ENT Flashcards
- vertigo lasting < 30 seconds
- on changing head position/rolling over bed
- geotropic rotatory nystagmus, fatigue able
- nausea
- no hearing loss
- no tinnitus
Diagnosis?
Structure affected?
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)
structure affected: posterior semi-circular canal.
Test: Dix Hallpike Maneuver positive.
MX
- Epley’s maneuver (reposition otoliths)
- Brandt- Daroff exercise at home
- no need for medications
chalky white patches seen on eardrum.
Diagnosis?
TYMPANOSCLEROSIS
- recent pregnancy
- increasing hearing loss unilateral
- bone conduction better than air conduction
- Weber’s test lateralizes to same ear.
Diagnosis?
OTOSCLEROSIS
pregnancy accelerates progression.
- vertigo lasting few hours
- not provoked by movements
- tinnitus
- hearing loss
- feeling of pressure/fullness
- nausea/vomiting
- MRI normal
MENIERE’S DISEASE
Perform audiometry in clinic before ROUTINE REFERRAL
MX
- buccal or IM prochlorperazine
- other: cyclizine, cinnarizine, promethazine
- prevention of attack: betahistine TID for 3 months
- has tonsilitis/recent URTI
- cervical LN
- red bulging TM
- light reflex absent
- fever
- ear pain FOLLOWED by discharge
- vomiting
Diagnosis?
ACUTE OTITIS MEDIA
MX
no need antibiotics unless:
- less than 2 yrs old bilateral complaint
- severe case
- discharge after perforation (Mx: reassure and review in 6 weeks + antibiotics»_space;> if not healed then»_space; tympanoplasty)
- Amoxicillin
- if allergic: erythromycin/clarithromycin
- child increasing TV volume
- does not respond to parents calling them
- withdrawal in school
- lack of concentration
- bone conduction better than air conduction in both ears
Diagnosis?
OTITIS MEDIA WITH EFFUSION
RISK FACTOR: parental smoking
otoscope: dull grey tympanic membrane, air fluid level, absence of light reflex, retracted TM
Tests:
- Audiometry
- Tympanometry
MX
1st: Reassure and review in 3 months.
2nd: if persists for more than 3 months > grommets.
3rd: hearing aids
- unilateral pain
- headache
- foul smelling discharge
- post auricular swelling and erythema
- fever
- loss of post auricular sulcus
Diagnosis?
Management?
MASTOIDITIS
MX
- Iv antibiotics immediately
- CBC, CRP, ear discharge swab
- after 24 hrs if no improvement/abscess suspected > contrast CT scan of petrous bone and brain
- Mastoidectomy
- hx of trauma to nose
- difficulty breathing
- nasal pain
- fever
Diagnosis?
NASAL SEPTAL ABSCESS
MX
-Incision and drainage of septal hematoma to prevent abscess formation
- hx of sore throat and dysphagia
- unilateral bulge lateral to tonsil
- soft palate swelling with exudates
- drooling
- difficulty opening mouth due to trismus
- hot potato voice
- uvular deviation
Diagnosis?
Mangement?
PERITONSILLAR ABSCESS - QUINCY
MX
- Urgent admission
- Iv antibiotics (IV Benzylpenicillin)
- Aspiration for culture
- if no improvement in 24 hrs»_space;> I and D
- don’t choose referral to ENT as option»_space; will delay management leading to deep neck space infections
- hx of URTI
- vertigo
- no hearing loss
Diagnosis?
VESTIBULAR NEURITIS
MX
- oral/buccal/IV prochlorperazine
Wax obstruction
Management?
1st: give olive oil drops/almond oil/ Nacl drops/ sodium bicarbonate 5% drops for 3-5 days.
2nd: Irrigation
If unsuccessful > continue drops for 3-5 days more then try irrigation again.
Instill water, wait 15 mins and then irrigate.
refer to ENT.
Some patients go to private clinics for micro suction (much safer than irrigation)
- midline neck mass
- moves on tongue protrusion
Diagnosis?
THYROGLOSSAL CYST
- recurrent sinusitis
Gold standard investigation?
4 or more episodes in 1 year
Best investigation: CT of head and sinuses
- dysphagia
- hx of smoking/alcohol
- oral lesion with central ulceration that bleeds on touch at palatine tonsil
- long time sore throat
- hoarse voice
- weight loss (may/may not have)
Diagnosis?
TONSILLAR CANCER
signs of malignancy BUNIE:
B: bleeding
U: ulceration
N: nodules
I: Induration
E: erosion
- dysphagia
- pain on swallowing
- hx of asthma and on steroids for long time
- hoarse voice
Causative organism?
Candida albicans
steroids predispose to fungal infections and can cause laryngeal candidiasis which results in hoarseness of voice.
