ENT Flashcards
Four main features of vestibular neuronitis
- Vertigo
- Nausea + vomiting
- Horizontal nystagmus
- NO hearing loss or tinnitus
What examination can be used to distinguish vestibular neuronitis from posterior circulation stroke
HiNTs exam
Management of vestibular neuronitis (vertigo, N+V, nystagmus, NO hearing loss or tinnitus)
- Buccal or IM prochlorperazine
- Oral prochlorperazine or antihistamine for less severe cases for 1 week only then review
- Chronic symptoms for 6 weeks or more - vestibular rehabilitation exercises
Criteria for cochlear implant
- Children - issues developing basic auditory skills
- Adults - trialled hearing aids for at least 3 months with no improvement
Differences between allergic rhinitis:
(a) seasonal
(b) perennial
(c) occupational
(a) seasonal - same time each year
(b) perennial - throughout the year
(c) occupational - work place allergens
Management of allergic rhinitis
- Oral or intranasal anti-histamines if mild to moderate symptoms
- Intranasal corticosteroids if moderate to severe symptoms
- Short course of corticosteroids to cover important life events
Note short courses of topical nasal decongestants can lead to rebound symptoms if used for long time
3 red flags for sinusitis
- unilateral symptoms
- persistent symptoms despite compliance with 3 months of treatment
- epistaxis
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
what neck lump is this
thyroglossal cyst
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
what neck lump is this
cystic hygroma
An oval, mobile cystic mass that develops between SCM muscle and pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Can present after URTI
what neck lump is this
brachial cyst
Patients with this neck lump - 10% of them develop thoracic outlet syndrome. What is the lump/mass?
Cervical rib
Management of otitis externa
- Topical antibiotic or combined with steroid
- If tympanic membrane is perforated then avoid aminoglycoside
- If canal is swollen then ear wick is sometimes inserted
- If infection spreading then use oral flucloxacillin +/- antifungal
If a patient fails to respond to topical antibiotics in otitis externa what is the management
Oral antibiotics (flucloxacillin)
Refer to ENT
What are recommended as indications for consideration of adenotonsillectomy
- Sore throats due to tonsillitis
- episodes are disabling and prevent normal functioning
- 7 or more sore throats in last year; or
- 5 or more in each of last two years; or
- 3 or more in each of last three years
3 complications of tonsillitis
- otitis media
- quinsy - abscess
- rheumatic fever + glomerulonephritis
complications of tonsillectomy:
(a) primary <24 hours
(b) secondary >24 hours to 10 days
haemorrhage and pain for both
Diagnostic manoeuvre for BPPV
Dix-Hallpike manoeuvre
BPPV management
- Epley manoeuvre (80% success)
- Vestibular rehabilitation i.e. Brandt-Daroff exercises at home
Glue ear describes what
Otitis media with effusion
Glue ear - otitis media with effusion can lead to hearing loss. What is the treatment
- Monitor for 6-12 weeks as spontaneous resolution is common
- If hearing loss persists on 2 separate occasions (e.g. 1 week + 12 weeks) then refer to ENT for hearing tests
- Grommet insertion
- Adenoidectomy
What type of cancer is nasopharyngeal cancer
Squamous cell carcinoma
What virus is nasopharyngeal carcinoma associated with
EBV
Meinere’s disease features
Vertigo
Tinnitus
Hearing loss
Sensation of aural fullness
Treatment for Meniere’s disease
ACUTE ATTACKS
buccal or IM prochlorperazine
(prevention = betahistine + vestibular rehab exercises)