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ENT Flashcards

1
Q

Conductive deafness

A

occurs due to abnormalities of the outer or middle ear which impair conduction of sound waves from the external ear (pinna, ear canal or tympanic membrane) through the ossicles (malleus, incus and stapes) in the middle ear to the cochlea in the inner ear.

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2
Q

Sensorineural deafness

A

occurs due to abnormalities in the cochlea, auditory nerve or other structures in the neural pathway leading from the inner ear to the auditory cortex

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3
Q

Common causes of conductive deafness

A

Impacted Wax
Foreign bodies
Middle ear effusion ( glue ear)
Tympanic membrane perforation
Otosclerosis
infection
Cholesteatoma
Neoplasm
Exostoses

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4
Q

Common causes of sensorineural deafness

A

presbycusis
Congenital
Viral
Iatrogenic ( surgery, drugs)
Noise trauma/exposure
Meniere’s disease
Sudden sensorineural hearing loss
Vestibular schwannoma (also known as acoustic neuroma)
neuro eg MS and stroke
Systemic infections
malignancy
Labyrinthitis
Autoimmune conditions

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5
Q

Otosclerosis

A

Replacement of normal bone by vascular spongy bone

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6
Q

Otosclerosis clinical features

A

gradual-onset, bilateral, painless hearing loss in adults aged 30–50 years.
Causes a progressive conductive deafness
may have tinnitus,10% have flamingo tinge of tympanic membrane caused by hyperaemia. family history-AD

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7
Q

Mx otosclerosis

A

hearing aid and stampedectomy- surgical replacement of the stapes bone

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8
Q

Glomus tumour clinical presentation

A

pulsatile tinnitus, a feeling of fullness in the ear and hearing loss
A reddish blue mass may be visible behind a normal looking tympanic membrane

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9
Q

Sudden sensorineural hearing loss

A

Sudden onset of unilateral or bilateral hearing loss within 72 hours
May be associated with tinnitus, ear fullness or pressure, and vertigo
Examination is usually normal

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10
Q

what is Vestibular schwannoma (also known as acoustic neuroma)

A

slow growing, benign tumour (usually arising from Schwann cells in the vestibulocochlear nerve sheath) which causes hearing loss due to compression of the vestibulocochlear nerve
Bilateral acoustic neuromas almost certainly indicate neurofibromatosis type 2

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11
Q

Vestibular schwannoma (also known as acoustic neuroma) clinical features

A

gradual onset, unilateral hearing loss which may be associated with tinnitus and/or vertigo
neuro signs
sensorineural hearing loss

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12
Q

Mx Vestibular schwannoma (also known as acoustic neuroma)

A

MRI of the cerebellopontine angle is the investigation of choice
Surgery is the definitive management

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13
Q

What is Tympanosclerosis

A

chronic inflammation and scarring of the tympanic membrane leading to subsequent calcification

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14
Q

Associated causes of Tympanosclerosis

A

Long term otitis media and tympanostomy (grommet) insertion.

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15
Q

Clinical presentation Tympanosclerosis

A

significant hearing loss and on examination will present with chalky white patches on the tympanic membrane

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16
Q

What causes Ramsay hunt syndrome

A

reactivation of varicella zoster

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17
Q

Ramsay hunt syndrome clinical presentation

A

unilateral facial nerve (Cranial nerve VII) palsy (e.g. unable to raise eyebrow against resistance or bear teeth, loss of nasolabial fold)
vestibulocochlear nerve (cranial nerve VIII) symptoms (e.g. tinnitus, unilateral hearing impairment) and
lesions visible with crusting in or behind the ear
And pain and vesicular rash in the external auditory meatus, palate or tongue.

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18
Q

Tx Ramsay Hunt syndrome

A

treated with acyclovir and prednisolone

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19
Q

automated otoacoustic emissions (AOAE)

A

part of NHS Newborn Hearing Screening Programme
A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

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20
Q

Automated auditory brainstem responses (AABR)

A

used to clarify findings if there is no clear response from AOAE during screening. AABR is similar to an electroencephalogram, whereby electrodes are placed on the scalp and ear lobes and the waveform analysed after a stimulus is presented to the ear.

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21
Q

Distraction test

A

6-9 months
Performed by a health visitor, requires two trained staff.Sounds are produced to the right or left of the baby out of their field of view and the loudness required until they react to these is assessed.

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22
Q

Recognition of familiar objects

A

18 months - 2.5 years
Uses familiar objects e.g. teddy, cup. Ask child simple questions - e.g. ‘where is the teddy?’

