ENT Flashcards
DDx of vertigo?
CPA tumour
Cerebrovascular disease
Migraine
MS
Cervical vertigo
Drug-induced
Psychological
Examples of Cerebellopontine angle tumours?
Vestibular schwannoma
Brainstem glioma
Medulloblastoma
Neurofibromatosis
Characteristics of peripheral nystagmus?
Equal in direction, speed & amplitude in both eyes
No change in direction with gaze
Never purely vertical
Suppressed by fixation
Causes of BPPV?
Idiopathy >50%
Secondary = trauma, viral labyrinthitis, MD, Migraines
Surgery for BPPV?
Indication = refractory to conservative mx
Posterior semicircular canal occlusion
Vestibular neurectomy/singular neurectomy
invx for sudden unilateral SNHL?
MRI tro vestibular schwannoma
Blood tests
Syphilis, thyroid, CSR, ERP, RP etc
Mx of idiopathic acute unilat SNHL?
Oral Pred 1mg/kg up to 60mg for 10-14D BEST
2nd line intratympanic dexa
Hyperbaric O2 therapy
Mx of vestibular schwannoma?
<1.5cm = monitoring
1.5 - 2.5cm = Radiation vs Excision
>2.5cm = excision
Pathophysiology of Meniere’s?
Dysregulation of endolymphatic fluid homeostasis -> endolymphatic hydrops
Symptoms of MD?
Episodic vertigo, lasts minutes to hours
Tinnitus
Ear fullness
Hearing loss - fluctuating
Medical therapy for MD?
Diuretics + low-sodium diet
IT Dexa
Vestibular suppressants
Betahistine hydrochloride
Avoid caffeine + alcohol +derivatives
Mx of Labyrinthitis?
Acute phase:
- vestibular sedatives e.g. Stemetil, Sturgeron
- Bed rest
- Betaserc w/wo steroid
- Treat any viral infection
Convalescent phase:
- Betaserc
- Vestibular rehab
Cranial nerves usu injured in BOS frac?
CN 6 7 8
RF for NPC?
EBV infection
Salt-preserved food
1st degree relative
Epigenetic modulation
Histological classification of NPC?
Type 1 = SCC
Type 2 = undifferentiated SCC
2a = keratinizing undiff SCC
2b = non-keratinizing undiff SCC
Type 2b closely a/w EBV
Causes of conductive hearing loss - mid ear
AOM
OME
CSOM
Cholesteatoma
Otosclerosis
Temporal bone trauma
Think of ossicular chain disruption as well
Causes of Conductive hearing loss - external ear
Foreign body
Otitis externa
TM perforation or retraction
Causes of Sensorineural hearing loss - acquired
Noise-induced
Age-related
Infective/inflammatory
Ototoxic drugs
Tumour - Acoustic neuroma, CPA tumour
Meniere’s disease
Perilymph fistula
Causes of Sensorineural hearing loss - congenital
Intrauterine TORCH infections
Hereditary - syndromic/not
Birth trauma etc etc
Components of GRBAS scale?
For voice evaluation
Grade of hoarseness
Roughness
Breathlessness
Asthenia
Strain
Asthenia = physical weakness or no energy
What is the only legit mx for tinnitus?
Tinnitus retraining therapy. Kinda like psychotherapy - to modify emotional rxn to tinnitus.
Everyth else are placebo like gingko, meds wtv.
Ddx for unilateral leukoplakia?
Parakeratosis
Hyperkeratosis
Mild/moderate dysplasia
Malignant = SCC
Infective = TB, candida
invx of unilateral leukoplakia?
CT neck
Panendoscopy
Biopsy with laser
Causes of unilat vocal cord palsy?
Neurological - PICA, MS, AICA, lateral medullary syndrome
Neoplasia - larynx, mediastinum, thyroid, lung
Iatrogenic - Surgery, intubation
Mx of unilateral vocal cord palsy?
