ENT Flashcards
what is the typical presentation of vestibular neuronitis?
A history of vertigo lasting hours-days, preceded by a viral infection. Typically resolves within weeks. no hearing loss or tinnitus
What is the long term management of vestibular neuronitis?
vestibular rehabilitation exercises
What are the centor criteria?
- presence of tonsillar exudate
-tender anterior cervical lymphadeopathy - fever
- absence of cough
What are the 5 criteria of the feverpain score?
- fever over 38
- purulent tonsils
- attended rapidly (within 3 days)
- severely inflamed tonsils
- no cough or coryza
What is the treatment of bacterial tonsilitis?
phenoxymethylpenicillin (7/10 days)
clarithromycin if pen-allergic
What is the management of a unilateral glue ear in adults?
2-week wait to ENT to evaluate for posterior nasal space tumour
What is the management of acute otitis media with perforation?
Oral amoxicillin
What is the management of otitis externa?
combined gentamicin and dexamethasone drops
What do you use a HiNTs exam for?
To distinguish between peripheral and central causes of vertigo such as vestibular neuronitis and posterior circulation stroke
What are the HiNTs findings if there is a peripheral cause of vertigo?
abnormal head impulse test, with either unidirectional nystagmus or no nystagmus or vertical skew
What are the HiNTs findings if it is a central cause of vertigo?
a normal head impulse test, with either bidirectional or vertical nystagmus and a vertical skew
What is the management of OME in children?
- active observation for 3 months
- grommet insertion
- adenoidectomy to improve eustachian tube function
What is the management of persistent hoarseness in an over 45 y/o?
Chest X-ray and urgent referral to ENT
What are the otoscopy findings of acute otitis media?
- bulging tympanic membrane with loss of light reflex
- red/opacification of the tympanic membrane
- perforation
What is the management of a patient with acute sensorineural hearing loss?
Urgent referral to ENT for audiology and brain MRI
high dose oral corticosteroids in ENT
What are the features of viral labyrinthitis?
- recent viral infection
- sudden onset vertigo
- nausea and vomiting
- can affect hearing
What are the features of vestibular neuronitis?
- recent viral infection
- recurrent vertigo attacks lasting hours/days
- no hearing loss
What is the management of unresolving otitis externa?
urgent referral to ENT ?necrotising otitis externa
IV Abx that cover pseudomonas
What are the key features of malignant otitis externa?
- diabetic/immunocompromised
- severe otalgia
- temporal headaches
- purulent otorrhea
- not clearing despite treatment
What is the initial management of epistaxis?
Pinch the nostrils firmly and lean forwards for 20 mins
What is the management of mastoiditis?
IV antibiotics
What is the most common type of parotid tumour?
Benign pleomorphic adenoma
What are the features of a benign pleomorphic adenoma?
Slow-growing, lobular, most common parotid tumour
What are the features of a warthin tumour?
benign parotid tumour, associated with smoking,
What exercises can be done at home for BPPV?
Brandt-Daroff
What is the most likely causative organism for otitis externus?
Pseudomonas Aeruginosa
Which drugs are ototoxic?
FAV.Q&A
Furosemide, Aminoglycoside (gentamicin), vancomycin, quinine, aspirin
What is the first-line management of compacted earwax in GP?
1 week olive oil drops or ear syringing, then review
What are the features of vestibular neuronitis?
Vertigo following recent viral infection, attacks last hours to days, may have vomiting, no effects to hearing, horizontal nystagmus
What does the hints test distinguish?
Central Vs peripheral causes of vertigo
What is the management of vestibular neuronitis?
Prochlorperazine for rapid relief, antihistamine for longer term, vestibular rehabilitation exercises for treatment
What are the examination findings of quinsy?
Trismus, drooling, deviation of the uvula to the unaffected side
What are the tonsillitis indications for a tonsillectomy?
7 episodes in 1 year, 5 per year in 2 years, 3 per year for 3 years
What are the features of sialadenitis?
- inflammation of the salivary gland
- painful one sided neck swelling, temperature, submandibular mass, painful lymphadenopathy
What is ludwig’s angina?
infection of the submandibular or sublingual space
What is the management of unilateral glue ear in an adult?
Urgent referral to ENT to evaluate for posterior nasal space tumour
What is the management of Ramsey Hunt syndrome?
High dose aciclovir, high dose oral steroids and eye protection
What is the management of a post-tonsillectomy haemorrhage?
urgent ENT assessment
What is the scoring system used to assess obstructive sleep apnoea?
Epworth sleepiness scale
What is the management of otitis externa?
- topical antibiotic plus steroid
Which manoeuvres are used to diagnose BPPV?
Dix-Hallpike Manoeuvre
Which manoeuvres are used to treat BBPV?
Epley Manoeuvre and Brandt-Daroff exercises
What are the common causes of otitis media?
Moraxella, strep pneumoniae, haemophilus influenzae (often preceeded by a viral infection)
Which artery may need to be ligated if other management attempts have failure in epistaxis?
sphenopaletine artery
Explain the HINTs exam
HI test - hold head and turn 10-20 degrees, look for corrective saccade
N - look for nystagmus direction
S - test of skew, cover one eye, if uncovered eye moves vertically can show central cause
What is exostosis?
Bony projections in ear canal due to repeated exposure to cold water - causes conductive hearing loss
What is the management of otitis media with effusion (non infective)?
active observation for 6-12 weeks, unless Down’s syndrome or cleft palate. refer to ENT. grommets
What is indicative of a fungal otitis externa?
black dots, cotton wool debris. not better with abx (refer to ENT)
What is the management of otitis externa?
If mild: topical acetic acid. topical antibiotic, or combined topical antibiotic with steroid.
2nd line: oral fluclox, take a swab, refer
What is the last line management of epistaxis?
Sphenopalatine artery ligation
The presence of a persistent mouth ulcer over what time period warrants an ENT referral?
> 3 weeks - could be a squamous cell carcinoma
Which medication is used to help prevent meniere’s attacks?
Betahistine - histamine agonist, helps with fluid pressure balance of endolymph
Which analgesia should you try to avoid in asthmatics?
aspirin (+ NSAIDS) as are more likely to have a sensitivity
When should you prescribe antibiotics in acute otitis media?
> 4days. Perforated eardrum, gunky ear. systemically unwell, <2y/o with bilateral OM
What is the first line antibiotic in acute otitis media?
amoxicillin
