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)