Conservative = speech therapy
Surgical = injection / open surg
Surgical for pts with aspiration or need good voice use
use single lumen or double lumen tube for tracheostomy?
just double lumen used nowadays.
Must do CXR after putting in
Cutoff for “large volume” in epistaxis?
Above half cup volume each time
What is Wallenberg syndrome?
Neurological condition due to lateral medullary infarction due to occlusion of PICA / Vertebral artery
Dysphagia
Hoarseness
Ataxia / dysmetria / dysdiadochokinesia
Horner’s
Vertigo
Nystagmus, diplopia
Ipsilateral loss of pain and temp in face
Contralat loss of pain and temp in body below face
Risk factors for oral cavity cancer?
Smoking
Spirits
Spices
Sharp teeth
Sun exposure
Syphilis
Commonest subsite of oral cancer?
Common subtype of oral cancer?
Oral tongue, lateral border
SCC commonest.
Symptoms of oral canceR?
Non-healing ulcer
Oral cavity mass
Change in denture fit
Bleeding
Neck lump
Otalgia
Dysarthria
Trismus
Examples of benign cavity lesions?
Torus
Lingual thyroid
Dermoid
Ranula
Apthous ulcer
Pyogenic granuloma
Fibroma
Lichen planus
Pemphigus / pemphigoid
Cancer!
What is lichen planus?
T-cell mediated AI disorder where inflammatory cells attack skin annd mucosal keratinocytes.
What is otosclerosis?
New bone formation causing fusion of fixation of stapes footplate to the oval window
post-op mx of cholesteatoma?
Scan annually cuz recurrence is high.
Clearance of mucosa from ear is impaired after cholesteatoma surgery, so earwax accumulation is common
Use eardrops!
How to classify tinnitus?
in hx taking
Pulsatile vs Non-pulsatile.
TRO vascular origin cause.
Vascular causes -
1. Jugular bulb right below floor of inner ear. If got dehiscence of floor then can have transmitted noise/vibration.
- Sinus too near the mastoid
- Glomus jugulare = paraganglioma in mid ear. Will have red hue behind TM with rising sun shape, involving floor of cavity or the TM.
Blanching colour points to vascular tumour
Otoscopy of OME?
Yellow hue present. If recent OME then it has typical air fluid level that moves with valsalva maneuver.
Causes of referred pain in ear?
Tumours of hypopharynx
Tonsilitis
Sinusitis
TMJ disorder
Impacted tooth (wisdom tooth)
Anything in throat!! e.g. retropharyngeal abscess, epiglottitis, tumour etc
Surgery for pseudocyst of pinna?
만두귀. inside got serous fluid
there is separation btw leaflets of cartilage in pinna.
Aim is to remove the dead space btw the cartialge to prevent recurrence. They take out the anterior cartilage, then use buttoning/dental roll/tension dressing to keep them tgt.
What is a retention cyst in mouth?
Glands in mouth near tonsils get blocked -> forming cyst
Which level of LNs does thyroid lymph drain into?
2 3 4 6
4Cs for thyroid surgery indications?
Cancer
Compressive
Cosmesis
Control
Usu anyth >2cm we consider excision
Also consider if mass is growing retrosternally. Cuz if that happens then any surgery aft that is super hard cuz need to do thoracotomy
Why is RLN injury impt for thyroid surgery?
actl RLN is injured rarely, but its hard to find external branch of RLN which controls cricothyroid muscle.
The cricothyroid muscle pulls the thyroid palate forward to produce high pitched sound
only 3 invx needed to confirm thyroiditis?
TFT
FNAC
US
TSH low + Free T4 high
Air bone gap > 60 implies what?
Ossicular discontinuity
Are abx very useful for OME?
Not really
HEaring loss in Meniere’s?
Low frequency hearing loss.
With every MD attack the hearing drops a bit, so after 10-15 yrs of MD the SNHL is very profound, although the hearing loss kinda plateaus.
