ENT Flashcards
management fo a septal haematoma “ bilateral cherry-red swelling arising from the nasal septum”
emergency incision and drainage
labyrinthitis vs Menieres
both have tinnitus, vertigo, hearing loss
Menieres comes in 1-2 hour episodes and is not curable
labyrinthitis epodes can last longer eg days and you can recover/is curable
labyrinthitis = recent history of cold/infection, intense for few days then goes away slowly
Menieres = no obvious recent trigger, comes and goes
what condition characteristically causes hearing loss which is better when there is background noise
otosclerosis
in which condition do pts often speak quietly as their voice sounds louder in their head
otosclerosis
generalised hearing loss, pain, recent UTRI. possible discharge if tympanic membrane ruptured, bulging/ruptured tympanic membrane
otitis media (infection of middle ear)
what is a cholesteatoma and what happens if it gets infected
growths of keratinising squamous cells that form in the attic of the ear (area of middle ear behind tympanic membrane) - shows as a visible white mass behind the eardrum
non cancerous but can be erosive to surrounding structures
if infected: produce chronic foul-smelling discharge, and debris fills the ear canal, causing hearing loss, facial nerve paralysis, intracranial abscess
what is warthins tumour
benign, fast growing tumour of parotid gland
common in elderly men
what is a adenoid cystic carcinoma
malignant tumours of the parotid gland
are more likely to invade the surrounding structures such as the facial nerve, leading to the facial nerve palsy
what is a pleomorphic adenoma
most common tumour of parotid gland
usually benign
rarely invades the facial nerve and rarely causes facial nerve palsy
swelling of parotid glands
dry eyes
dry mouth
likely diagnosis
sjogrens syndrome
vestibular neuritis vs labyrinthitis
vestibular neuritis
- only vestibular nerve affected
–> vertigo, balance problems
labyrnthitis
- labyrinth also affected
–> hearing loss, balance problems
what is otalgia
ear pain
Tx for otitis externa vs otitis media
otitis externa:
topical abx drops
otitis media:
analgesia (usually viral cause)
if symptoms dont improve or child is systemically unwell, give abx or even admit in hospital
how to tell difference between otitis media and externa
using otoscope
- exerna will show infection on canal but normal tympanic membrane
- media will show infection on membrane
otitis media symptoms
Rapid onset of deep-seated ear pain
Fever
Irritability
Anorexia
Vomiting
Impaired hearing
Systemic illness
Aural fullness followed by discharge when the tympanic membrane perforates, leading to relief of pain
Injection of blood vessels and diffuse erythema of the tympanic membrane
what is subcutaneous sumatriptan used for
abortive (symptomatic) therapy of migraines
laryngitis symptoms
hoarseness, cough, and a sore throat
no difficulty swallowing or cervical lymphadenopathy
epiglottitis symptoms
rapid onset of severe sore throat,
high fever,
difficulty swallowing,
respiratory distress,
stridor
laryngitis vs pharyngitis
laryngitis: inflammation of voice box
-Irritating cough
-Hoarseness
-A change in the sound of your voice (dysphonia) or the inability to speak (aphonia)
-Sore, dry, or tickly throat
-Difficulty swallowing
pharyngitis: inflammation of back of throat
- Fever
-Painful swollen glands
-Throat redness
-Pain which can radiate into the ear
sensations of shortness of breath, nasal obstruction, and dryness
after having nasal / turbinate surgery
but no physical problems seen in the nose
diagnosis?
empty nose syndrome
Mx of empty nose syndrome
nasal irrigation
nasal saline / emollients
psychological support
if severe, reconstructive surgery
describe air and bone condition of sound in conductive vs sensineural hearing loss vs mixed hearing loss
conductive
- reduced air conduction, normal bone conduction
sensineural
- reduced air and bone conduction
mixed
- there is a difference between air and bone conduction, but neither is normal
Tx for otitis externa, mild, moderate, severe
mild:
acetic acid + hydrocortisone ear drops
moderate:
ciprofloxacin + hydrocortisone ear drops
severe:
Treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration
or oral abx if cant get into canal / severe infection, low immunity
why should amoxicillin be avoided in tonsillitis
strep throat and Epstein-Barr virus (EBV) present very similarly
If EBV is misdiagnosed as strep throat and amoxicillin is prescribed, a maculopapular rash commonly occurs
which nerve provides sensation to skin
trigeminal
risks with surgery around mastoid process
damage and permanent paralysis of facial nerve - runs in close proximity to mastoid process
what is geotropic nystagmus
nystagmus beating toward the ground
what is apogeotropic nystagmus
nystagmus beating away from the ground
what is a quinsy and why is it an emergency
abscess between the tonsil and the roof of the mouth
presents as fever, sore throat, inability to open mouth, thick muffled voice, tender mass in peritonsillar area
This requires urgent assessment as it can lead to
sepsis,
erosion
spread of the abscess into the head cavities,
airway obstruction
life-threatening haemorrhage
what is a Mucoepidermoid carcinoma
the most common malignant salivary gland tumour
Local invasion and lymph node are common and therefore present with facial nerve palsy and other symptoms
pt has lump overlying her right angle of mandible that is slowly growing in size.
