ENT Flashcards
most common otitis external organisms
pseudomonas - bc swimmers
stap aureus
otitis externa presentation
itchy painful ear
watery discharge
tragus tenderness
conductive hearing loss if pretty inflamed
may have fever and cervical lymphadenopathy
rx of acute otitis external
- lifestyle, medical
avoid swimming for 7 days, wear ear plugs or tight fitting swim cap
Keep shampoo and soap out of ears when showering
Dont use earphones/earplugs
aural toilet eg with irrigation so topical treatments work
paracetamol
if >12 give topical acetic acid for 7 days
Can give topical abx based on clinical judgement
Presentation of malignant otitis external
unremitting pain,
purulent ear discharge,
systemic illness,
hearing loss,
granulation tissue in the ear canal,
- possible facial nerve palsy
- can lead to meningitis
Rx of malignant otitis externa
ENT referral! for admission for IV abx
Who is at risk of malignant otitis externa
diabetics
immunocompromised eg on chemo
elderly
HIV
Acute otitis media common organisms
viral - after viral URTI
strep pneumoniae
haemophillus influenzae
mortadella caterrhalis
Acute OM presentation
in kids - tugging at ear, irritability, fever, recent hx of URTI
Acute OM O/E
red bulging TM, may be perforated
fever
When do you give abx for acute OM
Symptoms lasting more than 4 days or not improving
Immunocompromised
<2 with bilateral otitis media
Otitis media with TM perforation.
Complications of acute OM
mastoiditis
TM perf
facial nerve palsy
meningitis
sepsis
OME presentation
SAL delay
inattention at school
OME O/E
Retracted TM
Yellow
Fluid level/air bubbles
Rx of OME
most resolve spontaneously.
If not, grommets
Presentation of mastoiditis
Investigation
Rx
pain behind ear, sticky out ear, feels ‘boggy’ behind the ear
CT temporal bones
Admit for IV abx, myringotomy +/- mastoidectomy
What is cholesteatoma and its presentation
Locally destructive expansion of stratified squamous epithelium within the middle ear.
Smelly ottorhoea, ear pain, hearing loss, facial paralysis
complications of cholesteatoma
ossicle erosion - deafness
meningitis
cerebral abscess
Rx of ramsey hunt
Oral acyclovir and oral prednisolone
Need lubricating eye drops
What is ramsey hunt and presentation
shingles affecting the facial nerve
facial nerve palsy
vesicular rash in ear that may extend to 2/3 anterior tongue and palate
Fever PAIN score use and break down
What does centor have in addition
used to predict whether tonsillitis has been cause by strep or not
Fever in last 24hrs
Purulent tonsils
Attend in <3 days
Inflammation severe
No cough or coryza
Centor adds age - 1+ if 3-14, 0 if 15 - 44, -1 if >44
Rinnes and weber results in sens and cond
sens - lateralises to other ear. AC>BC
Cond - lateralisises to ear. BC>AC
peripheral and central causes of vertigo
Peripheral - Menderes, bppv, labrynthitis,
Central - stroke (POCS), meningitis, MS, vestibular migraine, SOL
differentiating between peripheral and central causes of vertigo
Central has vertical nystagmus (RED FLAG)
Rarely associated with tinnitus or hearing loss
what is inflamed in labrynthitis
presentation
Rx
semi circular canals, vestibule and cochlear
Acute onset vertigo, tinnitus and hearing loss most commonly preceded by a viral URTI. N+V
prochlorperazine and antihistamine for max 3 days
presentation of vestibular neuritis and course
rx
what ay they go on to develop
acute onset of vertigo and n+v. Often incapacitating for few days then gets better over 2-6 weeks
Rx - prochlorperazine and antihistamine for 3 days
BPPV
BPPV pathophys
which way will nystagmus move in dix hallpike
rx including name of exercises to do at home
otoconia (crystals of calcium carbonate) dislodge into semicircular canals causing disruption to endolymph flow
towards affected ear
employ manoeuvre. Cawthorne cooksey exercises
How is epley manoeuvre performed
head at 45 degrees with neck extended.
