ENT Flashcards
Otitis Media
Infection in the middle ear
Causes - bacterial infection 2nd to viral URTI (strep pneum, Hib, Moraxella cattarrhalis)
= acute onset, ear pain, fever, hearing loss, URTI, effusion (bulging, discharge), inflam
Inv - otoscopy (bulging, red, loss of light reflex)
-> 5-7d amox (or erythromycin) if not improving >3 days, <2yrs and bilateral, systemically unwell, IC, perf
Comp - perf can cause chronic suppurative OM, labyrinthitis, hearing loss, mastoiditis, meningitis, FN paralysis
Glue Ear
Otitis media with effusion, common in childhood
RF - male, FHx, bottle fed, smoking
= peaks at 2yrs, conductive hearing loss, speech and language delay
-> observe 3m, grommets (allow air to pass through middle ear), adenoidectomy
Otitis Externa
Causes - bacterial (staph), fungal (candida), recent swimming, seborrhoic and contact dermatitis
= itchy painful ear, discharge, red swollen flakey canal
-> topical Ab +/- steroid, refer to ENT if not responding, oral Abx if spreading, empirical antifungal
Malignant Otitis Externa
RF - IC (elderly diabetics), pseudomonas
= worsening pain, osteomyelitis, severe headaches, otorrhea, FN nerve issues
Inv - CT
-> IV Abx (ciproflox)
Acoustic Neuroma
Benign tumour of Schwann cells of auditory nerve
RF - NF2 (bilateral)
= vertigo, tinnitus, SN hearing loss (CN VIII), absent corneal reflex (CN V), facial palsy (CNVII)
Inv - urgent referral to ENT, MRI cerebellopontine angle
-> observe, surgery or radiotherapy
Submandibular Gland Disease
Sialolithiasis
Salivary gland stones, calcium based (radio-opaque)
= colicky pain, post-prandial swelling
Sialadenitis
Staph aureus infection
= pus leaking from duct, redness
Salivary gland tumours
50% malignant
Inv - fine needle aspiration, CT, MRI
Conductive Hearing Loss
Causes - ear wax, infection, effusion, Eustachian tube issues, perf, otosclerosis, tumours and cholesteatoma
Inv - Webers (louder in affected ear), Rinnes -ve (bone better than air)
Sensorineural Hearing Loss
Causes - sudden onset (urgent referral, PO steroids), presbycusis, Meniere’s, noise, labyrinthitis, neuro issues, loop, aminoglycoside, cisplatin
Inv - Webers (louder in normal ear), Rinnes +ve (air better than bone)
Ramsay Hunt Syndrome
Herpes zoster oticus - reactivation of Varicella in geniculate ganglion of CN7
= auricular pain, facial nerve palsy, vesicular rash, vertigo, tinnitus
-> PO aciclovir and steroids
Eustachian Tube dysfucntion
= may be preceded by URTI, reduced / altered hearing, popping, fullness, tinnitus and pain
If no clear cause may need tympanomotry audiometry and CT
-> conservative, valsalva, decongestants, Otevnet OTC (blow into balloon using one nostril), surgery
Meniere’s Disease
Disorder of inner ear, excessive endolymph, higher pressure disrupts signals
= unilateral episodes of SN hearing loss (may become constant), tinnitus and vertigo, last 20min-1hr, in clusters, aural fullness, unidirectional nystagmus, +ve Rhomberg
Inv - ENT assessment
-> buccal/IM prochlorperazine (acute), betahistine / vestibular rehab (prevention), inform DVLA
Labrynthitis
Inflammation of the middle ear normally due to Viral URTI
= 40-70yrs, acute onset vertigo, worse with movement, n+v, SN hearing loss, tinnitus, unidirectional nystagmus to unaffected side, abnormal head impulse test, gait (fall to affected side)
-> self limit, prochlorperazine or antihistamines
Tonsillitis
Causes - viral most common, group A strep pyogenes, strep pneum
= sore throat, painful swallowing, fever, nodes, red swollen tonsils +/- exudate
