ent Flashcards
Ramsay Hunt syndrome
cause
reactivation of VZV in geniculate ganglion of CN VII
Ramsay Hunt syndrome
presentation (4)
auricular pain
facial nerve palsy
vesicular rash around the ear
vertigo and tinnitus
Ramsay Hunt mgt
PO aciclovir and corticosteroids
glue ear RF (5)
male sex
siblings with glue ear
bottle feeding
day care attendance
parental smoking
also note higher incidence in winter & spring
urgent referral to ENT for ?throat cancer if:
age >45 with either:
- persistent hoarseness
- throat lump
cholesteatoma
what is it?
non-cancerous growth of squamous epithelium that is “trapped” within skull base causing local destruction
choleseatoma
i. general features
ii. features if local invasion
i. foul-smelling, non-resolving discharge
hearing loss
“attic crust” on otoscopy
ii. vertigo
facial nerve palsy
cerebellopontine angle syndrome
otitis externa causes: (5)
infection:
- bacterial (s. aureus, pseudomonas aeroginosa)
- fungal
seborrhoeic dermatitis
contact dermatitis
swimming
otitis externa mgt in DM
ciprofloxacin
to cover for pseudomonas (most common cause of malignant otitis externa)
drug causes of tinnitus (4)
aspirin/ NSAIDs
aminoglycosides (e.g. gentamycin)
loop diuretics
quinine
otitis media abx mgt :
amoxicillin
if penicillin allergy:
erythromycin/ clarithromycin
otitis media cx (4)
mastoiditis
meningitis
brain abscess
facial n. paralysis
SE of amoxicillin in kids
non-allergic maculo-papular rash
(usually starts at trunk)
centor criteria
Cough (absence of)
Exudate
Nodes (tender cervical lymphadenopathy)
Temperature
score 0-2 3-17% chance of streptococci
score 3 or 4 32 to 56% chance of isolating streptococci
key difference between vestibular neuronitis and viral labyrinthitis
there is hearing loss in viral labyrinthitis
vestibular neuritis –> only vestibular n. is involved, therefore no hearing loss
vestibular neuronitis features: (4)
recurrent vertigo attacks lasting hours or days
nausea and vomiting
horizontal nystagmus
NO HEARING LOSS or tinnitus
vestibular neuronitis ddx (2)
viral labyrinthitis
posterior circulation stroke (use HiNTS ex to exclude)
NICE criteria for tonsilectomy:
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms)
the episodes of sore throat are disabling and prevent normal functioning
drug causes of gingival hyperplasia (3)
phenytoin
cyclosporin (immunosupressant)
CCBs (especially nifedipine)
non-drug causes of gingival hyperplasia
acute myeloid leukaemia
bacterial otitis media causative organisms: (3)
Streptococcus pneumonaie
Haemophilus influenzae
Moraxella catarrhalis
bilateral parotid gland swelling causes (5)
viruses: mumps
sarcoidosis
Sjogren’s syndrome
lymphoma
alcoholic liver disease
unilateral parotid swelling causes (3)
tumour: pleomorphic adenomas
stones
infection
Meniere’s disease
features (7)
cause is unknown but thought to be secondary to excessive endolymph
episodic (mins-hrs):
vertigo, tinnitus and hearing loss (sensorineural).
aural fullness/ pressure
nystagmus and a positive Romberg test
usually unilateral
Meniere’s disease
mgt:
i. acute attacks
prochlorperazine (buccal or im)
referral to ENT for initial dx
Meniere’s disease mgt:
ii. prevention
betahistine
vestibular rehabilitation
referral to ET for initial dx
normal hearing:
i. Weber
ii. Rinnie
i. midline
ii. air conduction> bone
conductive hearing loss
i. Weber
ii. Rinnie
i. lateralises to affected side
ii. bone conduction> air in affected side
air conduction > bone unaffected side
sensorineural hearing loss
i. Weber
ii. Rinnie
i. lateralises to unaffected ear
ii. air conduction> bone consuction bilaterally
