ENT Flashcards
What is quinsy ?
Common name for peritonsillar abscess
Arises when there is a bacterial infection with trapped pus forming an abscess in the region of the tonsils.
What are some generic symptoms of quinsy ?
Sore throat
Painful swallowing
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes
What are some additional symptoms that indicate quinsy in addition to the symptoms of tonsillitis ?
Trismus - refers to when the patient is unable to open their mouth
Change in voice - pharyngeal swelling ( hot potato voice )
Swelling and erythema in the area beside the tonsils
What is the most common cause of quinsy ?
Bacterial infection - streptococcus pyogenes
Also - staph aureus and H.Influenza
What is the management of quinsy ?
Incision and drainage
Some ENT surgeons give steroids ( dexamethasone )
What is a tonsillectomy ?
A surgical procedure for the removal of the tonsils
What are some indications for a tonsillectomy ?
Recurrent tonsillitis. NICE requires the number of episodes is :
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
Other indications - recurrent tonsillar abscesses and enlarged tonsils causing difficulty breathing, swallowing or snoring
What are some complications of a tonsillectomy ?
Pain, particularly a sore throat where the tonsillar tissue has been removed.
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks of a general anaesthetic
What is the main significant complication after a tonsillectomy ?
Post tonsillectomy bleeding
What is the management of post tonsillectomy bleeding ?
Call the ENT reg
Get IV access and send bloods - FBC, clotting screen, group and save and cross match
Analgesia
Spit blood rather than swallow
NBM
What is otitis media ?
Infection in the middle ear.
How can bacteria get into the middle ear ?
The bacteria enter from the back of the throat through the Eustachian tube.
A bacterial infection of the middle ear is often preceded by a viral upper resp tract infection
What are the most common bacterial causes of otitis media ?
Streptococcus pneumoniae
Other causes - h. Influenza, Moraxella catarrhalis
How does otitis media present ?
Ear pain
Reduced hearing in the affected ear
Fever
Upper airway infection - cough, coryzal symptoms, sore throat
What is seen on examination in otitis media ?
Use on otoscope
Bulging, red, inflamed looking membrane
What is the management of otitis media ?
Most resolve without antibiotics
Simple analgesia
Consider prescribing antibiotics - amoxicillin
What are some factors in prescribing antibiotics for otitis media ?
Less than 2 years old
Bilateral otitis media
Otorrhoea
What are some complications of otitis media ?
Otitis medial with effusion
Hearing loss
Perforated eardrum
Recurrent infection
Mastoiditis
Abscess
What is glue ear ?
Otitis media with effusion - the middle ear becomes full of fluid, causing a loss of hearing in that ear.
What is the main symptom of glue ear ?
Reduction in hearing of that ear
What is the main complication of glue ear ?
Infection
What would show up on otoscopy in glue ear ?
Dull tympanic membrane with air bubbles
Visual fluid level
What is the management of glue ear ?
Referral for Audiometry to help establish the diagnosis
Glue ear is usually treated conservatively and resolves within 3 months.
What are some conditions increasing the risk of glue ear ?
Down’s syndrome
Cleft palate
What are grommets ?
Tiny tubes inserted into the tympanic membrane by an ENT surgeon.
This is allows fluid from the middle ear to drain through the tympanic membrane to the ear canal.
What are some congenital causes of hearing loss ?
Maternal rubella or cytomegalovirus infection during pregnancy
Genetic deafness
Down’s syndrome
What are some perinatal causes of hearing loss ?
Prematurity
Hypoxia during or after birth
What are some causes of hearing loss that happens after birth ?
Jaundice
Meningitis and encephalitis
Otitis media or glue ear
Chemotherapy
How can hearing loss present in babies ?
Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance
How does sensorineural hearing loss present on an audio gram ?
Both air and bone conduction readings will be more than 20dB.
How does conductive hearing loss present on audio gram ?
Bone conduction readings will be normal however air conduction readings will be greater than 20dB
What is the management of hearing loss ?
