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ENT Flashcards

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1
Q

How do you perform Weber’s test ?

A

Place tuning fork in centre of patients forehead ask patient if they can hear the sound and which ear is loudest

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2
Q

what is Weber’s test in sensorineural hearing loss?

A

sound will be louder in the normal ear

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3
Q

what is Weber’s test in conductive hearing loss?

A

louder in the affected ear

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4
Q

how do you perform Rinne’s test?

A

Place the flat end of the tuning fork on the mastoid process (the boney lump behind the ear) – this tests bone conduction
Ask the patient to tell you when they can no longer hear the humming noise
When they can no longer hear the noise, remove the tuning fork (still vibrating) and hover it 1cm from the same ear
Ask the patient if they can hear the sound now – this tests air conduction
Repeat the process on the other side

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5
Q

what is an abnormal Rinne’s test?

A

bone conduction is better than air conduction
this suggests conductive hearing loss

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6
Q

State 3 causes of sensorineural hearing loss

A

Presbycusis
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
Infections (e.g., meningitis)
Medications

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7
Q

name 3 types of medications that can cause sensorineural hearing loss

A

Loop diuretics (e.g., furosemide)
Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)

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8
Q

State 3 causes of conductive hearing loss

A

Ear wax
Infection (e.g., otitis media or otitis externa)
Fluid in the middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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9
Q

State 3 risk factors for Presbycusis

A

Older Age
Male gender
Family history
Loud noise exposure
Diabetes
Hypertension
Ototoxic medications
Smoking

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10
Q

what sound is affected first in Presbycusis ?

A

high-pitched sounds

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11
Q

What is the investigation of choice for establishing the diagnosis and extent of hearing loss?

A

Audiometry

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12
Q

Sudden sensorineural hearing loss (SSNHL) is defined as …..

A

hearing loss over less than 72 hours, unexplained by other causes

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13
Q

how does Eustachian tube dysfunction present?

A

Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus

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14
Q

What are the treatment options for Eustachian tube dysfunction?

A

No treatment, waiting for it to resolve spontaneously (e.g., recovering from the viral URTI)
Valsalva manoeuvre
Decongestant nasal sprays (short term only)
Antihistamines and a steroid nasal spray for allergies or rhinitis
Surgery may be required in severe or persistent cases

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15
Q

What is Otosclerosis?

A

Remodelling of the small bones in the middle ear, leading to conductive hearing loss

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16
Q

what is the inheritance pattern of otosclerosis?

A

autosomal dominant

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17
Q

what is the typical presentation of otosclerosis?

A

patient under 40 years presenting with unilateral or bilateral:
Hearing loss
Tinnitus

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18
Q

what sound is more affected in otosclerosis?

A

lower-pitched sounds

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19
Q

what is the most common cause of bacterial otitis media?

A

streptococcus pneumoniae

Others:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

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20
Q

what are the presenting features of otitis media?

A

Ear pain
Reduced hearing
fever
coryzal symptoms

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21
Q

what is the appearance of otitis media on otoscopy?

A

bulging, red, inflamed looking membrane

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22
Q

when should you consider immediate antibiotics for otitis media?

A

significant co-morbidities, are systemically unwell or are immunocompromised

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23
Q

what antibiotics are given in otitis media (if required)?

A

Amoxicillin for 5-7 days first-line
Clarithromycin (in penicillin allergy)
Erythromycin (in pregnant women allergic to penicillin)

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24
Q

State 4 complications of otitis media

A

Otitis media with effusion
Hearing loss (usually temporary)
Perforated tympanic membrane (with pain, reduced hearing and discharge)
Labyrinthitis (causing dizziness or vertigo)
Mastoiditis
Abscess
Facial nerve palsy
Meningitis

