ENT Flashcards
What are some features of BPPV?
- Vertigo triggered by change in head position
- May be associated with nausea
- Each episode typically lasts 10-20 seconds
- Positive Dix-Hallpike
Vertigo, tinnitus and hearing loss is most likely to indicate?
Meniere’s disease
What is the management for acute attacks of Meniere’s disease?
Buccal or IM prochlorperazine
What is the management for prevention of Meniere’s disease?
Betahistine and vestibular rehabilitation exercises may be of benefit
Features of Viral Labyrinthitis?
- Recent viral infection
- Sudden onset
- Nausea and vomiting
- Hearing may be affected
Features of Vestibular neuronitis?
- Recent viral infection
- Recurrent vertigo attacks lasting hours or days
- No hearing loss
What are some differentials for tonsillitis?
Pharyngitis: Symptoms include sore throat, fever and headache, unlike tonsillitis patients do not usually have lymphadenopathy
Mononucleosis: Characterized by fatigue, sore throat, fever and swollen lymph nodes. Key difference is the presence of extreme fatigue and splenomegaly
What is Lemierre’s Syndrome?
It is a complication of tonsillitis where inflammation leads to pharyngotonsillitis, inflammation within the internal jugular vein and septic emboli.
Treatment may require high-dose benzylpenicillin and surgical debridement.
What is a retropharyngeal abscess?
It is a rare complication of tonsillitis characterised by soft tissue swelling, more common in young children. Symptoms include a stiff and extended neck and refusal to eat or drink.
What is the most common complication of tonsillitis?
Recurrent tonsillitis.
What are some risk factors for head and neck neoplasms?
- Smoking
- Alcohol misuse
- Viral Infections, HPV (Specifically type 16) and EBV
- Exposure to radiation, including both UV and ionizing radiation
- Immunosuppression
- Occupational exposure to harmful substances like acid mists, asbestos, wood dust
- Family history
What are some indications for Adenoidectomy?
- Recurrent or persistent otitis media (due to obstruction of the eustachian tube by enlarged adenoids)
- Adenoid hypertrophy resulting in upper airway obstruction
- In association with a tonsillectomy for recurrent tonsillitis
- Recurrent or chronic sinusitis or adenoiditis
- Dysphagia with failure to thrive
- Speech impairment
What type of reaction is Allergic Rhinitis?
Type 1 hypersensitivity reaction
What is the first-line treatment of otitis externa?
- Topical antibiotic or a combined topical antibiotic with a steroid
What is the treatment of Ramsey Hunt syndrome?
Oral Aciclovir (800mg orally 5 times a day for 7 days) and corticosteroids (Prednisolone 60mg orally daily for 5 days)
What bacteria are commonly implicated in Otitis Media?
Streptococcus Pneumoniae
Haemophilus Influenzae
Moraxella Catarrhalis
What is the management of recurrent or chronic sinusitis?
- Avoid Allergen
- Intranasal corticosteroids
- Nasal irrigation with saline solution
What are some red flag symptoms in Chronic Sinusitis?
- Unilateral symptoms
- Persistent symptoms despite compliance with 3 months of treatment
- Epistaxis
What are some complications of Rhinosinusitis?
- Persistent infection
- Orbital Cellulitis
- Intracranial involvement: Meningitis and encephalitis
- Mucoceles
- Osteomyelitis
- Pott’s puffy tumour (Subperiosteal abscess)
What is a cholesteateoma?
Cholesteateoma is a complication of chronic otitis media caused by the abnormal accumulation of skin, squamous epithelium within the middle ear cleft and mastoid air cells
What is the diagnostic criteria for acute rhinosinusitis?
Sudden onset of symptoms for less than 12 weeks duration including one of:
Nasal blockage/congestion OR nasal discharge
Facial pain/pressure OR loss/reduction of sense of smell
What bacteria are commonly implicated in Otitis Externa?
- Pseudomonas Spp
- Staphylococcus Aureus
What are the clinical features of mastoiditis?
Similar symptoms and signs of acute otitis media in addition to inflammation over the mastoid process (retro-auricular), pinna protrusion, and loss of post-auricular sulcus.
What are the clinical features of a cholesteateoma?
A cholesteateoma presents with persistent foul smelling discharge, headache and otalgia
What is the management of a Cholesteatoma?
Surgical intervention to remove the abnormal skin and squamous epithelium accumulation. This approach helps prevent severe complications such as facial nerve palsy and CNS complications
What imaging is recommended for a suspected middle ear cholesteatoma?
High-resolution CT scan of the petrous temporal bone
What is a Schwartze sign and when is it seen?
It is reddish discoloration of the promontory seen during otoscopic examination .
The discoloration is the result of the increased blood flow to the promontory due to the characteristic otosclerotic lesion.
Occurs in up to 10% of patients with otosclerosis
What structures are in the inner ear?
