ENT Flashcards
What are some indications for antibiotic use in otitis media?
- bulging tympanic membrane
- bilateral OM in a child <2 years
- lasting >4 days
- ottorhoea in a child
Give some post-operative complications of a tonsillectomy
Pain - can increase for up to 6 days
Haemorrhage - usually in first 6-8 hours - urgent return to theatre
Secondary haemorrhage - 5-10 days, wound infection association, treat with admission and antibiotics
What is the presentation of a cholesteatoma?
- Offensive discharge
0 Hearing loss, gradual conductive, unilateral - vertigo and facial paralysis can occur if it erodes into bone
- It is a destructive, expanding keratinised debris collection of squamous cells
- Results in inflammation, discharge, vertigo, hearing loss
What is preauricular sinus?
Foul smelling discharge
Common congenital condition in which an epithelial defect forms around the external ear
Small require no treatment, large may become blocked and develop and infection
How might an acoustic neuroma present?
- Gradual progressive unilateral deafness and tinnitus
- Vertigo (if vestibular nerve involvement)
- vestibular schwanoma
- MRI must be done in unilateral hearing loss to rule this out
- Mx watch and wait if small, stereotactic radiosurgery or microsurgery
What is Ramsay Hunt syndrome?
Herpes zoster oticus
Vesicular lesions on anterior 2/3rd of the tongue and soft palate
Auricular pain
Facial nerve palsy
Vertigo, tinnitus
Treat with oral acyclovir and corticosteroids (PO Pred)
Give some differentials to facial pain.
Sinusitis (cold, facial ‘fullness’, nasal discharge)
Trigeminal neuralgia (sharp, shooting pains, triggered by touch, unilateral)
Temporal arteritis (pain over trigeminal distribution)
Cluster headache (regular for 4-12 weeks, an 15mins to 2 hr duration, intense eye pain, redness, lacrimation, lid swelling)
Give some differentials for a neck lump
Reactive lymphadenopathy (post-infection, common)
Lymphoma (rubebry, painless, night sweats, splenomegaly)
Thyroid swelling (moves upwards on swallowing)
Thyroglossal cyst (moves upwards on protrusion on the tongue)
Pharygeal pouch (posteromedial herniation, dysphagia, regurgitation, gurgling lump)
Cystic hygroma (congenital lymphatic neck lump)
Cervical rib (extra rib, risk of thoracic outlet syndrome)
Carotid aneurysm (pulsatile neck mass)
What features are included in the CENTOR criteria?
Tonsillar exudate
Tender lympadenopathy
History of fever
Absence of cough
3+ give antibiotics
What is your management for a perforated tympanic membrane and would anything change your management?
Reassure and follow-up, self-limiting
Amoxicillin if sign of infection
What is Rinne’s and Weber’s and what does a positive test indicate?
Weber’s - midline, tuning for 512Hx, normal hearing should be in the middle, if sounds louder in one ear then this indicates conductive hearing loss in that ear, or sensorineural hearing loss in other ear
Rinne’s - mastoid tip, should be louder in air next to ear, if not indicates conductive deafness
AIR CONDUCTION SHOULD BE BETTER THAN BONE CONDUCTION
What is the anterior and posterior triangle of the neck?
Anterior - sternocleidomastoid, mandible and midline
Posterior - trapezius, clavicle, sternocleidomastoid
What is the difference between otitis externa and otitis media and what symptoms occur in each?
Externa - inflammatory of external auditory canal, otalgia, otorrhoea, ear discharge
Media - effusion of middle ear, hearing loss, itching, pain => can be acute or chronic or with glue ear
What is the causative organism in ear infections?
Pseudomonas
Staph aureus
What are some complications of acute otitis media?
Abscesses
CNS infections
Sinus thrombosis
Mastoiditis
Labyrithitis
COM - chronic otitis media
What is Ludwig’s angina?
Cellulitis of the mouth that develops in immunocompromised patients with poor dentition
Swelling of lymph nodes, purexia
What does the monospot test look for?
EBV - mononucleosis
What risk factor exists for malignant otitis externa?
What is the usual causative organism?
