ENT Flashcards
Bacterial causes of otitis media
Streptococcus pneumonia
Moraxella Catarrhalis
Haemophillus pneumonia
3 signs to diagnose acute otitis media
Acute onset of symptoms
Presence of middle ear effusion-> bulging TM, otorrhoea, decreased mobility of TM
Inflammation of TM (erythema)
Management of acute Ottis media (& Abx criteria)
self limiting usually!! & analgesia
- Seek medical advice if symptoms do not improve after 3 days
Antibiotics prescribed immediately if:
- more than 4 days of symptoms/ not improving
- systemically unwell
- immunocompromised
- younger <2 w bilateral OM
- OM w perforation/ canal discharge
If Abx given for acute Ottis media, first line & duration?
5-7 days of amoxicillin
penicillin allergy: erythromycin or clarithromycin
Acute sinusitis infectious agents
Strep pneumonia
Haemophillus influenza
Rhinovirus
Management of acute sinusitis
- analgesia
- intranasal corticosteroids if symptoms present for over 10 days
- oral Abx if severe: systemically unwell, high risk of complications, double sickening
Mx of allergic rhinitis
- allergen avoidance
- mild/ moderate: oral or intranasal antihistamines
- moderate/ severe persistent: intranasal corticosteroids
short course oral corticosteroids for important life events
(maybe oral decongestants but only for short courses -> tachyphylaxis and rhinitis medicamentosa)
Why should topical nasal decongestants (give example) not be used for prolonged periods?
Oxymetazoline
Tachyphylaxis - increasing dose are required to achieve same effect
Rhinitis medicaments - Rebound hypertrophy of nasal mucosa
What is the threshold of normal hearing on an audiogram?
20dB
Management of BPPV
Epley manoeuvre (80% success)
Brandt-Daroff exercises - vestibular rehabilitation
(medication - betahistine is of limited value)
What is black hairy tongue & management?
defective desquamation of the filiform papillae - may be black, brown, green, pink or another colour.
RFs: poor oral hygiene, abx, radiation, HIV, IV drug use
Mx
swab tongue to exclude Candida
topical antifungals if Candida
Branchial cyst morphology
px- early adulthood
asymptomatic
lateral neck lump, anterior to sternocleidomastoid muscle
acellular fluid with cholesterol crystals , encapsulated by stratified squamous epithelium
differentials of neck lumps in children (congenital, inflammatory, neoplastic)
congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
inflammatory: reactive lymphadenopathy, lymphadenitis,
neoplastic: lymphoma, thyroid tumour, salivary gland tumour
chronic rhino sinusitis definition
inflammatory disorder of the paranasal sinuses and linings of the nasal passages
lasts 12 weeks or longer!!
Mx of recurrent or chronic sinusitis
avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
red flags for rhino sinusitis symptoms
unilateral
persistent despite 3mo compliant tx
epistaxis
Criteria for suitability of cochlear implant
severe to profound hearing loss
children: audiological assessment , difficulty developing basic auditory skills
adults: completed a trial of appropriate hearing aids for at least 3 months
surviving spiral ganglion neurones
Causes of severe-to-profound hearing loss In children
Genetic (accounts for up to 50% of cases).
Congenital e.g. following maternal cytomegalovirus, rubella or varicella infection.
idiopathic (accounts for up to 30% of childhood deafness).
Infectious e.g. post meningitis.
Causes of severe-to-profound hearing loss In adults
Viral-induced sudden hearing loss.
Ototoxicity e.g. following administration of aminoglycoside antibiotics or loop diuretics.
Otosclerosis
Ménière disease
Trauma
otosclerosis inheritance pattern
Autosomal dominant
which frequencies are affected in noised damage hearing loss?
frequencies of 3000-6000 Hz
Ototoxic drugs
aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
Cos affected in acoustic neuroma?
CN 8, 5, 7
NF type 2
Tx for ear wax
Irrigation or Ear drops:
- olive oil
- sodium bicarb
- almond oil
(CI to mx: perforation/ grommets)
Mx of epistaxis (haemodynamically stable)
First aid measures:
- ask pt to sit w torso forward & mouth open
- pinch (cartilaginous) soft area of nose firmly for 20 mins
First aid measures successful:
- topical antiseptic (Naseptin - chlorhexidine & neomycin or Mupirocin) - reduce crusting and the risk of vestibulitis
- admission if potential underlying cause (comorbidity or under 2-leukaemia?)
Unsuccessful:
- cautery if bleed source visible & antiseptic
- packing if source not visible
- failed everything: sphenopaletine ligation
Naseptin cream should be cautioned in which patients
contains peanut oil so
patients that have peanut, soy or neomycin allergies
Causes of gingival hyperplasia
Drug causes of gingival hyperplasia
- phenytoin
- ciclosporin
- calcium channel blockers (especially nifedipine)
Other causes of gingival hyperplasia include
- acute myeloid leukaemia (myelomonocytic and monocytic types)
Red flag of unilateral glue ear?
