in renal function
Furosemide toxicity
Ototoxicity, SNHL
Otosclerosis
Slow conductive hearing loss, tinitus, family history
Vertebrobasilar ischaemia
Elderly patient
Dizziness on extension of neck
Acoustic neuroma
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2
Alternative exercises for BPPH
Brandt-Daroff
