ENT Flashcards
Old age hearing loss name
Presbycusis
Hearing loss history questions
- Onset & progression
- Symptoms: otorrhoea, otalgia
- Vertigo, tinnitus or disequilibrium
- Headaches (acoustic neuroma)
- Exposure to loud noise
- Head trauma, ear trauma, barotrauma
- Ear surgery
- Recurrent ear infections, major infections
- Family history
- Ototoxic medications: frusemide, gentamicin
- Systemic symptoms; eg thyrotoxicosis (late stage)
Examination for hearing loss
- Otoscopy
- Pneumatic otoscopy
- Weber & Rinne test
- Cranial nerve exam
Conductive hearing loss causes
OUTER EAR
- Otitis externa
- trauma
- Wax
- Exostotsis
- Osteoma
- Congenital atresia
MIDDLE EAR
- Otitis media
- Cholesteatoma
- Otosclerosis
- TM perforation
- Temporal bone trauma
- Congenital atresia
Sensorineural hearing loss causes
- Presbycusis (age related sensorineural HL)
- Hereditary hearing loss
- Accoustic neuroma
- Menier’s
- Ototoxic drugs
- Noise exposure
- CVA
- Barotrauma
- Meningitis
- Thyrotoxicosis
History questions for Ear ache
- Fever
- Otorrhoea
- Hearing loss
- URTI /coryzal symptoms (most AOM, OME follow on from nasal congestion/infection)
- Swimming (OE) (barotrauma)
- ATSI
- Trauma
- Speech issues
- Attention /behaviour /school issues
- Balance issues
- Second hand smoke exposure
- Air travel (barotrauma)
Indications for antibiotics in acute otitis media
- <6m
- Bilateral <2
- Systemically unwell
- ATSI
- Otorrhoea (perforation)
- Immunocompromised
- Cochlear implant
Analgesia in AOM
Paracetemol 15mg/kg
Lignociane 2% 1-2 drops to INTACT TM
Ibuprofen 10mg/kg
Acute otitis media NON Aboriginal no red flags
- Analgesia
- Review 48 hours –> can give abx then
- Review 3 months to ensure effusion resolved
Persistent otitis media with effusion AKA
Glue ear
Features of chronic suppurative OM
Infection of middle ear
Perforated TM
Discharge
TIME COURSE: > 6 weeks
Treatment for Chronic suppurative OM
- Dry Aural Toilet 6hourly
- Ciprofloxacin 0.3% 5 drops BD until no d/c for 3days
OME (otitis media with effusion) Definition
Middle ear effusion without:
- Bulging membrane,
- fever
Looks like
- Loss of lucency
- Grey/white fluid
- Immobile TM with dilated vessels
OME referral for grommets (tympanostomy)
<3 months of OME
BUT with hearing loss and or learning/speech problems
> 3 months
Bilateral hearing loss
ATSI persistent otitis media with effusion (glue ear) for >3 months
- Refer for hearing assessment
- Consider 2-4 weeks of abx (amox 50mg/kg/day)
- Referral to ENT if OME> 3 months OR DB>20 loss in better ear
ATSI Acute Otitis Media with poor compliance antibiotics
Azithromycin 30mg/kg stat day 1 and 7
ATSI AOMwiP (with perforation) management
= Small hole (difficult to see) but with discharge
Amox 50-90mg/kg/day for 14 days
OR
Single dose azithromycin 30mg/kg
Review at day 7
If no better then 90mg/kg amox or second dose azithro
ATSI Recurrent AOM (rAOM)
Prophylactic not routine
but consider
Amox 50/mg on time per day for 3-6 months
??seems like a massive dose. (if child is <2)
ATSI chronic suppurative OM (CSOM)
= visible perf and discharge
- Clean pus
- Cipro 0.3% ear drops 5 drops BD
- Add amox 50-90mg/kg/day if perf not readily visible
- Continue for at least 3 days after ear becomes dry3
Tinnitis - causes
External ear:
- wax
- OE
Middle ear:
- OM
- Otosclerosis
- Cholesteatoma
Inner ear
- Schwannoma
- Menniers
- Ototoxicity
- nueritis
Non Auditory cuases
- Vascular anomalies
- Nasopharyngeal carcinoma
Imaging for tinnitis - when is it reasonable?
Pulsatile
- Vascular cause- get CT angio
Unilateral
- Focal lesion
Asymmetrical hearing loss
- MRI
Risk factors for head and neck cancers
- Smoking
- etOH
- > 40
- Previous neck malignancy
RED flags for head and neck masses
- Mass <2 weeks
- Voice change
- Dysphagia, odynophagia
- Otaliga, epistaxis, nasal obstruction (ipsilateral)
- Weight loss, loss of apetite