ENT Flashcards
define acoustic neuroma
benign tumours of Schwann cells surrounding vestibulocochlear nerve,
acoustic neuroma, aka (x2)
vestibular schwannoma
*cerebellopontine angle tumours
acoustic neuroma presentation
- bi or unilateral?
- age group
- may be associated with what palsy?
- 4main symptoms
Typically unilateral. (Bilateral =ass. w/ neurofibromatosis type II).
Aged 40-60 years
facial nerve (CNVII) palsy
- Gradual onset of:
o Unilateral sensorineural hearing loss (often the first symptom)
o Unilateral tinnitus
o Dizziness or imbalance
o A sensation of fullness in the ear
*
BPPV
Dx manouvre
Mx manaouvre
Dx- Dix-hallpike
Mx - Epsley
BPPV
give 2
- Sx associated with the vertigo
- Sx NOT associated with the vertigo
- Triggered by head movement
- symptoms last 20-60s
not ass/ w/
- hearing loss
- tinnitus
comonly associated cause of epiglottitis
Haemophilus influenzae b (Hib) - reduced since vaccines
Other causes are: Infectious (Streptococcus spp, Staph aureus, Pseudomonas, Herpes simplex) or Non-infectious (Thermal, foreign bodies, radiotherapy)
key differential Sx of epiglotitis (x4)
high temperature, inspiratory stridor, difficulty breathing, drooling, and irritability.
differentials :
croup: barking cough & coryzal w/inspiratory stridor in moderate/severe cases. Sx worse at night.
Bacterial Tracheitis: Sx intermediary between croup and epiglottitis, (difficulty breathing, SOB, High temp)
2 steps in managing epiglottitis
1 Nebulised adrenaline and IV dexamethasone ) reduce mucosal oedema)
2 If medical mx unsuccessful – intubate to get definitive airway
acute unilateral vertigo lasting 15 hours. With ipsilateral dulling of hearing.
It began suddenly, no obvious trigger, while sat on the sofa.
Can hear a faint buzzing in the ear and feels nauseous.
Hx: mild viral illness one week earlier.
Exam: CN intact. Otoscopy:translucent tympanic membrane with normal ossicles and no effusion. What is the most likely diagnosis?
Acute labrynthitis
In BPPV, what type of nystagmus is seen in Dix-hallpike manouevre
rotatory nystagmus
what is the most likely location of bleeding in epistaxis>
Littles area ( comtains Kiesselbachs plexus, where belled comes form
Give 10 causes of epistaxis
- Nose picking
- Colds
- Sinusitis
- Vigorous nose-blowing
- Trauma
- Changes in the weather
- Coagulation disorders (e.g., thrombocytopenia or Von Willebrand disease)
- Anticoagulant medication (e.g., aspirin, DOACs or warfarin)
- Snorting cocaine
- Tumours (e.g., squamous cell carcinoma)
4 reasions to admit patient with epstaxis
o bleeding >10 – 15 minutes,
o sesvere bleed
o bilateral bleed
o haemodynamically unstable
Mx eistaxis ( acute x 2, post-event )
acute:
nasal packing
nasal cautery
Naseptin nasal cream QDS 10/7 (reduces crusting, inflammation and infection)
Give 3 other names for glandular fever
kissing disease
infectious monocnucleosis
mono
typical infectious monocnucleosis Sx in :
- childhood
- teen/adulthood
childhood - minimal Sx
teen/adult: fever, sore throat, fatigue
other: * Lymphadenopathy (swollen lymph nodes)
* Tonsillar enlargement
* Splenomegaly & splenic rupture (rare)
name 2 tests used in EBV Dx
Heterophile Ab teat ( Monospot test / Paul-Bunnell test
Viral capsid antigen test ( specific EBV Ab)
EBV Mx
condition is self-imiting, lasts 2-3 weeks
what shoud patiets with EBV avoid ( x3)
Alcohol
Contact sports
Ammoxicillin/cephalosporin
x6 complications of EBV
- Splenic rupture
- Glomerulonephritis
- Haemolytic anaemia
- Thrombocytopenia
- Chronic fatigue
- Increased cancer risk e.g., Burkitt’s lymphoma.
