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Med Finals - Surgery > ENT > Flashcards

ENT Flashcards

1
Q

What are the two types of hearing loss

A

Conductive
Sensorineural hearing loss

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2
Q

Define conductive hearing loss

A

Porblems with sound travelling from the environment to the inner ear. The sensory system works correctly but the sound is not conducted to it. Putting in ear plugs causes conductive hearing loss.

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3
Q

Define sensorineural hearing loss

A

Caused by problems with in the sensory system or vestibulochoclear nerve.

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4
Q

What is Weber’s Test

A

Placing a tuning fork in the middle of the head and asking which ear it is loudest in

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5
Q

What is a normal Weber’s test result

A

Heard equally in both ears

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6
Q

What is the Weber’s test result in sensorineural hearing loss

A

Sound is louder in the normal ear / quiter in the affected ear.

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7
Q

What is the Weber’s test result in conductive hear loss

A

Sound will be louder in the affected ear.

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8
Q

What is Rinne’s test

A

Placing a tuning for on the mastoid process and removing when can no longer hear it, then testing air conduction

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9
Q

What is a Rinne’s positive test result

A

Air conduction is better than bone conduction - this is the normal result

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10
Q

What is Rinne’s negative test result

A

Bone conduction is worse than air - this suggest a conductive hearing loss as sound is not conducted through the air

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11
Q

Common causes of sensorineural hearing loss

A

Sudden sensorineural hearing loss (<72 hrs)
Presbycusis (age related)
Noise exposure
Meniere’s disease
Labarynthitis
Acoustic neuroma
Nueological conditions - stroke, MS,
Infection
Medication - loop diuretics, gentamicin, cisplatin.

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12
Q

Common causes of conductive hearing loss

A

Ear wax
Infection
Fluid in middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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13
Q

Define Presbycusis

A

Age related hearing loss - sensorineural. Affects high-pitched sounds

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14
Q

Risk factors for presbycusis

A

Age
MAle
FH
Loud noise exposure
Diabetes
Hypertension
Ototoxic medications
Smoking

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15
Q

History of presbycusis

A

Gradual insidious onset hearing loss
Loss of high pitch - speech difficult to hear
Associated tinnitus

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16
Q

Management of presbycusis

A

Optimise environment - reduce ambient noise
Hearing aids
Chochlear implants

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17
Q

Define eustachian tube dysfunction

A

When the tube between the middle ear and throat are not functioning properly.
Often related to URTI.

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18
Q

History of eustachian tube dysfunction

A

Reduced hearing
Popping noises or sensations in ear
Sensation of fullness in ear
Pain or discomfort
Tinnitus
Symptoms worse when external air pressure changes - flying, climbing.

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19
Q

Management of eustachian tube dysfunction

A

Watchful waiting
Valsalva manoeuvre
Decongestants - nasal sprays
Antihistmines
Surgery - if persistent, grommets

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20
Q

Define otosclerosis

A

A condition where there is remodelling of the small bones in the middle ear leading to conductive hearing loss.

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21
Q

History of otosclerosis

A

<40 y/o
Unilateral/bilateral
Hearing loss - affecting lower pitched sounds
Tinnitus

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22
Q

History of otosclerosis

A

<40 y/o
Unilateral/bilateral
Hearing loss - affecting lower pitched sounds
TinnitusM

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23
Q

Management of otosclerosis

A

Conservative - hearing aids
Surgical - stapedectomy/otomy

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24
Q

Define otitis media

A

An infection in the middle ear - ie behind the tympanic membrane

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25
Q

History of otitis media

A

Ear pain
Reduced hearing
Generally unwell
Fever
Cough
Coryzal symptoms
Sore throat
URTI
Balance/vertigo issues

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26
Q

Clinical signs of otitis media

A

Bulging inflamed red tympanic membrane
Sometimes perforated

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27
Q

Management of otitis media

A

Will resolve within 3 days
Abx make little difference to symptoms.

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28
Q

Common complications of otitis media

A

Effusion
Hearing loss
Perforation
Labyrinthitis
Mastoiditis
Abscess
Facial nerve palsy
Meningitis

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29
Q

Define otitis externa

A

Infection of the outer ear - ie outside the tympanic membrane, swimmers ear

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30
Q

History of otitis externa

A

Ear pain
Discharge
Itchiness
Conductive hearing loss

31
Q

Clinical signs of otitis extrena

A

Erythema and swelling of cancal
Tnederness
Pus or discharge
Lymphadenopathy

32
Q

Management of otitis externa

A

Acetic acid - OTC
Topical abx - oral if severe

33
Q

Define tinitus

A

Refers to the persistent addition of sound that is heard but not present in the environment
Ringing in ears - buzzing, hissing, humming.

34
Q

Common causes of tinnitus

A

Primary - occurs in sensorineural hearing loss
Secondary - Impacted wax, infection, Meniere’s disease, noise exposure, medications, acoustic neuroma, MS, trauma, depression,
Systemic - anaemia, diabetes, hypothyroidism, hyperlipidaemia

35
Q

Red flags of tinnitus

A

Unilateral
Pulsatile
Hyperacusis - hypersensitivity, pain or distress with environmental sounds.
Associated unilateral hearing loss
Sudden onset
Dizziness or vertigo
Headaches or visual disturbance
Actue focal neurology
Suicidal ideation

36
Q

Management of tinnitus

A

Treat cause
Hearing aids
Sound therapy
CBT

37
Q

Define Benign Paroxysmal Positional Vertigo

A

BPPV is a common cause of recurrent episodes of vertigo triggered by head movement.

