ENT Flashcards
What is the most common histological type of head and neck cancer?
squamous cell carcinoma
What are some of the risk factors associated with squamous cell carcinoma?
- Chewing betel quid or tobacco
- HPV 16 & EBV
- Smoking and alcohol
What are the 2 most common causes of otitis externa
Pseudomonas aeruginosa & s. aureus
What is the treatment for mild otitis externa?
topical acetic acid 2%
What is the treatment for moderate otitis externa?
topical abx and steroid (Otomize spray = neomycin, dexamethasone and acetic acid)
What is the treatment for severe otitis externa?
oral or IV abx
What is the treatment for fungal otitis externa?
clotrimazole
How do pathogens get access to the middle ear in order to cause otitis media?
Pathogens enter from the back of the throat via the Eustachian tube
What are the two most common bacterial causes of otitis media?
strep pneumoniae & H. influenzae
How is otitis media managed?
Analgesia only unless :
* >4 days & not improving
* systemically unwell
* Ruptured eardrum
* <2 years old and bilateral
In cases as above, give Amoxicillin
Can give a Delayed prescription of abx (3 day delay) if suspect symptoms may worsen
what is the risk associated with mastoiditis?
can cause intracranial infection if left untreated
How are peripheral and central causes of vertigo differentiated?
HINTs test
What causes BPPV?
otolith crystal free in the semi-circular canal
How does BPPV present?
Short bursts of vertigo and nystagmus triggered by head movement
How is BPPV diagnosed?
Dix-Halpike manoeuvre
How is BPPV treated?
Eply manoeuvre
What causes labrynthitis?
Inflammation of the semi-circular canals, vestibule and cochlea (usually triggered by a recent viral URTI)
How does labrynthitis present?
Vertigo
Tinnitus
Hearing loss
How is labrynthitis managed?
Prochlorperazine
Antihistamines
What causes Ménière’s?
Excessive build-up of endolymph
How does Ménière’s present?
Episodic Vertigo
Tinnitus
Unilateral sensioneural
hearing loss
Unidirectional nystagmus
How is Ménière’s managed?
Manage symptoms during an attack
Prochlorperazine
Antihistamines
What drug is given as Ménière’s prophylaxis?
Betahistine
What causes vestibular neuritis?
Inflammation of the vestibular nerve (usually triggered by a recent viral URTI infection)
How does vestibular neuronitis present?
Vertigo
NO hearing loss!
How is vestibular neuronitis managed?
Prochlorperazine
Antihistamines
What time frame counts as ‘rapid onset’ hearing loss?
<72 hours
What should happen if a patient has rapid onset sensioneural hearing loss?
Refer to ENT
What is the hearing test conducted in the newborn period (and what is the 2nd line test if they fail the first one?)
Otoacoustic Emissions then Auditory Brain stem responses if they fail the first test
What is the hearing test conducted from 6-18 months?
Distraction test
what is the hearing test conducted in children aged 1-3 years?
Visual reinforced audiometry
What is the hearing test conducted in children aged 3-5 years?
Play audiometry
What is the hearing test conducted in those >4 years old?
Pure tone audiometry
How are Rinne’s and Weber’s interpreted?
Rinne’s
* Positive test = normal
Weber’s
* Sensioneural = louder in normal ear
* Conductive = louder in abnormal ear
Name three medications/types of medication that cause sensioneural hearing loss
- Loop diuretics
- Gentamycin (aminoglycoside abx)
- Chemotherapy (cisplatin)
What is plotted on the x and y axis of an audiogram
X = Frequency
Y = Volume
Above what decibels is considered a normal hearing range?
> 20dB
What does conductive hearing loss look like on an audiogram?
Gap between the lines
What does sensioneural hearing loss look like on an audiogram?
drops off
what is the name given to age related hearing loss
Presbycusis
Which pitch of sounds are lost first in presbycusis?
High pitched sounds
Which pitch of sounds are lost first in otosclerosis:?
Low pitched sounds
How is otosclerosis managed?
Hearing aids, stapedectomy or stapedotomy
What condition is associated with bilateral acoustic neuromas?
Neurofibromatosis Type II
Where in the brain are acoustic neuromas found?
Cerebellopontine angle
How can acoustic neuromas be managed?
conservative management, surgery or radiotherapy
Name 4 causes of sinusitis
- Infection
- Allergy
- Obstruction of drainage (trauma, polyp, foreign body)
- Smoking
How should acute sinusitis be managed?
Watch and wait for first 10 days
Then 14 days of steroid nasal spray and a 7 day delayed abx prescription
How should chronic sinusitis be managed?
- Saline nasal irrigation
- Steroid nasal sprays
- Functional endoscopic sinus surgery
Name 6 causes of nasal polyps
- Asthma
- chronic rhinitis
- sinusitis
- Cystic fibrosis (test for this using the sweat test)
- Allergic fungal sinusitis
- Churg-Strauss syndrome
How are nasal polyps managed?
Bilateral = nasal steroids to shrink themor polypectomy
Unilateral = urgent referral to ENT
What is the most common cause of tonsillitis
Viral cause
What is the most common bacterial cause of tonsillitis?
Group A strep (strep pyogenes)
What is the antibiotic of choice in bacterial tonsillitis? How long should the course be?
Phenoxymethylpenicillin (10 days)
What are the indications of antibiotic prescription in patients with bacterial tonsillitis?
Centor score ≥ 3
FeverPAIN score ≥ 4
immunocompromised
very young
co-morbid
rheumatic fever
What are the indications for tonsillectomy?
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
- > 2 episodes of quinsy
- Enlarged tonsils causing difficulty breathing, swallowing or crying
How should a post tonsillectomy bleed be managed
A) within 24 hours of tonsillectomy
B) >24 hours post tonsillectomy
A) return to theatre
B) admit for IV ABx
What should you worry about if you see a patient with leukoplakia or eryhtoplakia?
They are pre-cancerous lesions- refer!!
What causes gingival hyperplasia?
vit C deficiency
pregnancy
AML
gingivitis
What causes glossitis?
iron deficiency anaemia
B12 deficiency
folate deficiency
coeliac disease
What causes geographic tongue?
stress
mental illness
psoriasis
atopy
diabetes
What causes strawberry tongue?
Kawasaki disease and scarlet fever
What causes black hairy tongue?
dehydration
dry mouth
poor oral hygiene
smoking
