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ENT Flashcards

1
Q

presentation of menieres

A
  • hearing loss- sensorineural
  • tinnitus
  • vertigo

feeling of fullness

lasts several hrs
get recurrent attacks
unilateral

horizontal nystagmus

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2
Q

what is menieres

A

excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals
= endolymphatic hydrops

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3
Q

mx menieres

A

For acute attacks, short-term options for managing symptoms include:
Bed rest
Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Prophylaxis is with:
Betahistine

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4
Q

what is Benign paroxysmal positional vertigo (BPPV)

A

common cause of recurrent episodes of vertigo triggered by head movement

prob is peripheral (in ear) caused by debris in semicircular canals

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5
Q

presentation of BPPV

A

severe vertigo when moving head
does not cause hearing loss or tinnitus

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6
Q

ix bppv

A

dix hallpike manouvre = rotatory nystagmus

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7
Q

tx bppv

A

epley manouvre

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8
Q

what is an acoustic neuroma / vestibular schwannoma

A

benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear

occur at the cerebellopontine angle - referred to as cerebellopontine angle tumours

usually unilateral

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9
Q

what are Bilateral acoustic neuromas assoc w

A

neurofibromatosis type II

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10
Q

acoustic neuroma / vestibular schwannoma presentation

A

hearing loss - Unilateral sensorineural (often first sx)
vertigo - dizzy
tinnitus
absent corneal reflex

facial nerve palsy if large

sx for months

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11
Q

ix for acoustic neuroma / vestibular schwannoma

A

MRI cerebellopontine angle
audiometry

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12
Q

mx acoustic neuroma / vestibular schwannoma

A

refer to ENT

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13
Q

what is Vestibular neuronitis

A

inflam of vestibular nerve usually due to viral infection

It distorts the signals travelling from the vestibular system to the brain, confusing the signal required to sense movements of the head. This results in episodes of vertigo, where the brain thinks the head is moving when it is not.

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14
Q

Vestibular neuronitis presentation

A

acute onset of vertigo - recurrent attacks lasting hrs or days

history of a recent viral upper respiratory tract infection.

Nausea and vomiting (may be severe)
Balance problems

HORIZONTAL NYSTAGMUS usually seen

NO tinnitus or hearing loss

Symptoms are most severe for the first few days, after which they gradually resolve over the following 2-6 weeks.

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15
Q

how to differentiate between central and peripheral causes of vertigo

A

head impulse test

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16
Q

mx epistaxis w first aid measures

A

torso forward + mouth open
pinch catilaginous area 20 mins

topical antiseptic (naseptin)
admission + follow up if suspected underlying cause (or under 2 yrs)
self care advice

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17
Q

mx epistaxis if still bleeding after 10-15 mins pressure

A

cautery - if source of bleed is visible + it is tolerated (anaesthetic spray then silver nitrate stick)

packing - if cautery not viable of bleeding site not visible
admit for obs + review

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18
Q

mx epistaxis when no emergency measures have worked

A

sphenopalatine ligation

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19
Q

common trigger for otitis externa

A

recent swimming

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20
Q

sx otitis externa

A

ear pain, itch, discharge

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21
Q

otoscopy otitis externa

A

red, swollen or eczematous canal

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22
Q

otitis externa mx

A

if v mild (e.g. no deafness or discharge, mild discom/pruritis) = topical acetic acid 2% spray

moderate = topical abx / combined w steroid = otomise spray (neomycin, dexamethazone, acetic acid)
(ensure tympanic membrane is not perforated b4 using aminoglycosides)

failure to respond to topicals = ENT referral

severe/systemic = ENT - oral/IV abx

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23
Q

what is malignant otitis externa

A

more common in elderly diabetics

extension of infection into the bony ear canal + the soft tissues deep to the bony canal
- have worsening unrelenting pain despite strong analgesia

need IV abx

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24
Q

causes of acute otitis media

A

usually preceded by viral URTI

which allows bacteria to enter via the eustachian tube: Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