- Semicircular canals
- Vestibule (Middle section)
- Cochlear
What is the most common cause of a perforated tympanic membrane?
Infection
Other causes include barotrauma or direct trauma
What is the management of a perforated tympanic membrane?
- No treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks.
- Refer to ENT if not resolving within this time
What would you find on otoscopy in 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
When should you prescribe antibiotics in otitis media?
- Symptoms lasting more than 4 days and not improving
- Systemically unwell
- Immunocompromise
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canacl
What is Presbycusis?
Type of sensorineural hearing loss that affects elderly individuals.
Occurs as sensory hair cells and neurons in the cochlea atrophy over time.
What is the treatment of Ramsey Hunt syndrome?
- High dose aciclovir
- High dose steroids
- Eye protection
What drugs give you Gingival hyperplasia?
Phenytoin
Ciclosporin
CCBs
AML
What are the main features of Cholesteatoma?
- Foul-smelling, non resolving discharge
- Hearing loss
What is the management of cholesteatoma?
Patients are referred to ENT for consideration of surgical removal
Where is the most likely source of bleeding in Epistaxis?
Kiesselbach’s plexus
If bleeding in Epistaxis does not stop after 10-15minutes of continuous pressure what should you do?
- If you can see the bleed –> Cautery
- If no obvious source of bleeding –> Packing
What should be done for patients with epistaxis that have failed all emergency management?
May require sphenopalatine ligation in theatre
When should someone with acute sensorineural hearing loss be seen?
It is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI
What symptoms can impacted ear wax cause?
- Pain
- Conductive hearing loss
- Tinnitus
- Vertigo
What are some risk factors for Glue ear?
- Male sex
- Siblings with glue ear
- Higher incidence in winter/spring
- Day care attendance
- Parental smoking
- Bottle feeding
What is Little’s area?
Little’s area in the anterior nasal septum is the site of Kiesselbach’s plexus, supplied by 4 arteries. Epistaxis therefore most commonly originates from the anterior of the nose.
What predisposing factors are there for Black Hairy tongue?
- Poor oral hygiene
- Antibiotics
- Head and neck irradiation
- HIV
- IVDU
How do you get black hairy tongue?
Results from defective desquamation of the filiform papillae
What is Ludwig’s Angina?
Life-threatening cellulitis of the soft tissues involving the floor of the mouth and neck
What are the features of nasal polyps?
- Nasal obstruction
- Rhinorrhoea, sneezing
- Poor sense of taste and smell
What is the management of 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
What is a red flag symptoms of nasal polyps?
Unilateral polyps
What are the features of a thyroglossal cyst?
Usually midline, between the isthmus of the thyroid and the hyoid bone.
Moves upwards with protrustion of the tongue
Why should you refer urgently for Unilateral glue ear?
They need evaluation for a posterior nasal space tumour
What are the red flag signs of a neck lump that point towards malignancy?
- A hard and fixed mass
- The patient is over 35 years old
- The presence of a mucosal lesion
- A history of persistent hoarseness or dysphagia
- The presence of Trismus
- The presence of unilateral ear pain
What is the initial management for epistaxis?
Lean forward and apply pressure to pinching the outside of their nose just above the nostrils for 15 minutes
What is the management for septal haematoma?
Immediately refer to ENT for incision and drainage under general anaesthetic.
Must be done quickly to preserve blood supply to the nasal cartilage. Untreated can lead to saddle-nose deformity
What is Samter’s triad?
Asthma, Aspirin sensitivity and nasal polyposis
What is the penicillin allergy alternative for tonsillitis?
Clarithromycin
What should you do in primary haemorrhage following tonsillectomy
Immediate return to theatre
Primary haemorrhage = 6 to 8 hours following tonsillectomy
What is Ramsey Hunt caused by?
Herpes Zoster Oticus
Why do Auricular Haematomas require urgent referral to ENT?
They are a build up on blood between the cartilage and perichondrium.
They can restrict blood supply and lead to necrosis of the connective tissue/
What is the treatment of Quinsy?
Needle aspiration or I&D + IV Antibiotics, some may use steroids
What are the symptoms of Nasopharyngeal carcinoma?
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/or epistaxis
Cranial nerve palsys
What is the management of a nasal septal haematoma?
- Surgical drainage
- Intravenous antibiotics
What type of nystagmus indicates BPPV on Dix-Hallpike manouvre?
Vertical Nystagmus
In what condition would you see bilateral vestibular schwannomas?
Neurofibromatosis type 2
What is the investigation of choice for vestibular schwannomas?
MRI Cerebellopontine angle
Why do you get trismus in quinsy?
The pus causes the pterygoid muscles to go into spasm preventing them
from opening their mouth.
What lymph node is most commonly involved with a quinsy?
Jugulodiagastric lymph node