38
Q

History of BPPV

A

Sudden attacks of vertigo lasting a short period of time, triggered by specific head movements - commonly rolling in bed.

39
Q

How is BPPV diagnosed

A

Dix-Hallpike manoeuvre - sat upright, head at 45 degrees and rapidly lowered backwards look for nystagmus

40
Q

Management of BPPV

A

Epley manoeuvre - dix hall pike then rotate head and body and sit up sideways.
Brandt-Daroff exercises - similar but to be performed at home.

41
Q

Define vestibular neuronitits

A

Describes inflammation of the vestibular nerve - often caused by viral infections

42
Q

History of vestibular neuronitits

A

Acute onset vertigo
Recent URTI
Associated nausea and balance issues
No loss of hearing

43
Q

History of vestibular neuronitits

A

Acute onset vertigo
Recent URTI
Associated nausea and balance issues
No loss of hearing

44
Q

Investigations in vestibular neuronitis

A

Head impulse test - rapid jerks and nystagmus

45
Q

Management of vestibular neuronitits

A

Management of vertigo - Prochlorperazine, antihistamine
Vestibular rehabilitation therapy

46
Q

Define labyrinthitis

A

Inflammation of the bony labyrinth of the inner ear - semicircular canals, vestibule and cochlea. Usually caused by URTI

47
Q

History of labyrinthitis

A

Acute onset vertigo
Hearing loss
Tinnitus
Following URTI

48
Q

Management of labyrithitis

A

Supportive
Vertigo - prochlorperazine, antihistamines,
Abx if bacterial

49
Q

Define Meniere’s Disease

A

Long term inner ear disorder that causes recurrent attacks of vertigo, symptoms of hearing loss, tinnitus and feeling of fullness within the ear.
Hearing loss
Vertigo
Tinnitus

50
Q

History of Meniere’s disease

A

40-50
Unilateral hearing loss, tinnitus and vertigo.
Attacks lasting minutes to hours, in clusters over weeks. Not triggered by movement
Sensorineural hearing loss
Fullness in ear
Enexplained falls
Imbalance
Spontaneous nystagmus

51
Q

Management of Meniere’s disease

A

Manage symptoms in acute attack - prochlorperazine, antihistamines.
Prophylaxis - betahistine

52
Q

Define acoustic neuroma

A

Benign tumours of Schwann cells surrounding the vestibulocochlear nerve.

53
Q

What is associated with bilateral acoustic neuromas

A

Neurofibromatosis type II

54
Q

What is associated with bilateral acoustic neuromas

A

Neurofibromatosis type II

55
Q

History of acoustic neuromas

A

50-60
Gradual onset of unilateral sensorineural hearing loss
Unilateral tinitus
Dizziness
Fullness in ear
Facial nerve palsy

56
Q

Management of Acoustic neuromas

A

Conservative
Surgery
Radiotherapy

57
Q

Define cholesteatoma

A

Abnormal collection of squamous epithelial cells in the middle ear. Non-cancerous but can invade local tissues and nerves and erode bones of the middle ear.

58
Q

History of cholesteatoma

A

Foul discharge from ear
Unilateral conductive hearing loss
Infection
Pain
Vertigo
Facial nervy palsy

59
Q

Management of cholesteatoma

A

Surgical removal - Confirmed on ct head

60
Q

Define facial nerve palsy

A

Isolated dysfunction of the facial nerve.
Typically presents with unilateral facial weakness.

61
Q

What is the presentation of an upper motor neurone of a facial nerve palsy.

A

Forehead sparing unilateral weakness

62
Q

Define bell’s palsy

A

Idiopathic unilateral lower motor neurone facial nerve palsy. Majority fully recover in one week.

63
Q

Management of Bell’s Palsy

A

If present within 72 hours. Prednisolone - 50 for 10 then 60 for 5 and reducing regieme.
Lubricating eye drops.

64
Q

Define Ramsy-Hunt syndrome

A

Unilateral lower motor neurone facial nerve palsy. Typically caused by viral infection

65
Q

History of Ramsy-Hunt syndrome

A

Painful vesicular rash in ear canal, pinna
Facial weakness

66
Q

Management of Ramsy-Hunt sundrome

A

Prednisolone and aciclovir.

67
Q

Define tonsilitis

A

Inflammation of the tonsils
Usually viral infection

68
Q

History of tonsilitis

A

Sore throat
Fever
Pain on swallowing

69
Q

What is FeverPAIN score

A

Probability of bacterial tonsilitis
Fever
Purulence
Attends within 3 days
Inflamed tonsils
No cough/coryza

70
Q

Define quinsy

A

Common name for a peitonsillar abscess, Arises from puss being trapped in the region of the tonsils. Normally follows tonsilitis.

71
Q

History of quinsy

A

Sore throat
Painful swallow
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes
Trismus - unable to open mouth
Change in voice
Swelling and erythema

72
Q

Management of quinsy

A

ENT for surgical incision and drainage
Steroids and abx

73
Q

Red flags of neck lumps

A

Unexplained lump in >45
Persistent unexplained lump
Growing in size

Med Finals - Surgery (7 decks)

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