ENT Flashcards
When to refer to ENT within 24h with hearing loss?
- Unexplainable sudden onset unilateral or bilateral (<3 days) hearing loss developed in last 30 days
- Unilateral hearing loss + focal neurology (facial droop, stroke?)
- Hearing loss associated with head or neck injury
- Hearing loss associated with severe infection (Necrotising otitis media or Ramsay hunt)
What is the management for cerumen impaction hearing loss?
- Removal by ear drops:
- Sodium bicarbonate 5%
- Olive oil
- Sodium chloride 0.9% - Ear irrigation or micro suction
- Refer
What is the diagnostic test for a suspected acoustic neuroma?
Dx - MRI
How does the tympanic membrane look in acute otitis media?
TM:
- Red, yellow or cloudy
- bulging + loss of landmarks
- Perforation +/- discharge
Mx of acute otitis media?
No perforation or discharge
-> topical analgesia (ear drops) + back-up antibiotic
Symptoms >3 days, discharge or <2y with bilateral ear infection -> antibiotic
When should you admit a baby <6months with acute otitis media to hospital?
Admit if <3mo or 3-6mo with >39°C
Px of otitis media with effusion (glue ear)?
Slow hearing loss + no otalgia
Poorly behaved child
Recurrent ear infections / URTI
Balance problems / clumsiness
- Tympanic membrane altered colour, visible fluid bulging
Mx for otitis media with effusion?
Grommets if >3 months
Hearing aids (first line for down’s syndrome)
What is the mx of otitis externa?
Acute:
- Keep ear dry
- Avoid swimming during mx
Mild – OTC 2% acetic acid ear drops
Moderate – Topic antibiotic +/- corticosteroid
Severe acute -> oral antibiotics
What antibiotic for acute otitis media if needed?
Antibiotics if age is less than 2, systemically unwell, bilateral or exudate
1. Amoxicillin (5-7 day course)
Pen Allergic -> clarithromycin or erythromycin
2. Co-amoxiclav
What is a cholesteatoma?
Repeat infection -> ear drum collapse (retraction) -> creates pocket where dead skin cells collect
Keratin in middle ear -> hearing loss
1. Enzymes erode surrounding bone
2. Bacteria grow on keratin -> discharge complications
What is otosclerosis?
New bony deposits occur on stapes footplate -> gradual onset hearing loss
Which patient group is more likely to suffer form otosclerosis?
More common in women (oestrogen related) [20-30s]
o Progresses more rapidly during pregnancy
o Hormone replacement therapy
Mx of otosclerosis?
Stapedectomy (stapes replaced with prosthesis)
What is presbycusis?
Degenerative hearing loss due to loss of outer hair cells, ganglion cells and strial atrophy
What is observed on an audiometry in a patient with presbycusis?
Characteristic dip at 4kHz
What is the px of acoustic neuroma?
Insidious unilateral hearing loss +/- tinnitus or vertigo
Sensation of fullness in ear
LMN facial nerve palsy
What condition makes bilateral acoustic neuroma more likely?
Neurofibromatosis type 2
What is battle’s sign?
Bruising behind the ear due to a fractured temporal bone
What are the causes of peripheral vertigo?
BPPV
Meniere’s
Vestibular neuronitis
Labrynthitis
What is the Ix and Mx for BPPV?
Ix – Dix Hallpike manoeuvre
Mx – Epley manoeuvre (re-positioning)
What is the mx of Meniere’s?
Mx – Refer
- ITS, ITG
N&V -> Prochlorperazine
Prophylaxis – Betahistine
What is the difference between vestibular neuronitis and labyrinthitis?
Labrynthitis px with hearing loss +/- tinnitus
What anti-emetic is given for peripheral vertigo?
Prohlorperazine
What are some causes of central vertigo?
Posterior circulation infarction
Vestibular migraine
Multiple sclerosis
Brain tumour
What is the Centor criteria for bacterial tonsillitis?
1 point for each:
- Fever (>38 degrees)
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymph nodes
How many points of Centor criteria to offer antibiotics?
> 3 points = 40-60% of bacterial tonsillitis -> offer antibiotics
What is the FeverPAIN criteria for tonsillitis?
1 point for each:
- Fever during last 24h
- Purulence (pus on tonsilis)
- Attended within 3 days of onset of symptoms
- Inflamed tonsils
- No cough or coryza
How many points on FeverPAIN to offer antibiotics?
Score of 4-5 = 62-65% chance of bacterial tonsillitis -> offer antibiotics
What antibiotic for bacterial tonsillitis?
Penicillin V (phenoxymethylpenicillin)
o Clarithromycin if allergic
When to admit with tonsillitis?
Admission if immunocompromised, systemically unwell, dehydrated, stridor, resp distress, peritonsillar abscess or cellulitis
What is the Px of Quinsy’s?
Fever, throat pain, painful swallow, trouble opening mouth (trismus)
o Displaces tonsil and uvula
Mx of quinsy?
Refer to ENT for aspiration + antibiotics
o Dexamethasone to settle inflammation
What not to give if a patient has suspected glandular fever?
NO AMOXICILLIN – will cause an itchy maculopapular rash
Mx of nose bleeds
- ABCDE
- Sit up and tilt head forwards squeezing soft part of the nostrils for 10-15 mins
o Spit out any blood in mouth instead of swallowing - If bleeding >10-15 minutes or from both nostrils
o Nasal packing – nasal tampons or inflatable packs
o Nasal cautery – using silver nitrate sticks
What can be given after a patient has a nosebleed?
Naseptin (chlorhexidine and neomycin) to reduce crusting, inflammation and infection
What are some midline neck lumps?
Thyroid swelling
Thyroglossal cyst
Laryngeal swelling
Submental lymph node
Dermoid cyst
What are some anterior triangle neck lumps?
Thyroid swelling
Pharyngeal pouch
Submandibular swelling
Branchial cyst
Lymph nodes
Parotid swelling
What are some posterior triangle neck lumps?
Lymph nodes
Carotid artery aneurysm or tumour
Cervical rib
Lipoma
When would a patient be given a 2-week wait referral for a neck lump?
- Unexplained neck lump in someone aged >45
- Persistent unexplained neck lump at any age
How long to wait for an ultrasound for a neck lump growing in size?
- <25 years – less than 48h
- > 25 years – less than 2 weeks
What are the Mx options for mild-moderate rhinitis?
o PRN intranasal antihistamine - azelastine
o Oral antihistamine – loratadine, cetirizine
o PRN intranasal chromone – sodium cromoglicate
What is the Mx for moderate to severe rhinitis?
o Intranasal corticosteroid (mometasone, fluticasone)
When to refer to ENT with rhinitis?
o Red flag features – unilateral px, bloody discharge, recurrent epistaxis, pain
o Structural abnormality making mx difficult, uncertain dx
o For skin prick testing, persistent symptoms despite optimum mx in primary care
