ENT Flashcards
How do you perform Weber’s test ?
Place tuning fork in centre of patients forehead ask patient if they can hear the sound and which ear is loudest
what is Weber’s test in sensorineural hearing loss?
sound will be louder in the normal ear
what is Weber’s test in conductive hearing loss?
louder in the affected ear
how do you perform Rinne’s test?
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
what is an abnormal Rinne’s test?
bone conduction is better than air conduction
this suggests conductive hearing loss
State 3 causes of sensorineural hearing loss
Presbycusis
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
Infections (e.g., meningitis)
Medications
name 3 types of medications that can cause sensorineural hearing loss
Loop diuretics (e.g., furosemide)
Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)
State 3 causes of conductive hearing loss
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
State 3 risk factors for Presbycusis
Older Age
Male gender
Family history
Loud noise exposure
Diabetes
Hypertension
Ototoxic medications
Smoking
what sound is affected first in Presbycusis ?
high-pitched sounds
What is the investigation of choice for establishing the diagnosis and extent of hearing loss?
Audiometry
Sudden sensorineural hearing loss (SSNHL) is defined as …..
hearing loss over less than 72 hours, unexplained by other causes
how does Eustachian tube dysfunction present?
Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus
What are the treatment options for Eustachian tube dysfunction?
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
What is Otosclerosis?
Remodelling of the small bones in the middle ear, leading to conductive hearing loss
what is the inheritance pattern of otosclerosis?
autosomal dominant
what is the typical presentation of otosclerosis?
patient under 40 years presenting with unilateral or bilateral:
Hearing loss
Tinnitus
what sound is more affected in otosclerosis?
lower-pitched sounds
what is the most common cause of bacterial otitis media?
streptococcus pneumoniae
Others:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
what are the presenting features of otitis media?
Ear pain
Reduced hearing
fever
coryzal symptoms
what is the appearance of otitis media on otoscopy?
bulging, red, inflamed looking membrane
when should you consider immediate antibiotics for otitis media?
significant co-morbidities, are systemically unwell or are immunocompromised
what antibiotics are given in otitis media (if required)?
Amoxicillin for 5-7 days first-line
Clarithromycin (in penicillin allergy)
Erythromycin (in pregnant women allergic to penicillin)
State 4 complications of otitis media
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
The inflammation in otitis externa may be caused by:
Bacterial infection
Fungal infection (e.g., aspergillus or candida)
Eczema
Seborrhoeic dermatitis
Contact dermatitis
What are the 2 most common bacterial causes of otitis externa?
Pseudomonas aeruginosa
Staphylococcus aureus
what are the typical symptoms of otitis externa?
Ear pain
Discharge
Itchiness
Conductive hearing loss
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
what is the management of mild otitis externa?
acetic acid 2%
what is the management of moderate otitis externa?
topical antibiotic and steroid
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.
what key finding indicates malignant otitis externa?
Granulation tissue at the junction between the bone and cartilage in the ear canal
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
what are the complications of malignant otitis externa?
Facial nerve damage and palsy
Other cranial nerve involvement
Meningitis
Intracranial thrombosis
Death
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
what are the 4 most common causes of vertigo?
Benign paroxysmal positional vertigo
Ménière’s disease
Vestibular neuronitis
Labyrinthitis
state 3 central causes of vertigo
Posterior circulation infarction (stroke)
Tumour
Multiple sclerosis
Vestibular migraine
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
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
what are 2 short term management options for the symptoms of peripheral vertigo?
Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
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
what is used to treat BPPV?
Epley manoeuvre
Brandt-Daroff Exercises can be done by the patient at home
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
how can you distinguish between labyrinthitis and neuronitis?
Labyrinthitis – Loss of hearing
Neuronitis – No loss of hearing
What are the presenting features of Labyrinthitis?
acute onset vertigo
Hearing loss
Tinnitus
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
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
where do acoustic neuromas occur?
cerebellopontine angle
what are bilateral acoustic neuromas associated with?
neurofibromatosis type II
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
What is a Cholesteatoma?
collection of squamous epithelial cells in the middle ear
how do cholesteatoma’s present?
Foul discharge from the ear
Unilateral conductive hearing loss
what are the 5 branches of the facial nerve?
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
what is the sensory function of the facial nerve?
It carries taste from the anterior 2/3 of the tongue
what is the parasympathetic supply of the facial nerve?
Submandibular and sublingual salivary glands
Lacrimal gland (stimulating tear production)
what is the management of Bell’s palsy?
prednisolone if presenting within 72hrs
Lubricating eye drops
what causes Ramsay-Hunt syndrome?
varicella zoster virus (VZV)
what is the management of Ramsay-Hunt syndrome?
Prednisolone
Aciclovir
Lubricating eye drops
Where do nose bleeds usually originate from?
Kiesselbach’s plexus, which is located in Little’s area
when is sinusitis classed as being chronic?
more than 12 weeks
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)
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
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
when should you prescribe nasal steroids sprays for sinusitis?
symptoms that are not improving after 10 days
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
how may nasal polyps present?
Chronic rhinosinusitis
Difficulty breathing through the nose
Snoring
Nasal discharge
Loss of sense of smell (anosmia)
what is the management of nasal polyps ?
intranasal topical steroid drops or spray
surgery e.g. intranasal polypectomy
State 4 risk factors for obstructive sleep apnoea
Middle age
Male
Obesity
Alcohol
Smoking
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
what is used to assess symptoms of sleepiness associated with obstructive sleep apnoea?
Epworth Sleepiness Scale
what are the management options for obstructive sleep apnoea?
reverse risk factors
CPAP
surgery
what is the most common bacterial cause of tonsillitis?
group A streptococcus (Streptococcus pyogenes)
what are the Centor criteria?
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes
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
State 4 complications of tonsilitis
Peritonsillar abscess, also known as quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritix
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
what is the management of quinsy?
needle aspiration or surgical incision and drainage
antibiotics
what are the most common type of head and neck cancer?
squamous cell carcinomas
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
State 3 causes of glossitis
Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure
what are the treatment options for oral candidiasis ?
Miconazole gel
Nystatin suspension
Fluconazole tablets (in severe or recurrent cases)
state 3 causes of geographic tongue
Stress and mental illness
Psoriasis
Atopy (asthma, hayfever and eczema)
Diabetes
what does Leukoplakia and Erythroplakia increase the risk of?
squamous cell carcinoma
state 3 risk factors for gingivitis
Plaque build-up on the teeth (inadequate brushing)
Smoking
Diabetes
Malnutrition
Stress
state 3 causes of gingival hyperplasia
Gingivitis
Pregnancy
Vitamin C deficiency (scurvy)
Acute myeloid leukaemia
Medications, particularly calcium channel blockers, phenytoin and ciclosporin
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
