ENT Flashcards
Otitis externa, otitis media w effusion
Otitis externa – swab. Gentamicin, microsuction
Otitis media – analgesia, oral antibiotics, grommet
(recurrent)
With effusion – tympanogram (flat), pure tone audiogram
(conductive hearing loss). Conservative, hearing aids,
surgery grommets +/- adenoidectomy
otosclerosis
Otosclerosis: progressive hearing loss, family history,
tinnitus, hear better with background noise. Tympanogram,
pure tone audiogram (conductive hearing loss, notch at
2kHz). Hearing aid, stapedectomy
BBPV
Benign paroxysmal positional vertigo: seconds, head
movement – otoliths in semicircular canal abnormally
stimulating hair cells. Dix-Hallpike test (nystagmus and
symptoms). Epley manoeuvr
Meniere’s disease
Meniere’s disease: tinnitus, hours to mins, fluctuating
sensorineural hearing loss, aural fullness – increased fluid in
endolymphatic compartment. Dietary, thiazide diuretic
(bendroflurazide), betahistine, prochlorperazine (acute),
grommet, dexamethasone middle ear injection, sac
decompression, vestibular destruction, surgical
labyrinthectomy
auricular haematoma
auricular haematomas are common in rugby players and wrestlers. Prompt treatment is important to avoid the formation of ‘cauliflower ear’.
Management
auricular haematomas need same-day assessment by ENT
incision and drainage has been shown to be superior to needle aspiration
acoustic neuroma
Acoustic neuroma: vertigo, hearing loss, tinnitus, absent
corneal reflex. Surgery, radiotherapy
vestibular neuronitis
Vestibular neuronitis: several days, incapacitating,
nystagmus. Vestibular rehabilitation exercises
Sudden onset sensorineural hearing loss: pure tone
audiogram, MRI (acoustic neuroma). Steroids
rhinosinusitis
Rhinosinusitis: acute <12w (viral and non-viral), chronic
>12w (+/- polyps). Acute: analgesia, nasal decongestants,
topical nasal steroids, oral antibiotics. Skin prick test if
?allergy, CT sinuses, polypectomy
nasal septal haematoma
nasal septal haematoma is an important complication of nasal trauma that should always be looked for. It describes the development of a haematoma between the septal cartilage and the overlying perichondrium.
Features
may be precipitated by relatively minor trauma
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea are also seen
on examination, classically a bilateral, red swelling arising from the nasal 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
Management
surgical drainage
intravenous antibiotics
If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a ‘saddle-nose’ deformity
peritonsillar abscess
A peritonsillar abscess typically develops as a complication of bacterial tonsillitis.
Features include:
severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility
Patients need urgent review by an ENT specialist.
Management
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence
ramsay 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.
Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Management
oral aciclovir and corticosteroids are usually given
nasopharngeal carcinoma
Basics
Squamous cell carcinoma of the nasopharynx
Rare in most parts of the world, apart from individuals from Southern China
Associated with Epstein Barr virus infection
Presenting features
Systemic Local
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
Imaging
Combined CT and MRI.
Treatment
Radiotherapy is first line therapy.
mastoiditis
Mastoiditis typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone.
Features
otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated
The diagnosis is typically clinical although a CT may be ordered complications are suspected.
Management
IV antibiotics
Complications
facial nerve palsy
hearing loss
meningitis
epiglottis
anaphylaxisis
