ENT Flashcards
Someone present with persistent unilateral discharge. How should they be managed?
Suspect Cholesteatoma - Referal to ENT
If pressing on the soft part of the nose hasn’t helped in epistaxis. What is the likely origin of the bleed?
Sphenopalentine Artery
Management of a severe epistaxis
Compression -10-15mins can add cold packs
Cautery + Lidocaine and phenyphrine spray
Nasal Packing
Artery ligation and embolism
Risk Factors for Tympanosclerosis
Chronic Otitis Media
Grommets
How does tympanosclerosis present?
White chalky patches on ear drum
Hearing loss
How is tympanosclerosis managed?
Hearing Aids
Surgical resection of sclerosis
When shoulda perforated ear drum be refereed to ENT?
Unresolved by 6-8 weeks
What nerve if damaged would cause a hoarse voice?
Recurrent Laryngeal
What nerve is damaged would cause an inability to reach high pitches?
Superior Laryngeal
Criteria for diagnosing and administering antibiotics for a soar throat
Absence of cough >38 degrees Tender anterior lymphadenopathy Exudate 3/4 = Bacterial Tonsilitis >3 = Antibiotics given
What antibiotics are used in bacterial tonsillitis?
Phenoxymethylpenicillin
Clarithromycin in penicillin allergy
Smooth generalised swelling which moves up on swallowing.
Thyroid Goitre
Remember will have systemic symptoms
<20yrs
Midline between isthmus of the thyroid and hyoid bone
Upwards on tongue protusion
Thyroglossal Cyst
Present from birth
Left sided #
Transilluminates
Cystic Hygroma
Oval mobile mass
Anterior triangle infront of sternocleidomastoid and behind pharynx
Early adulthood
Cholesterol crystals in fluid
Branchial cyst
First line management if the source of the epistaxis can be visualised.
Cautery
First line management if the source of the epistaxis cant be visualised.
Anterior packing
Criteria for administering antibiotics in Acute Otitis Media
Amoxicillin or Clarithromycin Persistent and no improvement over 4 days Systemically unwell <2 years + bilateral Perforation
What is used to manage Acute Otitis Media
Amoxicillin
Erythromycin or clarithromycin in pen allergic
Diagnostic manœuvre that will trigger a rotatory nystagmus Nausea +/- vomiting in BPPV.
Dix Hallpike
The manœuvre designer to reposition and treat BPPV
Epley
Common causes of acute sinusitis
Strep Pneumonia
Haemophilus Influenza
Rhinovirus
Management of acute sinusitis
Supportive and Analgesia
Over 10 days of symptoms - intranasal steroid
Severe symptoms - Phenoxymethylpenicillin or Co-Amoxiclav is really bad
Management of nasal polyps
All should be referred to ENT
Topical corticosteroids
Risk factors for developing nasal polyps
Asthma Aspirin intolerance Infective sinusitis CF Kartenagars syndrome Churgg strauss - cANCA
In a patient presenting with a persistent hoarse voice what investigation should be done whilst waiting for the 2 week urgent referral?
Chest X ray to exclude apical lung lesion
Colickly pain and post prandial swelling
80% of time affecting submandibular gland
Sialolithiasis - salivary gland stone
Commonly Calcium Phosphate or Carbonate
Management and investigation in sialolithiasis
Sialography - visualise where the blockage is occurring
Distal Wharton’s duct - orally removed
Gland excision may be required for the rest
What is the commonest organism linked to sialadenitis?
Staph Aureus
Women 30-60
Slow progression and long history
Parotid gland
Pleomorphic adenoma - commonest benign tumour
Malignant potential if left
Men over 50
Strong association with smoking
Often bilateral and multi centric
Warthins tumour
Benign
Over 40
Parotid gland
Perineural invasion - loss of facial nerve
Adenoid Cystic Carcinoma
Commonest malignant salivary gland tumour in UK
Malignant tumour that is common in the parotid but can appear in any gland
Mucoepidermoid carcinoma
Commonest malignant tumour of the salivary gland world wide
Unilateral persistent epistaxis congestion or discharge
Unilateral persistent middle ear effusion
Otalgia
Cranial nerve palsy III - VI
South China origin or lived
Nasopharyngeal Carcinoma
Type of squamous cell carcinoma - linked EBV
CT and MRI imaging
Radiotherapy is management +/- surgical resection
Management of Post tonsillectomy haemorrhage.
