ENT Flashcards
What are the typical features of BPPV
Vertigo triggered by change in head position and movement, associated with nausae and lasts between 10-20 secs
Episodes for several weeks then resolve for a while
Calcium carbonate crystals- viral infection head trauma or no clear cause
Positive dix hallpike - will have rotatory nystagmus and vertigo when done
Epley manoeuvre can give relief
What is prebycusis
Age related sensorineural hearing loss
Gradual onset
Loss of high pitched noise
Audiometry will show bilateral high frequency hearing loss
What is otosclerosis
Autosomal dominant condition
Conductive hearing loss due to bone remodelling
Mainly affects the base of the stapes
Hearing loss and tinnitus
Normal bone is replaced with spongey bone - conductive deafness, tinnitus
Management
Conservative hearing aids
Surgical- stapedectomy or stapedotomy
What is glue ear
Otitis media with effusion
Peaks at 2 yrs old
Hearing loss - common cause of conductive hearing loss in childhood
speech and language delay
What is Meniere’s disease
Endolymph build up
More common in middle aged adults
Vertigo, tinnnitus and sensorineural hearing loss
Sensation of fullness in the ear- trio- hearing loss, vertigo, tinnitus
Attacks will last several hours and not position related
Nystagmus during attacks - hearing will gradually deteriorate over time
Positive Romberg test and nystagmus
Treat with Betahistine to reduce attacks F
What drugs can cause ototoxicity
Gentamicin or other aminoglycosides, furosemide, aspirin
What are the features of noise damage hearing loss
Bilateral hearing loss worse at frequencies of 3000-600Hz
What are the features of an acoustic neuroma (vestibular scwannoma)
Depends on affected cranial nerve
CN VIII: Hearing loss, vertigo, tinnitus
CN V- Absent corneal reflex
CN V11: facial palsy
Bilateral acoustic neuromas are seen in neurofibromatosis type 2
Patients usually around 40-60
What are the features of viral labrinthitis
Usually between 40-70 yrs
Acute onset can be triggered by viral/ bacterial infection or systemic disease
Hearing loss distinguishes it from vestibular neuritis
Acute onset- vertigo not triggered by movement
Nausea and vomiting, hearing loss and tinitus
Preceeding upper resp tract infection
Unidirectional horizontal nystagmus towards unaffected side
Sensorineural hearing loss
What is the management of sudden onset sensorineural hearing loss
Urgent ENT referral
Usually idiopathic
Need a loss of at least 30 decibels in 3 different frequencies on audiogram
MRI scan needed to exclude vestibular schwannoma
High dose oral corticosteroids needed can also have intra-tympanic steroids
What shows for Rinne’s and Webers if hearing loss is conductive
Rinne’s
Bone conduction is greater than air conduction in the affected ear
Air conduction is better than bone conduction in the unaffected ear
Weber’s
Lateralises to the side of the affected ear
What are the features of Rinne’s and Weber’s if the hearing loss is sensorineural
Air conduction better than bone conduction bilaterally- Rinne’s positive
Lateralises to the unaffected ear
What are the features of acute otitis media
Associated with URTIs - strep penumonaie, haemophilus influenzae, moraxella catarrhalis, staph aureus
Otalgia, hearing loss, fever, bulging tympanic membrane
Pearly grey shiny
Management
Self limiting
Analgesia
If symptoms last more than 4 days or immunocompromised, perforated or discharge in the canal- give abx
5-7 days amoxicillin (clarith if allergy)
Eryth if pregnant and allergic to pen
What is the management of epistaxis
Sit forward with mouth open- pinch cartilage for 20 mins
Use topical antiseptic - Naseptin - CONTAINS PEANUTS
Cautery if source of bleeding is visible
Packing can be used if cautery not able
What are the features of vestibular neuronitis and how is it treated
Inflam of the vestibular nerve usually due to viral infection
Symptoms most severe for the first day or days xf
-Recurrent vertigo attacks lasting hours/days
-Nausea and vomiting
-Horizontal nystagmus
-No hearing loss/ tinnitus
Management
Buccal/ IM prochloperzine for rapid relief
Oral procholperazine or antihistamine if less severe
If chronic- vestibular rehab exercises
What is the treatment for auricular haematoma
Rugby players and wrestlers- avoid cauliflower ear
Need same day ENT assessment
Incision and drainage needed
What are the features of the feverPAIN score for tonsilitis
1 point for each - max score 5
Fever over 38
Purulence
Attended within 3 days or less
Severely inflamed tonsils
No cough/ cold
10 day course of phenoxymethylpenicillin or clarithromycin
What are the causes of sensorineural hearing loss
Sudden sensorineural hearing loss (less than 72 hrs)
Presbycusis (age related)
Noise exposure
Menireres disease
Labyrinthitis
Acoustic neuroma
Neurological conditions - stoke MS, brain tumours
Infections
Meds
Loop diuretics
Aminoglycoside antibiotics
Chemo
What are the features of conductive hearing loss
Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perf tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours
What audiometry findings will be present in sensorineural hearing loss
Both air and bone conduction will be more than 20DB
Below the 20DB line
