ENT Flashcards
Acute viral Labrynthitis presentation:
- Sudden onset horizontal nystagmus towards unaffected side, nausea, vomiting, hearing disturbances, a cold in the past few days, hearing loss, tinnitus, vertigo(not triggered by movement, exacerbated-made worse by movement)
ddx: Vestibular Neuronitis= except hearing would not be affected in this condition.
Acute viral labrynthitis: sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo
Meniere’s disease presentation difference:
- Presents with aural fullness
- Has similar features to Viral Labrynthitis but is a more recurrent condition
-Duration: Episodes lasts for MINutes to hours
Symptoms: Unilateral hearing loss and Tinnitus - ENT assessment is required to confirm the diagnosis.
Mx: Acute attack- Buccal/IM Prochlorperazine and might need admission. Prevention: Betahistine and vestibular rehab exercises.
-Patients should inform DVLA.
- Presbyacusis presentation:
- Bilateral age related hearing loss
-Progressive bilateral sensorineural hearing loss
-Typical audiogram: Bilateral Impairment, high frequency hearing loss, downward sloping pure-tone thresholds.
Ddx: Acoustic Neuroma: would present with unilateral hearing loss and nausea/vomiting are common
Cholesteatoma Presentation:
- Unilateral hearing loss
- Otoscopy: would show a pearly white lump in the tympanic membrane
- Audiogram: Conductive hearing loss
Osteoma Presentation:
- ear canal bony growth commonly seen in cold water swimmers
- ## conductive hearing loss on audiogram
Otosclerosis Presentation:
- Is a hereditary condition where the stapes(smallest inner most bone of ear) of the ear are fixed.
- Hearing loss becomes noticeable before middle age.
- Causes conductive hearing loss
Red flags for chronic sinusitis:
- Unilateral symptoms(as cancer of nasopharynx is more likely to produce one sided symptoms depending on its location.
- Pain worse on leaning forwards is a classical sign of sinusitis.
- other features: nasal pain, post nasal drip, mouth breathing
Tonsillitis Diagnosing criteria for a BACTERIAL cause:
CENTOR score(4 characteristics)-
1. Temp more than 38 degrees
2. Tender anterior cervical lymphadenopathy
3. ABSENCE of a cough
4. Exudate present on tonsils
- if person has 3/4 of these criteria, diagnosis is likely.
- is similar to the fever pain score
Quinsy (Peri-tonsillar Abscess):
Is a complication of bacterial tonsillitis.
- Presentation: severe throat pain on one side, deviation of uvula to unaffected side, difficulty opening mouth, reduced neck mobility.
- Patients need urgent review by specialist
Mx: IV Antibiotics+needle aspiration(or incision or drainage)+ consider tonsillectomy in a few weeks.
BPPV Presentation:
- Vertigo is caused by change in position and only lasts for seconds, there is no change in hearing.
Rinne’s and Weber’s test:
Rinne Weber
Positive ( normal) Normal
- Air conduction > bone Sound heard equally in both ears
- Healthy individuals
- Individuals with significant sensorineural hearing loss
Negative Sensorineural hearing loss
- Suggests conductive hearing loss Sound heard louder on side of intact ear(on normal ear, sound is louder)
Conductive hearing loss
Sound is heard louder on affected ear(sound is louder on pathology ear)
Horizontal nystagmus is a feature of which condition?
Vestibular Neuronitis
- Also presents with viral URTI beforehand
Vestibular Neuronitis:
- Caused by inflammation of vestibular nerve.
- Presents with: Vertigo, nausea, vomiting, balance problems
-Horizontal Nystagmus
Acoustic Neuroma (4 classical features) :
- Tinnitus
- Vertigo
- Hearing Loss (caused by tumour pressing on cranial nerve 5)
- Therefore can also cause an absent corneal reflex
-Symptoms get worse with each episode
Otitis Externa (question will say: external auditory canal) management?
1st line Treatment: Topical antibiotics with or without steroid eg: topical ciprofloxacin and dexamethasone
- Recent swimming is risk factor: mx with: Neomycin + dexamethasone ear spray