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23
Q

Speech discrimination tests

A

> 2.5 years
Uses similar-sounding objects e.g. Kendall Toy test, McCormick Toy Test.. These are done in young children over 2-years-old and assess the child’s ability to understand speech and differentiate it from background noise.

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24
Q

Pure tone audiometry

A

> 3 years
Done at school entry in most areas of the UK

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25
Cholesteatoma
abnormal sac of keratinizing squamous epithelium and accumulation of keratin within the middle ear or mastoid air cell spaces which can become infected and also erode neighbouring structures
26
Cholesteatoma risk factors
M Middle ear disease Eustachian tube dysfunction Otological surgery or trauma Congenital anomalies and genetic syndromes FHx
27
Cholesteatoma clinical features
persistent or recurrent discharge from the ear that is often foul smelling Hearing loss or tinnitus Less commonly, otalgia, vertigo, or facial nerve (VII) involvement (altered taste or facial weakness)
28
Cholesteatoma on examination
may appear as white mass being tympanic membrane Crust or keratin in the upper part of the tympanic membrane. ear discharge
29
Mx cholesteatoma
otomicroscope and micro-suctioning for discharge pure tone audiology assessment to assess the degree of hearing loss. and a CT scan of the temporal bone clinical judgement should be used to decide whether to treat for presumed infection canal wall up mastoidectomy, which allows removal of cholesteatoma but leaves the canal wall intact emergency admission for serious cx eg neuro
30
Causes of earwax obstruction
Overproduction Obstruction Inadequate epithelial migration
31
Clinical presentation ear wax impaction
Hearing loss (most common symptom) Blocked ears Ear discomfort Feeling of fullness in the ear Earache Tinnitus (noises in the ear) Itchiness Vertigo (not all experts believe that wax is a cause of vertigo) Cough
32
Risk factors for earwax impaction
>50y and <5y M Narrow/deformed ear canal Down syndrome Dermatological condtions use of cotton buds Repeated insertion of hearing aids or earplugs
33
Common causes tinnitus
Presbycusis meniere's disease noise induced hearing loss Impacted wax Otosclerosis ototoxicity Very rarely unilateral tinnitus can be cause by an acoustic neuroma associated with Ear infections and temporomandibular joint dysfunction
34
Ototoxic drugs include:
Loop, aspirin and NSAID, Antimalarials, tetracyclines, macrolide antibiotics, amino glycoside antibiotics, cytotoxic drugs
35
Mx of tinnitus
Refer immediately if high risk suicide, acute vertigo, neuro problems, pulsatile etc Treat underlying cause sound therapy to reduce the impact of tinnitus Psychological approach Hearing aid if communication difficulty Advice ( eg stress, exposure to loud noise can make it worse)
36
Vertigo
false sensation of movement (spinning or rotation) of the person or their surroundings in the absence of any actual physical movement
37
Common causes of vertigo
Meniere disease Acute vestibular failure Vestibular neuronitis and labyrinthitis Benign positional vertigo brainstem vascular disease/stroke Migraine
38
Acute vestibular syndrome
acute onset dizziness and/or vertigo; intolerance of head movement; continuous dizziness of 24 hours to several weeks' duration; spontaneous or gaze-evoked nystagmus; unsteadiness of gait; nausea and/or vomiting. can be caused by peripheral conditions vestibular neuronitis or labyrinthitis or stroke and MS
39
Drugs that may cause vertigo
aminoglycosides, furosemide, antidepressants, antipsychotics
40
Examining a person with vertigo
examine ear neuro exam and cranial nerves fundoscopy check peripheral neuropathy examine gait CVS exam Specific clinical tests
41
Dix-Hallpike manoeuvre
to help make a diagnosis of benign paroxysmal positional vertigo Left ear BPPV has a clockwise torsional nystagmus, right ear BPPV nystagmus rotates anti-clockwise.
42
Unterberger's test
to identify dysfunction of one of the labyrinths.Ask the person to march on the spot with their eyes closed and observe them for lateral rotation.If there is labyrinthine damage, the person will rotate to the side of the affected labyrinth.
43
Epidemiology Benign paroxysmal positional vertigo
commonly presents between the fifth and seventh decades F>M
44
Risk factors BPPV
can be precipitated by a head injury a prolonged recumbent position ear surgery following an episode of any inner ear pathology may also be associated with sleep position; people with BPPV are more likely to lie on the side of the affected ear
45
Clinical presentation BPPV