She has no other symptoms
likely diagnosis?
pleomorphic adenoma
most common benign parotid tumour and in general does not cause neurovascular invasion of local structures
what is presbycusis
age related hearing loss
what does presbycusis look like on audiogram
bilateral symmetrical sensineural hearing loss at higher frequencies
how does noise induced hearing loss change with frequency
loss of hearing on the audiogram is maximal at 4000Hz before recovering at higher frequencies
type of hearing loss with otosclerosis
conductive - hear better when there is background noise
management of quinsy
drainage and abx
what is quinsy a complication of
acute tonsillitis
fever, sore throat, trismus (inability to open the mouth), hot potato voice, and a palpable, tender mass in the peritonsillar area
tonsillitis history
diagnosis
quinsy
how do rinne and webers test differentiate between sensineural and conductive hearing loss
negative rinne test :
conductive hearing loss
webers:
If the hearing loss is conductive, the sound will be heard best in the affected ear.
If the loss is sensorineural, the sound will be heard best in the normal ear
what is a positive rinne test and is it normal or abnormal
air conduction is heard louder than bone
normal
rinnes positive
webers heard best in right ear
what is the type of hearing loss and in which ear
sensioneural hearing loss in left ear
viral vs allergic rhinitis
viral
- shorter duration (approx a week)
- fever
- sore throat
- malaise
allergic
- longer duration (over week)
- sneezing
- watery eyes
- itchy nose and eyes
- nasal congestion
how does background noise affect conductive vs sensineural hearing loss
conductive: better with background noise
sensineural: worse with background noise
what type of hearing loss is presbycusis
sensineural
what type of hearing loss does Menieres cause
sensineural
what does a single nasal polyp suggest
nasopharyngeal cancer
what is a tympanostomy / grommet
time placed into eardrum/tympanic membrane in children who have chronic middle ear infections (otitis media), prevents fluid accumulation in middle ear
what does tympanostomy/grommets and otitis media history predispose to
tympanosclerosis
what does a non healing, painful, bleeding mouth ulcer raise suspicion of
squamous cell carcinoma
what oral signs would you see in vit C deficiency
loose teeth and poor gingival health
what is oral leukoplakia
white lesion on oral mucosa
cancer precursor
when is tonsillectomy considered for a pt
if a patient suffers more than 5 episodes of tonsillitis per year for 2 years, if the episodes interfere with daily life.
what is an acoustic neuroma
a type of non-cancerous (benign) brain tumour
likely cause of progressively worsening hearing loss, tinnitus and vertigo
acoustic neuroma - symptoms worsen as it grows
likely diagnosis of progressively worsening bilateral conductive hearing loss with no vertigo or tinnitus
otosclerosis
definitive Tx for otosclerosis
stapedectomy
(hearing aids and steroids are used to mange symptoms but dont fix the abnormal bone growth)
voice hoarseness
throat pain
ear pain
likely diagnosis
aqueous cell carcinoma of larynx
what is CSF rhinorrhea and what is it usually caused by
leak of CSF through the nose
usually secondary to base of skull fracture
what organ dysfunction can recurrent epistaxis be a sign of
liver disease causing clotting issues –> order LFTs
what does a history of “bad tonsillitis at age 16” suggest the pt had
infectious mononucleosis caused by EBV
what is a rare, but malignant cause of unilateral glue ear in adults
nasopharyngeal carcinoma
which cancer does infectious mononucleosis/EBV increase risk of
nasopharyngeal carcinoma
non-tender and “rubbery” lymph nodes
night sweats and weight loss
likely diagnosis
Hodgkin’s Lymphoma
acoustic neuroma symptoms
sensineural hearing loss,
tinnitus,
dizzines
progressive bilateral conductive hearing loss
intact tympanic membrane
no discharge
family history of same thing
likely diagnosis
otosclerosis
what should be done if a child with tonsillitis has problems breathing or swallowing
could indicate Quincy, so admit to hospital and give IV abx and do drainage
inheritance pattern of HHT
autosomal dominant
what is a dermoid cyst and where is it found