menieres triad
- Hearing loss
- Vertigo
- Tinnitus
typical menieres presentation
40-50 years old,
unilateral UNILATERAl vertigo (20mins-hrs, not triggered by mvtm), hearing loss (fluctuating, ass.w/ vertigo, then permanent), and tinnitus (gradually becomes permmanent
also
* A sensation of fullness in the ear
* Unexplained falls (“drop attacks”) without loss of consciousness.
* Imbalance (can persist after episodes of vertigo resolve
Dx Ix for menieres
audiooogy assessment
menieres Mx
acute x2
prophylaxis x 1
For acute attacks
short-term:
* Prochlorperazine
* Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
Prophylaxis:
* Betahistine
OSA
define
5x risk factors
def: collapse of the pharyngeal airway characterised by episodes of apnoea during sleep
RF: * Middle age
* Male
* Obesity
* Alcohol
* Smoking
OSA Mx
1 who to refer 2
1st-3rd line Mx
Management
* ENT specialist / specialist sleep clinic
* 1st step: correct reversible risk factors: weightloss, stop alcohol, stop smoking
* 2nd: CPAP
* 3rd Surgery: reconstruction of the soft palate and jaw.
give 5 causes of otitis externa
Bacteria ( pseudomonas aeruginosa, staph. aureus)
fungal ( aspergillus, candida)
eczema
sebhorrhoeic dermatitis
contact dermatitis
the stages of otitis externa and the management
mild - acetic acid
mod - topical abx & steroid *(e.g. otomize spray - neomycine+dex+acetic acid)
sev: oral abx, ear wick before ear drops/soray , clotrrimozole
malignant: Adx, IV Abx & MRI/CT for assessing extent of infeciton
4 causes of otitis media
most common - strep. pneumonia
also: H. influenzae, M. catarrhalis, Staph. aureus
(bacterial inflection often preceded by viral URTI)
the 1st line meds for otitis media
Amoxicillin 5-7 days
if allergic: clarithromycin
if allergic & pregnant: erythromycin
sinusitis vs rhinosinusitis
rhinosinusitis = sinusitis (imnflammed paranasal siniuses) combined with infammation of nasal cavity
how does sinusitois occur
normally: sinuses is where mucous is produced and this drains into the ostia
blocked ostia –> no drainage –> sinusitis
name the paranasal sinuses
frontal sinuses (above eyebrows)
maxillary sinuses )either soide of nose, the largest)
ethmoid sinuses (in ethmoid bone, mid nasal cav ity)
sphenoid sinuses (sphenoid bone, back of nasal cavity
acute sinusitis Mx
- Sx for <10 days
- Sx for >10 days (x2)
no Rx - resolves in 2-3wks if viral
Mometasone 200mcg BD 14days (high dose steroid nasal spray
Delayed Rx ABx (phenoxymethylpenicillin 1st line)
Mx Chronic sinusitis
x3
nasal irrigation
nasal spray/drop (mometasone/fluticasone
FESS (Functional endoscopic suinus surgery)
most common cause of tonsillitis
viral
most common bacterial cause of tonsillitis
GAS (strep pyogenes)
or strep pneumoniae
other common bact. causes are same as in otitis media (h.influenza, M.catharrhalis, Staph. aureus
what name describes the tonsil ring
how many areas of tonsil tissue are there? Name them
which of them is typically enlarged in tonsillitis
Waldeyer’s tonsillar ring = 6 areas of limphoid tissue
adenoid, x2 tubal, x2 palatine, lingual
palatine
when would you Rx Abx in tonsillitis? (x3)
- Centor score >/= 3
- FeverPAIN >/=4
- high risk for infection
1st line Tx in tonsillitis
Penecillin V )(phenoxymethylpenecillin/ clarithromycin (if allergic)
give 7 complications of tonisllitis
chronic tonsillitis
Wuinsy
Otitis media
