ENT Flashcards
acoustic neuroma.
aka vestibular scwhanoma
benign slow growing, arises from vestibulocohlear nerve.
can result in brain stem compression and hydrocephalus.
S+S: progressive unilateral sensorineural hearing loss. +/- tinnitus, intermittent dizzy.
Ix:
audiography- asymetrcal loss >10db in 2 contiguous frequencies, or 15 in a single. —> MRI
gadolinium enhanced MRI- confirmatory
Rx: if small (1-2 grade) observe
3-4 radiation or surgery (surg generally)
complications- hearing loss, facial weakness/ numbness
discuss koos grading system for vestibular schwannoma
1- intra canalicular
2- minimal extension into cerebello pontine angle <2
3- into cerebellar pontine angle but no brainstem displacement
4- large with brainstem displacement.
discuss acute labyrinthine failure/ labrynthitis.
inflammation of otic organs due to recent/ current infection (usually virus)
symptoms settle in a few days but 6-8 weeks to fully recover.
S+S: dizzy/ vertigo. N+V, occ nystagmus. — no hearing loss + tinnitus.
Ix: clinical diagnosis but may audiogram/ head impulse test.
Rx: self resolution.
maybe bed rest to avoid falling
no drive
consider anti-emetics- prochlorperazine/ cyclizine.
BPPV
benign (obs) self limiting
vertigo experienced when moving head.
- brief but repetitive.
crystals / otoconia found in semi-circular canals.
posterior canal problem usually.
RF: age, female, head trauma
Ix: dix hallpike manoeuvre/ provocation manoeuvres (need symptoms + nystagmus)
consider brain mri
Rx: medication not effective.
repositioning manoeuvres
if not effective- surgery
epistaxis
most of the time (95%) occurs at little’s area. - where 5 arteries meet!
step wise: sat up + forward. - spit blood
compression- cartilage portion. - ice to bridge
inspect- if able
if not -adrenaline soaked tampon/ wool ball.
cauterise if visible spot
if not pack with Foley/ balloons. leave for 24 hrs.
can do surgery.
obviously correct anything poss-i.e coagulopathies.
don’t cauterise both sides at the same time- septum may die.
maj hemorrhage protocol if:
SBP<90
no response to fluid bolus
discuss foreign body ingestion
most are harmless and pass through tract. most likely stuck point is oesoph/gastro junction.
consider if stridor, wheeze, drool/ dysphagia, choking, cough, vom, abdo pain.
hazardous objects are: batteries (button espesh) sharp + long (6cm) or wide (2cm)
magnets
filled balloons/ very big.
- batteries can discharge current- build up of sodium hydroxide- necrosis/ burns–> fistulas. (up to 28 days post ingestion)
magnets if multiple can stick together and pinch loops of bowel together- necrosis.
Ix: metal detector/ x-rays of area- if below diaphragm + tolerating food–> home
respiratory problems- refer to ENT (if in upper oesophagus)
Rx: endoscopy usually.
safety net: vom. haematemesis, abdo pain, Pr bleeding.
refusing to eat/ drink.
menieres disease
episodic auditory and vestibular disease
increased production of endolymph (or dec reabsorbtion)
S+S: hearing loss, vertigo, tinnitus, fullness in ear.
low frequency hearing loss- early sign
Ix: audiometry, mri, tft, lyme/ana testing.
Rx: dietary changes + lifestyle (restrict salt, caff,alcohol)
Add diuretic (thiazide)
add vestibular suppressant or steroid - either injection into ear to chemically labrynthectomy or systemically. - meclozine, promethazine.
surgery if not successful.
discuss nasal trauma
50% of facial fractures are nasal bone
with any trauma- als assessment first.
if laceration- approximate the edges.
red flag is septal hematoma- bleeding within the perichondrium- causes peeling back of it- can lead to avascular necrosis if not treated–> you will see big boggy red/purple swellings in nostrils.- can get saddle nose deformity.
Rx: incision and drainage- GA.
fracture- semi-elective (7-10 days post injury) assess deformity and airflow.
MUA within 14-21 days post injury if needed.
RED FLAG- CSF rhinorrhea –> fracture of cribiform plate —> leak—> usually resolves after 2 weeks, needs surg if not.
discuss obstructive sleep apnoea
loud snoring, gasping during sleep, apnoeas, unrefreshing sleep, daytime sleepiness.
causes: obesity, jaw deformities, oropharyngeal narrowing, macroglossia
Ix: polysonmnography- 5 episodes per hour + symptoms diagnostic, 15 with no symptoms.
Rf: male, fat, post menopause, large neck, pcos.
Rx: CPAP
2nd line- opal appliance therapy.
surgery
or lifestyle changes.
discuss pinna haematoma
common- cauli ear.
perichondrial blood vessels tear.
can cause AVN- same as nose.
need to be drained within 24 hours + compression applied- necrosis and fibrosis will occur otherwise
can be done with needle
or incision.
need sterile field.
discuss presbycusis
age related hearing loss.
affects higher frequencies before lower.
progressive, irreversible, bilateral.
sensurineural- sensory part- is hair loss. neural part is ganglion breakdown.
1 in 3 over 65.
Ix: audiography with classification based of defecit (multiple tone testing)
classified as mild- 25-45 db range
moderate- 45-65
severe- 65-85
profound-85 of higher.
Rx: no pharm
cochlear inplants is v bad
surgically implantable hearing aids or normal hearing aids
vocal fold paralysis
as a result of recurrent laryngeal nerve palsies.
causes: trauma, tumour, MS/ myasthenia gravis
laryngeal lymph drainage is glotic sub+ supra (remember which one is best)
Ix: laryngoscopy
Rx: bulk injections (may have atrophied, thiese literally ‘bulk’ it out’ , surgery (implants or re-innervation),
