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