Then turn 90 degrees to other side. then another 90 degrees by getting pt to roll on to side. Then pt sits up
first line abx treatment for AOM if meets criteria for abx
penicillin
or clarithro if pen allergic
acute vs prophylactic rx of menieres
acute - prochlorperazine and antihistamine
prophylaxis - betahistine
rx of cholesteatoma
ent referral for surgery
which window is the stapes connected to
oval window
what condition can cause low pitch hearing loss (opposite to presbycusis)
otosclerosis
ix results for otosclerosis - audiometry, tympanometry, high res CT
conductive hearing loss
stiff, non compliant tm
bony changes
rx of otosclerosis
hearing aids
or surgery for stapes prosthesis
who is affected by otosclerosis
under 40s
risk factors for presbycusis
increased age
male
fix
loud noise exposure
diabetes
htn
ototoxic meds
rx of presbycusis
Optimising the environment, for example, reducing the ambient noise during conversations, lights instead of doorbells
Hearing aids
Cochlear implants (in patients where hearing aids are not sufficient)
what is acoustic neuroma a tumour of
where in the brain do they occur
schwann cells around vestibularcochlear nerve
cerebellopontine angle
what do b/l acoustic neuromas almost always indicate
neurofibromatosis type 2
presentation of acoustic neuroma
The typical patient is aged 40-60 years presenting with a gradual onset of:
Unilateral sensorineural hearing loss (often the first symptom)
Unilateral tinnitus
Dizziness or imbalance
A sensation of fullness in the ear
abx choice for bacterial tonsillitis and course length
penicillin V for 10 days
rx of post tonsillectomy bleeding as an fy1
call on call ent surgeon
encourage to spit blood not swallow
give fluids
take bloods - fbc, clotting, cross matt, g+s
NBM incase theatre needed
symptoms of quinsy
‘hot potato’ voice
inability to open mouth
swelling and erythema
sore throat
painful swallowing
fever
tender lymphadenopathy
rx of quinsy
refer to hospital for ent
needle aspiration or surgical incision and drainage
broad spec abx
first aid rx for active nose bleed
other advice after
sit forward
squeeze soft part of nose
spit don’t swallow
don’t pick nose
med review if needed
stay out of sun
rx of epistaxis if:
- after 15 mins first aid is successful
- after 15 mins first aid is unsuccessful and the bleed site is visible
- after 15 mins first aid is unsuccessfuland the bleed site is not visible
- if doesn’t stop at all
- topical naseptin antiseptic
- cautery
- packing
- sphenopalatine ligation
who can’t have naseptin antiseptic after a nose bleed
what is an alternative
if peanut allergy
can use muciprocin
examination and presentation of thyroglossal cyst inc location of neck
moves up on swallowing and tongue protrusion
asymptomatic
branchial cyst presentation inc age group and inc location of neck
typically presents in young adults when an URTI causes it to increase in size
usually painless
anterior or posterior triangle
cystic hygroma presentation and location in neck
diagnosed at birth or prenatally. Typically presents in left posterior triangle. Benign but often require surgery
red flag of nasal polyp
unilateral polyp
what other conditions are nasal polyps commonly associated with
chronic rhinits/sinusitis
asthma
cystic fibrosis
who are nasal polyps rare in
<10s
consider neoplasms or cystic fibrosis
rx of sudden snesironeural hearing loss (<72 hrs with no obvious cause)
urgent referral to ENT <24hrs
Classed as an otological emergency
high dose oral corticosteroids used
hypocalacaemia on an ecg (complication of thyroid surgery - parathyroid damage)
long QTc
rx of uncomplicated sinusitis
rx of complicated inc what makes it complicated
uncomplicated - analgesia, keep hydrated
complicated
- if >10 days - intranasal corticosteroids
- abx not usually used unless severely unwell or ‘double sickening’ ie had a viral and now got worse again
rx of recurrent or chronic sinusitis
nasal irrigation with saline
avoid any allergens
what can secondary haemorrhage after tonsillectomy indicate
rx
infection
admit and give abx
