ENT Flashcards
Most common site of epistaxis
Little’s area
Vessel most commonly causing epistaxis
Ethmoid artery
Management epistaxis
Sit forwards and pinch nose
Manage with fluids
Which drug has epistaxis as a common s/e
isotretinoin
What is trigeminal neuralgia caused by?
Compression of nerve root
Treatment of trigeminal neuralgia
Carbamazepine
Sx trigeminal neuralgia
Stabbing pain - unilateral
Mandibular OR maxillary region
Sx sinusitis
Dull pain
Worse on bending
Tender nasal skin
Sinus commonly affected by sinusitis
Maxilalry
Cause of post-herpetic neuralgia
Varicella zoster
Treatment post-herpetic neuralgia
Analgesia
Gabapentin
Sx post-herpetic neuralgia
Facial pain >3 months
Burning pain
Altered sensation in area
Benign paroxysmal positional vertigo
caused by change in head position, lasts seconds - minutes and accompanied by nausea
Dx BPPV
Dix-Hallpike test - rotate and extend head and observe for nystagmus
Mx BPPV
Epley manœuvre
Viral labyrinthitis sx
Recent URTI - sudden onset N and V, hearing loss and vertigo
Acoustic neuroma
Benign tumour of Schwann cells of vestibulocochlear nerve
Sx acoustic neuroma
Unilateral sensorineural hearing loss, no corneal reflex
+/- facial palsy if CN7 involved
Vestibulocochlear neuronitis
Infection of vestibulocochlear nerve after URTI
Sx vestibular neuronitis
Sudden onset, nausea and vomiting, no tinnitus
Treatment vestibular neuritis
prochlorperazine
Ménière’s disease
Excess fluid in inner ear
Management Meniere’s disease
acute: prochlorperazine, chronic: betahistine
Sx meniere’s disease
Vertigo, tinnitus, hearing loss, aural pressure
Treatment tonsillitis
Penicillin or tonsillectomy
Otitis externa cause
Swimming
Tx otitis externa
Flucloxacillin
Malignant otitis externa
Severe, deep otalgia and headaches
Cause malignant otitis externa
Pseudomonas aeruginosa
Otitis media
Bulging tympanic membrane
Sx otitis media
Otalgia, pulling ear, coryza sx
cyst that moves on tongue movement
thyroglossal cyst
Pleomorphic adenoma
benign tumour of salivary gland
Adenoid cystic carcinoma
Most common malignant tumour of salivary glands
Causes of conductive hearing loss
otitis externa, wax, foreign body, abnormalities of ossicles
sensorineural hearing loss causes
MMR, jaundice, meningitis, otitis media,
Causative organism sinusitis
strep pneumoniae
Which CN is affected by Ramsay-Hunt syndrome
7
Sx Ramsay Hunt
Auricular pain, facial nerve palsy, vesicular rash around ear
Tx Ramsay Hunt
Aciclovir
Causes of sensorineural hearing loss
presbyacusis
Noise exposure
inflammatory disease - measles/mumps etc
gentamicin
causes of conductive hearing loss
ear drum perforation
otosclerosis
What is presbyacusis
Loss of hair cells on cochlear associated with normal ageing - normally presents over 60
Higher frequencies lost first
carbamazepine MOA
binds to sodium channels to increase refractory period
Causes of referred otalgia
OA and RA
tonsillitis
teeth issues
URTI or sinusitis
what is sensorineural hearing loss
pathology in cranial nerves or cochlea
irreversible due to hair cell damage on organ of corti
Both bone and air reduced but air better than bone
what is conductive hearing loss
pathology is in outer or middle ear - abnormal ossicles, otitis etc
Sx otitis externa
Ear pain, itching, purulent discharge, fever
What is malignant otitis externa?
Spread to mastoid and temporal bones
Tx malignant otitis externa
ciprofloxacin
Causative organism of tonsillitis
strep pyogenies
sx tonsillitis
sore throat
tonsillar exudate
pyrexia
What is a quinsy?
Peritonsillar abscess
Sx quinsy
asymmetrical uvula
severe sore throat
What is vertebrobasilar ischaemia?
Elderly pt gets dizziness on extending neck due to compression of basilar artery
What is vestibular neuritis
Infection of vestibular nerve following URTI
Sx vestibular neuronitis
Sudden onset vertigo, nausea and vomiting, horizontal nystagmus
NO HEARING LOSS OR TINNITUS
Sx acute otitis media
ear pain resolving if TM perforates, fever, lethargy, URTI sx, red TM
Children tugging ears
causes of acute otitis media
Can be secondary to URTI or caused by bacteria like strep pneumoniae
Tx acute otitis media
Normally self-limiting but can give amoxicillin
what is otitis media with effusion
glue ear - chronic inflammation of middle ear
sx otitis media with effusion
hearing loss, ear pain, crackling/popping in ear aural fullness, with-drawn TM with no light reflex
Tx otitis media with effusion
None
What is otosclerosis?
