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ENT Flashcards

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1
Q

How common are acoustic neuromas?

A

5% of intracranial tumours

90% of cerebellar pontine angle tumours

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2
Q

Where are acoustic neuromas found?

A

Cerebellar pontine angle

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3
Q

Name 4 masses that can be found at the cerebellar pontine angle.

A

S - schwannoma
A - aneurysm, arachnoid cyst
M - meningioma
E - ependymoma

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4
Q

What causes a bilateral acoustic neuroma?

A

Neurofibromatosis type II

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5
Q

What is the classic history of acoustic neuroma?

A

Vertigo
Hearing loss
Tinnitus
Absent corneal reflex

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6
Q

Which cranial nerves are affected by an acoustic neuroma?

A

5, 7 and 8

V - trigeminal (absent corneal reflex)
VII - facial (absent corneal reflex)
VIII - vestibulocochlear (vertigo, tinnitus, hearing loss)

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7
Q

What is the gold standard investigation for an acoustic neuroma?

A

MRI of CPA

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8
Q

How should an acoustic neuroma be managed?

A

Referral to ENT –> surgery, radiotherapy, observation

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9
Q

What is a cholesteatoma?

A

A destructive, hyperproliferating growth of keratinizing squamous epithelial cells of the middle ear.

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10
Q

What are the risk factors for developing a cholesteatoma?

A

Recurrent acute otitis media
Eustachian tube dysfunction
Previous ear surgery

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11
Q

How do cholesteatoma’s commonly present?

A

Otorrhoea, often brown (most common)
Conductive hearing loss - damage to the ossicles
Sensorineural hearing loss - invasion of the cochlea
Dizziness - invasion of the semi-circular canals
Facial nerve palsy - invasion of cranial nerve II (runs through the middle ear)

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12
Q

Which investigation is needed to confirm the diagnosis of cholesteatoma?

A

CT temporal bone (also needed for pre-operative planning).

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13
Q

What might be seen on otoscopy in cholesteatoma?

A

Pearly white/grey appearance

Brown discharge

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14
Q

What is the management of cholesteatomas?

A

Complete surgical removal.

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15
Q

Name two complications of cholesteatomas.

A

Intracranial invasion

Infection

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16
Q

Name two causes of true ear pain.

A

Otitis media

Otitis externa

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17
Q

Name 4 causes of referred ear pain.

A

CN V - trigeminal nerve (disease of the teeth)
CN VII - facial nerve (herpes zoster infection, Bell’s palsy)
CN IX - glossopharyngeal (tonsillitis, pharyngitis)
Cervical spinal nerves (cervical arthritis)

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18
Q

What is conductive hearing loss?

A

Sound is not conducted at the ear canal to the inner ear
It is a problem of the external or middle ear
Think about what it sounds like when you have ear plugs or headphones in - this mimics the symptoms of conductive hearing loss

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19
Q

What is sensory hearing loss?

A

Sound is received at the inner ear but issue at the sensory organ (Cochlear) or the vestibulocochlear nerve
It is a problem of the inner ear or cranial nerve VIII
Most commonly caused by age-related changes- think of elderly family and friends who you always have to speak loudly to

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20
Q

What are the different causes of sensorineural hearing loss?

A 
• Sudden sensorineural hearing loss (over less than 72 hours)
• Presbycusis (age-related)
• Noise exposure
• Ménière’s disease
• Labyrinthitis
• Acoustic neuroma
• Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
• Infections (e.g., meningitis)
Medications
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21
Q

Which drugs cause sensorineural hearing loss? Name three.

A

• Loop diuretics (e.g., furosemide)
• Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)

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22
Q

What are the different causes of conductive hearing loss?

A 
• Ear wax (or something else blocking the canal)
• Infection (e.g., otitis media or otitis externa)
• Fluid in the middle ear (effusion)
• Eustachian tube dysfunction
• Perforated tympanic membrane
• Otosclerosis
• Cholesteatoma
• Exostoses
Tumours
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23
Q

What are the risk factors associated with presbycusis?

A

Age
Exposure to loud noise
Smoking
Male

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24
Q

What is the typical presentation of presbycusis?

