ENT Flashcards
bacterial sinusitis Fx
Double sickening - unilateral frontal facial pain + nasal discharge, gets better, then gets much worse
Common infectious sinusitis causes
Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses
Acute sinusitis Mx
Majority self resolve as viral
Nasal corticosteroids - if symptoms >10days
PO Abx if severe - phenoxymethylpenicillin
Cholesteatoma Fx
Non resolving, foul smelling discharge
unilateral hearing loss
Other local complications:
vertigo
facial nerve palsy
Otoscopy: “attic crust” - upper part of ear drum
Otitis externa Mx
1st - Top Abx (acetic acid 2%) +/- Top steroid
Differentiating vertigo symptoms
BPPV - Sx lasting seconds to one minute
Menierres - Sx lasting 30 mints to hours, with associated hearing loss (sensorineural)/ tinnitus/ fullness of ear- recurrent episodes
Labyrinthitis/ Vestibular neuronitis - Sx sudden and constant, last for days, recent viral infection
- Labyrinthitis has associated hearing loss and tinnitus/ neuronitis does not
Vestibular migraine - Episodic, phonophobia, Hx migraines
Acoustic neuroma Fx
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Performated tympanic membrane Mx
Self resolve after 6-8 weeks - if not resolved then for ENT
advised not to swim during this episode
Abx if OM
Vestibular neuronitis Mx
Acute - buccal/ IM prochlorperazine
Chronic (>6 weeks despite acute Mx) - vestibular rehabilitation
Otitis medias with effusion Mx
Amoxicillin + FU 2 weeks
Gingivitis Mx
Refer to dentist
PO Metronidazole 3/7
Chlorhexidine mouthwash
Analgesia
Epistaxis Mx
If no red flags
1st - Naseptin (chlorhexidine/ neomycin) cream
2nd - ENT either “hot clinic” or OP referral
Chronic Rhinosinusitis Mx
1st - intranasal corticosteroids/ nasal irrigation with saline
Red flags requiring ENT
- unilateral symptoms
- persistent symptoms >3 months of treatment
- epistaxis
Ear Wax Mx
olive oil
sodium bicarb
almond oil
If grommets in situ - refer ENT
Otosclerosis Fx
Bilateral conductive hearing loss in young with positive family history
Nasal polyp Mx
bilateral
- routine ENT
- Top corticosteroids
unilateral
- urgent ENT
Otitis media with effusion (glue ear) Mx
Self resolve within 6-12 weeks
If need abx - Amoxicillin + FU 2 weeks
If has Downs or cleft palate - refer ENT
Mouth ulcer Mx
low potency steroid (eg hydrocortisone lozenge), antimicrobial mouthwash, topical analgesia
if >3 weeks = refer
BPPV diagnostic tool?
Dix hall-pike
Rotary nystagmus = positive result = BPPV positive
Dix = Diagnostic
Samter’s triad is…
Aspirin sensitivity
nasal polyps
asthma
Menierres disease Mx
ENT to confirm diagnosis
DVLA - stop driving until control of symptoms
Acute - buccal/ IM Prochlorperazine
Prevention: Betahistine, vestibular rehab
Otitis media Mx (without effusion)
1st - self resolve within 3 days
2nd - Amox (Clari/ Eryth if pen allergy)
For Abx if:
<2yo + bilateral OM
Otorrhoea
immunocompromised
Acute otitis media Fx
Cause - often viral, bacteria - strep pneumo, h influenza, moraxella
otalgia - eg tugging at ear
fever
hearing loss
recent URTI eg coryza
ear discharge otorrhea - if perforated TM
Acute otitis media otoscopy findings
Bulging ear drum
Loss of light reflex
perforation - if purulent
Otitis media Mx
1st - supportive only first 3 days
Abx if:
>3 days no improvement
systemically unwell
immunocompromised
<2yo + bilateral AOM
Perforation or discharge
Abx - Amoxicillin 5-7 days. Clari/ eryth if pen allergy
Gingival hyperplasia causes
Phenytoin
Ciclosporin
CCB (Nifedipine)
Acute Myeloid Leukaemia
EBV is risk factor for what cancer
Lymphoma
Nasopharyngeal Ca
