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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
what is an auricular haematoma
collection of blood between cartilage + overlying perichondrium happens due to trauma can lead to cauliflower ear
26
sx of acute otitis media
otalgia - children tugging at ear fever in 50% hearing loss discharge if tympanic membrane perforates recent URTI sx - eg coryza
27
otoscopy otitis media
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
28
criteria for otitis media dx
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
29
mx otitis media
self-limiting condition that does not require an antibiotic prescription analgesia safety net if sx worsen / no not improve after 3 days
30
when to prescribe abx for otitis media + which
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)
31
chronic suppurative otitis media (CSOM) definition
perforation of the tympanic membrane with otorrhoea for > 6 weeks
32
sinusitis sx
facial pain - typically frontal pressure pain which is worse on bending forward nasal discharge: usually thick and purulent nasal obstruction
33
mx sinusitis
analgesia intranasal decongestants or nasal saline?? intranasal corticosteroids may be considered if the sx have been present >10 days
34
what abx to give in v severe sinusitis
phenoxymethylpenicillin first line co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications
35
most common bacteria to cause tonsillitis
strep pyogenes
36
what is glue ear
otitis media w effusion
37
risk factors for glue ear
male sex siblings with glue ear higher incidence in Winter and Spring bottle feeding day care attendance parental smoking
38
glue ear features
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
tx glue ear
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
features of peritonsillar abscess (quinsy)
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
tx quinsy
urgent review by an ENT specialist needle aspiration or incision & drainage + intravenous antibiotics tonsillectomy should be considered to prevent recurrence
42
what is mastoiditis
typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone.
43
mastoiditis features
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
tx mastoiditis
urgent same day referral to paeds IV abx
45
what is rinne's test
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
what is a positive rinne's test i.e. what sld happen normally
air conduction is better than bone conduction if negative (bone better than air) - they have conductive deafness (can't test for sensoineural)
47
what is weber's test
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
result of weber's test in unilateral sensorineural deafness
sound is localised to the unaffected side
49
result of weber's test in unilateral conductive deafness
sound is localised to the affected side
50
what is presbycusis
age-related sensorineural hearing loss high freq hearing is affected bilaterally
51
what is otosclerosis
AD replacement of normal bone by vascular spongy bone in ear. Onset is usually at 20-40 years
52
features of otosclerosis
conductive deafness tinnitus +ve FHx
53
what is a nasal septal haematoma
comp of nasal trauma dev of haematoma between the septal cartilage + the overlying perichondrium
54
mx nasal septal haematoma
ref to ENT asap need surgical drainage IV abx
55
what happens if nasal septal haematoma is left untreated
irreversible septal necrosis may dev within 3-4 days -> saddle nose
56
features of nasal septal haematoma
- 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
what is ramsay hunt syndrome caused by
reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
58
ramsay hunt syndrome features
auricular pain is often the first feature facial nerve palsy vesicular rash around the ear other features include vertigo and tinnitus
59
ramsay hunt syndrome tx
oral aciclovir and corticosteroids
60
causes for gingival hyperplasia (overgrowth of gum tissue)
P - Phenytoin A - Acute Myeloid Leukaemia N - Nifedipine (CCBs) I - Idiopathic C - Ciclosporin
61
what to do when someone presents with sudden onset sensorineural hearing loss (SSNHL)
uregent ENT ref - MRI to exclude vestibular schwannoma high dose corticosteroids
62
sx viral labyrinthitis
Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected
63
what is malignant otitis externa most commonly caused by
Pseudomonas aeruginosa
64
what conditions are assoc w nasal polyps
asthma (particularly late-onset asthma) aspirin sensitivity infective sinusitis cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome
65
features of nasal polyps
nasal obstruction rhinorrhoea, sneezing poor sense of taste and smell
66
tx nasal polyps
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
mx perforated tympanic membrane
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
tonsillitis presentation
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
FeverPAIN Score criteria
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
FeverPAIN Score results
2–3 = 34 – 40% probability, delayed abx 4–5 = 62 – 65% probability, prescribe abx of bacterial tonsillitis
71
tx tonsillitis
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
what is Infectious mononucleosis (glandular fever) caused by
Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4)
73
triad in Infectious mononucleosis (glandular fever)
sore throat pyrexia lymphadenopathy
74
blood test change in Infectious mononucleosis (glandular fever)
transient rise in ALT due to hepatitis lymphocytosis
75
what happens in px who take ampicillin/amoxicillin whilst they have infectious mononucleosis
a maculopapular, pruritic rash develops
76
dx Infectious mononucleosis (glandular fever)
heterophil antibody test (Monospot test)
77
mx Infectious mononucleosis (glandular fever)
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
Unilateral glue ear in an adult
needs evaluation for a posterior nasal space tumour -> two weeks-wait referral to ENT
79
Otalgia in the absence of any ear signs
red flag for head and neck malignancy and must be investigated further - referred pain
80
post tonsillectomy comp + what to do
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
3 main structures in inner ear
semi-circular canals vestibule cochlea
82
3 main structures in middle ear
malleus incus stapes
83
what is the external acoustic meatus
sigmoid tube that extends from the deep park of the concha to the tympanic membrane

finals (27 decks)

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