small, painless lump which contains epithelial lining so can grow hair or teeth
found on head and neck - esp outer 1/3 of eyebrow
lump lateral to midline of neck, in anterior triangle
painful around meal times
doest move on tongue protusion
sialadenitis - infection of salivary gland
congenital large swelling in neck of child, swells in infection
do not move on tongue protrusion nor auscultate or transilluminate
likely diagnosis
branchial cyst
what is the most common cause of neck umps in children
branchial cyst
best scan for vestibular shwannoma aka acoustic neuroma
MRI head
what is the most common cause of hearing loss/impairment post head injury
perforated tympanic membrane
give 2 signs which can be seen of a basal skull fracture
racoon eyes
bruising of mastoid
most common causes of stridor
- laryngomalacia - congenital condition where some larynx tissue falls onto and partially blocks airway
- vocal cord/larynx paralysis
what is glue ear
middle part of the ear canal fills up with fluid
what is vertigo and dizziness on sudden and certain head movements associated with
BPPV
what is proptosis
exophthalmos
what is ophthalmoplegia
paralysis of the extraocular muscles that control the movements of the eye
mild vs moderate otitis externa
mild has no pain or discharge, moderate has both
what condition causes
optic neuritis, which leaves decreased vision in the affected eye and a relative afferent pupillary defect
and
unilateral sensorineural hearing loss
MS
best investigation for MS
MRI head and spine
what does Tympanometry showing a type B (flat) curve with normal canal volume suggest
otitis media with effusion (OME)
if a child chokes and CXR shows a circular radio-opaque foreign body with a halo, what is it
button battery
Eustachian tube dysfunction symptoms
aural fullness, mild hearing loss, tinnitus, and clicking or popping noises
treatment for chronic otitis externa
remove debris from ear
topical abx
management of cholesteatoma or mastoid abscess
mastoidectomy
what’s persistent bleeding and crusting from one nostril with unilateral nasal obstruction a red flag symptom for
sinonasal carcinoma
managment of swollen red ear after trauma
aspiration
what type of nose bleed is a nasal ballon catheter used for
posterior bleeds
Mx of anterior nose bleed if compression doesn’t work
if can see site of bleed: nasal cautery
if cant see site if bleed or cautery fails: nasal packing
tensor tympani innervation
vestibularcoclear nerve
what does painless cervical lymphadenopathy suggest and how do you investigate it
malignancy
Fine-needle aspiration cytology (FNAC)
when is antibiotics considered for children with titis media under 2 years old
bilateral otitis media
or systemic infection
or symptoms >3 days
what is Ramsay hunt syndrome and what is it characterised by
reactivation of the varicella zoster virus in the geniculate ganglion
characterised by
unilateral Facal nerve palsy
vestibulocochlear nerve symptoms eg tinnitus, unilateral hearing impairment
lesions visible with crusting in or behind the ear
what is the cause of discharge from ear that demonstrates a halo sign when dropped onto filter paper
basal skull fracture - cerebrospinal fluid leaks through the fracture out of the auditory canal
what are the signs of cancer of parental sinus
adult presenting with chronic rhinosinusitis for first tumour
blood stained nasal discharge
swelling over sinus
Ix for cholestateoma
HRCT
a blocked nose
a runny nose
a feeling that mucus is slowly dripping down the back of your throat (postnasal drip)
a reduced sense of smell or taste
snoring
feeling like having a cold but not getting better
likely diganosis?
nasal polyps
first line tx for nasal polyps
nasal steroid drops
Tx for allergic rhinitis
1) antihistamine
2) intranasal steroids if antihistamines are ineffective / recurrent episodes
what does scanty discharge mean
a little bit of discharge
what is the most important part of management for mild/moderate otitis externa
keep ear dry for 7-10 days
noise induced hearing loss on audiogram
follows a similar pattern of symmetrical bilateral hearing loss worse at higher frequencies
a ‘spike’ or peak at 4 kHz before the hearing loss slightly improves at the next regular frequency of 8 kHz.
