ENT Flashcards
Bilateral age related sensorineural hearing loss
Presbycusis
presenting complaint of presbycusis
cannot follow conversations
bilateral conductive hearing loss at 20-30 years with associated tinnitus and vertigo
otosclerosis
inheritance of otosclerosis
autosomal dominant
otoscopy finding in otosclerosis
flamingo tinge
pathophysiology of otosclerosis
normal bone is replaced by vascular spongey bone
conductive hearing loss at 2 years
otitis media with effusion (glue ear)
3 complications of glue ear
speech and language delay
behavioural problems
balance issues
2 conditions requiring immediate ENT referral for glue ear
downs or cleft palate
name 4 ototoxic drugs
aminoglycosides (gentamicin)
furosemide
aspirin
cytotoxic drugs
bilateral high frequency hearing loss in a factory worker
noise damage
explain the meaning of rinne negative and positive
negative is abnormal (bone > air)
positive is normal (air > bone)
explain webers results in unilateral sensorineural and conductive hearing loss
conductive: weber localises to the affected side
sensorineural: weber localises to the unaffected side
most common organism in otitis media
h. influenzae
when do you give abx in otitis media
if perforation, systemically unwell or under 2 years
what abx are given in otitis media
5 day amoxicillin
management of otitis externa
topical steroid and abx drops
difference in management of otitis externa in diabetes
ciprofloxacin to cover pseudomonas
perforated tympanic membrane for 6w
refer to ENT for myringoplasty
management of acute sensorineural hearing loss
immediate ENT referral
high dose oral prednisolone
MRI, audiology
most common cause of sensorineural hearing loss
idiopathic
criteria for cochlear implant in adults
failed trial of hearing aid
sudden onset vertigo post viral infection with loss of hearing
viral labyrinthitis
recurrent vertigo attacks post viral infection with no hearing loss
vestibular neuronitis
examination findings for vestibular neuronitis
horizontal nystagmus
treatment of vestibular neuronitis
prochlorperazine in acute phase
then vestibular rehabilitation exercises
gradual onset of vertigo triggered by changes in head position which last 1-20 seconds
BPPV
diagnosis and treatment of BPPV
Diagnosis: Dix Hallpike
Treatment: Epley
what would the dix hallpike test show in BPPV
rotatory nystagmus
elderly patient with dizziness on neck extension
vertebrobasilar ischaemia
recurrent episodes of vertigo, tinnitus and sensioneural hearing loss lasting 30-60 mins with a sensation of fullness/roaring in the ear
Meniere’s disease
examination findings in meniere’s disease
Romberg positive
Nystagmus
medication to prevent meniere’s
Betahistine
unilateral vertigo, tinnitus and sensorineural hearing loss with an absent corneal reflex and possible facial palsy
Acoustic neuroma
(vestibular schwannoma)
association with acoustic neuromas
Neurofibromatosis type 2
cranial nerves involved in acoustic neuroma
V: absent corneal reflex
VII: facial nerve palsy
VIII: hearing loss, vertigo and tinnitus
what does the HINTS exam distinguish between
vestibular neuronitis and posterior circulation stroke
age of onset for cholesteatoma
10-20 years
medication which can cause tinnitus
Aspirin/NSAIDS
unilateral middle ear effusion in an adult
can indicate nasopharyngeal cancer
what is samters triad
- asthma
- aspirin sensitivity
- nasal polyps
treatment for nasal polyps
topical steroid
unilateral polyps
red flag
most common site of bleeding in epistaxis
little’s area
anterior nasal septum
management of epistaxis for a non visible bleeding site
anterior packing
management of epistaxis for a visible bleeding site
silver nitrate cautery
medication to avoid in peanut allergy
Naseptin
management of epistaxis when the nose will not stop bleeding
sphenopalatine ligation in theatre
management of ramsay hunt syndrome
7 day oral aciclovir
5 day steroids
when would you consider abx and intranasal decongestants in sinusitis
no recovery in 10 days
or double sickening
management of chronic rhinosinusitis
nasal irrigation with saline
what is rhinitis medicamentosa
rebound nasal congestion due to extended decongestant use
neck lump after viral infection
reactive lymph nodes
rubbery and painless neck lump which worsens with alcohol and is associated with night sweats and splenomegaly
lymphoma
neck lump which moves up on swallowing and is associated with thyroid symptoms
thyroid swelling
midline neck lump in a 20 year old patient between the thyroid isthmus and hyoid bone which moves up with protrusion of the tongue and can present as painful if infected
Thyroglossal cyst
older man presenting with dysphagia, regurgitation, aspiration and chronic cough with a midline lump that gurgles
pharyngeal pouch
congenital lymphatic lesion in the neck at birth (commonly the left) which transilluminates
cystic hygroma
mobile cyst between the sternocleidomastoid muscle and pharynx presenting in early adulthood with cholesterol crystals and fluid
branchial cyst
pathophysiology of branchial cyst
failure of closure of the second branchial cyst
multiloculated and heterogeneous lump above hyoid
dermoid cyst
what is a cervical rib associated with
thoracic outlet syndrome
epidemiology of cervical rib
adult female
pulsatile neck mass which does not move on swallow
carotid aneurysm
young adult presenting with pancreatitis, orchitis, hearing loss and encephalopathy with a neck lump
mumps
viral parotitis
facial nerve palsy and parotid swelling
sarcoidosis
slow growing painless mobile lump in parotid gland of older female
pleomorphic adenoma
management of simple bacterial tonsillitis
10 days of oral pen v
tonsillitis with ulnar deviation
quinsy (peritonsillar abscess)
management of quinsy
IV Abx and surgical drainage
consider tonsillectomy in 6w
management of a primary and secondary post-tonsillectomy haemorrhage
for both CALL ENT
primary (in hrs): return to theatre
secondary (5-10 days): abx (commonly infection)
what infection is tonsillar SCC associated with
HPV
globus, hoarseness, no red flags
laryngopharyngeal reflux
management of laryngopharyngeal reflux
trial of PPI
management of 3w hx of mouth ulcer
2ww to oral surgery
name 4 causes of gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers and AML
what is ludwigs angina
rare infection of mouth floor and neck and soft tissues
treatment of acute necrotising ulcerative gingivitis
paracetamol
metronidazole
chlorhexidine mouthwash
what is mastoiditis
post auricular inflammation
management of mastoiditis
IV Abx immediately (can cause meningitis)
what is siaidentitis
inflammation of the salivary glands secondary to obstruction (stones in submandibular gland occlude wharton’s duct)
episodic facial pain, dry mouth and halitosis
siaidenitis
which duct drains the parotid gland
stenses duct