Centor: prob of bacterial (>38, exudates, absence of cough, tender cervical nodes)
FeverPAIN: fever, pus, <3d of onset, inflamed, no cough
-> penicillin V for 7-10 days
Comp - chronic, quinsy, otitis media, scarlet fever, rheumatic fever, GN, reactive arthritis
Acute Sinusitis
Inflammation of the mucous membranes of the paranasal sinuses
Causes - strep pnuemoniae, Hib, rhinoviruses
RF - nasal obstruction (deviated septum, polyps), recent local infection, swimming, smoking
= facial pain, worse bending forward, discharge, obstruction, double sickening (viral to bacterial)
-> analgesia, IN decongestants, IN steroids if >10 days, Abx if systemically unwell/ high risk of comp (phenoxymethyl)
Allergic rhinitis
Inflammatory disorder, sensitised to allergens
= sneezing, obstruction, discharge, drip, itchy
-> avoid allergen, oral/ IN antihistamines, IN steroids, short course of PO steroids for events
Topical decongestants should not be used for a long time due to tachyphylaxis and rebound hypertrophy of nasal mucosa
Chronic Rhinosinusitis
Inflammation of paranasal sinuses >12wks
-> IN steroids and saline irrigation
Red flags incl. unilateral, >3m treatment, bleeding
Auricular Haematoma
Prompt treatment to avoid cauliflower ear
-> same day assessment by ENT, incise and drain
Black Hairy tongue
Defective desquamation of filiform papillae, can be variety of colours
RF - poor dental hygiene, Abx, radiation, HIV, IVDU
Swab to exclude candida
-> tongue scraping
Branchial Cyst
Benign developmental defect of the branchial arches, filled with acellular fluid and cholesterol crystals
= late childhood, male, asymp lateral neck lump. ant to SCM, smooth, non tender, fluctuant, no movement on swallow (doesn’t transilluminate)
Inv - refer to ENT, US
-> can be surgically removed
Cholesteatoma
Non-cancerous growth of squamous epithelium, trapped in skull base = local destruction
RF - cleft palate
= 10-20yrs, foul smelling discharge, hearing loss, local invasion can cause vertigo/ FN palsy
Inv - otoscopy (attic crust)
-> ENT referral, surgery
Nosebleeds
Anterior - visible source, Kiesselbachs plexus
Posterior - profuse and deeper, more dangerous
-> sit forward with mouth open, pinch nose for 20 min
If successful consider top antiseptic (Naseptin chlorhexidine/neomycin)
If unsuccessful at 10mins try cautery (packing if can’t see source)
If everything fails use sphenopalatine ligation
Gum disease
Gingival Hyperplasia
Causes - phenytoin, CCB (n), ciclosporin, AML
Gingivitis
Simple (painless bleeding and swelling) or acute necrotizing (painful and punched out lesions)
-> nec refer to dentist, oral metro + chlorhexidine mouth wash + pain relief
Head and Neck 2WW
Laryngeal:
45+ with persistent hoarseness or unexplained neck lump
Oral:
Unexplained ulceration >3wks or unexplained neck lump
Refer to dentist if lump in lip/oral cavity or patch consistent with erythro/leukoplakia
Thyroid:
Unexplained thyroid lump
Layngopharyngeal reflux
GORD causes inflammatory changes to the larynx
= 70% have sensation of globus (midline), hoarse, chronic cough, dysphagia, heartburn, sore throat, redness of posterior pharynx
Clinical diagnosis if no red flags
-> lifestyle, PPI, gaviscon
Ludwigs angina
Progressive cellulitis that invades the floor of the mouth and soft tissue of neck
Causes - odontogenic infections (infected stones) which spread to submandibular area
= neck swelling, dysphagia, fever
-> Life-threatening, airway management, IV Abx