ALL REFER URGENTLY TO ENT
Primary = 6-8hrs post - urgent return to theatre Secondary = 5-10 days later - generally due to infection - Abx and surgery
If topical antibiotics have failed to slow progression of erythema in Otitis Externa what should you do?
Oral antibiotics
Consider fungal cause
Sore throat + pyrexia + lymphadenopathy
+/- Malaise, anorexia, palatial petechia, splenomegaly, transient hepatitis
Atypical Lymphocytosis
Cold haemolytic anaemia
Glandular Fever
Symptoms persist over weeks
Break out into maculopapular rash if given amoxicillin
What test should be done if you are suspecting glandular fever?
FBC and Monospot in 2nd week of symptoms
FBC - haemolytic anaemia and atypical lymphocytosis
Common causes of glandular fever?
EBV CMV HHV-6
Branchial cyst management
Exclude other causes
USS -> ENT referral -> FNA
When examining the eardrum of someone with recurrent unilateral discharge where is the most important part to visualise?
Attic - to ensure you don’t miss cholesteatoma
Family history of hearing issues
Conductive hearing loss
Accelerated during pregnancy
Schwartz sign positive
Otosclerosis
Redness over cochlear promontory = Schwartz signs
Facial pain worse on leaning forwards
Nasal discharge - clear
Nasal obstruction - mouth breather
Post nasal drip - chronic cough
Chronic rhinositus
Avoid allergens, Intranasal steroids, nasal irrigation with saline
Red flags - unilateral symptoms + persistence despite three months of treatment
Management of Acute Otitis Externa
Topical Abx +/- steroid
No improvement = refer to ENT -> oral antibiotic (flucloxacillin) or topical anti fungal
If severe debris removal may be needed
A progressive cellulitis affecting floor of the mouth and the neck.
Ludwigs Angina
Medical emergency - immediate admission for IV antibiotics and surgery as airway compromise can be sudden.
Air > bone bilaterally
High frequency hearing loss
presybiscus
Bilateral nasal polyps
Routine referral to ENT -> intranasal steroids
Bilateral non tender parotid swellings + xerostomia
Think sarcoid if alongside other symptoms
Preceptal cellulitis
IV antibiotic and admission
Or antibiotics and daily follow up
Management of Quincy
IV antibiotics and drainage
Consider tonsillectomy in 6 weeks time
Otitis Media with effusion - management
Active observation for 6-12 weeks
Immediate referral if cleft palate or they have Down Syndrome
Cause and management of Rhinitis Medicamentosa
Prolonged nasal decongestant use - causes symptoms similar to what they were using it for
Management - stop using decongestant causes symptoms to resolve
In a hypoglossal nerve lesion the tongue points in what direction?
When stuck out the tongue deviates towards the side of the lesion.
How is a sudden onset sensorineural hearing loss managed?
7 days oral prednisolone + urgent ENT referral
Majority are idiopathic
Which way does the uvula point in a vagus nerve lesion?
Away from the site of the lesion
What is the cut off for normal hearing on an audiogram?
Anything below 20db is classed as hearing loss
Menieres - management
Cease driving until symptoms controlled
Acute - Prochlorperazine
Prevention - Betahistine + Vestibular rehab
Vestibular Neuritis - management
Buccal or IM Prochlorperazine is first line
Vestibular rehab is key management for prevention
Persistent Dysphonia for over 3 weeks
Referral to ENT
What can be used to give a brief period of control to resistant hay fever?
Oral steroids
What antibiotics is indicated in otitis externa in diabetics?
Ciprofloxacin to cover pseudomonas