Diabetics
Normall caused by pneumococcus
What are some ear-related causes of vertigo?
Viral labyrinthitis (recent viral infection, acute, n+v, hearing, nystagmus)
Meniere’s (tinnitus, aural fullness)
Vestibular neuronitis (recent viral infection, recurrent vertigo, NO hearing loss)
BPPV (nystagmus associated with moving in bed)
Vestibular schwannoma (focal neurology association, unilateral hearing loss)
What medications are given for otitis externa and in what form?
Topical antibiotic - cipro/fluclox
2nd line - PO flucloxacillin
What is a common cause of bacterial otitis media?
H. influenzae
Strep pneumoniae
Morazella catarrhalis
When should antibiotics be prescribes in otitis media?
Symptoms >4 days
Systemically unwell
Immunocompromise
<2 years with bilateral otitis media
Performation and/or discharge in canal
Amoxicillin
What is otosclerosis?
- Genetic condition (AD inheritance)
- Fusion of middle ear ossicular chain
- Leads to progressive conductive deafness in middle-age, bilateral
- worsens in pregnancy and menstruation because of oestrogen increase
- ‘Flamingo tinge’ to tympanic membrane
What are some causes of hearing loss?
Presbycusis - age related sensorineual hearing loss, high frequency bilateral loss
Otosclerosis - conductive, low frequency, middle-age, genetic
Glue ear
Meniere’s disease - vertigo, tinnitus
Drug ototoxicity - gentamycin
Noise damage - bilateral, frequencies of 3000-6000
Acoustic neuroma - unilateral
What drugs could cause tinnitus?
Quinine
Loop diuretics
Aminoglycosides
Aspirin
What are complications of malignant necrotising otitis externa?
Meningitis
Cerebral abscess
Dural sinus thrombosis
What is acute mastoiditis and it’s treatment?
Infection of the mastoid bone, occurs as a complication of acute otitis media
Treat with broad spectrum antibiotics
Corticol mastoidectomy if unsuccessful
What is the difference between conductive and sensorinueral hearing loss?
Conductive - affects the middle of outer ear
Sensorinureal - affects cochlear of CNVIII
What are some common causes of deafness in children?
Hereditary - Perre Robin, Alport, Usher’s, Treacer-Collins
Maternal infection - rubella, CMV
Perinatal - anoxia, birth trauma, cerebral palsy
Postnatal - meningitis, lead poisoning
What should always be done in asymmetrical hearing loss?
MRI
Rule out acoustic neuroma
What are the three components that affect balance?
Vision
Proprioception
Vestibular apparatus
What is your management for acute labyrinthitis?
Inflammation of labyrinth - vertigo, deafness, tinnitus
Bed rest
Demenhydrinate
Prochlorperazine
IV abx if infection
What is the curative manoeuvre for BPPV?
Epley’s
What do you expect to see on Hallpike’s Test for Benign Paroxysmal Positional Vertigo?
Positional nystagmus that fatigues
What are the three staple features of meniere’s disease?
Vertigo episodes
Tinnitus
Hearing loss
What does the vertigo occur typically in BPPV?
When rolling over in bed or sharp head turns
Give some management options for Meniere’s Disease
Reduce salt and caffeine intake
Beta-histime
Diuretics (furosemide, bendroflumethiazide)
Cloproperazine for acute attacks
What is the more common location of epistaxis?
Anterior - Little’s Area
What is your management for sinusitis?
Analgesia
Topical nasal steroids
Antibiotics - amoxicillin, metronidazole
Nasal douching
What are some risk factors for epistaxis?
Dry climate
Deviated nasal septum
Vessel rupture
Coagulation disorders
Septal perforation
How do you treat epistaxis?
Cautery (AgNO3 (silver nitrate)
Packing
What is a Ringer’s Tumour?
A benign tumour of the nose - inverted papilloma
A septal haematoma is a complication of what and how do you manage it?
Nasal trauma #
Necrosis of nasal septum, risk of perforation or saddle-nose deformity
Requires urgent drainage
Prophylactic antibiotics
What would a 2-3 on the FEVER Pain or CENTOR criteria result in?
Consider delayed antibiotics
What are common bacterial causative organisms of tonsillitis?
