ENT Flashcards
1
Q
Presbycusis audiogram?
A
- Bilateral impairment
- High frequency hearing loss (The loss of hearing is most pronounced at higher frequencies (e.g., 2,000–8,000 Hz), which are important for understanding speech sounds like consonants (e.g., “s,” “f,” “th”).
- Downward sloping pure tone thresholds
*Gradual deterioration
*Sensorineural HL
2
Q
Presbycusis causes?
A
- Arteriosclerosis
- DM, HTN, Hyperlipidaemia
- Noise exposure
- Drug exposure = salicylates, aminoglycosides, chemo (Cisplatin)
- Stress (Oxidative from free radicals)
- Genetic predisposition
- Age related (cochlear haircell loss, basilar membrane stiffening)
3
Q
Presbycusis presentation?
A
Cant hear when old
4
Q
Presbyacusis signs?
A
Possible Weber’s test bone conduction localisation to one side if sensorineural hearing loss not completely bilateral
5
Q
Presbyacusis Ix?
A
- Otoscopy = normal
- Tympanometry = normal middle ear function with hearing loss
- Audiometry = bilateral sensorineural hearing loss
- Bloods = normal
6
Q
Labyrinthitis definition?
A
Inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases
7
Q
Most common form of labyrinthitis?
A
Viral
8
Q
How to distinguish between viral labyrinthitis and vestibular neuritis?
A
Vestibular neuritis = only vestibular nerve involves, so there is no hearing impairment
9
Q
Viral labyrinthitis presentation?
A
Acute onset of:
1. Vertigo
2. N&V
3. Hearing loss
4. Tinnitus
5. Preceding or concurrent URTI
10
Q
Viral labyrinthitis signs?
A
- Unidirectional horizontal nystagmus towards unaffected side
- Sensorineural hearing loss
- Abnormal head impulse test: impaired VOR
- Gait disturbance: pt may fall towards the affected side
11
Q
Viral labyrinthitis Dx?
A
History and examination
12
Q
Viral labyrinthitis Rx?
A
- Usually self limiting
- Prochlorperazine or antihistamines may help reduce the sensation of dizziness
13
Q
Epistaxis classification?
A
Anterior and posterior bleeds
14
Q
Anterior epistaxis from?
A
Kiesselbach’s plexus
15
Q
Posterior epistaxis mushkies?
A
Tend to be more profuse and originate from deeper structures. They occur more frequently in older patients and confer a higher risk of aspiration and airway compromise.
16
Q
Epistaxis causes?
A
- Trauma
- Foreign bodies
- Bleeding disorders
- Juvenile angiofibroma
- Cocaine use
- HHT
- GPA
17
Q
Epistaxis Rx?
A
- 1st aid
- If 1st aid successful
- Bleeding not stopping
- Haemodynamically unstable
18
Q
Epistaxis 1st aid?
A
- Sit with torso forward and mouth open
- Pinch cartilagenous area firmly for 20 mins
19
Q
If 1st aid successful?
A
- Naseptin to reduce crusting and risk of vestibulitis (caution if peanut/soy/neoymcin allergy, use mupricon instead)
- Consider admission if comorbidity or < 2 y/o
- Self care advice = blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks should be avoided
20
Q
If bleeding does not stop after 10-15 mins?
A
- Cautery = if bleed visible and cautery tolerated, blow nose, topical anaesthetic spray e.g. co-phenylcaine and wait 3-4 mins, apply silver nitrate stick for 3-10 seconds, apply naseptin/mupirocin
- Packing = anaesthetise with co-phenylcaine, pack nose, admit for observation and review
21
Q
Bleed from unknown posterior source Rx?
A
Admit to hospital
22
Q
Epistaxis that has failed all emergency management?
A
Sphenopalatine ligation
23
Q
Sinusitis definition?
A
Inflammation of the mucous membranes of the paranasal sinuses. The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.
24
Q
Acute sinusitis predisposing factors?
A
- Nasal obstruction = septal deviation, nasal polyps
- Recent local infection
- Swimming/diving
- Smoking
25
Acute sinusitis features?
1. Facial pain = frontal pressure pain worse on bending forwards
2. Nasal discharge = thick and purulent
3. Nasal obstruction
26
Acute sinusitis Rx?
1. Analgesia
2. Intranasal decongestants
3. Sx > 10 days = Intranasal corticosteoids
4. Oral abx for severe presentations = Phenoxymethylpenicillin first-line, co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications'
27
Why CXR for hoarseness?