MDT
Speech and language therapy
Educational psychology
ENT specialist
Hearing aids for children who retain some hearing
Sign language
What are nosebleeds ?
Originate from kiesselbach’s plexus and occurs when the mucosa is disrupted in the area
What is the presentation of nosebleeds ?
Usually unilateral
Bleeding from both nostrils may indicate posterior bleed
What are some triggers for nosebleeds ?
Nose picking
Colds
Vigorous nose blowing
Trauma
Changes in the weather
What is the management of mild nosebleeds ?
Most resolve without medical assistance
Sit up and tilt head forwards
Squeeze soft part of the nostrils for 10-15 minutes.
Sit nay blood rather than swallowing
What is the management of a nosebleed that lasts longer than 10-15 minutes ?
Nasal packing - nasal tampons or inflatable packs
Nasal cautery using a silver nitrate stick
Consider prescribing naseptin
What is a cleft lip ?
A congenital condition where there is a split or open section of the upper limb. This opening can occur at any point along the top lip and can extend as high as the nose.
What is a cleft palate ?
A defect exists in the hard or soft palate at the roof of the mouth. This leaves an opening between the mouth and the nasal cavity.
What are some complications of a cleft palate or lip ?
Not life-threatening
Significant problems - feeding, swallowing and speech.
Potential impact on mother and child bonding
What is the management of a cleft lip or palate ?
Surgically corrected at 3 months
Leaving a subtle scar
What is tongue tie also known as ?
Ankyloglossia
What is tongue tie ?
A short and tight frenulum - the attachment of the tongue to the floor of the mouth. This prevents them properly extending their tongue out of the mouth
How does tongue tie usually present ?
Poor feeding
Noticed by the mother, midwife or doctor on newborn checks
What is the management of tongue tie ?
Frenotomy
What are some complications of tongue tie ?
Excessive bleeding
Scar formation
Infection
What is a cystic hygroma ?
A malformation of the lymphatic system that results in a cyst filled with lymphatic fluid.
Congenital abnormality and located in the posterior triangle of the neck on the left side
What are some key features of cystic hygroma ?
Present in the neck or armpit
Large, soft, non tender and transilluminate
What are some complications of cystic hygroma ?
Can interfere with feeding, swallowing or breathing
What is the management of cystic hygroma ?
Watching or waiting
Aspiration, surgical removal and sclerotherapy
How does a thyroglossal cyst develop ?
During foetal development the thyroid gland starts at the base of the tongue.
From here it gradually travels down the neck to its final position in front of the trachea.
It leaves a track behind called the thyroglossal duct which then dissappears.
When part persists a fluid filled cyst can develop.
what is the main complication of a thyroglosal cyst ?
Infeciton of the cyst
What are some features of thyroglossal cysts ?
Occur in the midline of the neck
Mobile, non-tender, soft and fluctuant
how is a diagnosis of thyroglossal duct made ?
USS or CT scan
What is the management of thyroglossal cysts ?
Usually surgically removed
The cyst can reoccur after surgery unless the full thyroglossal duct is removed.
What is a branchial cyst ?
A congenital abnormality arising when the second branchial cleft fails to properly form during foetal development.
This leaves a space surrounded by epithelial tissue which can fill with fluid.
How does branchial cysts present ?
A round, soft, cystic swelling between the angle of the jaw and the SCM in the anterior triangle of the neck.
What is a sinus ?
Blind ending pouch
What is a fistula ?
An abnormal connection between two epithelial surfaces.
What is a branchial cleft sinus ?
Describes when the branchial cyst is connected via a tract to the outer skin surface. There will be a small hole visible in the skin beside the cyst.
What is a branchial pouch sinus ?
Describes when the branchial cyst is connected via a tract to the oropharynx
What is a branchial fistula ?
Describes when there is a tract connecting the oropharynx to the outer skin surface via the branchial cyst.
What is the management of a branchial cyst ?
Where there is no functional or cosmetic issues conservative treatment may be appropriate
Recurrent infections or functional or cosmetic issues may require surgical excision