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25
Q

what is an auricular haematoma

A

collection of blood between cartilage + overlying perichondrium

happens due to trauma

can lead to cauliflower ear

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26
Q

sx of acute otitis media

A

otalgia - children tugging at ear
fever in 50%
hearing loss
discharge if tympanic membrane perforates

recent URTI sx - eg coryza

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27
Q

otoscopy otitis media

A

bulging tympanic membrane , loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope

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28
Q

criteria for otitis media dx

A

acute onset of symptoms
- otalgia or ear tugging
presence of a middle ear effusion
- bulging of the tympanic membrane, or
- otorrhoea
- decreased mobility on pneumatic otoscopy
inflammation of the tympanic membrane
- i.e. erythema

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29
Q

mx otitis media

A

self-limiting condition that does not require an antibiotic prescription

analgesia

safety net if sx worsen / no not improve after 3 days

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30
Q

when to prescribe abx for otitis media + which

A

Sx>4 days / not improving
Systemically unwell
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
<2 years with BILATERAL otitis media
Otitis media with perforation and/or discharge in the canal

5-7 days oral amoxicillin (erythromycin or clarithromycin if allergic)

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31
Q

chronic suppurative otitis media (CSOM) definition

A

perforation of the tympanic membrane with otorrhoea for > 6 weeks

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32
Q

sinusitis sx

A

facial pain
- typically frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction

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33
Q

mx sinusitis

A

analgesia
intranasal decongestants or nasal saline??
intranasal corticosteroids may be considered if the sx have been present >10 days

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34
Q

what abx to give in v severe sinusitis

A

phenoxymethylpenicillin first line

co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications

35
Q

most common bacteria to cause tonsillitis

A

strep pyogenes

36
Q

what is glue ear

A

otitis media w effusion

37
Q

risk factors for glue ear

A

male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking

38
Q

glue ear features

A

peaks at 2 yrs old
hearing loss is usually the presenting feature
secondary problems such as speech and language delay, behavioural or balance problems may also be seen

39
Q

tx glue ear

A

for first presentation of otitis media with effusion: active observation for 3 mths - no intervention is required

if a background of Down’s / cleft palate -> refer to ENT

grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months

adenoidectomy

40
Q

features of peritonsillar abscess (quinsy)

A

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

41
Q

tx quinsy

A

urgent review by an ENT specialist

needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence

42
Q

what is mastoiditis

A

typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone.

43
Q

mastoiditis features

A

otalgia: severe, classically behind the ear
hx of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external EAR may PROTRUDE forwards
ear discharge may be present if the eardrum has perforated

44
Q

tx mastoiditis

A

urgent same day referral to paeds
IV abx

45
Q

what is rinne’s test

A

testing for conductive hearing loss
tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus

46
Q

what is a positive rinne’s test i.e. what sld happen normally

A

air conduction is better than bone conduction

if negative (bone better than air) - they have conductive deafness
(can’t test for sensoineural)

47
Q

what is weber’s test

A

to localise hearing loss
tuning fork is placed in the middle of the forehead equidistant from the patient’s ears
the patient is then asked which side is loudest - sld be same

48
Q

result of weber’s test in unilateral sensorineural deafness

A

sound is localised to the unaffected side

49
Q

result of weber’s test in unilateral conductive deafness

A

sound is localised to the affected side

50
Q

what is presbycusis

A

age-related sensorineural hearing loss

high freq hearing is affected bilaterally

51
Q

what is otosclerosis

A

AD
replacement of normal bone by vascular spongy bone in ear.
Onset is usually at 20-40 years

52
Q

features of otosclerosis

A

conductive deafness
tinnitus
+ve FHx

53
Q

what is a nasal septal haematoma

A

comp of nasal trauma
dev of haematoma between the septal cartilage + the overlying perichondrium

