ENT Flashcards
what are the causes fo epistaxis?
idiopathic
truamatic
iatrogneic
froeign body
inflammatory (polyps, rhinitis)
neoplastic
HTN/coagulopathies
name the managemnt step by step of epistaxis?
- A-E (check for shock)
- pinch soft part of nose and lean forward (spit out blood) for 15 mins
- cautery with silver nitrate (with anterior rhinoscopy - anterior or rigid endoscope - posterior) + adrenaline topically if needed (IF able to LOCATE source of bleeding)
- nasal packing if all else fails (anterior +/or posterior pack)
- surgical ligation of radiological embolisation to sphenopalatine/anterior ethmoidal/external carotid
what are teh two complications from a nasal fracture?
- CSF leak
- septal heamatoma
what is teh initial management of a septal fracture?
- A-E
- exclude for septal heamatoma
- MUA within 2 weeks (after swelling has gone down)
- if major truama needs evacuation under GA with packing +/- suturing
what is teh main complication from a septal heamatom?
saddle nose deformity
what are nasal polyps?
benign growths than can be seen in chronic sinusitis due to extreme inflammation
normally bilateral (if unilateral must biopsy just in case malignant)
red flags for polyps?
polyps that are unilateral, fast growing, bleeding
what is teh best imaging for rhinosinusitis?
CT sinuses -> done if surgery planned
what is the surgical treatment done for chronic rhinosinusitis?
nasal polypectomy -> very high rate of recurrence
functional endoscopic sinus surgery to improve ventilation/drainage
septoplasty and reduction of inferior turbinates
name complications of functional endoscopic sinus surgery
bleeding, infection, CSF leak, visual loss or disturbnace
medical treatment for chronic rhinosinusitis?
- antihistamines
- topical nsala steroids
- oral steroids (1 wk course)
- oral ABx (at least 6-8 weeks)
what is the defintiion of rhinosinusitis?
2 symptoms of:
- nasal blockage
- nasal discharge or post nasal drip
- facial pain
- reduced or loss of smell
+/- endoscopic signs of polyps, mucopurulent discharge or oedema in middle meatus
+/- CT changes (mucosal or sinus changes)
what investigations are doen to test for alleric rhinitis?
- skin prick test for speicifc allergens
- RAST blood tests if SPT not possible (tests IgE antibodies)
tretament fro allergic rhinitis
- allegren avoidance
- nasal douching
- antihistamines
- topical nasal steroids
- immunotherapy
what defines the difference between mild and moderate allergic rhinitis?
mild: normal daily acitvities and sleep
moderate: impairment of daily activites nd sleep
what are the mian risk factors for head and neck cancer ?
alcohol (MAIN)
tobacco (MAIN)
beetle nut chewing for oral cavity malignancies
chinese ethnic origin for nasopharyngeal malignancy
male
what investigations are importnat to do for supsetced H&N cancers?
CT neck
panendoscopy or laryngopharyngo-oesophagoscopy with biopsy
FNA of lymph nodes is suspected spread
CT chest if mets suspetced
most common type of head and neck cancer
SCC (90%)
management of head and neck cancers?
- palliation
- radiotherapy to primary site +/- to neck +/ chemo
- surgery - endoscopic (laser) or open
where do the recurrent laryngeal nerves run and what is the consquence of injuring them during thyroid surgery?
run in the tracheo-oesophageal groove
- they suply muscles of larynx and sensation below vocal cords = hoarsness and airway obstruction porblems
complications of thyroid surgery?
- recurrent laryngeal nevre palsy (=hoarseness and airway obstruction)
- superior laryngeal nerve palsy
- bleeding
- infection
- pain
- laryngeal oedeam = airway obstruction
- hypoparathyroidism (if parathyroid glands removed by accident) = hypocalcemia
if thyroid carcinoma is suspected, woudl investigation needs to be done?
fine needle aspiration of nodule
OR can just do a hemithyroidectomy to do definitive histology if there is diagnostic uncertainty
what are teh signs of a septal heamotoma?
- pinky, large mass in either side of nasal airway (feels boggy when palpated, not firm (firm wld indicate you are touchign part of the deviated septum)
presentation of a pt with polyps?
