ENT Flashcards
When should prochlorperazine be used in vestibular neuronitis?
In the acute phases only as it can delay recovery if used long term
What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?
HiNTs exam - head impulse test, test of skew and assessing nystagmus
What are the red flags of chronic rhinosinusitis?
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis
Vestibular neuronitis vs acute labyrinthitis?
Hearing will not be affected in VN
Ear swelling/rash behind the ear in someone with ?otitis media
Same day referral to Paeds ?Mastoiditis
Horizontal nystagmus is a sign of what?
Vestibular neuronitis
How should a perforated ear drum be managed?
Refer to ENT if persists beyond 6 weeks
What is a C/I to prescribing naseptin cream?
peanut, soy or neomycin allergies
conductive hearing loss, tinnitus and positive family history
Otosclerosis
bilateral high-frequency hearing loss suggests what?
Prebycusis
What are the 2 common post op complications of tonsillectomy?
- Pain
- Haemorrhage
How does haemorrhage present following tonsillectomy?
Primary: Within 6-8 hours following surgery -> needs immediate return to theatre
Secondary: 5-10 days after surgery usually associated with wound infection -> treated with admission/abx
When should intranasal steroids be considered for sinusitis?
If symptoms have been present for 10 days or more
What is the management of acute sensorineural hearing loss?
Urgent referral to ENT for audiology and brain MRI
What is Ludwigs angina?
A progressive cellulitis which invades floor of the mouth and soft tissues of the neck usually following dental infection
How does Ludwigs angina present?
- Neck swelling
- Dysphagia
- Fever
- Needs immediate referral to hospital for airway management and IV Abx
Management of post op stridor for thyroidectomy?
Urgent removal of sutures and call for senior help
What does post thyroidectomy stridor suggest?
Post op bleed which build pressure behind suture line and compresses trachea causing stridor
What are the NICE indications for tonsillectomy?
- Sore throats due to tonsillitis
- 5 or more episodes per year
- Symptoms occurring for atleast 1 year
- Episodes of sore throat are preventing normal function
What is the most common cause of bacterial otitis media?
H influenzae
What does pain on palpation of the tragus, itching, discharge and hearing loss suggest?
Otitis externa
What is the management of a patient with persistent hoarse voice?
Refer to ENT
What causes gingival hyperplasia?
phenytoin, ciclosporin, calcium channel blockers and AML
When should Abx be given for acute otitis media?
- Symptoms lasting more than 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromise or high risk of complications
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
Which drugs cause tinnitus?
- Aspirin/NSAIDs
- Aminoglycosides e.g gentamicin
- Loop diuretics
- Quinine
What is the most important part of the tympanic membrane to visualise in patients with chronic discharge?
Attic - rule of cholesteatoma
After referral to ENT, patients with sudden onset sensorineural loss should be given what?
high-dose oral corticosteroids
What is an indication of positive Dix-Hallpike?
Rotatory nystagmus
What can be used to shrink nasal polyps?
Intranasal steroid spray/drops
What is the biggest risk factor for malignant otitis externa?
Diabetes Mellitus
What is the most common cause of sudden onset sensorineural hearing loss?
Idiopathic
What is a complication of nasal trauma?
Nasal septal haematoma
What is a nasal septal haematoma?
- Bilateral red swelling arising from the nasal septum
- Needs ENT referral for surgical drainage and IV Abx
What are signs of more severe otitis externa?
- a red, oedematous ear canal which is narrowed and obscured by debris
- conductive hearing loss
- discharge
- regional lymphadenopathy
- cellulitis spreading beyond the ear
- fever
How should otitis externa be managed?
Topical Abx or Abx + Steroids
How to interpret audiograms?
- is there anything below 20dB
yes = move to step 2
no = normal hearing - is there a gap? (b/w air and bone conduction)
yes = conductive or mixed hearing loss
no = sensorineural hearing loss - is one below or both below the 20dB line
one = conductive
both = mixed
What would be the results of audiometric testing for presbycusis?
Bilateral high-frequency hearing loss with air conduction better than bone
Patient with black/brown/green tongue?
- Think black hairy tongue
- More common in those with poor hygiene/IV drug users/HIV
- Treated with tongue scraping/antifungals if candida
What can occur after trauma to the ear?
Auricular haemtoma - needs same day assessment by ENT for drainage
What is the first line oral abx for otitis externa?
Oral Flucloxacillin
What is the management of otitis externa in diabetics?
Ciprofloxacin ear drops to cover for Pseudomonas
Elderly patient dizzy on extending neck/moving head up?
Vertebrobasilar ischaemia
Managament of Children presenting with glue ear with a background of Down’s syndrome or cleft palate
Refer to ENT
Epistaxsis management?
- Direct compression
- Nasal cautery
- Nasal packing
- Aggressive therapies such as balloon catheter
Why do FBC when someone has epistaxis?
- Assess HB
- Assess platelet count
What is the term for pain upon swallowing?
Odynophagia
What is the name of the lymph node commonly enlarged in tonsillitis?
Jugulodigastric lymph node
What does difficulty swallowing solids suggests vs solids and liquids?