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25
The inflammation in otitis externa may be caused by:
Bacterial infection Fungal infection (e.g., aspergillus or candida) Eczema Seborrhoeic dermatitis Contact dermatitis
26
What are the 2 most common bacterial causes of otitis externa?
Pseudomonas aeruginosa Staphylococcus aureus
27
what are the typical symptoms of otitis externa?
Ear pain Discharge Itchiness Conductive hearing loss
28
what will examination of otitis externa show?
Erythema and swelling in the ear canal Tenderness of the ear canal Pus or discharge in the ear canal Lymphadenopathy
29
what is the management of mild otitis externa?
acetic acid 2%
30
what is the management of moderate otitis externa?
topical antibiotic and steroid
31
what is malignant otitis externa?
severe and potentially life-threatening form of otitis externa. The infection spreads to the bones surrounding the ear canal and skull. It progresses to osteomyelitis of the temporal bone of the skull.
32
what key finding indicates malignant otitis externa?
Granulation tissue at the junction between the bone and cartilage in the ear canal
33
what is the management of malignant otitis externa?
Admission to hospital under the ENT team IV antibiotics Imaging (e.g., CT or MRI head) to assess the extent of the infection
34
what are the complications of malignant otitis externa?
Facial nerve damage and palsy Other cranial nerve involvement Meningitis Intracranial thrombosis Death
35
what are the 3 main methods for removing ear wax?
Ear drops – usually olive oil or sodium bicarbonate 5% Ear irrigation – squirting water in the ears to clean away the wax Microsuction – using a tiny suction device to suck out the wax
36
what are the 4 most common causes of vertigo?
Benign paroxysmal positional vertigo Ménière’s disease Vestibular neuronitis Labyrinthitis
37
state 3 central causes of vertigo
Posterior circulation infarction (stroke) Tumour Multiple sclerosis Vestibular migraine
38
what 4 things should you examine when assessing a patient presenting with vertigo?
Ear examination Neurological examination (inc. cerebellar) Cardiovascular examination Special tests e.g. Romberg's, Dix-Hallpike, HINTS
39
what are the components of the HINTS examination and what is it used for?
used to distinguish between central and peripheral vertigo. It stands for: HI – Head Impulse N – Nystagmus TS – Test of Skew
40
what are 2 short term management options for the symptoms of peripheral vertigo?
Prochlorperazine Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
41
what is used to diagnose BPPV and what is a positive result?
Dix-Hallpike manoeuvre (will trigger rotational nystagmus and symptoms of vertigo) eye will have rotational beats of nystagmus towards the affected ear
42
what is used to treat BPPV?
Epley manoeuvre Brandt-Daroff Exercises can be done by the patient at home
43
what is the typical presentation of vestibular neuronitis?
may be a history of a recent viral upper respiratory tract infection may be a history of a recent viral upper respiratory tract infection Vertigo Nausea and vomiting (may be severe) Balance problems
44
how can you distinguish between labyrinthitis and neuronitis?
Labyrinthitis – Loss of hearing Neuronitis – No loss of hearing
45
What are the presenting features of Labyrinthitis?
acute onset vertigo Hearing loss Tinnitus
46
what are the presenting features of Meniere's disease?
recurrent attacks of vertigo, and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear
47
what is the management of Meniere's disease?
For acute attacks, short-term options for managing symptoms include: Prochlorperazine Antihistamines (e.g., cyclizine, cinnarizine and promethazine) Prophylaxis is with: Betahistine
48
where do acoustic neuromas occur?
cerebellopontine angle
49
what are bilateral acoustic neuromas associated with?
neurofibromatosis type II
50
what is the typical presentation of acoustic neuroma?
Gradual onset of: Unilateral sensorineural hearing loss (often the first symptom) Unilateral tinnitus Dizziness or imbalance A sensation of fullness in the ear They can also be associated with a facial nerve palsy
51
What is a Cholesteatoma?
collection of squamous epithelial cells in the middle ear
52
how do cholesteatoma's present?
Foul discharge from the ear Unilateral conductive hearing loss
53
what are the 5 branches of the facial nerve?
Temporal Zygomatic Buccal Marginal mandibular Cervical
54
what is the sensory function of the facial nerve?
It carries taste from the anterior 2/3 of the tongue
55
what is the parasympathetic supply of the facial nerve?
Submandibular and sublingual salivary glands Lacrimal gland (stimulating tear production)