Unilateral glue ear in an adult needs evaluation for a posterior nasal space tumour -> ENT 2ww
Gingivitis mx
simple gingivitis:
- dentist review
acute necrotising ulcerative gingivitis:
- dentist referral &…
- oral metronidazole for 3 days
- chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
- simple analgesia
Glue ear tx options
- active observation for 3 months if first presentation
- grommet insertion
- adenoidectomy
2ww criteria for laryngeal cancer
aged 45 and over with:
- persistent unexplained hoarseness or
- unexplained lump in the neck
2ww criteria for oral cancer
suspected cancer 2ww:
- unexplained ulceration in the oral cavity >3 weeks or
- persistent and unexplained lump in the neck.
urgent referral 2ww to dentist :
- a lump on the lip or in the oral cavity or
- a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
malignant ottis media cause
Pseudomonas aeruginosa
in immunocompromised ppl - 90% in diabetics
non-resolving otitis media mx
potentially malignant otitis externa so…
Urgent referral to ENT
CT scan
IV antibiotics that cover pseudmonal infections
Ix& Mastoiditis mx
clinical dx, but CT if complications suspected
IV antibiotics
Mx of Meniere’s
- ENT assessment to confirm dx
- Patients should inform DVLA: cease driving until satisfactory control of symptoms
- Acute: buccal or IM prochlorperazine (admission sometimes required)
- Prevention: betahistine and vestibular rehabilitation exercises maybe of benefit
oral lesion 2ww refer to oral surgery criteria:
- oral ulceration/ mass > 3 weeks
- red/ white patches which are painful, swollen, bleeding
- unilateral head/ neck pain > 4 weeks, associated w ear ache
- recent neck lump/ previously undiagnosed lump that has changed over a period of 3 to 6 weeks
- persistant sore or painful throat
- abnormalities in oral cavity > 6wks, which cannot be diagnosed as a benign lesion
RFs for oral ca
> 40, smokers, heavy drinkers, chew tobacco or betel nut (Areca nut)
Samter’s triad
asthma
aspirin sensitivity
nasal polyposis
nasal polyps tx
red flag: unilateral symptoms or bleeding
Mx:
- referred to ENT for a full examination
- topical corticosteroids shrink polyp size in 80% of pts
nasopharyngeal carcinoma aetiology
squamous cell carcinoma
rare, except Southern China
Epstein Barr virus
Nasopharyngeal carcinoma px
ear: unilateral serum otitis media , otalgia
nose: nasal obstruction, discharge, epistaxis
CN palsies: 3-6
(dx- CT head, mx- radiotherapy)
pharyngeal pouch anatomy
posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
cystic hygroma px?
congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
px birth-2yrs
Causes of otitis externa
infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
seborrhoeic dermatitis
contact dermatitis (allergic and irritant)
recent swimming is a common trigger of otitis externa
otitis externa mx
topical antibiotic w or without steroid
if doesn’t work —> ENT referral
if perforated (aminoglycosides not used - ENT say this is BS)
(careful if elderly diabetic- malignant otitis media needing IV abx ?)
types of benign parotid tumours
most common: Benign pleomorphic adenoma or benign mixed tumour - malignant transformation common
Warthin tumor (papillary cystadenoma lymphoma or Adenolymphoma) - also benign, lymphocytic infiltrate and cystic epithelial proliferation , males
monomorphic adenoma
Heamangioma - mainly in children less than 1
Malignant parotid gland tumors
Muciepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Acinic cell carcinoma
Adenocarcinoma
Lymphoma
perforated tympanic membrane tx
- advice - will heal after 6-8 wks. Avoid getting water in ear
- abx if following acute otitis media
- myringoplasty if tympanic membrane doesn’t heal by itself
ramsy hunt tx
oral aciclovir and corticosteroids
salivary gland types and content
parotid (serous) - most tumours
submandibular (mixed) - most stones
sublingual (mucous)
sore throat (pharyngitis, tonsillitis, and laryngitis) mx
- paracetamol or ibuprofen for pain relief
- Abx not routinely indicated but if indicated
—>phenoxymethylpenicillin (or clarithromycin if pen allergy), 7-10 day course
Abx indications
- marked systemic upset
- unilateral peritonsillitis
- rheumatic fever hx
- increased risk from acute infection (child with diabetes mellitus or immunodeficiency)
- 3 or more Centor criteria are present
Centor criteria
- tonsillar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- fever
- absence of cough
score = Likelihood of isolating Streptococci
0-2 = 3 to 17%
3-4 = 32 to 56%
FeverPAIN criteria
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
drug causes of tinnitus
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
indications of tonsillectomy. all of the following:
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning
vestibular neurinitis mx
rapid relief for sever cases buccal or IM prochlorperazine
less severe: short oral course of prochlorperazine
chronic: vestibular rehabilitation exercises
malignant otitis externa tx
urgent ENT referral (non-resolving OE w worsening pain)
IV antibiotics covering pseudomonas infections:
- ciprofloxacin - topical
- flucloxacillin - for systematic infection
