ENT Flashcards
what are red flag symptoms of rhinosinusitis
Unilateral symptoms
Persistent symptoms despite compliance with 3 months of treatment
epistaxis
what is the criteria for urgent referral of hearing loss
Sudden onset ( over 3 days or less) unilateral / bilateral hearing loss occured within past 30 days with no external / middle ear causes
Unilateral hearing loss + focal neurology
hearing loss + head/ neck injury
hearing loss + severe infection ( Necrotising Otitis Externa/ Ramsay Hunt syndrome)
What scan is done on urgent referral to ENT for hearing loss ? what condition is it trying to investigate?
MRI, Vestibular Schwannoma
air conduction louder than bone conduction suggests which type of hearing loss
Sensorineural hearing loss
how is Quinsy managed
IV Antibiotics and surgical drainage
give 5 features of viral labyrinthitis
sudden onset horizontal nystagmus
hearing disturbances
nausea
vomiting
vertigo
which type of hearing loss does ear wax cause
conductive hearing loss
what is the first line management of impacted ear wax
olive oil drops followed by ear syringing
what is a benign tumor of the parotid gland known as
Pleomorphic adenoma
what are 2 clinical features of a Pleomorphic adenoma
gradual onset, painless unilateral swelling of parotid gland
movable on examination
what is Samter’s triad
Asthma
aspirin sensitivity
nasal Polyposis
what is a red flag indication in Nasal polyps
unilateral polyps
name 6 conditions that can lead to Nasal polyps
Asthma
Aspirin sensitivity
Infectivity sinusitis
CF
Kartagener’s syndrom
Churg Strauss syndrome
give 3 features of nasal polyps
nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell
following referral to ENT , patients with sudden onset sensorineural hearing loss are treated with ____________
high dose oral corticosteroids
what is a Rinne’s positive
air conduction better than bone conduction - as is in a healthy individuals and individuals with significant sensorineural hearing loss
what is a normal weber’s test
sound is heard equally in both ears
what is a sign of sensori-neural hearing loss on Weber’s test
sound is heard louder on the side of the intact ear ( opposite to affected one)
what is a sign of conductive hearing loss on Weber’s test
sound is heard louder on the side of affected ear
when is Rinne’s test negative
conducting hearing loss
what is the management of patients with nasal polyps
ENT referral and topical steroids
what is an alternative for phenoxymethylpenicillin for a bacterial sore throat
Clarithromycin
_________ is an example of conductive hearing loss associated with chronic smelly ear discharge and history of glue ear
Cholesteatoma
what is presbycusis
age related Sensorineural hearing loss
what is the nature of inheritance of otosclerosis
Autosomal dominant
when is the onset of otosclerosis? give 3 features and 1 clinical sign
conductive deafness
tinnitus
positive fhx
- flamingo tinge to tympanic membrane
give 4 drugs that can cause deafness
Aminoglycosides ( Gentamicin)
Furosemide
aspirin
cytotoxic agents
how do you manage auricular haematomas
same day assessment for ENT
what is the most common cause of sudden onset sensorineural hearing loss
idiopathic
which swelling most suggests malignancy of cervical lymph nodes
enlarged supra-clavicular nodes
what is the first line investigation for Mono
Monospot test
name a monoclonal antibody used in the management of squamous cell carcinomas of head and neck
cetuximab
which strain of HPV is linked with oral cancer
Strain 16
next step in management of persistent mouth ulcer
refer under 2 week wait
what sign is indicative of a positive Dix- Hallpike manouvre
Rotatory nystagmus
what is an important complication of nasal trauma
Nasal septal haematoma
what is the classical sign of a nasal septal haematoma
bilateral red swelling arising from nasal septum
what is the management of nasal septal Haematoma
Surgical drainage and IV Abx
what is a complication of nasal septal haematoma ? which deformity can it result in
irreversible septal necrosis leading to saddle nose deformity
which people commonly present with auricular haematomas
rugby players, wrestlers
what type of cyst moves upwards with tongue protrusion
thyroglossal cyst
what is ‘’ double sickening’’ ? What condition is it associated with ?
