ENT Flashcards
Presbyacusis
Old age bilateral hearing loss
Bilateral high frequency sensorineural hearing loss
Difficulty following conversations
Otosclerosis
Autosomal dom
Age 20-40
conductive deafness
tinnitus
10% have flamingo tinge on TM
Family history
Glue Ear
OM with effusion
peak age 2 years
hearing loss usually presentation
Menieres
Middle aged adults
vertigo tinnitus and hearing loss
nystagmus and + Rhomberg
Aural fullness
Minutes to hours duration
Ototoxic drugs
Gentamicin (aminoglycosides)
Furosemide
Aspirin in OD
quinine
Acoustic Neuroma
Hearing loss, tinnitus vertigo
absent corneal reflex
facial palsy
neurofibromatosis type 2 - bilateral
Post nasal drip
chronic cough, bad breath
Fever Pain
Fever - 1
Pus on tonsils - 1
Attends rapidly (</= 3 days) - 1
Inflamed tonsils - 1
No cough - 1
2/3 = delayed ABX
4/5 = ABX
Centor Criteria
tonsillar exudate - 1
tender cervical LN - 1
Fever - 1
No cough - 1
3 or more = ABX
Strep throat
phenoxymethylpenicillin 10 days
Clarithromycin if pen allergy
dysphagia, regurgitation, aspiration and chronic cough more commonly in older men
pharyngeal pouch
posteriomedial herniation
midline lump if large
GURGLES on palpation
cystic hygroma
90% age <2
classically left side
most evident at birth
non tender
transilluminates
Branchial Cyst
oval mobile cystic mass
between sternocleidomastoid and pharynx
usually early adulthood
Cervical rib
young
women>men
hard lump at bottom of neck
can have thoracic outlet syndrome
Rinnes Test
tuning fork over mastoid until cant hear then over ear canal
normal = AC>BC
conductive loss –> BC>AC
sensorineural loss –> AC still >BC
Webers Test
Tuning fork onto forehead
Conductive loss = louder in affected ear
SN loss = louder in unaffected ear
sudden unilateral sensorineural hearing loss
refer urgently to ENT and start high dose steroids 60mg/day for 7 days
usually idiopathic but can be vestibular swannoma
perforated TM - check ups
2 week GP
6 weeks - consider ENT if still present
keep ear dry
no need further ABX if dry
Chronic sinusitis
management-
avoid allergen
intranasal steroids
nasal washout
red flags-
unilateral
persistent despite 3 months Rx
epistaxis
when to refer oral ulcers under 2ww
> 3 weeks
Menieres Disease
vertigo
tinnitus
hearing loss (sensorineural)
aural fullness common
vertigo minutes to hours not related to head movement
acute Rx - prochlorperazine
prevention - betahistine/vestibular rehab
acute sinusitis
Rx
uncomplicated <10 days - analgesia
uncomplicated >10 days - IN steroids
NEVER PO steroids or IN decongestants
PenV if complicated
