ENT Flashcards
- failure of sounds to progress to the cochlea
- MC cause is effusion
- ignoring commands, increased TV volume
- often correctable with surgery and hearing devices
- causes: small malformed ears, perforated TM, tympanosclerosis, cholesteatoma
Conductive hearing loss
- purulent ear DC despite Abx, foul smelling
- retraction of the TM with squamous debris
- keratinization of the epithelial cells in the middle ear
- refer to specialist
Cholesteatoma
- -malfunction of the cochlea and or auditory nerve
- loop diuretics, aminoglycosides, salicylates (reversible)
- meningitis, related to age of patient and when Abx are started
Sensorineural Hearing Loss
- testing appropriate for school age children who can cooperate with commands
- can differentiate bt conductive and SNHL
Conventional Pure Tone Audiometry
- testing for infants <6mo
- screening test
- if fails, must undergo ABR testing
Behavioral Observational Audiometry (BOA)
- testing for preschool children
- tests for bilateral hearing loss to prevent language impairment
Visual Reinforcement Audiometry
-flat tympanogram
middle ear fluid or stiff membrane
-peaked tympanogram
Normal TM
-low peaked tympanogram
-perforation or PE tubes
- dizziness, vomiting, pale with REM
- no LOC
- variant of migraines
Benign Paroxysmal Vertigo
- acute onset of unsteadiness and decreased hearing
- abnl course of communication between middle and inner ear
- progressive loss of perilymph, vertigo with ataxia, and hearing loss
Perilymphatic Fistula
-pt with bloody drainage from PE tubes and a large erythematous mass
Tympanostomy tube granuloma
- pain with movement of the pinna
- purulent DC
- MC pseudomonas
- Tx: floxacin gtts/steroid gtts
Otitis Externa
- swelling and deformity of the external ear following blunt trauma
- evacuation of hematoma by needle
Cauliflower ear
- postauricular swelling and erythema
- Dx: CT
- Tx: IV Abx and surgery
Mastoiditis
-nasal smear with eosinophils
allergic rhinitis
-teenager with nasal congestion
Cocaine
-cyanosis while feeding and resolution while crying
Choanal atresia
-first study to order in a patient with nasal polyps
Sweat testing
- persistent nighttime cough, foul breath, following a URI
- Tx: HD Amox
- complications: orbital cellulitis, brain abscess,
Acute Sinusitis
-next step in evaluating a patient with worsening epistaxis
CT sinus to r/o posterior nasopharyngeal mass
- fever, ST, fatigue, LAD, HA
- fever can last 1-2 weeks
- thick exudate and palatal petichiae
- HSM
- Dx: monospot, EBM titers
- Tx: restrict activity, steroids if airway compromise
Mono
- dysphagia, difficulty opening mouth, unilateral swelling around the tonsil, and deviation of the uvula
- trismus, drooling, hot potato voice, cervical LAD
- Tx: needle aspiration and drainage, Unasyn, Clinda, or Augmentin
Peritonsillar abscess
- widening of the retropharyngeal space on the lateral neck film
- neck is hyperextended with drooling and respiratory difficulties
- surgical emergency
- Tx: Clinda or Unasyn
- MC in pts <4yo
Retropharyngeal abscess
- hypothyroidism
- hypopituitarism
- hypoplasia (ectodermal)
- hypohidrosis
- rickets
Causes of delayed eruption of teeth
- tissues at the entrance of the larynx collapse into the airway with inspiration
- MC cause of extra-thoracic airway obstruction
- suprasternal and subcostal retractions
- worsens with agitation, improves when prone
- improves with time
- wet, variably pitched stridor
Laryngomalacia
- due to traumatic injury of the recurrent laryngeal nerve
- weak cry
- high pitched inspiratory stridor
- if unilateral, persistent hoarseness
Vocal Cord Paralysis
- -presents with a weak cry
- does not change with position
Laryngeal web
- progressive hoarseness less severe in the morning without stridor or dysphagia
- MC in males
- improve with puberty
Vocal Cord Nodules
- weak tracheal wall rings collapse during expiration
- expiratory stridor
- associated with TEF repair
Tracheomalacia
- fixed wheezing from extrinsic compression of the trachea and esophagus
- feeding difficulties
Vascular ring
-biphasic stridor with louder inspiratory component
subglottic stenosis
- -supraglottic stenosis presenting with biphasic stridor
- leaning forward and drooling
- dysphagia, dysphonia, distress
- agitated, refusing to lie down
- may be unvaccinated (H. flu)
- keep the patient calm, prepare for intubation, CTX
Epiglottitis
- AKA psuedomembranous croup, membranous laryngotracheitis
- inspiratory stridor and barking cough
- thick purulent secretions, fever, and severe resp symptoms
- prefer supine position
- Tx: removal of secretions vis scope, airway mgmt, hydration, airway humidification, and IV Abx
Bacterial tracheitis
- allergic etiology (h/o atopic derm, or FHx)
- recurrent croup in the absence of a preceding URI
- no fever and no viral URI Sx
- Tx: may need steroids
Spasmodic croup
- -hoarse, barky cough, inspiratory or biphasic stridor
- may be tripoding with mouth breathing and dysphagia
- etiology: RSV, influenza, parainfluenza
- Tx: racemic epi and cool mist, decadron
- MC in age 2
- preceded by URI and mild fever
Croup (laryngotracheobronchitis)
- MC tumor in the larynx of children
- cause hoarseness
- HPV
- Tx: laser exision
- can become malignant
Laryngeal papillomas
- midline lesion on the anterior neck
- do not remove! Only thyroid tissue left
Thyroglossal duct cyst
- preauricular adenopathy
- conjunctivitis
Adenovirus LAD
- MC cause is Staph and GAS
- order CBC, ESR, bld Cx, PPD, Bartonella
- Tx: Augmentin, Clinda, erythromycin
Bacterial LAD
-Tx for atypical mycobacteria LAD
Surgical excision
- chronic adenopathy, HSM
- exposure to farm animals, or ingestion of unpasteurized milk
Brucellosis
- school aged child with parotid swelling and weakness and fever
- swelling and erythema around the opening of Stenson’s Duct
- no erythema of the overlying skin
- may be unimmunized or HIV
Viral parotitis
- occurs before age 10
- toxic appearing with high temp
- MC Staph parotitis
Bacterial parotitis
-swelling of both parotid glands
Salivary gland stone