pt presents with neck swelling, doesn’t move on tongue protrusion or swallowing
had a cold a couple weeks ago before lump appeared
likely diagnosis
branchial cyst - often undetectable until grows in size due to infection
what does tympanogram demonstrating a flat (type B) tympanogram curve suggest
is indicative of fluid behind the tympanic membrane - eg middle ear congestion
which virus is associated with oral pharyngeal and laryngeal cancer
HPV type 16
first lien tx for acute mastoiditis
IV abx
the if doesn’t work investigate via CT - could have an abcess and need mastoidectomy
what is most common causative agent for otitis externa
pseudomonas aeruginosa
why should you od a nasal endoscopy and CT if as pt presents with swollen nose after trauma and difficulty breathing
rule out any septal haematoma, which if left untreated can result in necrosis and deformity of the nasal cartilage
what does positive Schwarze sign on otoscope suggest
otoslcerosis
headache, sensineural hearing loss, eye problems
likely diagnosis
vestibular shwannoma
why is haemophilia uncommon in females
its an X linked recessive condition
most likely condition if recurrent epistaxis runs in family
Hereditary haemorrhagic telangiectasia
Tx for acute otitis media
analgesia
can give delayed abx prescription
only give abx straight away if systemically unwell and fever, or immunocompromised
list some features of EPGA (eosinophilic granulomatosis polyangiitis)
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive
cardiomyopathy
kidney disease
gastrointestinal involvement
pt has many bilateral nasal polyps
adult-onset asthma,
symptoms of nasal obstruction
likely diagnosis
EGPA (eosinophilic granulomatosis polyangiitis)
EGPA (eosinophilic granulomatosis polyangiitis) vs GPA (granulomatosis polyangiitis)
EGPA:
bilateral nasal polyps
adult-onset asthma,
symptoms of nasal obstruction
GPA:
saddle nose,
nosebleeds and crusting
marked systemic upset (arthritis, renal impairment, nervous system)
what steps should be taken if GP presents with sudden sensineural hearing loss
urgent referral to ENT - emergency
ENT specialist can provide advice and commence high-dose steroids which are around 85% effective if started within 24-48 hours of onset. Anti-viral medication may also be considered
which scan is required for a neck lump
ultrasound - as allows you to do ultrasound guided biopsy
then if its malignant can do a staging CT
if a pt presents with bilateral jaw joint pain but no other signs what is the likely diagnosis
temporomandibular joint dysfunction
This is a biopsychosocial disorder that is thought to be caused by stress. the majority of cases improve without specific treatment
what is a cystic hygroma
a birth defect that appears as a sac-like structure with a thin wall that most commonly occurs in the head and neck area of an infant
likely diagnosis if a pt with acute otitis media presents with unusual sleepiness/drowsiness, projectile vomiting, severe headache, seizures
intracerebral abscess
likely diagnosis for progressively worsening sensineural hearing loss
vestibular schwannoma
type of hearing loss on cholesteatoma
conductive hearing loss
likely cause of a submandibular gland mass that hast caused any facial weakness or cervical lymphadenopathy
pleomorphic adenoma
most common type of oral cancer
squamous cell carcinoma
in which group of people is an oral squamous cell carcinoma more common
males who identify as homosexual as this population has a higher incidence of human papillomavirus of the mouth, which is a risk factor for carcinoma
what sign in a pt with recurrent rhinosunsitis indicates possible nasal neoplasm and requires urgent ENT referral
Unilateral bloodstained nasal discharge
which condition causes the formation of benign vascular tumours, called hemangioblastomas, throughout the body
von Hippel Lindau disease
which condition is characterised by intestinal hamartomas, which may present with features in keeping with gastrointestinal bleeding, such as melaena. also can have blue or dark brown macule around oral mucosa
Peutz-Jegher Syndrome
what is Caharts notch on an audiogram and which condition is it characteristic of
dip at 2kHz
otosclerosis
appearance of tympanic membrane in otosclerosis
normal
appearance of tympanic membrane in tympanosclerosis
white plaques
most common malignant tumour of parotid gland?
(presents as hard mass on gland, facial drooping)
Mucoepidermoid carcinoma
painless, mobile, and cystic swelling in the lateral aspect of the neck
diagnosis
branchial cyst
- not lipoma as not usually found on neck and doesn’t have cystic appearance
what does SCOOP stand for in approach to managing haematoma over thyroid surgery site
Skin exposure;
Cut sutures;
Open skin;
Open muscles;
Pack wound
how to differentiate pleomorphic adenoma vs warthins tumour
both are benign neoplasms
but warthins tumour is mire common in.
older males, smoking history, can occur bilaterally
first line Tx for noise induced hearing loss
hearing aids
neck mass, progressive facial swelling, painless
likely diagnosis
benign neoplasm eg pleomorphic adenoma or warthins tumour
where in the head/neck does HPV 16 often cause SSC
oropharynx
how does oral lichen planus present
white, lacy patches inside the mouth