Replacement of normal bone with spongy vascular bone
Sx of otosclerosis
Conductive HL - stapes fixed to oval window
Tinnitus
Flamingo TM
mx labyrinthitis
prochlorperazine
What is a cholesteatoma?
Non-cancerous growth of squamous epithelium trapped under skull
Cleft palate is risk factor
Sx cholesteatoma
Foul smelling discharge, HL
Vertigo and facial palsy if CN involvement
‘attic crust’ ear drum
Signs of tumour in pharyngeal pouch
bad breath, dysphagia, chronic cough
nasal cell obstruction + nasal discharge + epistaxis + disturbance of smell
squamous cell carcinoma
clear nasal discharge
allergic rhinitis
When is surgery preferred over medicine for tonsillitis?
If:
- sore throat caused by tonsillitis
- 5+ episodes a year
- symptoms have been around for more than a year
- symptoms are disabling
Which drugs can have tinnitus as a side effect?
NSAIDs, aspirin, loop diuretics
Cause of sudden-onset sensorineural hearing loss
vestibular schwannoma
What should you do with patients with sudden-onset sensorineural hearing loss?
Urgent ENT referral - MRI and corticosteroids needed
When should you give antibiotics if pt has sore throat?
systemic upset, tonsillitis, increased risk of infection
Antibiotics of choice for sore throat and duration
Phenoxymethylpenicillin or clarithromycin if allergic
7-10 days
What type of hearing loss is presbyacusis?
Bilateral sensorineural
Primary haemorrhage after tonsillectomy
6-8h post surgery
Secondary haemorrhage after tonsillectomy
5-10 days post surgery
How do you treat a perforated tympanic membrane?
Most causes will self-resolve but keep out of water
If due to otitis media, give ABx
What is allergic rhinitis?
Inflammatory disorder where the nose is sensitised to allergens - can be seasonal, perennial (throughout year) or occupational (through work)
Sx rhinitis
- Sneezing
- Nasal obstruction
- Nasal discharge
- Nasal drip
- Pruritus
Treatment rhinitis
- Mild-moderate: oral/intranasal antihistamines
- Moderate: intranasal corticosteroids
- Oral corticosteroids needed to cover special events
- Nasal decongestants can be used but not for extended periods of time
How would sensorineural deafness appear on an audiogram?
Bone and air reduced
How would conductive deafness appear on an audiogram?
Air conduction reduced
What are auricular haematomas?
Collection of blood in auricle, common in rugby players/wrestlers
How do you manage auricular haematoma?
Same day ENT referral, normally need some kind of draining
What is a branchial cyst?
Developmental defect of branchial arches
A cyst fills with fluid and cholesterol crystals
Sx branchial cyst
Unilateral
Smooth, non-tener
Anterior to SCM
No movement on swallowing
No transillumination
Treatment branchial cyst
ENT referral, needs ABs or surgery
What is a cholesteatoma?
Overgrowth of squamous epithelium at skull base
Sx cholesteatoma
Foul-smelling, plentiful discharge, hearing loss and vertigo
‘Attic crust’
Tx cholesteatoma
ENT referral for surgery
What is rhinosinusitis?
Inflammation of the nose and sinuses lasting >12 weeks
sx rhinosinusitis
Facial pain worse on bending forward
Nasal discharge
Nasal obstruction
Post-nasal drip
mx rhinosunisitis
allergen avoidance, intranasal corticosteroids
Inherited hearing loss
Otosclerosis - autosomal dominant
Drugs causing deafness
Gentamicin, furosemide and aspirin
VIII palsy (acoustic neuroma)
vertigo, hearing loss, tinnitus
V palsy (acoustic neuroma)
Absent corneal reflex
VII palsy (acoustic neuroma)
facial palsy
Sx impacted ear wax
Pain, conductive HL, tinnitus, vertigo
Tx impacted ear wax
Ear drops or irrigation (almond/olive oil, sodium bicarbonate)
Contraindication to ear irrigation
Grommets in situ
Differentials for face pain
Sinusitis: dull, worse on bending forward
Trigeminal neuralgia: unilateral face pain, electric shock pain, triggered by light touch/emotion
Cluster headache: pain occurs 1/2 times a day for a short duration, pain around eye
Temporal arteritis: pain around eyes/temples, raised ESR
What is geographic tongue?
