ENT Flashcards
what is parotitis?
inflammation of the parotid glands- most commonly caused by mumps, herpes, Epstein-Barr virus.
treatment- treat the underlaying cause
what is sialadenitis?- which glands are affected?
risks?
symptoms?
investigations?
management?
Inflammation of the salivary glands- parotid, submandibular and sublingual glands. Risk of spreading into deep tissues of the neck and head causing severe infection
Risks:
Infants
Sick or recovering from surgery
Dehydration, malnutrition, immunosuppression
Symptoms:
Enlargement of salivary glands/ swelling of cheek/ neck
Fever
Decreased saliva/ dry mouth (xerostomia)
Pain when eating
Investigations: USS, CT, endoscope
Management:
Abx- clindamycin
Home remedies- warm compress, massage of salivary glands
Non-surgical- IV fluids for hydrations
Surgical- abscess drainage, removal of stones/ blockage
Management of haemorrhage post tonsillectomy?
Primary
Secondary
Primary, or reactionary haemorrhage, most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery.
What are the indications for tonsillectomy?
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
The person has: (71, 52, 33)
7 episodes per year for one year
5 per year for 2 years,
3 per year for 3 years,
The episodes of sore throat are disabling and prevent normal functioning
Other established indications for a tonsillectomy include
recurrent febrile convulsions
obstructive sleep apnoea
stridor
dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment
Classic triad for infectious mononucleosis?
Sore throat
Pyrexia
Lymphadenopathy
Triad of symptoms for Croup? 4
Fever
Stridor
Barking cough
Intercostal/ subcostal recession
Causes of hoarseness?
voice overuse
smoking
viral illness
hypothyroidism
GORD
laryngeal cancer
lung cancer
What are the suspected laryngeal cancer referral guidelines?
2ww
A suspected cancer pathway referral to an ENT specialist should be considered for people
Aged 45 and over with:
-persistent unexplained hoarseness
or
-An unexplained lump in the neck.
When investigating patients with hoarseness a chest x-ray should be considered to exclude apical lung lesions.
Features of head and neck cancer?
neck lump
hoarseness
persistent sore throat
persistent mouth/ lip ulcer > 3 weeks
Risk factors for sleep apnoea?
Symptoms?
obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome
Emergency treatment for Croup?
Management
Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Prednisolone is an alternative if dexamethasone is not available
Emergency treatment:
-high-flow oxygen
-nebulised adrenaline
Causes of conductive hearing loss?
wax impaction
infection- otitis externa/ media
Eustachian tube dysfunction
tympanic membrane perforation
foreign body
otosclerosis
tumours
Causes of sensorineural hearing loss?
-presbycusis
-noise-induced hearing loss
-congenital infection- rubella, CMV
neonatal complications- meningitis
-drug induced- aminoglycosides
-vascular- stroke/ TIA
-Meniere’s disease
-labyrinthitis
-acoustic neuroma
Causes of peripheral vertigo?
Symptoms?
BPPV
Meniere’s disease
Vestibular neuritis/ labrynthitis
Ramsay Hunt syndrome
Cholesteatoma
Otosclerosis
No neurological signs present
Horizontal nystagmus
Causes of central vertigo?
Symptoms?
Stroke/ TIA
CPA tumour
Meningitis
MS
Hearing loss uncommon but can happen in stroke/ tumour
Other neurological signs present
Direction changing nystagmus
Sx for Meniere’s disease?
recurrent vertigo, tinnitus, sensorineural hearing loss
ear fullness/ pressure
nystagmus
mainly unilateral but can be bilateral after several years
Management for Meniere’s disease?
Prophylactic- betahistine
Acute- buccal or IM prochloperazine
Diuretics- specialist only
DVLA inform
Vestibular rehab exercises
Common causes of otitis externa?
Bacterial: Staphylococcus aureus, Pseudomonas aeruginosa or fungal
-Seborrhoeic dermatitis
-Contact dermatitis (allergic and irritant)
-Recent swimming is a common trigger of otitis externa
Causes of tinnitus?
Idopathic
Meniere’s disease
Otosclerosis
Presbycusis
Loud noise hearing loss
Drugs- aspirin, NSAIDs, aminoglycosides, loop diuretics, quinine
Ear wax impaction
Acoustic neuroma
Investigations for acute severe epistaxis?
FBC
VBG
Clotting screen
G&S + cross-match
Flexible nasendoscopy -> suspected tumour
Vwb bloods
Causes of epistaxis?
Trauma
Foreign bodies in the nose
Oxygen via nasal cannula
Recent ENT or maxillofacial surgery
Tumours
Inflammation, including rhinosinusitis, nasal polyps
Alcohol excess
Illicit drug use- cocaine
Medications such as nasal steroids
Bleeding disorders-thrombocytopenia, Von Willebrand disease, haemophilia, antiplatelet or anticoagulant medications
Environmental factors- inhaled irritants, temperature and humidity
Management for epistaxis?
ABCDE + MHP if haemodynamic instability
-Conservative: sitting forward + pinching nose 10-15 mins
-Topical antiseptic (naseptin) to reduce crusting + re-bleeding (check for nut allergy).
Chemical with silver nitrate or electrocautery
-If bleeding point can be visualised: nasal cautery (only 1 side to avoid perforation)
-If bleeding point cannot be visualised/ bleeding persists despite cautery: nasal packing. Posterior packing with Foley catheter left in place for 24-48 hours
-If bleeding persists then surgical approach with embolization
Medical approach with tranexamic acid to all patients with severe bleeding
Hold anticoag/ antiplatelets and discuss with haematology
Common cause of otitis media in children?
Viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria
Streptococcus pneumonaie
Haemophilus influenzae
Moraxella catarrhalis
Diuretics that cause tinnitus?
Loop diuretics
bumetanide and furosemide
