ENT Flashcards
What is otitis media?
List some symptoms of otitis media: (4)
What will you see on examination?
What is the 1st line management?
What is a concerning complication of otitis media?
Infection of the middle ear
Presentation:
~ ear pain (young children may tug at their ear)
~ reduced hearing in affected ear
~ URTI symptoms: fever, cough, sore throat, blocked nose (otitis media commonly follows from an URTI)
~ discharge if tympanic membrane perforates
O/E:
~ bulging, red, inflammed tympanic membrane
~ if perforation: discharge & hole in the tympanic membrane
Management: Simple analgesics
Main complication: Mastoiditis
What is the most likely diagnosis of the following:
Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.
What is the management of this?
Epiglottitis
1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)
The commonest cause of tonsillitis is viral > bacterial.
Which 2 criteria are used to estimate the probability that tonsillitis is due to a bacterial infection?
~ list the features within each criteria
~ state the score needed in each criteria to consider prescribing antibiotics
CENTOR: score of 3+
Fever over 38 degrees
Tonsillar exudates
NO cough
Tender anterior cervical lymph nodes
Fever PAIN: score of 4+
Fever
Purulent exudate
Attended within 3 days of the onset of symptoms
Inflamed tonsils
No cough/coryzal symptoms
Is the most common cause of tonsillitis bacterial or viral?
Name the 2 criteria used to differentiate between a bacterial or viral cause of tonsillitis:
~ state the score needed in each criteria to consider prescribing antibiotics
Viral
CENTOR (score of 3+ needed) & Fever PAIN (score of 4+ needed)
Name the commonest bacterial cause of tonsillitis:
~ what is the 2nd commonest cause?
What is the management of a bacterial tonsillitis?
Group A strep
~ 2nd commonest: strep pneumoniae
Penicillin V
Waldeyer’s tonsillar ring contains 6 areas of lymphoid tissue (tonsils). Where abouts in the body is this lymphoid tissue found?
Name the tonsils that are usually infected/enlarged in tonsillitis?
The pharynx
Palatine tonsils
State the 3 typical symptoms in a tonsillitis presentation:
Name the 2 criteria used to differentiate between a bacterial or viral cause of tonsillitis:
~ state the score needed in each criteria to consider prescribing antibiotics
- Sore throat
- Pain on swallowing
- Fever above 38 degrees
CENTOR (score of 3+ required) & Fever PAIN (score of 4+ required)
What is the management of a viral cause of tonsillitis?
What is the management of a bacterial cause of tonsillitis? (what if there is a penicillin allergy?)
Viral: simple analgesia for pain & fever control (paracetamol & ibuprofen) + worsening advice
Bacterial: Penicillin V for 10 days
Penicillin allergy: clarithromycin for 10 days
Name the 2 types of hearing loss and describe the reason behind hearing loss in each type:
Conductive hearing loss: essentially an obstruction - sound travelling from the environment is unable to reach the sensory system due to a blockage
~ eg, putting earplugs in causes a temporary conductive hearing loss!
Sensorineural hearing loss: the sensory system (semicircular canals / cochlear) or vestibulocochlear nerve are not working
Name A - K on the below diagram of the ear anatomy:
A - pinna
B - external auditory canal
C - tympanic membrane
D - malleus
E - incus
F - stapes
G - eustachian tube
H - semi-circular canals
I - vestibular system
J - vestibulo-cochlear nerve
K - cochlear
Sudden onset hearing loss is defined as hearing loss that has developed over what time frame?
List some symptoms associated with hearing loss that may indicate the cause: (5)
72 hours
- Tinnitus
- Pain (may indicate infection)
- Discharge (may indicate infection within the outer/middle ear)
- Vertigo
- Neurological symptoms (eg a stroke)
Name the 2 tests that are used to differentiate between sensorineural and conductive hearing loss:
~ describe how to perform each test and what the results mean
Weber’s:
~ Place tuning fork in middle of patients forehead & ask whether they can hear the sound + which ear it is loudest in
Results:
~ Normal: heard equally in both ears
~ Sensorineural hearing loss: heard quieter in affected ear
~ Conductive hearing loss: heard louder in affected ear (due to the obstruction, the sensory part of the affected ear has become over sensitised so when the sound waves travel through the skull and reach the sensory part of the ear, the sound is heard louder!)
Rinne’s:
~ Place tuning fork on mastoid process & get them to tell you when they can no longer hear the noise (this tests bone conduction as sound is travelling through the bones to the sensory part of the ear)
~ Then hold the tuning fork 1cm from the ear and ask whether they can hear the noise again now (this tests air conduction as sound is travelling through the air to the sensory part of the ear)
~ Normal (= rinne’s positive): patient can hear bone followed by air conduction (air conduction > bone conduction)
~ Abnormal (= rinne’s negative): patient cannot hear sound after removing tuning fork from mastoid process and holding next to ear (bone conduction > air conduction) = conductive hearing loss
Name the 3 commonest medications that are known to cause sensorineural hearing loss:
- Loop diuretics (eg furosemide)
- Gentamicin
- Chemotherapy medications (eg cisplatin)
What is otosclerosis?
