ENT Flashcards
How do auricular haematomas form and how do you manage them?
They occur after direct trauma to the ear and is due to a build up of blood between the cartilage and perichondrium. This can restrict blood supply and lead to necrosis of the connective tissue.
Management: same day ENT referral ± incision and drainage (preferred over fine needle aspiration)
What are risk factors for tonsilar squamous cell carcinoma?
Smoking
High levels of alcohol intake
Poor oral hygiene
*Also associated to HPV (especially HPV-16)
What is the most common cause of sudden-onset sensorineural hearing loss
Idiopathic
However you need to do an urgent referral to ENT where they will perform an MRI to rule out vestibular schwannoma. High-dose oral corticosteroids are also given.
What is Ménière’s disease?
It is a disorder of the inner ear whereby there is excessive pressure and progressive dilation of the endolymphatic system.
What are the features of Ménière’s disease?
- Recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
- A sensation of aural fullness or pressure is now recognised as being common
- Other features include nystagmus and a positive Romberg test
- Episodes last minutes to hours
- Typically symptoms are unilateral but bilateral symptoms may develop after a number of years
What is the management of perforated tympanic membrane?
No specific treatment as it will heal after 6-8 weeks. Advise to keep ear dry and avoid getting water in the ear.
Myringoplasty can be performed if the tympanic membrane does not heal itself.
Do you give antibiotics in acute sinusitis?
Not unless it is complicated where you would use phenoxymethylpenicillin first. If they are more systemically unwell, then consider Co-amoxiclav.
What symptoms should warrant an urgent ENT referral in patients 45 and over?
Persistent unexplained hoarseness or an unexplained lump in the neck.
What are the features of osteosclerosis?
Onset at 20-40 years
Progressive conductive deafness
Tinnitus
Normal tympanic membrane (but 10% will have a flamingo tinge caused by hyperaemia)
Positive family history
*caused by replacement of normal bone by vascular spongy bone
What are red flag symptoms of nasal polyps?
Unilateral polyps
Bleeding polyps
What is prebycusis?
Presbycusis describes age-related sensorineural hearing loss. Patients may describe difficulty following conversations
Audiometry shows bilateral high-frequency hearing loss
What is glue ear?
aka otitis media with effusion
- Peaks at 2 years of age
- Hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
- Secondary problems such as speech and language delay, behavioural or balance problems may also be seen
What is a nasal septal haematoma?
Complication of nasal trauma - development of a haematoma between the septal cartilage and the overlying perichondrium
Management:
* Surgical drainage
* Intravenous antibiotics
What is Ludwig’s angina?
Cellulitis that occurs on the floor on the mouth of the patient. This is deadly as it can spread in fascial spaces on the head and neck. It can eventually cause enough inflammation to push the floor of the mouth upwards and block air entry
What is vertebrobasilar ischaemia?
It is commonly seen in elderly patients with dizziness on extension of the neck.
Risk factors include cardiovascular disease
What drugs can cause tinnitus?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
How many episodes of tonsillitis do you need to have to be considered for a tonsillectomy?
Seven in 1 year
Or five per year in 2 years
Or 3 per year in 3 years
What ECG changes is associated with hypocalcaemia (i.e. post-thyroidectomy)?
Isolated QTC elongation
What is the management of mastoiditis and what are its complications?
Management: IV ABx
Complications: facial nerve palsy, hearing loss, meningitis
What are some causes of bilateral nasal polyps?
Chronic rhinosinusitis
Aspirin sensitivity
Asthma
Eosinophilic granulomatosis with polyangiitis (Wegener’s)
What is the feverPAIN scoring system?
1 point for each (maximum score of 5):
* Fever over 38°C.
* Purulence (pharyngeal/tonsillar exudate).
* Attend rapidly (3 days or less)
* Severely Inflamed tonsils
* No cough or coryza
*the higher the number, the greater the chance of isolating Streptococci
What are common complications of thyroid surgery?
- Anatomical such as recurrent laryngeal nerve damage.
- Bleeding: haematomas may rapidly lead to respiratory compromise owing to laryngeal oedema (due to confined space).
- Damage to the parathyroid glands resulting in hypocalcaemia.
When should you do 2WW referrals to oral surgery?
- Unexplained oral ulceration or mass persisting for greater than 3 weeks
- Unexplained red, or red and white patches that are painful, swollen or bleeding
- Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
- Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
- Unexplained persistent sore or painful throat
- Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion
What are the features of vestibular neuronitis?
- Recurrent vertigo attacks lasting hours or days
- Nausea and vomiting may be present
- Horizontal nystagmus is usually present
- No hearing loss or tinnitus
