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ICM - OBS > ENT > Flashcards

ENT Flashcards

1
Q

Investigations for hearing in adults

A

Exclude impacted ear wax and acute infections

Weber and Rinne test + Pure tone audiogram ( PTA)

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2
Q

Investigations for hearing in children?

A

Automated Oto-Acoustic Emission (AOAE) is done as part of new-born hearing screen
- ideally in children hearing should be checked within the first 4-5weeks

9/12 - 1.5yrs = ‘distraction testing’

4-5yrs = ‘conditioned auditory response’

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3
Q

What is tympanometry?

A

Test that helps in the evaluation of the proper functioning of the middle ear.

A probe is used to measure the electrical waves from the air. Screens the pressure changes and movement of the ear drum.

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4
Q

Tympanometry classifications?

A

Type A = normal movement of TM

Type B = little or no TM movement - possible fluid in middle ear

Type C = middle ear has negative pressure

  • ?retracted eardrum
  • ?blockade of eustachian tubes
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5
Q

What is flexible rigid fiberoptic nasopharyngoscopy?

What are its uses?

A

FNE is a diagnostic prodcedure used to visualise the anterior notstrils, through postnasal space into the upper airwarys to the epiglottis and vocal cords

  • often used in the investiagtions of foreign bodies, polpys and malignancy
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6
Q

What is microsuction? What is it used for?

A

microsuction is a cleaning procedure for the ear.

aural microsuction is commonly performed to removed impacted wax, discharge or foreign bodies

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7
Q

What is lymph node biopdy?

A

US-guided FNA can be used to get a sample from a neck lymph node or from a thyroid nodule

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8
Q

When is XR used in ENT?

A
  • lateral neck XR can be used in cases of suspected FB in the throat
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9
Q

When is CT used in ENT?

A
  • allows visualisation fo soft tissue and bony structures
  • visualise possible sinus disease
  • iodine contrast - abnormal blood flow to lymph node enlargement and cancer
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10
Q

When is MRI used in ENT?

A

anatomical definition provides better differentiation between normal or inflamed or neoplastic tissue

gadolinium contrast use - iodine should uo in areas of increased vascularity

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11
Q

When is contrast studies used in ENT?

A

when assessing swallowing using barium swallow as well as pharyngeal webs and pouches

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12
Q

When is US used in ENT?

A

particularly used for swelling of the head and neck area

also used to guide fine needle aspiration

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13
Q

Indications for Ear swabs

A

Not indicated unless recurrent Ottis media or if treatment fails.

Also useful if effusion leaks into external auditory canal secondary to a TM perforation

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14
Q

Indications for nasopharyngeal swabs

A

flu, covid19, RSV, whooping cough, meningitis and MRSA

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15
Q

Indications for throat swabs

A

not routinely done

  • concerned about rare cause of STI or diphtheria
  • concerned about scarlett fever
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16
Q

When is Dix-hallpike manoeuvre used?

A

suspected paroxysmal vertigo & BPPV

  • turn pts head to one side at 45°
  • lay them down flat quickly
  • observe for any nystagmus for at least 30s
  • repeat on the other side
17
Q

When is the Epley manoeuvre used?

A

Treats BPPV once diagnosis confirmed by Dix-hallpike manoeuvre

  • have pt lying flat and just off the edge of bed
  • turn head 90° and hold fro 30s
  • rotate pt to their side and rotate head so theyr’re facing the floor, hold 30-60s
  • sit up pts maintaining sideways position
  • once upright, realign head to midline
18
Q

What Investigations are done in suspected acute otitis media?

A

usually a clinical diagnosis

if perforated with visible discharge - can do ear swb
- usually only in recurrent cases or if tx fails

19
Q

What Investigations are done in suspected cerumen impaction?

A

usually clinical diagnosis aided with otoscopy

20
Q

What Investigations are done in suspected Labrynthitis?

A

usually a clinical diagnosis

21
Q

What Investigations are done in suspected otitis externa?

A

clinical diagnosis with otoscopy

ear swab - usually not required but can be used to find out causative organism

22
Q

What Investigations are done in suspected malignant otitis externa?

A

CT scan of head

sometimes MRI head

23
Q

What Investigations are done in suspected BPPV?

A

clinical diagnosis with +ve dix-hallpike - rotatory nystagmus

24
Q

What Investigations are done in suspected meniere’s disease?

A

clinical diagnosis

  • vertigo, hearing loss and tinnitus
  • aural fullness/pressure
25
Q

What Investigations are done in suspected Vestibular neuritis/neuronitis?

A

usually a clinical diagnosis

- no tinnitus or hearing loss

26
Q

What Investigations are done in suspected Mastoiditis?

A

usually a clinical diagnosis

culture of the ear if discharge present

CT scan - If complications suspected

27
Q

What Investigations are done in suspected hearing impairment?

A

clinical diagnosis

clinical examination - rhinne’s and webers

28
Q

What Investigations are done in suspected Perforated tm?

A

usually a clinical diagnosis with otoscopy

  • loss of cone of light
  • handle of maleus
29
Q

What Investigations are done in suspected Acoustic Neuroma?

A

Suspected Acoustic neuroma needs urgent ENT referral

MRI cerebellopontine angle

audiometry important - check for any sensorineural hearing loss

30
Q

What Investigations are done in suspected cholesteatoma?

A

CT head - confirm diagnosis and planning for surgery

MRI - assess invasion and damage to local soft tissue

31
Q

What Investigations are done in suspected vestibular migraine?

A

usually a clinically diagnosis

32
Q

Indication for investigating hear in babies, older children & adults

A
  1. Babies- Not making appropriate noises for their developmental stage or do not appear to be reacting to sounds should be referred.
  2. Older children- mispronouncing words, concerns raised by school, poor concentration, difficulty locating the origin of a sound, not responding when their name is called, talking loudly and listening to the television at a high volume.
  3. Adults- sudden = hearing loss, trauma related or associated with necrotic infections.
33
Q

Referral criteria for audiological assessment

A
  • sudden loss of hearing = Immediate ENT

- if more than 30days = 2wwr ENT

ICM - OBS (18 decks)

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