Exclude apical lung lesion
28
Laryngeal cancer 2ww referral?
45 and over with
1. Persistent unexplained hoarseness
2. Unexplained lump in the neck
29
Otitis externa causes?
1. Infection = S. aureus, P. aeruginosa, fungal
2. Seborrhoeic dermatitis
3. Contact dermatitis
4. Recent swimming
30
Otitis externa causes?
1. Infection = S. aureus, P. aeruginosa, fungal
2. Seborrhoeic dermatitis
3. Contact dermatitis
4. Recent swimming
31
Otitis externa features?
1. Ear pain, itch, discharge
2. Otoscopy: red, swollen or eczematous canal
32
Otitis externa Rx?
1. Combined topical Abx + Steroid (Or just topical Abx)
2. Consider removal of canal debris
3. If extensively swollen canal consider ear wick
4. 2nd line = Flucloxacillin if spreading, Empirical use of antifungal, taking swab inside ear canal
33
Otitis externa fails to respond to topical Abx Rx?
Refer to ENT
34
Malignant otitis externa more common in?
DM
35
Malignant otitis externa definition?
Extension of infection into the bony ear canal and the soft tissues deep to the bony canal. Intravenous antibiotics may be required.
36
BPPV average age of onset?
55 y/o
37
BPPV features?
1. Vertigo triggered by change in head position
2. Nausea
3. Each episode 10-20 seconds
4. Positive Dix-hallpike = experiences vertigo with rotatory nystagmus
38
BPPV prognosis?
Resolves spontaneously after a few weeks to months
39
BPPV symptomatic relief?
1. Epley manoeuvre (successful in 80%)
2. Brandt-Daroff exercises
3. Betahistine sometimes given but of limited value
40
BPPV recurrence?
50% will have recurrence 3-5 years after diagnosis
41
Rinne's positive?
Normal = AC > BC
42
Rinne's negative?
Conductive deafness = BC > AC
43
Weber's interpretation?
1. Unilateral sensorineural deafness = sound localised to unaffected side
2. Unilateral conductive deafness = sound localised to affected side
44
Normal hearing Rinne and Weber?
1. AC > BC bilaterally
2. Weber midline
45
Conductive hearing loss Rinne and Weber?
1. BC > AC in affected ear
2. Weber lateralises to affected ear
46
How to remember conductive hearing loss?
Everything points to the side affected
47
Sensorineural hearing loss Rinne and Weber?
1. AC > BC bilaterally (normal)
2. Lateralises to unaffected ear
48
Nasal polyp epidemiology?
1. 1% in UK
2. 2-4x more common in men
49
Nasal polyp associations?
1. Asthma
2. Aspirin sensitivity
3. Infective sinusitis
4. CF
5. Kartagener's syndrome
6. Churg-Strauss syndrome
50
Samter's triad?
1. Asthma
2. Aspirin Sensitivity
3. Nasal polyposis
51
Nasal polyp features?
1. Nasal obstruction
2. Rhinorrhoea, sneezing
3. Poor sense of taste and smell
52
Unilateral nasal polyp?
Red flag
53
Nasal polyp Rx?
1. Refer to ENT
2. Topical corticosteroids will shrink polyp size in 80%
54
Otosclerosis mushkies?
1. AD, replacement of normal bone by vascular spongy bone. Onset 20-40 y/o
2. Features = conductive deafness, tinnitus, tympanic membrane flamingo tinge, positive FHx
55
Flamingo tinge?
Otosclerosis
56
Commonest cause of conductive hearing loss in childhood?
Glue ear
57
Glue ear AKA?
OME
58
Meniere's more common in what age group?
Middle aged adults
59
Noise damage hearing loss mushkies?
Bilateral and typically worse at frequencies 3000-6000 Hz
60
Acoustic neuroma features?
1. Cranial nerve VIII: hearing loss, vertigo, tinnitus
2. Cranial nerve V: absent corneal reflex
3. Cranial nerve VII: facial palsy
61
Black hair tongue definition?
Relatively common condition which results from defective desquamation of the filiform papillae. Despite the name the tongue may be brown, green, pink or another colour
62
Black hairy tongue predisposing factors?
1. Poor oral hygiene
2. Antibiotics
3. Head and neck radiation
4. HIV
5. IVDU
63
Black hairy tongue Ix?
Swabbed to exclude candida
64
Black hair tongue Rx?
1. Tongue scraping
2. Topical antifungals if Candida
65
Audiogram interpretation rules?