Group A beta-haem strep
Staph aureus
Strep pneumonia
Mycoplasma pneumonia
What are common viral causes of tonsillitis?
Herpes simplex
Adenovirus
Rhinovirus
Influenza
RSV
EBV
What are indications for tonsillectomy?
Recurrent tonsillitis
>7 in a year
>5 each year for 2 years
>3 each year for 3 years
Unilateral tonsillar changes
What is Quincy and how is it treated?
Peritonsillar abscess
Presents with sore throat, dysphagia, a ‘hot potato’ voice (patient can’t open their mouth fully)
Aspiration
What is the organism that causes glandular fever?
Infectious mononucleaosis
What should be advised to patients with glandular fever?
No contact sports as risk of splenic rupture
No alcohol
What is the organism that causes epiglottitis?
Haemphilus influenza
What is your management priority in epiglottitis?
Secure the airway - call an anaethetist, intubation or tracheostomy may be necessary
What type of cancers are laryngeal carcinomas?
Squamous cell carcinomas - risk factors include smoking, alcohol and HPV
What does a nasal septal haematoma look like on examination?
Bilateral red swelling from midline
Slightly boggy
Post-trauma
Urgent ENT review for surgical drainage and IV antibiotics
How might a nasopharyngeal carcinoma present?
What is an at-risk ethnic group?
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction/discharge/epistaxis
Cranial nerve palsies III-VI
Southern China
What are epidermoid cysts?
Common
Cutanous cyst
Asymptomatic, can occur at any age
Firm, round nodules
Central punctum
What is a lipoma?
Transillumination is equal to surrounding tissue
Intradermal
Soft and mobile
Asymptomatic
What is your management order in haemorraging epistaxis?
Compression - sit forwards with mouth open, pinch the cartilaginous tissue for 15 minutes and breath through their mouth
If site identifiable: cautery with silver nitrate
Anterior packing
How do you distinguish vestibular neuritis from labyrinthitis?
Vestibular neuritis - vestibular nerve is involved and there is NOT HEARING IMPAIRMENT
Labyrinthitis - when both the vestibular nerve and labyrinth and involved
What is a worrying feature of nasal polyps?
Unilateral - refer to ENT, risk of malignancy
What is presbycusis?
Occurs in older people
The loss of outer hair cells in the cochlear
Gradual progressive bilateral hearing loss
Loss of high frequencies first
Mx - hearing aids or cochlear implant
What hearing loss pattern occurs in noise induced hearing loss?
Excess sound history
Gradual bilateral hearing loss
Not progressive
Tympanic membrane looks normal
What must be done in Meniere’s Disease?
Inform the DVLA
Ear pain + fever + conductive hearing loss is typically…?
Acute otitis media
What are some symptoms of glandular fever?
Tonsillar enlargement
Petechiae on palate
Lymphadenopathy
Fever
Sore throat
What is the main difference between labyrinthitis and vestibular neuritis?
L - inflammation of labyrinth as well so there is hearing loss
VN - no hearing loss
Similarities - incapacitating rotational vertigo not triggered by head movement, nausea and vomiting, self-limiting
Advise not to drive
What are some risk factors for throat cancer (oropharyngeal cancer)?
Alcohol
Smoking
Age
HPV
What is the most common histology of laryngeal cancer?
Squamous Cell Carcinoma
What investigations are done in oropharyngeal cancer? List 6
Nasal endoscopy
Biopsy
Fine Needle Biopsy
CT Scan
MRI scan
PET scan
Bloods
What is your management plan for oropharyngeal cancer?
Radiotherapy (if small)
Surgery (if larger, can be curative or symptom relief)
What are some clinical features of chronic otitis media?
Recurrent otorrhoea, conductive hearing loss
Do you get tinnitus in labyrinthitis?
No, just vertigo and hearing loss
What are some complications of an acoustic neuroma due to cranial nerves being affected?
Cranial nerve VIII – vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
Cranial nerve V – absent corneal reflex
Cranial nerve VII – facial palsy
What is your investigation of choice for a vestibula schwannoma?
MRI of cerebellopontine angle
