ENT Flashcards
Medications that can cause tinnitus
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
Describe a presentation of menieres
Middle aged adults (F>M)
recurrent episodes lasting minutes-hours of:
- vertigo
- tinnitus
- hearing loss (sensorineural)
+/- aural fullness, Nystagmus, rombergs positive
Vertigo is usually the prominent symptom
Describe a presentation of a thyroglossal cyst
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
describe a pharyngeal pouch
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
older men usually
what is this
Branchial cyst
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx.
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
How does vestibular neuritis and labrinthitis present, and what is the key difference
Both affect the vestibular nerve and cause
Sudden, severe vertigo
Dizziness
Nausea and vomiting
Tinnitus (ringing in the ears)
Difficulty with balance
labrinthitis also causes hearing loss in the affected ear as it also affects the cochlea
both often after a virus
what is Ramsey hunt syndrome
reactivation of VSV in facial nerve VII
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo, hearing changes and tinnitus
tx is
infection can also spread to cranial nerves 3,4,5,6,7,8,9,11,12
Inequities with AOM
solutions to reduce this
High rates of AOM in maori/PI
Due to overcrowding, low SES , delays in tx can lead to HL and learning difficulties
solutions
- parental smoking cessation
- Breastfeeding
- Housing support
- UTD vaccinations
What is OME or glue ear
middle ear effusion without symptoms or signs of an acute ear infection
Duration usually 6-10 weeks, most resolve within <3/12
typically presents as hearing loss or learning difficultes
TM dull and retracted, Type B curve on tympanometry
First and second line ABx for dental infections
- Amox OR metronidazole
- Erythromycin
Chlorhex mouth washes and I+D can also be useful depending on the situaiton
amox + metronidazole can be used together for severe infections
When do high risk patients (valve replacements, valvular RHD, prev endocarditis ) need prophylactic abx prior to dental surgey
when the OT involves
- manipulation of gingival tissue
- the tooth root
- perforation of the oral mucosa
- tonsillectomy/adenoidectomy.
What is malignant otitis externa
osteomyelitis of the petrous temporal bone
Mainly seen in immunocompromised and T1DMs
Tx: urgent ENT referral and IV Abx
What is TMJ disorder
how does it present
group of disorders of the TMJ and surrounding muscles (myofascial tmj)
Very common
pain in the facial or jaw muscles
trismus: Reduced jaw movement
earache, tinnitus or hearing loss
your jaw locking open or closed
grating, clicking or popping sounds when the jaw moves
headaches
neck pain
Treatment of TMJ disorders
40% will self resolve
- education and reassurance
- jaw rest, warm compress, soft diet, avoiding triggers (recreational drugs, alcohol, stress reduction tht causes bruxism), passive stretching, CBT
- NSAIDs, botox injections, benzos, tricyclics
Treatment of epistaxis
- Head flexed at 45 degrees, compressing nasal ala for 10 mins
- Compress w local anaesthestic + vasoconstrictor (lidocaine/adren) for 5 mins
- If ongoing then insert a nasal pack or tampon then refer to ED
If bleeding already controlled or recurrent episodes consider silver nitrate
if bleeding occurs in teenage males, and Little’s area is normal to exam
DONT cauterise both sides, risk of septal perforation
what are the 3 salivary glands
- Parotid gland
- Submandibular gland
- Sublingual gland