56
what is the management of Bell's palsy?
prednisolone if presenting within 72hrs Lubricating eye drops
57
what causes Ramsay-Hunt syndrome?
varicella zoster virus (VZV)
58
what is the management of Ramsay-Hunt syndrome?
Prednisolone Aciclovir Lubricating eye drops
59
Where do nose bleeds usually originate from?
Kiesselbach’s plexus, which is located in Little’s area
60
when is sinusitis classed as being chronic?
more than 12 weeks
61
what are the 4 sets of paranasal sinuses?
Frontal sinuses (above the eyebrows) Maxillary sinuses (either side of the nose below the eyes) Ethmoid sinuses (in the ethmoid bone in the middle of the nasal cavity) Sphenoid sinuses (in the sphenoid bone at the back of the nasal cavity)
62
State 4 causes of sinusitis
Infection, particularly following viral upper respiratory tract infections Allergies, such as hayfever (with allergic rhinitis) Obstruction of drainage, for example, due to a foreign body, trauma or polyps Smoking
63
what are the presenting symptoms of sinusitis?
Nasal congestion Nasal discharge Facial pain or headache Facial pressure Facial swelling over the affected areas Loss of smell
64
when should you prescribe nasal steroids sprays for sinusitis?
symptoms that are not improving after 10 days
65
what conditions are associated with nasal polyps?
Chronic rhinitis or sinusitis Asthma Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy) Cystic fibrosis Eosinophilic granulomatosis with polyangiitis
66
how may nasal polyps present?
Chronic rhinosinusitis Difficulty breathing through the nose Snoring Nasal discharge Loss of sense of smell (anosmia)
67
what is the management of nasal polyps ?
intranasal topical steroid drops or spray surgery e.g. intranasal polypectomy
68
State 4 risk factors for obstructive sleep apnoea
Middle age Male Obesity Alcohol Smoking
69
what are some presenting features of obstructive sleep apnoea?
Episodes of apnoea during sleep (reported by their partner) Snoring Morning headache Waking up unrefreshed from sleep Daytime sleepiness Concentration problems Reduced oxygen saturation during sleep
70
what is used to assess symptoms of sleepiness associated with obstructive sleep apnoea?
Epworth Sleepiness Scale
71
what are the management options for obstructive sleep apnoea?
reverse risk factors CPAP surgery
72
what is the most common bacterial cause of tonsillitis?
group A streptococcus (Streptococcus pyogenes)
73
what are the Centor criteria?
Fever over 38ºC Tonsillar exudates Absence of cough Tender anterior cervical lymph nodes
74
what are the features of the FeverPAIN score?
Fever during previous 24 hours P – Purulence (pus on tonsils) A – Attended within 3 days of the onset of symptoms I – Inflamed tonsils (severely inflamed) N – No cough or coryza
75
State 4 complications of tonsilitis
Peritonsillar abscess, also known as quinsy Otitis media Scarlet fever Rheumatic fever Post-streptococcal glomerulonephritis Post-streptococcal reactive arthritix
76
How does Quinsy present?
Sore throat Painful swallowing Fever Neck pain Referred ear pain Swollen tender lymph nodes Trismus Change in voice Swelling and erythema in the area beside the tonsils
77
what is the management of quinsy?
needle aspiration or surgical incision and drainage antibiotics
78
what are the most common type of head and neck cancer?
squamous cell carcinomas
79
State 4 risk factors for head and neck cancer
Smoking Chewing tobacco Chewing betel quid (a habit in south-east Asia) Alcohol Human papillomavirus (HPV), particularly strain 16 Epstein–Barr virus (EBV) infection
80
State 3 causes of glossitis
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury or irritant exposure
81
what are the treatment options for oral candidiasis ?
Miconazole gel Nystatin suspension Fluconazole tablets (in severe or recurrent cases)
82
state 3 causes of geographic tongue
Stress and mental illness Psoriasis Atopy (asthma, hayfever and eczema) Diabetes
83
what does Leukoplakia and Erythroplakia increase the risk of?
squamous cell carcinoma
84
state 3 risk factors for gingivitis
Plaque build-up on the teeth (inadequate brushing) Smoking Diabetes Malnutrition Stress
85
state 3 causes of gingival hyperplasia
Gingivitis Pregnancy Vitamin C deficiency (scurvy) Acute myeloid leukaemia Medications, particularly calcium channel blockers, phenytoin and ciclosporin
86
what underlying conditions are associated with Aphthous ulcers?
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) Coeliac disease Behçet disease Vitamin deficiency (e.g., iron, B12, folate and vitamin D) HIV

Finals (21 decks)

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