ENT Flashcards
What is conductive hearing loss?
Sensory system is working fine but the sound is not reaching it - problem with the sound travelling
What is sensorineural hearing loss?
Problem with the sensory system or vestibulocochlear nerve
What are the three bones in the middle ear?
Malleus
Incus
Stapes
What is Weber’s test?
Tuning fork in the centre of patient’s forehead
Which ear is loudest
In sensorineural: sound louder in normal ear
In conductive: sound louder in affected ear
What is Rinne’s test?
Tuning fork to mastoid process
Move to in front of ear
Normal is for air conduction to be better than bone conduction
Abnormal is bone conduction is better
Abnormal suggests conductive hearing loss
What are causes of sensorineural hearing loss?
Sudden sensorineural hearing loss (over less than 72 hrs)
Presbycusis (age-related)
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions
Infections
Medications (loop diuretics, amino glycoside antibiotics, chemo - furosemide, gentamicin, cisplatin)
Causes of conductive hearing loss
Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours
Causes of conductive hearing loss
Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours
What is plotted on the x axis in an audiogram?
Frequency
What is plotted on the y axis in an audiogram?
decibels (but with loud at the bottom and quiet at the top)
So better hearing is higher up on the y axis
What do X ] O and [ stand for in audiometry?
X - left sided air conduction
] left sided bones conduction
O right sided air conduction
[ right sided bone conduction
What is the normal hearing range for audiometry?
Between 0 and 20 dB
What is the difference on audiometry between sensorineural and conductive hearing loss?
Sensorineural: both bone and air conduction will be lower
Conductive: only air conduction is lower than normal
Mixed: Both are lower than normal but air conduction is more lower than bone
What is presbycusis?
Age-related hearing loss
Sensorineural, high pitched sounds first
What is the pathophysiology of presbycusis?
Several different mechanisms
Loss of hair cells in the cochlea
Loss of neurones in the cochlea
Atrophy of the stria vascular
Reduced end-lymphatic potential
What is one way of managing idiopathic sudden sensorineural hearing loss?
Oral or intra-tympanic steroids
What can happen when there is Eustachian tube dysfunction?
Unequal air pressure
Middle ear can fill with fluid
Reduced or altered hearing
Popping noises or sensations
A fullness sensation in the ear
Pain or discomfort
Tinnitus
What is tympanometry?
Creating different air pressures in the canal and measuring sound absorbed and reflected
Sounds is absorbed best when the air pressure matches the ambient air pressure
In Eustachian tube dysfunction, a tympanogram will show peak admittance (absorption) with negative ear canal pressures
What are the treatment options for Eustachian tube dysfunction?
Valsalva manoeuvre
Decongestant nasal sprays
Antihistamines and steroid nasal spray
Surgery (adenoidectomy, grommets, balloon dilatation eustachian tuboplasty)
What is otosclerosis?
Remodelling of the small bones in the middle ear leading to conductive hearing loss
Is otosclerosis more common in men or women?
Women
What is the normal presentation for otosclerosis?
Unilateral or bilateral hearing loss or tinnitus
Affecting lower-pitched sounds more than higher pitched sounds
Sensorineural is intact so patients can experience their voice as being loud even if they are talking quietly
What is a stapedectomy in otosclerosis management?
Surgical removement of the stapes bone and replaces it with a prosthesis
What is the presentation of vestibular neuritis?
Acute onset of vertigo
Recent history of viral URTI
Often associated with nausea and vomiting and balance problems
Essential to differentiate between peripheral and central causes - any neurological symptoms, consider a posterior circulation infarction
Don’t get tinnitus or hearing loss - if present consider labyrinthitis or menieres disease
What is the head impulse test in vestibular neuronitis?
Patient sat upright and fixing gaze on examiners nose
Examiner rapidly jerks it 10-20 degrees left or right while the patient continues looking at the examiner’s nose. Repeat opposite direction.
Abnormal result: eyes will saccade (rapidly move back and forth).
Normal: no current symptoms or central cause
What is the management for vestibular neuronitis?
Prochlorperazine
Antihistamines (e.g. cyclising, cinnarizine, promethazine)
What is the presentation of labyrinthitis?
Acute onset vertigo
Hearing loss
Tinnitus
Recent viral URTI or meningitis
What is the management for labyrinthitis?
Prochlorperazine
Antihistamines
What are the triad of symptoms in Menieres disease?
Hearing loss
Vertigo
Tinnitus
What is the pathophysiology of Ménière’s disease?
Excessive buildup of endolymph in the labyrinth of the inner ear (end-lymphatic hydrops)
What is the classic presentation of Menieres disease?