What are the audiometry findings will be present in conductive hearing loss
Normal bone conduction readings between 0-20DB
Air conduction will be greater than 20DB
Below the 20 DB level
Think that 20DB is quiet so patients with hearing loss can’t hear this and will only hear louder sounds
What are the features of eustachian tube dysfunction
Fluid can’t drain freely from the middle ear
Can be related to URTI, allergies or smoking
Reduced hearing, popping noise, fullness, pain, tinnitus
Otoscopy
Management
No treatment
Valsalva manoueurvre
Decongestant
Antihistamines and steroid nasal sprays
Surgery
Adenoidectomy
Grommets
Balloon dilatation eustachian tuboplasty
What are the features of otitis externa
Can be acute or chronic
Swimmers ear
Bacterial (pseudomonas aeruginosa (gram neg rod shaped)/ staph aureus/ fungal infection/ eczema
Can treat pseudomonas aeruginosa- treat with gent/ quinolones/ ciprofloxacin
Don’t give aminosalicylates gent etc if there is a perforated tympanic membrane- ototoxic
Ear pain, discharge, itchy, conductive hearing loss
Management
Mild- acetic acid 2% - antifungal and antibacterial
Prophylactic before and after swimming
Moderate - topic antibiotic and steroid eg. neomycin and dex
Severe- oral abx
Ear wicks can be used
If fungal- clotrimazole ear drops
What are the features of malignant otitis externa
Severe and life threatening
Spreads to bones around ear
Osteomyelitis of temporal bone
Diabetes, immunosuppression, HIV
Headache, severe pain and fever
Granulation tissue between the bone and cartilage in ear
Admit to hosp
Iv abx
Imaging
What are some red flags associated with tinnitus
Unilateral
Pulsatile
Hyperacusis
Unilate hearing loss
Sudden onset hearing loss
Vertigo/ dizzy
Headaches
Neuro symptoms
Suicidal ideation
What are some central causes of vertigo
Posterior circulation infarction- sudden onset- ataxia, diplopia, cranial nerve defects, limb symptoms
Tumours
MS- relapsing and remitting
Vestibular migraine– mins to ours- aura and headache
What are the features of the cerebellar examination
DANISH
Dysdiadochokinesia
Ataxia gait (walk heel to toe)
Nystagmus
Intention tremor
Speech
Heel shin test
What special tests are used to diagnose vertigo
Rombergs test- proprioception and vestibular function
Dix-Hallpike - diagnose BPPV
HINTS Head impulse, nystagmus, test of skew to distinguish peripheral and central vertigo
What are the features of cholesteatoma
Squamous epithelial cells
Foul discharge
Unilateral conductive hearing loss
Infection pain vertigo facial nerve palsy
How is bells palsy treated
Unilateral lower motor neurone
Treat with prednisone
50mg for 10 days
60mg for 5 days followed 5 days reducing regime of 10mg a day
Lubricating eye drops
How is ramsay hunt treated and presented
VCZ
LMNL
Painful tender vesicular rash in ear
Pred and aciclvir
How is a nose bleed managed
Sit up tilt head forward, squeeze nostrils spit out blood don’t swallow
Wait 10-15 mins
If doesn’t stop
Nasal packing- nasal tampons/ inflatable packs
Nasal cautery
After acute nosebleed- naseptin nasal cream 4x/ day for 10 days
Can’t give in peanut allergy
What is the treatment for sinusitis
Nothing with symptoms for up to 10 days- viral can take 2-3 weeks to resolve
If symptoms not improving in 10 days give
High dose nasal steroid for 14 days
A delayed abx prescprtion if not improving in another 7 days - phenoxymethylpenicillin
Can predispose to nasal polyps- usually bilateral
Unilateral nasal polyp- red flag
What are the features and treatment of tonsillitis
Viral infection usually
Bacterial causes- group A strep (Pen V)
Strep pneumonia, Hib, Morazella, staph aureus
Palatine tonsils usually affected
Sore throat, fever above 38, pain on swallowing- red inflamed tonsils, cervical lymphadenopathy
FeverPAIN score 4-5 65% probability of it being bacterial
Fever in 24 hrs
Purulemce
Attending within 3 days onset
Inflamed tonsils
No cough
Management
Simple analgesia if viral suspected
Fever pain >4 antibiotics- pen V 10 days or clarity if pen allergic
Complication- peritonsilar abscess- quincy
What are the features of quincy
Peritonsilar abscess
Sore throat, painful swallow, fever, neck pain, ear pain, tender lymph nodes
Trismus- can’t open mouth
Change in voice - hot potato voice
Swelling
Bacteria- usually group A strep
Urgent ENT refer - needle aspiration and surgical incision
Dexamethasone to settle inflam and broad spec abx- coamoxiclav
What are the features of infectious mononucleosis
EBV
Fever sore throat fatigue lymphadenopathy
Intense maculopapular rash in response to amoxicillin or cefalosporins
First line monospot test
Management supportive- avoid alcohol and contact sports
What are the features of carotid body tumours
painless, pulsatile, bruit on auscultation, mobile side to side but not up and down
Carotid body tumours can compress nerves of the face- can cause a Horner’s syndrome
Ptosis, mitosis, anhidrosis
What is the difference between a thyroglossal cyst and a brachial cyst
Thyroglossal cyst
Mobile, non tender, soft, fluctuant - Can become infected and painful
Brachial cysts- round soft cystic between angle of jaw and sternocleidomastoid
How is squamous cell carcinomas of the head and neck
Cetuximab- monoclonal antibody
