ENT Flashcards
How do you treat perforated tympanic membrane?
- no treatment is needed as usually heal after 6-8 weeks. (avoid getting water in the ear during this time)
- can prescribe antibiotics to perforations which occur following an episode of acute otitis media.
myringoplasty may be performed if the tympanic membrane does not heal by itself
If someone receives minor trauma to the nose, has a nosebleed, and OE there is bilateral swelling visible- what is the initial management?
Immediate ENT referral- nasal septal haematoma. Needs drainage to avoid necrosis and ‘saddle nose’ deformity
What congenital condition can increase the risk of cholesteatomas?
cleft palate (100 fold)
What is the Dx and treatment of BPPV?
- Dx Dix-hallpike manouvre
Treatment- epley manouvre or Brandt-Daroff exercises- vestibular rehabilitation
What are the main symptoms of cholesteatoma?
Hearing loss
Foul smelling non- resolving discharge
At what age are cholesteatomas most common in?
10-20 yo
Where is the most common origin of nosebleeds?
Little’s area in anterior nasal septum - confluence of 4 arteries (Kiesselbach’s plexus)
anterior 90%, posterior 10%
What is the management for a patient with haemorrhage 5-10 days after tonsillectomy (at GP)?
Refer to ENT and consider Abx prescription (ass with wound infection)
Management for persistent mouth ulcer (>3 weeks)
Refer 2ww oral surgery -> squamous cell carcinoma ?
define otosclerosis
sclerosis of bones and fixation of stapes to oval window, often leading to BL conductive HL. autosomal dominant, and affects 20-40yo. may be precipitated by pregnancy
define presbycusis
age related SN hearing loss
high freq BL
slow progression as sensory hair cells and neurons in cochlea atrophy over time
Define ramsay hunt syndrome
reactivation of the varicella zoster virus in the geniculate (sensory) ganglion of the seventh cranial nerve.
Medication to treat vestibular neuronitis first line
prochlorperazine
- buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
- a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
What imaging is needed for voice hoarsness?
Cxr to exclude apical lung lesions
Which Abx would you use for otitis media if needed?
Amoxicillin or erythromycin
What features can indicate a septal haematoma?
- Sensation of nasal obstruction
- Bilateral red swelling arising from nasal septum
-Boggy swelling (nasal deviations are firm)
what are some signs of a basal skull fracture?
battle sign in ear and raccoon eyes
how should you treat otitis externa in diabetics?
prescribe ciprofloxacin drops to cover pseudomonas infections that can cause malignant otitis externa
what organism is malignant otitis externa most commonly caused by?
Pseudomonas aeruginosa
what is the pathophysiology of malignant otitis externa?
Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
Progresses to temporal bone osteomyelitis
Management of malignant otitis externa
non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections
Management of recurrent or chronic sinusitis
avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
Abx for managing tonsillitis
Phenoxymethylpenicillin or clarithromycin 7-10 days
pathophysiology of Cholesteatoma
squamous epithelium forming in small pockets on the tympanic membrane which becomes cyst-like as it produces keratin and sloughs over time. There will be middle ear erosion which will create an environment for anaerobic bacterial growth to occur.
