ENT Flashcards
What is glue ear
otitis media with effusion
Positive rinnes test means?
normal
ie air>bone
webers test lateralises to where
Affected ear in conductive
unnaffected ear in sensorineural
Post viral horizontal nystagmus no tinnitus no hearing loss
vestibular neuritis
nasal septal haematoma tx
complications `
immediate ENT referal for drainage
saddle nose bc disrupted vasc supply to cartilage
how to differentiate nasal septal haematoma from deviated septum
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm
Auricular haematomas tx and complication
same day ENT asssesment for incision and drainage to prevent cauliflower ear
nasopharyngeal carcinoma type
SSC
nasopharyngeal carcinoma sx
Nasopharyngeal carcinoma is more common in people of Asian origin, and typically presents with epistaxis, headaches, lymph node metastasis or unilateral hearing loss.
unilateral middle ear effusion in adult can be presenting sign
perf Tympanic membrane that doesnt heal tx
myringoplasty
‘Consider making an urgent referral (to be seen within 2 weeks) to an ear, nose and throat service for adults of Chinese or south-east Asian family origin who have
hearing loss and a middle ear effusion not associated with an upper respiratory tract infection’.
nasopharyngeal carcinoma
Bugs causing otitis media
resp epithelium =
haemophilis influ. B
strep pneum
moraxella
what is ramsey hunt
Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
ramsey hunt sx
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
ramsey hunt tx
oral acyclovir and oral corticosteroids
ototoxic meds
gentamicin
furesomide
quinine
aspirin
chemo agents
Globus hystericus
This is the sensation of a lump being stuck in the throat, with no physical findings present
Globus, hoarseness and no red flags
¬hing on CXR and larygoscopy
laryngopharyngeal reflux
rinne and weber result of sensurineural hearing loss of left ear
postive rinnes bilaterally
weber lateralises to right ear
acoustic neuroma/vestibular schwannoma sx (depending on cranial nerve)
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
bilateral acoustic neuroma
neurofibromatosis type 2
when to refer a child with glue ear to ENT
if they have persisting significant hearing loss on two separate occasions (usually 6-12 weeks apart)
unilateral glue ear in adult mx
refer two week wait ENT for malignancy
posterior nasal space tumor
nasal polyps tx
Intranasal corticosteroid spray or drops can be used to shrink nasal polyps ie
intranasal mometasone furoate,
fluticasone furoate,
fluticasone propionate
drops if severe obstruction
How long should you give nasal polyp tx for
Intranasal corticosteroids should be trialled for 4-6 weeks.
what conditions in children need to be referred to ENT if they have glue ear
down syndrome
cleft palate
acute necrotising gingivitis mx
dentist
metronidazole
chlorhexadine mouthwash
paracetamol
recurrent otitis externa following abx tx and fungal discharge
candida
vestibular neuronitis tx acute and chronic
prochlorperazine (acute phase only)
vestibular rehab exercises
vestibular neuronitis sx
post viral
vertigo hours to days
maybe N&V
horizontal nystagmus
NO hearing loss or tinnitus
complications of thyroid surgery
damage to Parathyroid glands = hypocalcaemia
chronic rhinosinusitis tx
nasal saline irrigation
labrynthitis sx
acute onset
vertigo
N&V
hearing loss (both U&Bi)
Tinnitus
post URTI
labrynthitis vertigo type
not triggered by movement but worsened by movement
Labrynthitis signs
spontaneous unidirectional horizontal nystagmus towards the unaffected side
sensorineural hearing loss
abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
gait disturbance: the patient may fall towards the affected side
labrynthitis mx
self resolves
prochlorperazine for dizziness
meniers management
life
acute
prophylaxis
inform DVLA
buccal/IM prochlorperazine
betahistine
maybe vestib rehab
cochlear implants when
failed trial of hearing aid - 3 month trial
presbyacusis
normal loss of high frequency hearing with old age
salivary gland calculi/ sialolithiasis MC
form in submandibular gland and so therefore block whartons duct
menieres main features
others
recurrent episodes 10-30mins
vertigo tinnitus hearing loss (sensineu)
aural fullness/pressure senstion
nystagmus
+ve rombergs
how to tell between vestibular neuronitis and posterior circulation stroke
HiNTs exam
abnormal in peripheral cause and normal in central cause
where are acoustic neuromas best visualised
MRI of cerebellopontine angle
pain on swallowing
odynophagia
sx of tonsillitis
soar thrat
pain and diff swallowing
fever
change in voice
ear pain
anorexua
abdo pain
name of LN which is enlarged in tonsillitis
jugulodigastric lymph node
why pen V in tonsillitis instead of amox
just incase mono –> will cause rash
area of nose where anterior epistaxis originates
littles area / klesselbacks plexus
conservative mx epistaxis
lean forward
squeeze bottom of nose
ice pack to nose brudge
mx of epistaxis in child <2yo
admit and follow up
underlying cause more likely to be haemophilia or leukemia in this age group
first aid measurement failed epistaxis
bleeding hasnt stoppeed after 10-15 mins
packing
silver nitrate cauterisation
ligation of sphenopalatine