1. Anything above 20dB normal
2. In sensorineural hearing loss both air and bone conduction impaired
3. In conductive hearing loss only air conduction impaired
4. In mixed hearing loss both air and bone conduction are impaired, with air conduction often being 'worse' than bone
66
Malignant otitis externa most common cause?
Pseudomonas aeruginosa
67
Malignant otitis externa most common cause?
Pseudomonas aeruginosa
68
Malignant otitis externa can progress to?
Temporal bone osteomyelitis
69
Malignant otitis externa history features?
1. DM (90%) or immunosuppression
2. Severe, unrelenting, deep-seated otalgia
3. Temporal headaches
4. Purulent otorrhoea
5. Possibly dysphagia, hoarseness and/or facial nerve dysfunction
70
Malignant otitis externa Dx?
CT scan
71
Malignant otitis externa Rx?
1. Non-resolving otitis externa with worsening pain should be referred urgently to ENT
2. IV Abx that cover Pseudomonas e.g. IV Ciprofloxacin
72
Diabetic pt presenting with non-malignant otitis externa Rx?
Ciprofloxacin
73
Otosclerosis inheritance?
AD
74
Otosclerosis definition?
Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window.
75
Otosclerosis features?
1. Conductive deafness
2. Tinnitus
3. Normal tympanic membrane/10% have flamingo tinge caused by hyperaemia
4. Positive FHx
76
Otosclerosis Rx?
1. Hearing aid
2. Stapedectomy
77
Sore throat encompasses?
1. Pharyngitis
2. Tonsillitis
3. Laryngitis
78
Sore throat indications for Abx?
1. Marked systemic upset
2. Unilateral peritonsillitis
3. Hx of rheumatic fever
4. Increased risk e.g. child with DM/immunodeficiency
5. 3 or more Centor criteria
79
Sore throat scoring systems?
1. Centor criteria
2. FeverPAIN criteria
80
Centor criteria?
3 of:
1. Pus
2. Tender anterior cervical lymphadenoapthy
3. Fever
4. Absence of cough
81
FeverPAIN?
Greater than 3/4 of:
1. Fever > 38
2. Pus
3. Attend rapidly (<3d)
4. Inflamed tonsils
5. No cough/coryza
82
Sore throat Abx choice?
Phenoxymethylpenicillin or Clarithromycin (if allergic) --> Either a 7 or 10 day course should be given
83
Glue ear risk factors?
1. Male
2. Siblings with glue ear
3. Winter and spring
4. Bottle feeding
5. Day care attendance
6. Parental smoking
84
Glue ear features?
1. Peaks at 2 y/o
2. Hearing loss
3. Secondary = language delay, behavioural or balance problems
85
Glue ear Rx?
1. Grommet (allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months)
2. Adenoidectomy
86
Most common cause of a perforated tympanic membrane?
Infection
87
Perforated tympanic membrane Rx?
1. No treatment, usually heals in 6-8 weeks, avoid getting water in ear
2. Abx if perforation occurs following an episode of acute otitis media
3. Myringoplasty if tympanic membrane doesnt heal by itself
88
Ramsay Hunt syndrome cause?
Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
89
Ramsay Hunt syndrome features?
1. Auricular pain
2. Facial nerve palsy
3. Vesicular rash around the ear
4. Vertigo and tinnitus
90
Ramsay Hunt syndrome Rx?
Oral aciclovir and corticosteroids
91
Moves upward on swallowing?
Thyroid swelling
92
Thyroglossal cyst mushkies?
1. < 20 y/o
2. Midline
3. Upwards on protrusion of tongue
4. Painful if infected
93
Pharyngeal pouch mushkies?
1. Older men
2. Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
3. Midline lump in neck that gurgles on palpation
4. Dysphagia, regurgitation, aspiration and chronic cough
94
Cystic hygroma mushkies?
1. Lymphangioma on neck, usually left
2. More evident at birth, around 90% before 2 y/o
95
Branchial cyst mushkies?
1. Oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
2. Develop due to failure of obliteration of the second branchial cleft in embryonic development
3. Early adulthood
96
Cervical rib?
1. Adult females
2. 10% develop thoracic outlet syndrome
97
Pulsatile lateral neck mass which doesn't move on swallowing
Carotid aneurysm
98
Cholesteatoma definition?
Non-cancerous growth of squamous epithelium that is 'trapped' within the skull base causing local destruction
99
Cholesteatoma RFs?
1. 10-20 y/o
2. Cleft palate x100
100
Cholesteatoma features?