A 
Gradual
Symmetrical
High-pitched sound lost first
Concerns about dementia
Tinnitus
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25
What is the management of presbycusis?
Supportive | Hearing aid
26
What are the causes of sudden sensorineural hearing loss?
``` Idiopathic (80%) Infection Ototoxic medications MS Migraine Stroke Acoustic neuroma ```
27
How does sudden sensorineural hearing loss present?
<72 hours | Unilateral
28
What is seen on audiometry in sudden sensorineural hearing loss?
loss of 30 decibels in 3 consecutive frequencies
29
What is the management of sudden sensorineural hearing loss?
• Emergency - immediate referral to ENT (within 24 hours) • Treat underlying cause High-dose PO prednisolone
30
What are the risk factors for otosclerosis?
Women | Autosomal dominant
31
How does otosclerosis present?
<40 years Tinnitus Talk quieter
32
What is seen on audiometry in otosclerosis?
Low-pitched sound loss
33
What is the management of otosclerosis?
Supportive | Surgery: stapedectomy
34
What are the risk factors for Eustachian tube dysfunction?
Upper RTI Smoking Allergy
35
How does Eustachian tube dysfunction usually present?
``` Popping sensation Fullness Pain Tinnitus (symptoms worse when air pressure changes) ```
36
What is the management of Eustachian tube dysfunction?
``` • Conservative. • Valsalva manoeuvre • Decongestant nasal spray • Antihistamines/steroids Surgery (adenoidectomy, grommets, balloon dilation Eustachian tuboplasty) ```
37
What is true vertigo?
Sensation that the room is spinning.
38
What are the three most common causes of vertigo?
1. BPPV 2. Meniere's disease 3. Vestibular neuronitis
39
Name three central causes of vertigo.
1. Stroke 2. MS 3. Migraine
40
How can the causes of vertigo be classified?
Otological | Central
41
What is the gold standard test to confirm BPPV?
Dix-Hallpike Manoeuvre
42
Who is at risk of developing necrotising otitis externa?
Diabetes
43
When should you use intranasal steroids in acute sinusitis?
symptoms >10 days
44
When should you use antibiotics in acute sinusitis? What is first-line?
Severe/systemically unwell Phenoxymethylpenicillin
45
What is included under the umbrella term 'Head and neck cancer'?
oral cavity cancers cancers of the pharynx cancers of the larynx
46
Name some features of head and neck cancer
neck lump hoarseness persistent sore throat persistent mouth ulcer
47
When should you refer for 2WW in suspected laryngeal cancer?
>45 and: 1. persistent unexplained hoarseness 2. an unexplained lump in the neck
48
When should you refer for 2WW in suspected oral cancer?
unexplained ulceration in the oral cavity lasting for more than 3 weeks a persistent and unexplained lump in the neck.
49
When should your refer to a dentist in suspected oral cancer?
a lump on the lip or in the oral cavity a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
50
When should you refer to 2WW in suspected thyroid cancer?
unexplained thyroid lump
51
What is double-sickening?
an initial period of recovery followed by a sudden worsening of symptoms - associated with bacterial sinusitis
52
What is tonsilitis?
Infection of the palatine tonsils caused by viral or bacterial infection
53
What causes tonsilitis?
70% of infections are viral, the rest bacterial
54
Which virus' most commonly cause tonsilitis?
Adenovirus, influenza, rhinovirus and parainfluenza are the common viruses involved
55
Which bacteria most commonly cause tonsilitis?
Group A beta-haemolytic streptococci
56
What are the symptoms of tonsilitis?
Sore thorat Odynophagia Earache
57
What is the management of tonsilitis?
Self-resolving in 5-7 days (viral) | Paracetamol
58
Which criteria are used to indicate antibiotic use in tonsilitis?
Centor criteria 1-2 unlikely to benefit from abx 3-4 = penicillin V (10 days)
59
What four features make up the Centor criteria?
• History of pyrexia • Exudates on tonsil • Absence of cough - Tender cervical lymphadenopathy
60
What is the management of severe tonsilitis?
``` Admit: • IV fluids • IV analgesia • IV abx • IV dexamethasone • Throat swab Send home when can eat/drink normally ```
61
Name two complications of tonsilitis.
Quinsy (peritonsillar abscess) | Parapharyngeal and retropharyngeal abscess
62
What is the treatment of peritonsillar abscess (Quinsy)?
Incision & drainage | Send pus for MC&S
63
What is the tonsillectomy criteria?
• 7 episodes in the last year OR • 5 episodes in each of the last two years OR • 3 episodes in each of the last three years - Swelling from tonsillitis affecting normal function
64
Which nerves provide sensory innervation to the ear?