Middle aged person
Unilateral episodes of vertigo, hearing loss and tinnitus
Hearing loss is sensorineural and affects low frequencies first
Nystagmus can be seen
Can cause drop attacks without loss of consciousness
What is used in prophylaxis of menieres?
Betahistine
Where does bleeding usually originate in nosebleeds?
Kiesselbach’s plexus, located in Little’s area (remember the area most affected by little fingers picking noses)
What does bilateral nose bleeding indicate?
Bleeding posteriorly in the nose - higher risk of aspiration of blood
What is the management for nosebleeds?
Sit up and tilt head forwards
Squeeze the soft part of the nostrils together for 10-15 mins
Spit out any blood in mouth, rather than swallowing.
If it does not stop after 10-15 mins or is bilateral = hospital admission
What is the hospital treatment for nosebleeds?
Nasal packing with nasal tampons or inflatable packs
Nasal cautery using silver nitrate sticks
Naseptin after treatment to reduce inflammation (chlorhexidine and neomycin)
What is naseptin contraindicated in?
Peanut and soya allergy
Are nasal polyps usually bilateral or unilateral?
Bilateral
Unilateral is red flag for tumour
What are nasal polyps associated with?
Chronic rhinitis or sinusitis
Asthma
Samter’s triad (nasal polyps, asthma, aspirin intolerance/allergy)
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
How do people with nasal polyps present?
Chronic rhinosinusitis
Difficulty breathing through the nose
Snoring
Nasal discharge
Loss of sense of smell
What do nasal polyps look like?
Pale grey/yellow growth on the mucosal wall
What is the management for nasal polyps?
Intranasal topical steroid drops or spray
Intranasal polypectomy
Endoscopic nasal polypectomy
What is quinsy?
Peritonisllar abscess
Untreated or partially treated tonsillitis
Presents similarly to tonsillitis
What are the three additional symptoms that indicate peritonsillar abscess?
Trismus (unable to open mouth)
Change in voice (‘hot potato voice’)
Swelling and erythema
What are the three organisms that can cause a peritonsillar abscess?
Strep progenies (group A strep)
Staph aureus
H. influenzae
What type of cancer is most head and neck cancer?
Squamous cell carcinoma
How are head and neck cancer’s usually found?
Abnormal lymphadenopathy
What are risk factors for head and neck cancer?
Smoking
Chewing tobacco
Chewing betel quid (south-east Asia)
Alcohol
HPV
EBV
What are the red flags for head and neck cancer?
Lump in mouth or lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Erythroplakia or erythroleuoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump
What monoclonal antibody is used in treated squamous cell carcinomas of the head and neck?
Cetuximab - targets epidermal growth factor receptor
Also used in bowel cancer
What does glossitis look like?
Red, sore and swollen tongue with atrophy of the papillae making it look smooth
What are the causes of glossitis?
Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure
What are the top three causes of angioedema in the tongue?
Allergic reactions
ACEi
C1 esterase inhibitor deficiency (hereditary angioedema)
What is a geographic tongue?
Patches of the tongue lose the epithelium and papillae making it look like a map.
Relapsing and remitting
What can geographic tongue be associated with?
Stress and mental illness
Psoriasis
Atopy
Diabetes
What are the two key causes of strawberry tongue?
Scarlet fever
Kawasaki disease
What causes a black hairy tongue?
Decreased shedding of keratin from the tongue’s surface.
Papillae elongate and look like hairs, with bacteria and food causing the dark pigmentation
Sticky saliva and metallic taste
Causes: dehydration, dry mouth, poor oral hygiene, smoking
What is leukoplakia?
White patches in the mouth, often on the tongue or inside of cheeks
Precancerous condition
Asymptomatic, irregular and slightly raised
What is erythroplakia?
Red lesions in the mouth - associated with high risk of squamous cell carcinoma
What is lichen planus?
Autoimmune condition that causes chronic inflammation of the skin
Shiny purplish, flat topped raised areas with white lines across the surface (Wickham’s striae)
Usually in women over 45
What are the three patterns that lichen planus can take?
Reticular - web like
Erosive - bright red and sore
Plaques - larger continuous areas of white mucosa
What is acute necrotising ulcerative gingivitis?
Painful rapid onset of gingivitis usually caused by anaerobic bacteria
What are the risk factors for gingivitis?
Plaque build up
Smoing
Diabetes
Malnutrition
Stress
Which is gingival hyperplasia?
Abnormal growth of the gums
What can cause gingival hyperplasia?
Gingivitis
Pregnancy
Vit C def
AML
Medications, particularly calcium channel blockers, phenytoin and ciclosporin
What can apthous ulcers be an indication of?
IBD
Coeliac
Behçet’s disease
Vitamin deficiency
HIV