1. Foul-smelling, non-resolving discharge
2. Hearing loss
101
Cholesteatoma local invasion features?
1. Vertigo
2. Facial nerve palsy
3. Cerebellopontine angle syndrome
102
Cholesteatoma otoscopy?
Attic crust
103
Cholesteatoma Rx?
ENT referral for consideration of surgical removal
104
Supraglottitis Rx?
1. IV Abx
2. IV Dexamethaosone
3. Adrenaline nebulisers
4. ENT ward/ITU
105
Supraglottitis Rx?
1. IV Abx
2. IV Dexamethaosone
3. Adrenaline nebulisers
4. ENT ward/ITU
106
Mastoiditis features?
1. Otalgia = severe, classically behind the ear
2. Recurrent otitis media
3. Fever, unwell
4. Ear discharge if drum has perforated
5. Swelling, erythema and tenderness over the mastoid process
107
Mastoiditis Ix?
Clinical although CT may be ordered
108
Mastoiditis Rx?
IV Abx
109
Mastoiditis Complications?
1. Facial nerve palsy
2. Hearing loss
3. Meningitis
110
Unexplained oral ulcer persisting for >3 weeks?
2ww
111
Signs and symptoms in the oral cavity > 6 weeks?
2ww
112
Branchial cysts usually present during intercurrent what?
URTI
113
Conductive hearing loss causes?
1. Impacted wax
2. Inner ear effusion
3. Debris/foreign body in ear canal
4. Perforated ear drum
5. Otosclerosis
114
Vertigo definition?
False sensation that the body or environment is moving
115
Vertigo causes?
1. Viral labyrinthitis
2. Vestibular neuronitis
3. BPPV
4. Meniere's
5. Vertebrobasilar ischaemia
6. Acoustic neuroma
7. Other = POCS, trauma, MS, ototoxicity
116
Hearing loss, tinnitus, sensation of fullness?
Menieres
117
Dizziness on extension of neck?
Vertebrobasilar ischaemia
118
Tonsillitis complications?
1. Otitis media
2. Quinsy = peritonsillar abscess
3. Rheumatic fever
4. Glomerulonephritis
119
Tonsillectomy criteria?
All of:
1. Sore throats due to tonsillitis (not URTI)
2. 5 or more episodes per year
3. For at least 1 year
4. Episodes disabling and prevent normal functioning
120
Other established indications for tonsillectomy?
1. Recurrent febrile convulsions secondary to episodes of tonsillitis
2. OSA, stridor or dysphagia secondary to enlarged tonsils
3. Quinsy if unresponsive to standard treatment
121
Complications of tonsillectomy classification?
1. Primary = <24 hours
2. Secondary = 24h - 10 days
122
Tonsillectomy primary complications?
1. Haemorrhage in 2-3% (most commonly due to inadequate haemostasis)
2. Pain
123
Tonsillectomy secondary complications?
1. Haemorrhage (most commonly due to infection)
2. Pain
124
Meniere's disease definition?
A disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age.
125
Meniere's disease features?
1. Recurrent vertigo, tinnitus and sensorineural hearing loss
2. Sensation of aural fullness/pressure
3. Nystagmus, positive Romberg
4. Episodes last mins to hours
5. Typically unilateral but bilateral disease can develop after a number of years
126
Meniere's disease features?
1. Recurrent vertigo, tinnitus and sensorineural hearing loss
2. Sensation of aural fullness/pressure
3. Nystagmus, positive Romberg
4. Episodes last mins to hours
5. Typically unilateral but bilateral disease can develop after a number of years
127
Meniere's disease natural history?
1. Symptoms resolve in majority after 5-10 years
2. Majority of patients will be left with a degree of hearing loss
3. Psychological distress is common
128
Meniere's disease Rx?
1. ENT assessment to confirm Dx
2. Pts should inform DVLA - current advice is to cease driving until satisfactory control of symptoms is achieved
3. Acute attacks = Buccal/IM prochlorperazine
4. Prevention = Betahistine and vestibular rehab
129
Meniere's disease acute Rx?
Buccal/IM Prochlorperazine
130
Meniere's disease chronic Rx?
Betahistine and vestibular rehab
131
Post-tonsillectomy haemorrhage mushkies?
1. All post-tonsillectomy haemorrhages should be assessed by ENT
2. Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
3. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
132
Chronic rhinosinusitis epidemiology?
1 in 10
133
Chronic rhinosinusitis definition?
An inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer
134
Chronic rhinosinusitis predisposing factors?
