ENT Flashcards
What causes sinusitis?
- Infection → viral URTI
- Allergies → allergic rhinitis
- Obstruction of drainage → polyps, foreign body, trauma
- Smoking → impairs normal mucociliary clearance
How does sinusitis present?
- Nasal congestion & discharge
- Facial pain, headache, pressure
- Facial swelling over affected areas
- Loss of smell
- Tenderness on palpation of affected areas
How is acute sinusitis managed?
<10 days:
- Do not offer antibiotics → most cases are viral & will clear up within 2-3 weeks
- Paracetamol for pain
If symptoms haven’t improved after 10 days:
- High-dose steroid nasal spray for 14 days (mometsone)
- Delayed abx prescription, used if worsening or not improving within 7 days → phenoxymethylpenicillin
How is chronic sinusitis managed?
- Saline nasal irrigation
- Steroid nasal sprays or drops
- Functional endoscopic sinus surgery → clear any obstructions to the sinuses.
What is otitis externa, and what are the risk factors?
= inflammation of the skin in the external ear canal.
Risk Factors:
- Swimming → often referred to as ‘swimmers ear’
- Trauma to the ear canal → cotton buds or ear plugs
- Removal of ear wax
- Highest incidence in 7-12 year olds → however can affect all ages
- Hot & humid climates
- Dermatological issues
What are the common causes of otitis externa?
- Bacterial (90% cases): pseudomonas aeruginosa, s.aureus
- Fungal: aspergillis, candida, especially if extensive topical abx or steroid use
- atopic dermatitis
- Psoriasis
How does otitis externa present?
- Significant ear pain → progressive. The inflammation & swelling in the ear canal causing a rising pressure.
- Itch
- Discharge
- If fungal → Looks like wet newspaper, can see spores
- Sometimes conductive hearing loss → can present without hearing loss, helpful to differentiate between OE & AOM.
How is otitis externa managed?
Supportive:
- Keep the ear dry → can roll a ball of cotton in vaseline & gentle place in the eye when bathing. Very important to advise this!
- Avoid itching or using cotton buds.
Medical:
- Mild OE → acetic acid 2% (EarCalm OTC), which has an antibacterial & antifungal effects.
- Moderate → topical antibiotic & steroid
- Otomize spray → neomycin, dexamethasone, acetic acid
- If the tympanic membrane is perforated, then avoid these drops & others with aminoglycosides → if unable to visualise the TM then refer to ENT for microsuction.
- Severe/systemic symptoms → oral antibiotics (flucloxacillin) and potential admission.
What is malignant otitis externa? How does it present?
= a severe & life-threatening form of OE, where the infection has spread beyond the soft tissue, resulting in osteomyelitis of the temporal bone & skull base.
Presentation:
- Non-resolving OE despite adequate topical treatment
- Persistent headache
- Severe pain
- Fever
What is the most common cause of Acute Otitis Media?
Streptococcus pneumoniae
How does Acute Otitis Media present?
- Recent onset ear pain → irritability & ear pulling noted in non-verbal children.
- Fever, cough, coryzal symptoms, sore throat, anorexia
- Aural fullness, hearing loss
- Discharge from the ear → when the tympanic membrane has perforated.
- Balance issues & vertigo
How is Acute Otitis Media managed?
AOM is a self-limiting disease lasting 3 days-1 week & often does not require antibiotics.
Systemically Well:
- Reassurance & safety-netting
- Analgesia & antipyretic agents → paracetamol or ibuprofen
- If failure to improve within 48hrs, consider antibiotics (delayed prescription)
Unwell Child:
- Consider hospital admission (rare)
- Antibiotics → 5-7 days amoxicillin, then co-amoxiclav if worsening symptoms or first choice taken for 2-3 days without benefit.
What antibiotics are given for tonsillitis if they are required?
Phenoxymethylpenicillin for 10 days, or clarithromycin if there is a penicillin allergy.
What are the indications for tonsillectomy?
- If recurrent episodes, refer for tonsillectomy if the following criteria has been met:
- > 7 documented, adequately treated, sore throat episodes in 1 year
- > 5 episodes per year for 2 years
- > 3 episodes per year for 3 years
- Other indications:
- Recurrent tonsillar abscesses (2 episodes)
- Enlarged tonsils causing difficulty breathing, swallowing, or snoring