- diabetic/immunocompromised
- small tender mass on external canal
- no discharge
Diagnosis?
FURUNCLE
cause: staph aureus
MX
- may resolve spontaneously
- flucloxacillin
- I and D
- diabetic, poorly controlled
- severe pain
- intense headache
- skin around ear is black
- foul smelling discharge
- conductive hearing loss
- facial nerve palsy
- granulation seen on floor of canal
Diagnosis?
MALIGNANT OTITIS EXTERNA
needs URGENT referral.
MX
- CT temporal bone
- IV antibiotics
- elderly
- decreased hearing
- difficulty understanding speech
- worse in noisy environment
- eardrum is normal
- bilateral sensorineural loss and worse at high frequencies
Diagnosis?
PRESBYACUSIS
MX
high frequency specific hearing aids
- progressive sensorineural hearing loss, vertigo, tinnitus (CN 8)
- absent corneal reflex, reduced facial sensation (CN 5)
- diplopia on looking to the side (CN 6)
- facial palsy (CN 7)
Diagnosis?
ACOUSTIC NEUROMA/VESTIBULAR SCHWANNOMA
tumor originates from Schwann cells of vestibulocochlear nerve. (CN 8)
MRI of cerebellopontine angle/internal auditory meatus
- high BMI
- daytime sleepiness
- snoring
- morning headaches
- difficulty driving
Diagnosis?
OBSTRUCTIVE SLEEP APNOEA
- stop driving
- Epworth sleepiness scale to quantify the likelihood of patient falling asleep in certain conditions.
MX
initial: pulse oximetry and overnight study of breathing pattern
gold standard: polysomnography
- reduce weight
- reduce alcohol consumption
- CPAP
- rare cases may require tonsillectomy/adenoidectomy/tracheostomy
- daytime sleepiness
- sleep paralysis
- sleep disruption
- hallucinations
- brief loss of muscle tone during laughter
Diagnosis?
NARCOLEPSY
C: cataplexy
H: Hallucinations
E: excess daytime sleeping
S: sleep paralysis
S: sleep disruption
- swimming
- hx of travel to high humidity place
- pus/serous discharge from ear
- pain
- Itchy
- tragal tenderness
- TM normal
Diagnosis?
Management?
OTITIS EXTERNA
MX
- acetic acid 2% spray for 7 days
- topical gentamycin + hydrocortisone = Gentisone-HC
- topical aminoglycoside (not if TM perforated > use ciprofloxacin instead)
- neomycin sulphate + corticosteroids 3 drops for 7-14 days.
MALIGNANT OTITIS EXTERNA/NECROTIZING OTITIS EXTERNA
- severe
- headache
- purulent foul-smelling discharge
- conductive hearing loss
- granular tissue on floor of ear canal
MX
- urgent same day referral
- the ENT team will arrange CT scan of temporal bones first then IV antibiotics
- if systemically unwell then start IV antibiotics first
- recurrent epistaxis
- no bleed right now
- wants to prevent future episodes
Management?
Topical Naseptin
(chlorhexidine + neomycin)
- long standing foul smelling purulent ear discharge
- unilateral
- tried antibiotics but no improvement
- may or may not have perforated TM
- hx of recurrent otitis media
- conductive hearing loss
- keratin accumulation at the UPPER PART of the TM/ pearly white mass behind TM
Diagnosis?
CHOLESTEATOMA
MX
- Semi urgent referral
- ENT team will arrange CT scan and audiology assessment.
- if erosion»_space; facial nerve palsy and vertigo
- hx of trauma to pinna
- hematoma formed
- normal TM
- no hearing loss
Management?
I and D + antibiotics
(co-amoxiclav for 1 week)
if no I and D»_space;> Avascular necrosis»_space;> Cauliflower ear
- auditory hallucinations
- feels like music is played
- no hearing voices
Diagnosis?
Investigation?
MUSICAL EAR SYNDROME
- Pure tone audiometry
- swelling in submandibular region, pus can be seen when compressed
- more prominent and painful on chewing/during meals
- hx of sour taste
- dry mouth
tenderness - decreased jaw mobility
- weight loss
- dental pain
- keratitis
- SOB
- Lymphadenopathy
- fever/rigors/chills/malaise»_space; septicemia
- may or may not have palpable stone (precursor may be sialolithiasis)
Diagnosis?
CHRONIC SIALANDENITIS/KUTTNER’S TUMOUR
- painless, firm, mobile mass over angle of mandible.
- increasing in size over past few months
Diagnosis?
PLEOMORPHIC ADENOMA
- most common cause of salivary gland tumors.
- benign parotid tumor
- slow growing and painless