1. Atopy
2. Nasal obstruction
3. Recurrent local infection
4. Swimming/diving
5. Smoking
135
Chronic rhinosinusitis features?
1. Facial pain
2. Nasal discharge
3. Nasal obstruction = mouth breathing
4. Post-nasal drip = chronic cough
136
Chronic rhinosinusitis Rx?
1. Avoid allergens
2. Intranasal corticosteroids
3. Nasal irrigation with saline solution
137
Chronic rhinosinusitis red flags?
1. Unilateral symptoms
2. Persistent symptoms despite compliance with 3m of treatment
3. Epistaxis
138
Postnasal drip mushkies?
Occurs as a result of excessive mucus production by the nasal mucosa. This excess mucus accumulates in the throat or in the back of the nose resulting in a chronic cough and bad breath.
139
Head and neck cancer includes?
1. Oral cavity cancers
2. Cancers of the pharynx
3. Cancers of the larynx
140
Head and neck cancer features?
1. Neck lump
2. Hoarseness
3. Persistent sore throat
4. Persistent mouth ulcer
141
A history of unilateral earache with no obvious cause, persisting for more than 4 weeks?
2ww
142
OME children Rx?
Observe child for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period
143
Paediatric OME immediate referral criteria?
1. Symptoms significantly affecting hearing, development or education
2. Immediate referral in children with Downs syndrome or cleft palate
144
Nasal septal haematoma definition?
Development of a haematoma between the septal cartilage and the overlying perichondrium.
145
Nasal septal haematoma features?
1. Precipitated by relatively minor trauma
2. Sensation of nasal obstruction is the most common symptoms
3. Pain and rhinorrhoea
4. Bilateral, red swelling arising from nasal septum
5. BOGGY
146
Nasal septal haematoma Rx?
1. Surgical drainage
2. IV Abx
147
Nasal septal haematoma complication?
If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a 'saddle-nose' deformity
148
Bilateral parotid gland swelling causes?
1. Infection = Mumps
2. Inflammation = Sarcoid, Sjogrens
3. Malignancy = Lymphoma
4. Alcoholic liver disease
149
Unilateral parotid gland swelling cause?
1. Tumour = pleomorphic adenomas
2. Stones
3. Infection
150
Acute otitis media in children pathophysiology?
1. Whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
2. Viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube
151
Acute otitis media features?
1. Otalgia
2. Fever
3. Hearing loss
4. Recent Viral URTI Sx
5. Ear discharge if membrane perforates
6. Children may tug/rub ears
152
Otitis media otoscopy findings?
1. Bulging tympanic membrane --> loss of light reflex
2. Opacification or erythema of the tympanic membrane
3. Perforation with purulent otorrhoea
4. Decreased mobility if using a pneumatic otosopic
153
Otitis media Dx criteria?
1. Acute onset of symptoms
2. Presence of a middle ear effusion
3. Inflammation of the tympanic membrane
154
Acute otitis media Initial Rx?
Acute otitis media is generally a self-limiting condition that does not require an antibiotic prescription. There are however some exceptions listed below. Analgesia should be given to relieve otalgia. Parents should be advised to seek medical help if the symptoms worsen or do not improve after 3 days.
155
When should Abx be given for acute otitis media?
1. Symptoms lasting more than 4 days or not improving
2. Systemically unwell but not requiring admission
3. Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
4. Younger than 2 years with bilateral otitis media
5. Otitis media with perforation and/or discharge in the canal
156
Otitis media Abx choice?
5-7d Amoxicillin (erythromycin/carithromycin if pen allergic)
157
Otitis media common sequelae?
1. Hearing loss
2. Labyrinthitis
3. Perforation of tympanic membrane --> otorrhoea
158
CSOM?
1. Chronic suppurative otitis media
2. Unresolved acute otitis media with perforation may develop into CSOM
3. Defined as perforation of the tympanic membrane with otorrhoea for > 6 weeks
159
Otitis media complications?
1. Mastoiditis
2. Meningitis
3. Brain abscess
4. Facial nerve paralysis
160
Ramsay Hunt syndrome Rx?
Oral aciclovir and steroids
161
Vestibular neuronitis features?
1. Recurrent vertigo attacks lasting hours or days
2. N&V
3. Horizontal nystagmus
4. No hearing loss or tinnitus
5. Following viral infection
162
Vestibular neuronitis Ddx?
1. Viral labyrinthitis
2. POCS (use HiNTs exam)
163
Vestibular neuronitis Rx?