Solids - stricture issue (benign or malignant)
Both - motility issue
Management of oesophageal carcinoma
- Surgery
- Chemoradiotherapy
Recurrent otitis externa despite antibiotic treatment?
Candida
Unilateral symptoms in someone with chronic rhinosinusitis?
Urgent referral to ENT
dysphagia, regurgitation, halitosis, and a bulging neck on swallowing
Pharyngeal pouch
Branches of the facial nerve
Two Zebras Bite My Cake
Temporal
Zygomatic
Buccal
Mandibular
Cervical
What are long term impacts of Bells?
- Damage to eye
- Inability to close eye
- Altered taste
- Psychological impacts
What is vertigo?
The illusion of movement
Pathophysiology of BPPV
Debris in the semi circular canals which are disrupt movement of endolymph
How do childrens and adult eustachian tubes differ?
Childrens is shorter, narrower and more horizontal
What are the 4 paranasal sinuses?
Ethmoid, Frontal, Maxillary, Sphenoid
What are risk factors for head and neck cancers?
- Smoking
- HPV 16
- EBV
- Immunosuppression
- FH
Loss of corneal reflex
Acoustic neuroma
Unilateral glue ear in an adult
Refer to ENT to rule out posterior nasal space tumour
Prophylaxis of sinusitis?
Intranasal corticosteroids
What does ulnar deviation in someone with tonsillitis suggest?
Peritonsilar abscess- Quinsy
Atypical lymphocytes on blood film are suggestive of what?
Infective mono
palatal petechiae + cervical lymphadenopathy are suggestive of what?
Glandular fever
What can deranged LFTs with sore throat be indicative of>
Infective mononucleosis
What anaemia can infective mono cause?
Cold Haemolytic anaemia - IgM
OSA can cause what?
HTN
What are risk factors for OSA?
- Obesity
- Macroglossia (acromegaly, hypothyroidism)
- Large tonsils
- Marfans
What acid base problem can OSA cause?
Compensated respiratory acidosis
Epistaxis which fails all management may require ligation of what?
Sphenopalatine ligation
What are signs of quinsy?
- Deviation of uvula to unaffected side
- Trismus
- Reduced neck mobility
- Bulging of the soft palate
Which organism cause quinsy?
Strep pyogenes
Management options for nasal fractures?
- See in clinic in a week to allow swelling to subside
- Manipulate under anaesthetic
Discharge from nose which tests positive for beta-2 transferrin?
CSF
Why should haematomas be aspirated as soon as possible?
Risk of avascular necrosis
What is a cholesteatoma?
Overgrowth of keratinised squamous epithelium in the middle ear
What can suggest cholesteatoma on otoscopy?
- Discharge
- Attic crust
- Retracted/Perforated tympanic membrane
What are complications of cholesteatoma?
- Facial nerve palsy
- Meningitis
- Abscess
- Deafness
- Recurence
What are signs of thyroglossal cyst?
- Moves up when protruding tongue
- Mobile
- Non tender
What causes trismus in quinsy?
Pus causes the pterygoid muscles to go into spasm which prevents a patient from opening their mouth
Post tonsillectomy haemorrhage?
Refer for same day ENT assessment even if bleeding has resolved
Hearing impairment post head trauma?
Perforated tympanic membrane
What is the name for a malignant tumour of the parotid gland?
Adenoid cystic carcinoma
Most common bacteria which cause otitis externa?
- Staph aureus
- Pseudomonas
What can be exacerbated in pregnancy?
Otosclerosis
Pink tinge to tympanic membrane?
Schwarze sign -> otosclerosis
What can be a S/E of removal of mastoid abscess?
Unilateral facial weakness -> facial nerve runs close to the mastoid
Which sinus is most commonly involved in chronic sinusitis when mucus drains out upon leaning forward?
Maxillary
Which virus is associated with squamous cell carcinoma of the oropharynx?
HPV
What is the pathophysiology of Menieres?
Excessive build up of endolymph in inner ear which increases pressure and disrupts sensory signals -> sensorineural hearing loss
What are symptoms of Ramsay-Hunt?
- Vesicular rash
- Facial weakness
- Vertigo
- Headaches
- Fever
- Tinnitus
What is a complication of untreated tonsillitis?
- Parapharyngeal abscess
- Lemeirre’s syndrome: infective thrombophlebitis
What is the most common tumour of parotid gland?
Pleomorphic adenoma -> benign
Bilateral conductive hearing loss and tinnitus in young person?
Think otosclerosis
Snoring in someone with chronic sinusitis?
Nasal polyps have formed -> nasal steroid drops needed
Management of otosclerosis?
- Hearing aids
- Stapedectomy is gold standard
Unilateral glue ear?
Red flag -> nasopharyngeal carcinoma
Chinese person with history of EBV infection and one sided hearing loss?
Nasopharyngeal tumour
p16 is a marker for what?
HPV -> squamous cell carcinoma of oropharynx
What is temporo-mandibular joint dysfunction?
Pain in jaw with difficulty moving it as well as clicking/popping in the jaw when opening mouth
What can trigger temporomandibular dysfunction?
Trauma to the jaw
Stress
Management of TMD?
Resting, address triggers and ENT referral if severe