Benign condition mostly in females, erythematous areas with a pale border
What to do if pt bleeds after tonsillectomy?
Urgent ENT referral
what is gingival hyperplasia?
overgrowth of gums so they partially/completely cover teeth
tx gingival hyperplasia
improve oral hygiene or refer for surgery if severe
what is gingivitis
mild form of gum disease that causes inflammation of gingiva
sx gingivitis
simple: painless, red, swollen gums that bleed on contact
acute: painful, bleeding gums, halitosis
treatment gingivitis
oral hygiene
metronidazole if severe
medicinal causes of gingival hyperplasia
Ciclosporin, phenytoin, calcium channel blockers, AML, poor dental hygiene
what is glue ear?
otitis media with effusion
sx glue ear
conductive HL
speech and language delay, problems with balance
treatment for glue ear
grommets
NICE referral for laryngeal cancer
persistent hoarseness/neck lump
NICE referral oral cancer
unexplained ulcer >3 weeks
persistent neck lump
red and white patches in mouth
NICE referral thyroid cancer
unexplained neck lump
ENT referral hoarseness
> 45 with persistent unexplained hoarseness or neck lump
What is laryngopharyngeal reflux?
GORD causes inflammatory changes to the larynx
Symptoms of laryngopharyngeal reflux
- Sensation of a lump in the throat in the midline
- Hoarseness
- Coughing
- Dysphagia
- Examination of neck is normal
Treatment laryngopharyngeal reflux
Fatty foods, coffee, PPI if needed
What is Ludwig’s angina?
Cellulitis spreads through the mouth and soft tissues of the neck and can cause airway obstruction
Tx Ludwig’s angina
Urgent treatment needed - stabilise airway and give IV ABx
DVLA and Meniere’s disease
Inform DVLA, stop driving until symptoms under control
sx nasal polyps
nasal obstruction, rhinorrhoea, sneezing, poor taste/smell
tx nasal polyps
unilateral sx are red flag
all should be seen by ENT
topical corticosteroids can be used
treatment for perforated tympanic membrane
Normally no tx, heals within 6-8 weeks but should be kept away from water during this time
Sensitivity to which drug is commonly associated with nasal polyps?
aspirin
treatment sinusitis
normally SR, intranasal corticosteroids if >10 days, phenoxymethylpenicillin if severe
when should you refer people with a mouth ulcer?
> 3 weeks
brandt-daroff exercises
vestibular rehabilitation in BPPV
flamingo tympanic membrane
otosclerosis
treatment dental abscess
amoxicillin
management epistaxis
initial pinch nose for 15-20 mins - if this doesn’t work, packing or cautery
which age group do you refer to ED after nose bleed?
<2
cluster headaches
normally concentrated around one eye, periods of pain lasting 15m-2h lasting for 4-12 weeks
at-risk group of malignant otitis externa
diabetics
mx malignant otitis externa
urgent ENT
sudden onset sensorineural hearing loss tx
corticosteroids
how long does it normally take perforated tympanic membrane to heal?
6-8 weeks - no swimming during this time
what is Ramsay hunt syndrome
reactivation of varicella zoster virus in CN7
indications for Abx for sore throat
systemic upset, PMH rheumatic fever, immunosuppressed, 3+ Centor score (tonsillar exudate, anterior lymphadenopathy, fever, no cough)
ABx for sore throat
phenoxymethylpenicillin
what is otitis externa
infection of outer ear canal caused by staph aureus - associated with swimming
ix otitis externa
otoscopy shows normal tympanic membrane with erythematous ear canal
tx otitis externa
mild = acetic acid, moderate = topical gentamicin and hydrocortisone
what is malignant otitis externa
Otitis media spreads to osteomyelitis of temporal bone, caused by pseudomonas aeruginosa
sx malignant otitis externa
deep otalgia and headaches + ear discharge
mx malignant otitis externa
urgent ENT referral
acute sinusitis vs chronic rhinosinusitis
chronic = >12 weeks
mx acute sinusitis
analgesia and intranasal corticosteroids if >10 days
sx acute sinusitis/chronic rhinosinusitis
facial pain, nasal obstruction, nasal discharge, post-nasal drip
what kind of tracheostomy is used in ITU?
percutaneous tracheostomy
risk of long-term mechanical ventilation
tracheo-oesophageal fistula
cause of tonsillitis
group A strep
thyroglossal swelling vs cyst
swelling moves upwards on swallowing, cyst moves upwards on tongue protrusion
pharyngeal pouch sx
bad breath, dysphagia, cough
branchial cyst sx
unilateral mass anterior to SCM, non-tender fluctuant and smooth