1. Acute = Buccal/IM Prochlorperazine
2. Short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
3. Chronic = vestibular rehabilitation exercises
164
Allergic rhinitis definition?
An inflammatory disorder of the nose where the nose become sensitized to allergens such as house dust mites and grass, tree and weed pollens.
165
Allergic rhinitis classification?
1. Seasonal = symptoms occur around the same time every year. Seasonal rhinitis which occurs secondary to pollens is known as hay fever
2. Perennial = symptoms occur throughout the year
3. Occupational = symptoms follow exposure to particular allergens within the work place
166
Allergic rhinitis features?
1. Sneezing
2. Bilateral nasal obstruction
3. Clear nasal discharge
4. Post-nasal drip
5. Nasal pruritis
167
Allergic rhinitis Rx?
1. Allergen avoidance
2. Mild-moderate = oral/IN antihistamines
3. Moderate-severe = IN corticosteroids
4. Short course of oral corticosteroids occasionally needed to cover important life events
5. May be a role for short courses of topical nasal decongestants (e.g. oxymetazoline). They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal
168
Menieres triad?
1. Vertigo
2. Tinnitus
3. Hearing loss
169
Drug causes of gingival hyperplasia?
1. Phenytoin
2. Ciclosporin
3. CCBs esp. nifedipine
170
Other causes of gingival hyperplasia?
AML
171
Sudden-onset sensorineural hearing loss (SSNHL) Rx?
Urgent referral to ENT
172
Main cause of SSNHL?
Idiopathic
173
SSNHL Ix?
MRI to exclude vestibular schwannoma
174
SSNHL Rx?
High dose oral corticosteroids are used by ENT for all causes of SSNHL
175
Geohraphic tongue definition?
A benign, chronic condition of unknown cause. It is present in around 1-3% of the population and is more common in females
176
Geographic tongue features?
1. Erythematous areas with a white-grey border (the irregular, smooth red areas are said to look like the outline of a map)
2. Some pts report burning after eating certain food
177
Geographic tongue Rx?
Reassurance about benign nature
178
Thyroid surgery complications?
1. Anatomical = recurrent laryngeal nerve damage
2. Bleeding = Owing to the confined space haematoma's may rapidly lead to respiratory compromise owing to laryngeal oedema
3. Parathyroid damage --> hypocalcaemia
179
Tinnitus definition?
Perception of sounds in the ears or head that do not come from an outside source
180
Tinnitus prevalence?
1 in 10 people will experience an episode of tinnitus at some point in their life
181
Causes of tinnitus?
1. Idiopathic
2. Menieres
3. Otosclerosis
4. Acoustic neuroma
5. Hearing loss
6. Drugs
7. Impacted ear wax
182
Drugs that cause tinnitus?
1. Aspirin/NSAIDs
2. Aminoglycosides
3. Loop diuretics
4. Quinine
183
Tinnitus Ix?
1. Audiological assessment = detect underlying hearing loss
2. Imaging
184
Tinnitus imaging mushkies?
1. Not all patients will require imaging. Generally, non-pulsatile tinnitus does not require imaging unless it is unilateral or there are other neurological or ontological signs. MRI of the internal auditory meatuses (IAM) is first-line
2. Pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus
185
Tinnitus Rx?
1. Underlying cause
2. Amplification devices = more beneficial if associated hearing loss
3. Psychological therapy may help a limited group of pts e.g. CBT
4. Tinnitus support groups
186
Salivary glands?
1. Parotid (serous) = most tumours
2. Submandibular (mixed) = most stones
3. Sublingual (mucous)
187
Salviary gland pathology?
1. Tumours = 80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe
2. Malignant = short hx, painful, hot skin, hard, fixation, CN VII involvement
188
Pleomorphic adenoma mushkies?
1. Benign, AKA mixed parotid tumour, 80%
2. Middle age
3. Slow-growing, painless lump
4. Rx = superficial parotidectomy: risk = CN VII damage
189
Warthin's tumour mushkies?
1. Benign, AKA adenolymphomas, 10%
2. Males, middle age
3. Softer, more mobile and fluctuant (although difficul tto differentiate)
190
Salivary gland stones mushkies?
1. Recurrent unilateral pain and swelling on eating
2. May become infected --> Ludwig's angina
3. 80% submandibular
4. Plain XR = sialography
5. Rx = surgical removal
191
Other causes of salivary gland enlargement?
1. Acute viral infection = mumps
2. Acute bacterial infection = 2nd to dehydration/diabetes
3. Sicca syndrome and Sjogrens e.g. RA
