ENT Flashcards
Suggest the complication of otitis media
Facial nerve palsy
Mastoiditis
Petrositis - Gradenigo syndrome
Labrynthitis
Meningitis
Sigmoid sinus thrombosis
Brain abcess
What are some causes for otlagia?
50% non otological e.g. grinding, TMJ
Trauma
Eczema
Furunculosis
NOE
Barotrauma
Suggest the most common infections in the ear canal
Pseudomonas then staphylococcal
How are OE infections managed?
Antibiotics + steroid
Aural toilet
What are some otitis media infections?
Pneumococcus
Haemophillus
Moraxella
How is otitis media managed?
If no systemic symptoms and simply pain, may recover in 24 hours without antibiotics and simple analgesia. However if systemically unwell, fever or <2 years old may benefit from amoxicillin. Consider a delayed prescription
What is benign or inactive COM?
A perforated ear drum
Dry
No active infection
What is chronic serous otitis media?
Characterised by continous serous drainage
What is chronic suppurative otitis media?
Diagnosed when there is persistent purulent draiange
What are the complications of a cholesteosteoma?
Facial nerve palsy
Mastoiditis
Hearing loss
Petrositis
Cerebral abcess
What is a cause of middle ear infections in adults?
Posterior space tumours
How should children with bilateral OME be managed?
3 month period of active observation and re-assess wit repeat hearing tests at 3 months. Consider after 3 months of ventillation tubes i.e. grommets or surgery.
How should children modify activities with grommets?
Swimming is permitted
However diving is not or forcing water
What are some causes of hearing loss in children?
50% genetic e.g. Jervell Lange, Klippel-Feil syndrome, Waardenburg syndrome, Alport
25% are non-genetic e.g. TORCH infections, meningitis, encephalitis, measles and mumps, ototoxic drugs
25% idiopathhic
What tests may be done in neonates for hearing impairment?
Otoacoustic emission testing
Auditory brainstem response (ABR)
What are the causes of tinnitus in patients?
Objective:
Vascular disorders: AV malformations, globus tumours,
high cardiac output states.
Subjective:
Menierre’s syndrome
Ototoxic drugs
Otitis media
SNHL
Noise induced damage
How is tinnitis treated?
Manage depression, anxiety and insomnia
Hearing aids
Psychological support
CBT
What are the features of acoustic neuroma?
Unilateral hearing loss
Unilateral tinnitis
Dizziness
MRI and pure tone audigram
What is the Jastreboff model?
It suggests there is a limbic and autonomic link with tinnitus annoyance
What type of nystagmus is seen in peripheral vertigo/ vestibular vs central vertigo?
Peripheral = horizontal
Central = vertical
What is Unterberger’s test?
What are the two types of vertigo?
Central and peripheral
What is BPPV?
<30 seconds are provoked by head turning
Dix-Hallpike test +ve
Self limited
Epley manoeuvre
Brandt Daroff exercises
What is Meniere’s?
2 or more episodes of vertigo lasting between 20 mins and 12 hours
Abnormality with endolymph
Fluctuating hearing loss, vertigo, tinnitus and fullness
Acute use prochlorperazine
Prophylaxis: beta histine
What is vestibular neuritis and labyrinthitis?
Sudden attacks of unilateral vertigo and vomiting in a previously well person, often following an URTI.
Lasts 1-2 days improving over the week
Vestibular suppresants Prochlorperazine or buccastem and rehabilitation
Labrynthitis has hearing loss
What is FESS?
Functional endoscopic sinus surgery (FESS) is a minimally invasive surgery for serious sinus conditions. It is used to clear blockages in the sinuses and make breathing easier
What drains to the superior meatus?
Posterior ethmoidal
What drains to the inferior meatus?
Nasolacrimal duct
What does the maxillary, anterior ethmoidal, middle ethmoidal and front sinus drain to?
Middle meatus
What does the sphenoid sinus drain to?
Sphenoethmoidal recess
When should manipulation of the nasal bones be performed?
Day 7-14
First check for a boggy swelling a septal haematoma
What does CSF contain?
B2 tau transferrin and >0.5ml is gold standard for rhinorrhea
How is CSF rhinorrhea managed?
Check for glucose and B2 tau protein
Give antibiotics and prophylaxis pneumococcal vaccine
How is epistaxis managed?
Nosebleeds can be anterior or posterior
Can be life threatening
Assess blood loss: ABC, IVI, oyxgen sats
Which side? trauma? how much blood lost? on wafarin?