initial period of recovery followed by a sudden worsening of symptoms , Bacterial sinusitis
what is the main significant complication of a tonsillectomy
bleeding
In which patients is malignant otitis externa most common
diabetes
what organism causes malignant Otitis externa
Pseudomonas Aeruginosa
what is a complication of malignant otitis externa
temporal bone osteomyelitis
what investigation is done to diagnose malignant otitis externa
CT Scan
which neurological sign can malignant otitis externa precipitate
facial nerve dysfunction
give 3 features of malignant Otitis Externa
severe Otalgia
temporal headache
purulent otorrhoea
dysphagia, hoarseness
what is the management of malignant Otitis Externa
refer non-resolving –> ENT
IV Abx to cover Pseudomonal infections
how is Otosclerosis managed
hearing aid
Stapedectomy
what is the management of Ramsay Hunt syndrome
Oral aciclovir
Corticosteroids
what is the initial management of vestibular neuronitis
Buccal / IM Prochlorperazine
what pattern of hearing loss is seen in Presbycusis
Bilateral sensori-neural pattern hearing loss
what is the management of recurrent / chronic sinusitis
avoid allergen
Intra-nasal Corticosteroids
nasal irrigation with saline
give 3 contraindications for consideration of cochlear implant
- Chronic Infective Otitis media / mastoid cavity/ tympanic membrane perforation
- lesions of cranial nerve VIII / or in Brainstem causing deafness
- cochlear Aplasia
give 4 causes of gingival hyperplasia
phenytoin
ciclosporin
CCB’s such as nifedipine
AML
what is the most common cause of a perforated tympanic membrane
infection
what is the management of tympanic membrane rupture
self resolving in 6-8 weeks
what is the management of tympanic membrane perforation if membrane does not heal by itseld
Myringoplasty
give 4 complications of tonsillitis
otitis media
quincy
rheumatic fever
glomerulonephritis
otitis media with effusion is also known as _______.
Glue ear
what is the commonest cause of conductive hearing loss of in childhood
Glue ear
which test can be used to distinguish vestibular from posterior circulation stroke
HiNTs
What is the criteria used to diagnose Otitis media
Presence of middle ear effusion
Otalgia / ear tugging
inflammation of tympanic membrane
which area is a common site for Epistaxis to originate and why
Little’s area in the nasal septum because it is the confluence of 4 arteries
management of epistaxis where bleed site is difficult to localise
Anterior packing
which infection can occur following cat scratch
bartonella infection
which exercises can be performed by a patient at home to treat BPPV
Brandt daroff exercises
how is otitis media with perforation managed
5-7 day course of amoxicillin
how is otitis externa managed in a patient with diabetes
ciprofloxacin ear drops
4 features of mastoiditis
otalgia
fever
protruding ear
post-auricular tenderness
what is the first line treatment of otitis externa
Topical antibiotic and topical steroid for 1-2 weeks
give 3 common bacterial causes of otitis media
streptococcus pneumoniae
H. influenzae
Moraxella Catarrhalis
what type of hearing loss is presbycusis
sensorineural deafness
what is the first line treatment of acute sinusitis
analgesia and intranasal decongestants
what are the conditions for prescription of intranasal corticosteroids in the management of acute sinusitis
symptoms need to have been present for 10 days
tonsillar SCC is associated with which infection
HPV
unilateral middle ear effusion can be a presenting symptoms of _______________
nasopharyngeal cancer
give the three most common causes of acute otitis media
Strep. Pneumonia
Haemophilus Influenzae
Moraxella Catarrhalis
under what circumstances would you prescribe antibiotics for acute otitis media
<2 with bilateral infection
symptoms lasting > 4 days and not improving
systemic signs
immunocompromise
Otitis media with perforation / discharge
what is the initial management for epistaxis
adequate first aid - pinch nostrils firmly and lean forward for 20 minutes
how do you manage epistaxis if first aid provided for 10-15 mins does not work
cautery : if source of bleed is visible
packing : if bleeding point cannot be visualised
how do you manage epistaxis that has failed all emergency management
Ligation of the sphenopalatine artery in theatre
name 4 medications that can cause tinnitus
Aspirin / NSAIDs
aminoglycosides
quinine
loop diuretics
what are the referral guidelines for suspected laryngeal cancer
consider referral to ENT for those 45 and over with -
persistent unexplained hoarseness
unexplained neck lump
what is the first line management of otitis externa
topical antibiotic or combined topical antibiotic with a steroid
what is the prophylaxis of Meniere’s disease
Betahistine and Vestibular rehabilitation
which medications cause ototoxicity
Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin
Cisplatin
FAVQAC
what is the stepwise management of glue ear ?
- Active observation ( first presentation) for 3 months - unresolving then refer to ENT
** refer immediately to ENT if Down syndrome, Cleft palate
- Grommet insertion
- Adenoidectomy
what is the pathophysiology + symptoms of sialolithiasis
stones in submandibular gland blocking duct of Wharton
discomfort while eating
postprandial swelling
what is the most common parotid malignancy
Benign pleomorphic adenoma
what is the second most common benign parotid tumour
Warthin’s tumour
which parotid disorders might cause facial paralysis
Sarcoidosis
Parotitis
Adenoid cystic adenoma
sialadentitis
mucoepidermoid carcinoma
SPASM
how does glue ear normally present ?
hearing loss
peaks at age of 2
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
what is the most common cause of sudden sensorineural hearing loss? What investigations are performed? How is it managed?
majority of cases - idiopathic
MRI scan generally performed
High dose corticosteroids
what are the key features of vestibular neuronitis ?
recurrent vertigo, nausea and vomiting
horizontal nystagmus
NO HEARING LOSS / TINNITUS
what is the acute and chronic management of vestibular neuronitis
acute : buccal / IM prochlorperazine
chronic : vestibular rehabilitation exercise
what is the cause of black hairy tongue? what are its predisposing factors? how is it investigated and management?
occurs due to defective desquamation of the filiform papillae.
predisposing factors include : poor oral hygiene, abx, HIV, IVDU
tongue should be swabbed for Candida
management is by tongue scraping / topical antifungals
what does the Centor criteria include?