What type of hearing loss is associated with otosclerosis?
Otosclerosis: remodelling of the malleus/incus/stapes resulting in conductive hearing loss
What is the typical presentation of otosclerosis? (2)
What age group does this condition most commonly present within?
Unilateral OR bilateral:
- hearing loss
- tinnitus
Under 40y
What type of hearing loss is seen in otosclerosis?
Otosclerosis tends to affect the hearing of lower or higher pitched sounds?
Conductive hearing loss
Lower-pitched sounds
What is otosclerosis?
What examinations/investigations would you do in someone that presents with suspected otosclerosis? (5)
Otosclerosis: remodelling of the malleus/incus/stapes resulting in conductive hearing loss
- Otoscopy (would appear normal)
- Weber’s test
- Rinne’s test (show a conductive hearing loss)
- Audiometry (bone conduction > air conduction)
- Tympanometry (reduced absorbance of sound through the tympanic membrane)
What is the typical presentation of someone with otosclerosis?
Which 3 bones are involved in the pathophysiology of otosclerosis?
What are the 2 management options for this condition?
Unilateral OR bilateral:
- hearing loss
- tinnitus
Malleus, incus & stapes
~ Conservative (using hearing aids)
~ Surgical (stapedectomy (removal & replacement of entire stapes bone) / stapedotomy (removing part of the stapes bone & putting a prothesis through it))
What is otitis media?
Viral infections usually precede bacterial infections. What is the commonest bacterial cause of otitis media?
List some symptoms that otitis media may cause: (4)
If the infection affects the vesitbular system, what additional symptoms may people present with?
What additional symptom would you expect if the tympanic membrane perforates?
Infection of the middle ear
Strep pneumoniae
- Ear** **pain
- Reduced hearing in the affected ear
- URTI symptoms: cough, sore throat, runny nose
- Systemic symptoms: fever, fatigue
Vestibular system affected: vertigo/balance issues
Perforated membrane: discharge
What would you expect to see on otoscopy examination of someone with otitis media?
What is the management of otitis media?
~ how long does it usually take to resolve?
List 4 complications of otitis media:
Bulging, red, inflamed tympanic membrane +/- discharge if the membrane has perforated
Supportive management (ibuprofen/ paracetamol)
~ usually resolves within 3-7 days
- mastoiditis
- otitis media with effusion
- hearing loss (temporary)
- perforated tympanic membrane
What is otitis media?
What is the difference between otitis media and otitis media with effusion (also known as glue ear)?
Infection of the middle ear
Otitis media with effusion = non-infective fluid within the middle ear
Otitis media = infection within the middle ear
What is otitis externa?
What is the other name given to otitis externa?
What are the 2 commonest causes of inflammation in this condition?
Inflammation (commonly infection) of the skin in the external ear canal
Swimmers ear
Bacterial infection + fungal infection
What are the 2 commonest bacterial causes of otitis externa?
~ one of these bacteria is associated with a respiratory condition. What is this condition and which bacteria is associated with it?
List some of the symptoms seen in otitis externa: (4)
- Pseudomonas aeruginosa - associed with CYSTIC FIBROSIS infections!
- Staph aureus
- Ear pain
- Discharge
- Itchy ear
- Conductive hearing loss
A patient complains of ear pain and reduced hearing from one ear. On otoscopy examination you notice some smelly discharge in the external ear canal and a perforated tympanic membrane.
What 2 conditions should you have as differentials?
What is the most likely diagnosis? - why?
Differentials: otitis externa / otitis media
Diagnosis: otitis media - perforated tympanic membrane indicates a middle ear infection instead of just the external ear canal!
Otitis externa is inflammation of the external ear canal. What is the management of:
~ mild otitis externa
~ moderate otitis externa
~ severe otitis externa
Before giving a patient topical aminoglycosides (eg gentamicin/neomycin), what do you need to check? - why?
Mild: acetic acid 2% topical drops into the ear (contains a mix of antifungal & antibacterial!)
Moderate: topical antibiotic + steroid (eg neomycin, dexamethasone & acetic acid = otomize spray)
Severe: oral flucloxacillin
EXCLUDE a perforated tympanic membrane - these medications are otoxic & can cause hearing loss!!!!!
What manoeuvre is performed to diagnose BPPV?
~ what 2 signs would this manoeuvre elicited if the patient has BPPV?
What manoeuvre is performed for symptomatic relief of BPPV?
Dix-Hallpike manoeuvre
~ vertigo
~ rotatory nystagmus
Epley manoeuvre
Which medication is used to prevent attacks of Meniere’s disease?
Betahistine
