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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
History of otitis media
Ear pain Reduced hearing Generally unwell Fever Cough Coryzal symptoms Sore throat URTI Balance/vertigo issues
26
Clinical signs of otitis media
Bulging inflamed red tympanic membrane Sometimes perforated
27
Management of otitis media
Will resolve within 3 days Abx make little difference to symptoms.
28
Common complications of otitis media
Effusion Hearing loss Perforation Labyrinthitis Mastoiditis Abscess Facial nerve palsy Meningitis
29
Define otitis externa
Infection of the outer ear - ie outside the tympanic membrane, swimmers ear
30
History of otitis externa
Ear pain Discharge Itchiness Conductive hearing loss
31
Clinical signs of otitis extrena
Erythema and swelling of cancal Tnederness Pus or discharge Lymphadenopathy
32
Management of otitis externa
Acetic acid - OTC Topical abx - oral if severe
33
Define tinitus
Refers to the persistent addition of sound that is heard but not present in the environment Ringing in ears - buzzing, hissing, humming.
34
Common causes of tinnitus
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
Red flags of tinnitus
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
Management of tinnitus
Treat cause Hearing aids Sound therapy CBT
37
Define Benign Paroxysmal Positional Vertigo
BPPV is a common cause of recurrent episodes of vertigo triggered by head movement.
38
History of BPPV
Sudden attacks of vertigo lasting a short period of time, triggered by specific head movements - commonly rolling in bed.
39
How is BPPV diagnosed
Dix-Hallpike manoeuvre - sat upright, head at 45 degrees and rapidly lowered backwards look for nystagmus
40
Management of BPPV
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
Define vestibular neuronitits
Describes inflammation of the vestibular nerve - often caused by viral infections
42
History of vestibular neuronitits
Acute onset vertigo Recent URTI Associated nausea and balance issues No loss of hearing
43
History of vestibular neuronitits
Acute onset vertigo Recent URTI Associated nausea and balance issues No loss of hearing
44
Investigations in vestibular neuronitis
Head impulse test - rapid jerks and nystagmus
45
Management of vestibular neuronitits
Management of vertigo - Prochlorperazine, antihistamine Vestibular rehabilitation therapy
46
Define labyrinthitis
Inflammation of the bony labyrinth of the inner ear - semicircular canals, vestibule and cochlea. Usually caused by URTI
47
History of labyrinthitis
Acute onset vertigo Hearing loss Tinnitus Following URTI
48
Management of labyrithitis
Supportive Vertigo - prochlorperazine, antihistamines, Abx if bacterial
49
Define Meniere's Disease
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
History of Meniere's disease
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
Management of Meniere's disease
Manage symptoms in acute attack - prochlorperazine, antihistamines. Prophylaxis - betahistine
52
Define acoustic neuroma
Benign tumours of Schwann cells surrounding the vestibulocochlear nerve.
53
What is associated with bilateral acoustic neuromas
Neurofibromatosis type II
54
What is associated with bilateral acoustic neuromas
Neurofibromatosis type II
55
History of acoustic neuromas
50-60 Gradual onset of unilateral sensorineural hearing loss Unilateral tinitus Dizziness Fullness in ear Facial nerve palsy
56
Management of Acoustic neuromas
Conservative Surgery Radiotherapy
57
Define cholesteatoma
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
History of cholesteatoma
Foul discharge from ear Unilateral conductive hearing loss Infection Pain Vertigo Facial nervy palsy
59
Management of cholesteatoma
Surgical removal - Confirmed on ct head
60
Define facial nerve palsy
Isolated dysfunction of the facial nerve. Typically presents with unilateral facial weakness.
61
What is the presentation of an upper motor neurone of a facial nerve palsy.
Forehead sparing unilateral weakness
62
Define bell's palsy
Idiopathic unilateral lower motor neurone facial nerve palsy. Majority fully recover in one week.
63
Management of Bell's Palsy
If present within 72 hours. Prednisolone - 50 for 10 then 60 for 5 and reducing regieme. Lubricating eye drops.
64
Define Ramsy-Hunt syndrome
Unilateral lower motor neurone facial nerve palsy. Typically caused by viral infection
65
History of Ramsy-Hunt syndrome
Painful vesicular rash in ear canal, pinna Facial weakness
66
Management of Ramsy-Hunt sundrome
Prednisolone and aciclovir.
67
Define tonsilitis
Inflammation of the tonsils Usually viral infection
68
History of tonsilitis
Sore throat Fever Pain on swallowing
69
What is FeverPAIN score
Probability of bacterial tonsilitis Fever Purulence Attends within 3 days Inflamed tonsils No cough/coryza
70
Define quinsy
Common name for a peitonsillar abscess, Arises from puss being trapped in the region of the tonsils. Normally follows tonsilitis.
71
History of quinsy
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
Management of quinsy
ENT for surgical incision and drainage Steroids and abx
73
Red flags of neck lumps
Unexplained lump in >45 Persistent unexplained lump Growing in size

Med Finals - Surgery (7 decks)

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