Symptoms are brought on by specific movements and positions of the head relative to gravity (for example lying down, turning over in bed, looking upwards, or bending over) Transient vertigo N & V Light headiness/imbalance hearing is not affected and neither is tinnitus
46
Mx BPPV
Most people recover over several weeks simple repositioning manoeuvre (Employ) can help alleviate their symptoms get out of bed slowly and to avoid tasks that involve looking upwards Safety advice on driving, workplace, falls in home Brandt-Daroff exercises which the person can do at home
47
Epidemiology Meniere's disease
30–60 years F>M
48
Risk factors Meniere disease
Autoimmunity Gentics Metabolic disturbances Vascular factors Viral infection head trauma
49
Meniere's disease clinical features
Episodes of vertigo fluctuating hearing loss tinnitus and is associated with a feeling of fullness in the affected ear attacks last 20 mins- few hours
50
Mx Menieres
Admit people with severe symptoms to hospital for intravenous (IV) labyrinthine sedatives and fluids to maintain hydration, and nutrition if hearing loss symptoms, refer for an audiology assessment To help alleviate nausea, vomiting, and vertigo consider prescribing prochlorperazine or an antihistamine long-term condition, but vertigo usually significantly improves with treatment
51
Prevent recurring attacks of meniere disease
trial of betahistine to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo.
52
Vestibular neuronitis clinical features
Rotational vertigo occurs spontaneously N & V malaise, pallor, and sweating spontaneous nystagmus may be present at the start of the episode Balance affected Hearing loss and tinnitus are not features of vestibular neuronitis head impulse test may be positive
53
Mx Vestibular neuronitis
buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
54
Labyrinthitis clinical presentation
vertigo N&V sensoneural hearing loss preceding or concurrent symptoms of upper respiratory tract infection unidirectional horizontal nystagmus towards the unaffected side abnormal head impulse test gait disturbance
55
Mx labyrinthitis
episodes are usually self-limiting prochlorperazine or antihistamines may help reduce the sensation of dizziness
56
Otitis externa epidemiology
incidence peaks at age 7–12 y
57
most common cause of otitis externa
bacterial infection, caused by Pseudomonas aeruginosa or Staphylococcus aureus.
58
otitis externa clinical features
Ear pain and tenderness of the tragus and/or pinna (often severe), with possible jaw pain. Itch of ear cannal Ear discharge Hearing loss due to ear canal occlusion (less common)
59
Precipitating factors for otitis externa include
ear trauma excessive moisture dermatitis ear canal obstruction skin conditions acute otitis media
60
otitis externa on examination
Tenderness of the tragus and/or pinna. ear canal is red and oedematous, there may be debris and ear discharge contributing to swelling and canal occlusion Tympanic membrane erythema Cellulitis of the pinna and adjacent skin Conductive hearing loss (less common)
61
Chronic otitis externa symptoms
Constant itch in the ear. Mild discomfort or pain (rare).
62
Chronic otitis externa signs
Lack of ear wax in the external ear canal. Dry scaly skin in the ear canal Fluffy, cotton-like debris, hyphae, or dots of black debris may be seen in the ear canal if there is fungal infection. Conductive hearing loss.
63
Malignant/necrotising otitis externa
Unremitting disproportionate ear pain- disturbs sleep, headache, purulent otorrhoea, fever, or malaise. Vertigo. Profound conductive hearing loss may cause facial nerve palsy may cause additional cranial nerve palsies
64
Mx otitis externa
Managing any aggravating or precipitating factors (such as diabetes mellitus, dermatitis, or ear trauma). Offering paracetamol or ibuprofen for symptomatic relief tx infection topically Considering the need for investigations (such as taking an ear swab) self-care advice Referring to secondary care if needs apply local heat using a warm flannel for localised otitis externa incision and drainage if pus is causing severe pain and swelling
65
Benign positional vertigo clinical features
common, self limiting, patients gets sudden veritgo on sudden head movements, lasts a few seconds to a minute,not associated with tinnitus or hearing loss
66
Acute otitis media clinical presentation
earache. Younger children may hold or rub their ear, or may have non-specific symptoms such as fever, crying, poor feeding, restlessness, cough, or rhinorrhoea.
67
Causes of bilateral conductive hearing loss
bilateral otitis media with effusion (glue ear) ear wax in both ears, bilateral perforated tympanic membranes otosclerosis.
68
Otitis media with effusion/'glue ear
characterized by a collection of fluid within the middle ear space without signs of acute inflammation
69
Otitis media with effusion /glue ear epidemiology