Mastoiditis
Infection spreads from the middle ear to mastoid air spaces of the temporal bone
= severe pain behind ear, fever, very unwell, swelling, redness, ear may protrude forwards
Inv - clinical, CT
-> IV Abx
Comp - hearing loss, meningitis and FN palsy
Nasal Polyps
RF - M, adults
Link - asthma, aspirin sensitivity (samters triad), sinusitis, CF, Kartagener’s, Churg Strauss
= nasal obstruction, rhinorrhoea, sneezing, poor sense of taste and smell
-> refer to ENT for full exam (esp. unilateral/ bleeding), top steroids to shrink
Nasal Septal Haematoma
Complication of nasal trauma, bleed between septal cartilage and overlying perichondrium
= sensation of nasal obstruction, pain, rhinorrhea, bilateral red swelling and boggy
-> surgical drainage and IV Abx
Comp - irreversible septal necrosis in 3-4days
Nasopharyngeal cancer
Squamous cell, link to EBV and southern china
= otalgia, unilateral serous otitis media, nasal obstruction, epistaxis, CN 3-6 palsies, cervical nodes
Inv - combined CT and MRI
-> radiotherapy
Thyroglossal Cyst
Patent thyroglossal duct
= <20yrs, midline (between thyroid and hyoid), moves upwards on tongue protrusion
Cystic Hygroma
Congenital lymphatic lesion found on left side of neck
= neonate - 2yrs
Parotid gland disease
Malignant
Mucoepidermoid - 30% of all parotid cancers
Adenoid cystic - 35% survival, perineural spread
-> radical parotidectomy
Benign
Pleomorphic adenoma - most common tumour, some malignant degeneration
= gradual onset of painless unilateral swelling, movable
Warthin (papillary cystadenoma) - link to smoking, bilateral, male
-> superficial parotidectomy
Perforated tympanic membrane
Causes - infection, trauma
-> no treatment needed (heals in 6-8 weeks), avoid getting wet, myringoplasty if this does not work
Bleeding following tonsillectomy
All need to be assessed by ENT
Primary (<24hrs) - most 6-8hr after, return to theatre.
Secondary (>24hrs) - most 5-10 days after, usually a wound infection, admit and Abx
Presbycusis
SN hearing loss that comes with age
Causes - arteriosclerosis, DM, salicylates, noise exposure
= elderly, lose high pitch first, worse in noisy environments
Inv - normal otoscopy, audiometry (BL SN pattern)
Complications of thyroid surgery
Recurrent laryngeal nerve damage
Bleeding - can cause laryngeal oedema
Parathyroid gland damage = low calcium
Indications for tonsillectomy
Sore throats due to tonsillitis +
5 or more episodes a year +
Occuring for at least a year +
Disabling and prevent normal function
Other:
Recurrent febrile convulsions due to tonsillitis
OSA, stridor or dysphagia
Quinsy not responding
Audiogram Interpretation
Conductive - only air bad
Sensorineural - both bad
Mixed - both bad but air worse
Benign paroxysmal positional vertigo (BPPV)
= 55yrs, sudden onset dizziness/ vertigo, worse with head movement, nausea, 10-20secs, Dix-Hallpike manoeuvre, rotatory nystagmus
-> spont resolve in weeks-mths, Epley manoeuvre, vestibular rehab for home
Prog - 50% recur in 3-5yrs
Otosclerosis
AD, replacement of normal bone by vascular spongy bone, causes fixation of stapes at oval window
= 20-40yrs, progressive conductive deafness, tinnitus, 10% flamingo tinged eardrum (hyperaemia)
-> hearing aid, stapedectomy
Quincy
Peritonsillar abscess 2nd to bacterial tonsillitis
= severe throat pain, lateralises to one side, deviation of uvula to unaffected side, trismus (difficulty opening mouth), v neck mobility
-> urgent review by ENT, needle asp or incise and drain, + IV Abx, tonsillectomy