scarlet fever
rhematic fever
post-strep glomerulonephritis
post-strep ReA
give 4 main causes of peripheral vertigo
BPPV
Menieres
labrynthitis
vestiibular nueronitis
give 4 central causes of vertigo
Posterior circulation infarction
tumour
MS
vestibular migraine
(central vertigo = sustained, non-positional vertigo)
name the 4 types of exams to conduct in vertigo
ear (?infection)
neuro (inc cerebellar exam - danish)
CV exam
Special tests - rombergs, dix-hall-pike, HINTS
Mx peripheralvertigo
- 2 groups meds
- menieres prophylaxis
- DVLA instructions
Short term Mx in peripheral : Prochlorperazine/ antihistmisn (cyclizine, cinnarizine, promethazine)
Menieres prophylaxis - betahistine
DVLA - do not drive, inform DVLAA if liable to “ sudden, unprovoked episodes of disablign dizziness”
does vestibular neuronitis affect
tinnitus
hearing
no, as cochlea/cochlear nerve are not affected
3 Sx of vestibular neuronitis
vertigo ( most sivere for 1st ew days
nausea & vom , and balance problems
Examination ofr vestibular neuronitis
head impulse test
Mx in vestibular neuronitis
- when to afmit
- the short term Mx options
Adx ( in dehydration from N&V)
short term ( 3days)
prochlorperazine/ antihistamines (cyclizine, cinnariziene, promethazine)
prognosis of vestibular neuronitis (x2)
most severe st few days, slowly resolves over 2-6 weeks
may develop into BPPV
Short term Sx (vertigo) options in labyrinthitis/vestibular neuronitis/ menieres )
How long can these be prescribed for in vertigo?
Prochlorperazine
antihistamines ( cyclizine, cinnarizine, promethazine)
max 3 days
what differentiates labrythithisis fro vestuiiular neuronitis
similarities - acute onset vertigo ( esp followign viral URTI)
difference
Labryinthitis - Loss of hearing, and tinnitus
what differentiates labrythithisis fro vestuiiular neuronitis
similarities - acute onset vertigo ( esp followign viral URTI)
difference
Labryinthitis - Loss of hearing, and tinnitus
primary tinnitus
- what causes it?
- what Sx is it associated with (not tinnitus)
cause: no identifiable cause
Sx: sensorineural hearing loss
name 3 drugs associated with secondary tinnitus
secondary tinnitus - tinitus w/ associated cause
meds: loop diuretics, gentamicin, chemo drugs (cisplatin)
give 4 ENT & 4 systemic conditions associated with tinnitus
ENT - Ear infection acoustic neuroma, menieres, (MS)
Systemic - anaemia, diabetes, Hypo/hyperthyroid, hyperlipidaeimaia
additional sounds causing objective tinnitus
pulsatile carotid bruit
carotid artery stenosis
additional sounds causing objective tinnitus
radiating pulsatile murmur sounds
aortic stenosis
additional sounds causing objective tinnitus
pulsatile
arteriovenous malformations
additional sounds causing objective tinnitus
popping/clicking noises
eustachian tube dysfunction
5 mx options for tinnitus
- improves/ resolves over time w/o interventions.
- Tx Underlying causes (e.g., ear wax/infection).
- Hearing aids
- Sound therapy (adding background noise to mask the tinnitus)
- CBT
What are indications for hospital admission in Tonsillitis
Systemically unwell child
Dehydration
Suggestion of airway compromise
Cholesteatoma
- what is it
-What is the cause
Cause: recurrent otitis Media
Mx in acute labyrinthitis
- self-limiting
- Med: prochlorperazine or antihistamines (e.g. promethazine) for dizziness - can only be given for 3 days