Pinch the lower part of the nose for 10 minutes
Place an icepack on the dorsum on the nose
Prepare to cauterize the nose with silver nitrate
Use headlight and Thudicum’s speculum
Anterior nasal pack
Compare and contrast tonsillitis and quinsy?
Quinsy is a peritonsillar abscess
What is the fever pain score?
What are the complications of tonsilitis?
Peritonsilar abscess - presents with sore throat, dysphagia, peritonsilar bulge, uvular deviation, trismus and a muffled voice
Abscess of parapharangeal
Lemierre’s syndrome
What is Lemierre’s syndrome?
Infectious thrombophlebitis of the internal jugular vein caused by fusobacterium and emboli
What is the Paradise criteria?
How is a primary haemorrhage and secondary haenorrhage different following tonsillectomy?
Primary <24 hours back to theatre
Secondary >24 hours observe in hospital and antibiotics
What are the causes of stridor?
Congenital: Laryngomalacia
Inflammation: laryngitis, epiglossitis, group, anaphylaxis
Trauma: burns
What are the causes of drooling?
Not necessarily with epiglossitis
Angiooedema. rabies, muscular problems, ingestion of foreign body
List the causes of hoarseness
Vocal cord palsy
Spadmodia dysphonia
Cranial nerve palsy
Laryngitis
Vocal cord nodules
Laryngeal cancer
Reflux
Reinke’s oedema
Muscle tension dysphonia
Laryngeal vocal nerve palsy
What are the questions you should ask with swallowing difficulties?
- Solids
- Liquids - can’t swallow liquids well e.g. achalasia, bulbar palsy
- Initiate swallowing - can’t initiate bulbar palsy
- Painful - malignant swelling
- Swelling on drinking - retropharnygeal abscess
What is the most common cause of head and neck cancers?
HNSCC
What are some risk factors for HNSCC?
Cigarette smoking
HPV
Alcohol
Vitamin A and C deficiencies
GORD
What are some causes of dysphasia?
Achalasia
Strictures
Malignancy
Pharyngeal pouch
Globus hystericus/ pharyngeus
What are some tests for swallowing defects?
Barium swallow
Endoscopy
Motility studies
How are laryngeal cancers treated?
First line chemoradiotherapy
Second line surgery and radiotherapt
What are the intracranial nerves of facial nerve palsy?
Chorda tympani = 2/3rds taste
Branches to stapedius = hyeracusis
What are the causes of a cranial nerve palsy?
Intracranial: brainstem tumours, strokes, polio, MS, acoustic neuroma, meningitis
Intratemporal: Ramsay Hunt, cholesteatoma
Infratemporal: Parotid tumours
Others: Lyme disease and sarcoidosis
What are the tests for a facial nerve palsy?
ESR, glucose, Lyme disease, check parotids for lumps and bumps
What are some differentials for neck lumps?
Duration: if < 3 weeks likely reactive lympadenopathy
If midline:
<20 midline lump = dermoid cysts
<20 midline + elevates on tongue protrusion = thyroglossal cyst
>20 midline + elevates likely a thyroid mass/ goitre
If submandibular:
<20 self limiting = reactive lymphadenopathy
>20 = malignant lymphadenopathy
Could it be a submandiubular stone, tumour, or siadelinitis
If anterior triangle:
Lympadenopathy
Branchial cyst
Parotid tumours
Carotid artery aneurysm
Carotid artery tumour
If posterior triangle/ i.e. behind sternocleidomastoid
Cervical ribs
Pharyngeal pouches
Cystic hygroma
Lympadenopathy (TB, HIV)
If >20 lymphoma
What is the most common parotid tumour?
Pleomorphic adenoma
What is a high grade salivary tumour?
Mucoepidermoid carcinoma
Which salivary gland tumour spreads along the nerve?
Adenoid cystic tumours
Which salivary tumours tend to be bilateral?
Warthin’s tumour (adenolymphoma)
How is Vincent’s angina treated?
This is ncerotising ulcerative gingivitis
Amoxicillin and netroniazole
What are causes of gum hyperplasia?
Phenytoin, cyclosporin and nifedipine
How can you distinguish between pain in the teeth?
Caused by sugar or heat - pulpitis
Worse with percussion = osteitis or abcess
Exacerbated by movement - abscess
What are the causes of a black hairy tongue
poor oral hygiene
antibiotics
head and neck radiation
HIV
intravenous drug use