most common cause of hearing impairment in childhood between the ages of 6 months and 4 years more in winter months
70
Risk factors for Otitis media with effusion
cleft palate Down syndrome CF, primary ciliary dyskinesia allergic rhinitis Several environmental factors (such as low socioeconomic group, parental smoking, and frequent upper-respiratory infections)
71
Clinical presentation otitis media with effusion ( glue ear)
Hearing loss Mild intermittent ear pain with fullness or 'popping' may occur Aural discharge Recurrent ear infections, upper respiratory tract infections, or frequent nasal obstruction.
72
otitis media with effusion ( glue ear) on examination
Abnormal colour of the drum, such as yellow, amber, or blue. Loss of light reflex or a more diffuse light reflex. Opacification of the drum (other than that due to scarring). Air bubbles or an air/fluid level. A retracted, concave, or indrawn drum or, less frequently, fullness or bulging.
73
Mx middle ear effusion
Active observation (or 'watchful waiting') for 3 months Autoinflation Hearing aids may be offered to children with persistent bilateral otitis media with effusion (OME) and hearing loss as an alternative to surgical intervention Myringotomy and insertion of grommets (ventilation tubes) Adjuvant adenoidectomy is recommended for children over 4 y as it improves the efficacy of ventilation tubes
74
Otitis media epidemiology
from birth to 4 years
75
acute otitis media on examination
tympanic membrane is distinctly red, yellow, or cloudy and may be bulging.
76
Mx acute otitis media
resolves 3d-1w Pain and fever should be managed with paracetamol or ibuprofen. May benefit from Abx if high risk,5–7 day course of amoxicillin is recommended first-line Consider eardrops containing an anaesthetic and an analgesic for pain if an immediate oral antibiotic prescription is not given, and there is no eardrum perforation or otorrhoea.
77
Extra-cranial Complications of Otitis Media
facial nerve palsy Mastoiditis Petrositis Labrynthtitis
78
Intra-cranial Complications of Otitis Media
Meningitis Sigmoid sinus thrombosis Brain abscess
79
Mx epistaxis
person should sit with their upper body tilted forward and their mouth open; the soft part of the nose should be pinched firmly and held for 10–15 minutes 1. direct compression and if resolves neseptin o reduce crusting 2. nasal cautery 3. nasal packing 4. Aggressive therapies such as nasal balloon catheter and transnasal endoscopy with direct cautery/arterial ligation If a posterior bleed is suspected (bleeding is profuse, from both nostrils, and the bleeding site cannot be identified on examination), admission to hospital is recommended
80
Cause of glandular fever
Epstein Barr virus (EBV (also known as the human herpesvirus 4)).
81
Laryngitis
Hoarseness associated with GORD and or autoimmune disorders It commonly presents as worse in the morning can be viral or chronic
81
Glandular fever
incubation period of glandular fever is about 4–7 weeks causes more severe symptoms when adult Fever Sore throat Fatigue Lymphadenopathy Tonsillar enlargement splenomegaly
82
most common bacterial cause of sore throat
Group A beta-haemolytic streptococcus (GABHS), also known as Streptococcus pyogenes
83
The number of episodes of acute sore throat they specify for a tonsillectomy are:
7 or more in 1 year 5 per year for 2 years 3 per year for 3 years Other indications are: Recurrent tonsillar abscesses (2 episodes) Enlarged tonsils causing difficulty breathing, swallowing or snoring
84
Tonsillitis clinical features
tonsillar exudate and enlargement and erythema of the tonsils. Exudates are small white patches of pus on the tonsils. Pain on swallowing. anterior cervical lymphadenopathy fever >38°C,Headache, nausea, vomiting, and abdominal pain
85
Differences between bacterial and viral tonsillitis
Bacterial tonsillitis is more associated with cervical lymphadenopathy. Viral tonsillitis is associated with headache, apathy and abdominal pain.
86
CENTOR criteria
give an indication of the likelihood of a sore throat being due to bacterial infection. They are as follows: Tonsillar exudate Tender anterior cervical lymphadenopathy Fever over 38 Absence of cough A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.
87
Antibiotic for bacterial tonsillitis
Penicillin V (phenoxymethylpenicillin) as the first-choice antibiotic for a 10 day course .It has a relatively narrow spectrum of activity and is effective against Streptococcus pyogenes.
88
Quinsy
caused by spread of infection from the tonsils into the peritonsillar space this can pose a risk of airway compromise, aspiration of pus, and death due to vascular involvement sore throat and difficulty swallowing,uni-tonsillar bulge and uvula deviation

Medicine (72 decks)

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