54
Q

mx nasal septal haematoma

A

ref to ENT asap
need surgical drainage
IV abx

55
Q

what happens if nasal septal haematoma is left untreated

A

irreversible septal necrosis may dev within 3-4 days -> saddle nose

56
Q

features of nasal septal haematoma

A
  • relatively minor trauma
  • sensation of nasal obstruction
  • pain + rhinorrhoea on examination
  • classically a BILATERAL, RED SWELLING arising from the nasal septum
    (differente from a deviated septum by gently probing the swelling. Will be boggy whereas septums will be firm)
57
Q

what is ramsay hunt syndrome caused by

A

reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve

58
Q

ramsay hunt syndrome features

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

59
Q

ramsay hunt syndrome tx

A

oral aciclovir and corticosteroids

60
Q

causes for gingival hyperplasia (overgrowth of gum tissue)

A

P - Phenytoin
A - Acute Myeloid Leukaemia
N - Nifedipine (CCBs)
I - Idiopathic
C - Ciclosporin

61
Q

what to do when someone presents with sudden onset sensorineural hearing loss (SSNHL)

A

uregent ENT ref
- MRI to exclude vestibular schwannoma
high dose corticosteroids

62
Q

sx viral labyrinthitis

A

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected

63
Q

what is malignant otitis externa most commonly caused by

A

Pseudomonas aeruginosa

64
Q

what conditions are assoc w nasal polyps

A

asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome

65
Q

features of nasal polyps

A

nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell

66
Q

tx nasal polyps

A

all patients with suspected nasal polyps should be referred to ENT for a full examination
topical corticosteroids shrink polyp size in around 80% of patients

67
Q

mx perforated tympanic membrane

A

no tx needed in majority as it will usually heal after 6-8 weeks.
Avoid getting water in the ear during this time

Prescribe antibiotics to perforations which occur following an episode of acute otitis media.

if still perf when reviewed refer to ENT
myringoplasty may be performed if the tympanic membrane does not heal by itself

68
Q

tonsillitis presentation

A

Sore throat
Fever (above 38°C)
Pain on swallowing

exam =
red, inflamed and enlarged tonsils, with or without exudates
may be anterior cervical lymphadenopathy

69
Q

FeverPAIN Score criteria

A

Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza

70
Q

FeverPAIN Score results

A

2–3 = 34 – 40% probability, delayed abx
4–5 = 62 – 65% probability, prescribe abx
of bacterial tonsillitis

71
Q

tx tonsillitis

A

safety net - return if the pain has not settled after 3 days or the fever rises above 38.3ºC

simple analgesia with paracetamol and ibuprofen

if abx needed
- phenoxymethylpenicillin 10 days
- Clarithromycin if allergy

72
Q

what is Infectious mononucleosis (glandular fever) caused by

A

Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4)

73
Q

triad in Infectious mononucleosis (glandular fever)

A

sore throat
pyrexia
lymphadenopathy

74
Q

blood test change in Infectious mononucleosis (glandular fever)

A

transient rise in ALT due to hepatitis
lymphocytosis

75
Q

what happens in px who take ampicillin/amoxicillin whilst they have infectious mononucleosis

A

a maculopapular, pruritic rash develops

76
Q

dx Infectious mononucleosis (glandular fever)

A

heterophil antibody test (Monospot test)

77
Q

mx Infectious mononucleosis (glandular fever)

A

rest during the early stages, drink plenty of fluid, avoid alcohol

simple analgesia for any aches or pains

avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

78
Q

Unilateral glue ear in an adult

A

needs evaluation for a posterior nasal space tumour -> two weeks-wait referral to ENT

79
Q

Otalgia in the absence of any ear signs

A

red flag for head and neck malignancy and must be investigated further
- referred pain

80
Q

post tonsillectomy comp + what to do

A

haemorrhage

all need to be assessed by ENT
-> immediate return to theatre if bleeding in first 6-8 hrs (primary)

if 5-10 days after (secondary + rarer) -> admit + abx

81
Q

3 main structures in inner ear

A

semi-circular canals
vestibule
cochlea

82
Q

3 main structures in middle ear

A

malleus
incus
stapes

83
Q

what is the external acoustic meatus

A

sigmoid tube that extends from the deep park of the concha to the tympanic membrane

finals (27 decks)

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