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
what is the fever pain score?
Fever
Purulent tonsils
attend rapidly ( 3 days / less)
Inflamed tonsils
No cough / coryza
what are the symptoms of Meniere’s disease?
recurrent episodes of vertigo, tinnitus and sensorineural hearing loss.
sensation of aural fullness
unilateral symptoms
how does a branchial cyst present ? How is it different from a thyroglossal cyst ?
Smooth, fluctuant, non-tender, non translucent mass located anterior to left sternocleidomastoid muscle that does not move on tongue protrusion. Contains cholesterol crystals.
Thyroglossal cysts are typically midline and move with tongue protrusion.
what is Ludwig’s angina ? How does it present ? How is it managed?
Form of progressive cellulitis that invades the floor of the mouth / soft tissues of the neck. Usually due to odontogenic infections.
Features include :
neck swelling
dysphagia
fever
management is emergency - airways, IV Abx
what are the features of allergic rhinitis ?
sneezing
bilateral nasal obstruction
clear nasal discharge
post nasal drip
nasal pruritis
what is the management of allergic rhinitis?
allergen avoidance
oral / intranasal antihistamines if there are mild / moderate symptoms
intranasal corticosteroids if patient has moderate / severe symptoms
what are the side effects of topical nasal decongestants such as oxymetazoline
increasing doses required to meet same requirements - tachyphylaxis
rebound hypertrophy of nasal mucosa ( rhinitis medicamentosa)
what are the complications of a thyroidectomy?
anatomical : recurrent laryngeal nerve damage
bleeding
hypocalcaemia causing QT elongation
how is otitis media with perforated tympanic membrane managed
antibiotics
what are the guidelines for a 2 week wait referral for oral cancer?
- unexplained ulceration for > 3 weeks
- persistent / unexplained neck lump
- lump on lip
- red / white patch in oral cavity consistent with erythroplakia / erythroleukoplakia
what is the main complication of a tonsillectomy? How is it managed depending on the timeline?
Haemorrhage
first 6-8 hours : Immediate return to theatre
5-10 days post surgery : admission and antibiotics
how do you manage bleeding and stridor post thyroid surgery
urgent removal of sutures
call for help
this is due to risk of respiratory compromise due to laryngeal oedema
what are the causes of sensorineural hearing loss
Sudden
Meniere’s
Noise
labyrinthitis
acoustic neuroma
medications
neurological conditions
infections
what are the causes of conductive hearing loss
ear wax
infection
fluid
eustachian tube dysfunction
choleastoma
tumours
what is the DVLA advice surrounding Meniere’s disease
cease driving until satisfactory control of symptoms is achieved
how does a cystic hygroma generally presents?
congenital lymphatic lesion typically found in the neck on the left side. Generally trans illuminates and sacs are fluctuant
recurrent otitis externa despite numerous antibiotic treatment should raise suspicion for __________
Candida
what is the key feature of peritonsillar abscess
deviation of uvula towards unaffected side
How does vertebrobasilar ischaemia present?
elderly patient with dizziness on extension of the neck
how does otitis externa present on otoscopy
red, swollen or eczematous canal
how would you distinguish warthin’s tumour from pleomorphic adenoma
pleomorphic adenoma is slow growing and benign whereas Warthin’s tumour presents with nearby structure invasion, skin ulceration, skin tethering
what is sialadenitis and how does it present
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct causing tender mass and foul taste
how does nasopharyngeal carcinoma generally present
painless lymphadenopathy in the posterior triangle of the neck
what initial investigation needs to be performed when investigating someone for hoarseness ?
chest xray
how is labyrinthitis different from vestibular neuronitis?
labyrinthitis is when both the vestibular nerve and the labyrinth are both involved, whereas only the vestibular nerve is involved in vestibular neuronitis.
what are the symptoms of labyrinthitis
vertigo
N+V
Hearing loss
tinnitus
what are the signs of labyrinthitis
spontaneous unidirectional nystagmus towards unaffected side
sensorineural hearing loss
abnormal head impulse
gait disturbance
what does a typical BPPV history contain
vertigo triggered by change in head position
nausea
each episode lasting 10-20 seconds
what is a cholesteatoma ? What are it’s main features ? How does it present on otoscopy and how would you manage it?
It is a non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction.
Main features include :
foul smelling, non resolving discharge
hearing loss
vertigo, facial nerve palsy and cerebellopontine angle syndrome may also be present.
otoscopy shows : attic crust
management
refer to ENT for surgical removal
what is a RF for choleastoma?
cleft palate