CN V - trigeminal nerve (disease of the teeth) CN VII - facial nerve (herpes zoster infection, Bell's palsy) CN IX - glossopharyngeal (tonsillitis, pharyngitis) Cervical spinal nerves (cervical arthritis)
65
What is otitis externa?
Infection of the external ear - can cause canal oedema
66
What are the risk factors for otitis externa?
``` Increased water contact Humid conditions Excessive use of cotton buds Presence of hearing aids Immunocompromised patients ```
67
What is the most common bacterial cause of otitis externa?
Pseudomonas aeruginosa
68
What is the first-line management of otitis externa?
Topical abx and steroids (may need to be inserted by a Pope Wick) Amoxicillin PO if systemically unwell
69
When should you refer to ENT in otitis media?
Poor response to topical abx
70
What is malignant otitis externa?
Uncommon type of otitis externa found in immunocompromised individuals - diabetes.
71
How is malignant otitis externa diagnosed?
CT
72
How is malignant otitis externa treated?
IV ciprofloxacin
73
What causes AOM?
Upper respiratory tract infections: viral OR bacterial Viral: RSV, rhinovirus, enterovirus Bacterial: s.pneumoniae
74
Who is most likely to be affected by AOM?
Children (shorter eustachian tube)
75
What is first-line management of AOM?
Supportive, analgesia
76
What is management for severe AOM?
Abx: amoxicillin
77
How can you treat recurrent AOM?
Gromets
78
Name three complications of AOM.
1. Tympanic membrane rupture 2. Hearing loss (recurrent infections) 3. Mastoiditis 4. Facial nerve palsy 5. Intracranial infection
79
What are the symptoms of a perforated tympanic membrane?
Otorrhoea (discharge from the ear) | Sudden relief of pain
80
What causes chronic OM?
Recurrent otitis media infections leading to a perforated tympanic membrane Trauma Iatrogenic (gromet insertion)
81
What might be seen on otoscopy in chronic otitis media?
Perforated tympanic membrane
82
What is first-line management of chronic OM?
1. Aural toilet - washing out the ear canal | 2. Topical abx and steriods
83
What causes OM with effusion?
NON-INFECTIVE fluid in the middle ear Most common cause us eustachian tube dysfunction Other: cleft plate, allergies are risk factors
84
What might be seen on otoscopy in OM with effusion?
Dull tympanic membrane Light reflex reflected upwards Absent light reflex
85
What is management of OM with effusion?
50% resolve within 3 months If more than 3 months: hearing aids or gromets
86
What are the complications of OM with effusion in children?
Delayed speech development
87
What are the features of quinsy?
severe throat pain, which lateralises to one side deviation of the uvula to the unaffected side trismus (difficulty opening the mouth) reduced neck mobility
88
What is the treatment of post-tonsillectomy haemorrhage?
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
89
How long does it take for a perforated ear drum to heal?
6-8 weeks
90
When should packing be used before cautery in the management of epistaxis?
When the bleed is not visible
91
What is the most common type of parotid tumour?
Pleomorphic tumour
92
Which virus is associated with tonsillar SCC?
HPV
93
What is Ludwig's angina?
Cellulitis that occurs on the floor of the mouth Common in immunocomprised patients can cause airway obstruction
94
Describe the arterial supply to the nose.
* There are two clinically important plexuses to be aware of; anterior and posterior * Anterior is known as Little's area or Kiesselbach's plexus and has a rich blood supply that is the frequent source of epistaxis (nose bleeds) * Posterior is Woodruff's plexus and is the site of posterior nose bleeds
95
Which type of nosebleed is most common?
Anterior 90%
96
Which factors might predispose nose bleeds?
Mucosal dryness Children/elderly Hypertension/atherosclerotic disease
97
How should epistaxis be managed?
Step-wise approach, if the bleeding has not stopped, move on to the next step: 1. A-->E assessment 2. Pinch cartilage, sit forward - 20 minutes 3. Cauterise with silver nitrate 4. Pack 5. Surgical ligation
98
How is the nose packed?
Pack the nose, anterior or posterior depending on where you suspect the bleed is. This is essentially a tampon that absorbs and tamponades any bleeding. Posterior packing requires a catheter - the same as is used for urinary catheters.
99
What are the key symptoms on epiglottis?
3 D's are the key symptoms: Drooling Distressed Dysphagia
100
What is seen on a lateral C-spine in epiglottis?
Thumb-print sign
101
What causes epiglottis?
Haemophilus Influenza type B
102
What is the management of acute epiglottis?
Intubation | IV antibiotics

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