- males, >40yo
- watery anterio rhinorrhea
- pururlent post nasal drip
- nasal obstruction
- sinusitis
- headaches
- snoring
what investigations need to been done if polyps are suspected?
nasal endoscopy
CT scan and biopsy - if single, unilateral polyp/peadiatric polyp
managemnt for nasal polyps?
- medical: nasal steroids e/e/ betamethsone drops
- surgical: endoscopic polypectomy
complications of rhinosinusitis?
- orbital cellulitis/abcsess
- osteomyelitis
- intracranial infection
what are teh common signs and symptoms of head and neck cancers?
- dysphonia
- persistent dysphagia
- persistnet mouth ulcers (>3wks)
- dyspnoea
- unexplained neck lump
- pain (e..g otalgia with no ear signs)
- heamatemsis/epistaxis (rare)
- nasal blockage (progressive unilateral)
what is acute sialadenitis?
- infection to the salivary glands
how does acute sialadenitis present?
- foul tasting purulent discharge
causative organisms for acute sialadenitis?
bacterial (staph aureus due to poor dental hygeine)
viral (HIV, mumps, coxsackie)
what is sialolithiasis?
calculi in the salivary ducts -> 80% submandibular
what is the presentation of sialolithiasis?
- recurrent unilateral pain and swelling
- red tender and swollen gland
- worse upon eating
complciations of sialothiasis?
sialadenitis and abscess formation (pyrexia, drooling, dysphagia)
Ix done for pts with suspected sialolithiasis?
- US
- sialography
Tx for sialolithiasis?
(mostly conservative)
conservative: hydration and analgesia
surgical: intraoral removal of palpable stones/removal of salivary glands
what is sjogrens syndrome?
autoimmune disease causing lymphatic infiltration into the ductal tissue of teh salivary glands = reduced production of saliva
what is teh presentation of sjogrens syndrome?
- dry eyes, dry mouth and enlarged salivary glands
whic gland do most salivary neoplasms occur?
parotid gland
presenation of a parotid gland tumour?
- facial nerve palsy
- painless swelling
Ix done to investigate for parotid neoplasm?
- ENT exmaination
- US +/- CT
- FNAC
Mx for salivary neoplasms?
- parotidectomy
complications of parotidectomy?
- facial nerve palsy
- salivary fistula
- freys syndrome
what is freys syndrome?
redness and sweating over the parotid gland when eating/salivating
this is due to the auriculotemporal nevre reconnecting to skin sweat glands
presentation of a pt with retropharngeal abscess?
- commonly in young children after an URTI
- stiff, extended neck
- dysphagia/odynophagia (difficulty eating and drinking)
- systemically unwell
- failure to improve with IV ABx
what investigations are done to diagnose a retropharyngeal abscess?
- lateral neck XR shows widneing of the retropharygneal space
managment fo retropharyngeal abscess?
- secure airway if compromise
- IV ABx
- surgery -> incision and drainage
what is ludwigs angina?
- severe form of cellulitis involving the space between the floor of the mouth and the mylohyoid (mandible -> hyoid bone)
what does ludwigs angina present with?
- neck oedema
- bilateral submandibualr swelling
- dysphonia
- protruding tongue
- drooling
- airway comprimise
cause of ludwigs angina?
Bacteria from dental infections or poor oral hygiene are the cause of this skin infection.
what investigation is doen to diagnose ludwigs angina?
CT neck
what is the managment of ludwigs angina?
secure airway if comprimisd
IV ABx
surgery -> incision and drainage
common causes of OSA?
- obesity in adults
- adenotonsillar hypertrophy in peads
management of OSA?
- advice on lifestyle chnages including weight loss
- CPAP (mainstay treatment)
- surgeyr - adenotonsillectomy in children
what is epiglottitis?
inflammation and swelling of the epiglottitis usually seen in children aged 2-6yo
main causative agents -> heamophilus influenzae and group A strep
what is the managemnt of epiglottitis?
- EMERGENCY!
- intubation in theatre
- IV ABx (ceftriaxone) and dexamethasone
