ENT Flashcards
what is presbycusis?
it is age related hearing loss - SNHL with high pitched tones first - loss of hair cells, neurons, atrophy and reduced endolymphatic potential
what are the risk factors for presbycusis?
age, male, FHx, noise, DM, HTN, smoking, ototoxic medications
how does presbycusis present?
gradual, insidious, high pitched hearing loss, dementia concerns, tinnitus
how is presbycusis investigated and managed?
audiometry
optimise environment, hearing aids, cochlear implants
what is SSNHL?
it is hearing loss over less than 72 hours that is unexplained
from infection, menieres, ototoxic changes, MS, stroke, AN, migraines
how is SSNHL investigated and managed?
audiometry, MRI, CT
immediate ent referral, treat cause, idiopathic: oral or intratympanic steroids
how does inhaled FB present and what are red flags?
cough, stridor, dyspnoea
airway compromise, oesophageal perforation, button battery ingestion, mediastinal widening on CXR
how is inhaled FB investigated and managed?
tongue depressor, nasoendoscopy, radiograph, CT neck, CXR
forceps, endoscopy, follow up, carbonated drinks, glucagon, hyoscine, prokinetics
what are predisposing factors and presentation of OSA?
marfans, large tonsils, obesity, macroglossia
partner complaints, daytime sleepiness, compensated respiratory acidosis, HTN
how is OSA investigated and managed?
Epworth sleepiness scale, multiple sleep latency test, polysomnography
lose weight, CPAP, intraoral devices, inform DVLA, pharmacological?
what are the two types of vertigo?
peripheral e.g. menieres - vestibular system
central e.g. tumour - cerebellum or brainstem
how does vertigo present?
central - gradual onset, persistent, no HL or tinnitus, impaired coordination, mild nausea and vice versa for peripheral
how is vertigo investigated and managed?
ear, neuro and CV tests
CT MRI
short term - prochlorperazine, antihistamines, betahistine, epley, triptans, propanolol, topiratmate, amitriptyline, DVLA
what is BPPV and how does it present?
it is vertigo triggered by head movement - calcium carbonate crystals displaced in semicircular canal and disrupt flow of endolymph
older, movement triggers vertigo, 20-60seconds, can recur, over few weeks and resolves, no HL or tinnitus
how is BPPV investigated and managed?
Dix Hallpike
Epley manoeuvre, Brandt Daroff exercises
how does ET dysfunction present and what causes it?
reduced or altered hearing, popping, fullness, pain, discomfort, tinnitus, worse when external air pressure changes
infection e.g. URTI, allergies, smoking
how is ET dysfunction investigated and managed?
otoscopy, audiometry, tympanometry, nasopharyngoscopy, CT
conservative, valsalva, decongestant spray, antihistamines, steroid nasal spray, surgery e.g. adenoidectomy, balloon dilatation
what is otosclerosis and how does it present?
it is the remodelling of the small bones in the middle ear - conductive hearing loss and hardening (mostly stapes)
HL, tinnitus, lower pitch first
how is otosclerosis investigated and managed?
otoscopy, webers and rinnes, audiometry, tympanometry, HRCT
conservative with hearing aids, surgical - stapedectomy/otomy, and prosthetic
what is vestibular neuronitis?
it is inflammation of the vestibular nerve from recent URTI, and presents with vertigo, N&V, balance issues, no neuro sx or loss of hearing
how is vestibular neuronitis investigated and managed?
head impulse test
prochlorperazine, antihistamines up to 3d, vestibular rehabilitation therapy
what is acoustic neuroma and how does it present?
it is benign tumour of the schwann cells around auditory nerve - usually in cerebellopontine angle of PNS and unilateral unless NF2
40-60y, gradual onset unilateral SNHL, tinnitus, dizziness, imbalance, fullness sensation, facial nerve palsy
how is AN investigated and managed?
audiometry, MRI, CT
conservative, surgery, radiotherapy
what is menieres disease?
it is recurrent vertigo, HL, tinnitus and aural fullness due to excess endolymph
how is menieres investigated and managed?
ENT and audiology
prochlorperazine, antihistamine, betahistine
what is labrynthitis?
it is usually due to URTI, OM or meningitis - acute onset vertigo with HL, tinnitus and viral sx
how is labyrinthitis investigated and managed?
clinical, head impulse to rule out central cause
supportive, prochlorperazine, antihistamines, ABx
what is the difference between UMN and LMN facial nerve palsy?
forehead is spared in UMN
causes of UMN v LMN facial nerve palsies?
UMN - stroke, CVA, tumour, MND
LMN - tumours, systemic, infection, trauma
what is bells palsy?
it is unilateral LMN - can take up to 12 month to recover
give prednisolone to treat, and lubricating eye drops
what is ramsay hunt syndrome?
it is from VZV and LMN lesions
painful and tender vesicular rash
give prednisolone, aciclovir and lubricating eye drops
what is glossitis?
it is an inflamed tongue - red, sore, atrophy, swelling
causes: B12, iron, folate deficiency
mx - underlying cause
what is angioedema?
it is fluid in tissues - allergies, ACEi etc
what is strawberry tongue?
it is swollen, red, enlarged white prominent rash on tongue from Kawasaki or Scarlet fever
what is black hairy tongue?
it is exfoliation of keratin - elongated papillae, bacteria and food accumulate
causes - dehydration, dry mouth, poor hygiene
mx - hydration, brushing, stop smoking
what is geographic tongue?
inflammatory - loses epithelium and papillae, relapsing remitting and can be due to stress, psoriasis etc
give topical steroids, antihistamines for discomfort
what is oral candidiasis?
it is oral thrush - white patches - from INH corticosteroids, ABx, DM etc
give miconazole, nystatin or fluconazole
what is leukoplakia?
white patches on buccal mucosa, pre cancerous to SCC - raised, irregular and fixed
so biopsy and stop smoking and alcohol, monitor and remove
erythroplakia the same but red - also precancerous
what is gingival hyperplasia?
it is enlarged gums from gingivitis, vit C deficiency, AML etc
what is lichen planus?
autoimmune condition with chronic inflammation resulting in shiny, purplish flat lesions with wickhams striae across - reticular, erosive or plaque
mx - hygiene, stop smoking, steroids
what is gingivitis?
it is inflammation of the gums - swollen, bleeding, halitosis, pain
acute necrotising - severe, rapid onset
rfs - plaque, smoking, DM, malnutrition, stress
mx - hygiene, stop smoking, hygienist, chlorhexidine mouth wash, ABx, surgery
what are aphthous ulcers?
they are small, painful, well circumcised punched out white lesions from stress trauma, IBD, coeliac etc
head in 2w or lidocaine, benzydamine, choline salicylate
if severe give hydrocortisone, beta or beclomethasone and refer if >3w and unexplained
what is a quinsy?
it is a peritonsillar abscess with trapped pus, usually from tonsillitis - sore throat, dysphagia, fever, neck pain, swollen tender LNs, trismus, change in voice, swelling, erythema
how is quinsy managed?
ABx, I&D, aspiration, dexamethasone
what is the most common head and neck cancer?
SCC of mucosa - oral or nasal cavity, sinuses, glands, larynx, pharynx
how does H&N cancer spread?
usually to LNs first - enlarged
what are RFs for H&N cancer?
tobacco - chewing and smoking, betel quid, alcohol, HPV 16, EBV
what are red flags of H&N cancer?
lump, unexplained ulceration >3w, erythroplakia or leukoplakia, neck lump, hoarseness
how is head and neck cancer managed?
radio, surgery, targeted monoclonal AB eg. cetuximab - epidermal growth factor receptor, palliation
