ENT Flashcards
Otosclerosis sx
conductive hearing loss, tinnitus and positive family history
reddish blush visible on the cochlear promontory
‘flamingo tinge’
. Onset is usually at 20-40 years
Mx of perforated ear drum
no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
Nasal polyps. Sensitivity to which medication is associated with this condition?
Aspirin. Nasal polyps are a common finding in patients with aspirin sensitivity, forming part of the Samter’s triad (aspirin sensitivity, asthma and nasal polyps).
Ear ache, >1 month with nothing shown on otoscope mx
Unexplained, unilateral ear ache for more than 4 weeks with unremarkable otoscopy should be referred under the 2 week wait
Criteria for tonsillectomy
the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years,
Hypocalcaemia ECG
QTc elongation
Mx of glue ear
children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.
However, referral should be earlier if:
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate
Mx of acute otitis media
Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Amox 5-7 days
2ww for Laryngeal cancer
aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck
2ww Oral cancer
Unexplained oral ulceration or mass persisting for greater than 3 weeks
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion.
Mx of chronic rhinosinitis
avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
Mx of acute sinusitis
Analgesia
intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
Acute sensorineural hearing loss mx
requires urgent referral to ENT for audiology assessment and brain MRI
An MRI scan is usually performed to exclude a vestibular schwannoma.
High-dose oral corticosteroids are used by ENT for all cases of SSNHL.
Neuronitis vs labyrinthitis
Neuronitis
Recent viral upper respiratory tract infection, followed by acute vertigo with nausea and horizontal nystagmus, but crucially without auditory symptoms
Labyrithitis
involves both the vestibular and cochlear portions of the inner ear. Therefore, patients typically present with hearing loss and/or tinnitus in addition to vertigo
Cause of bacterial otitis media
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
Mx of bleeding after tonsillectomy
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
Secondary occurs at 5-10 days normally- Treatment is usually with admission and antibiotics
Menieres disease
vertigo, fluctuating sensorineural hearing loss, and a sensation of fullness or pressure in the affected ear.
Meniere disease mx
Routine referral- ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
Cause of gingival hyperplasia
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)
Drugs causing tinnitus
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
Mx of acute otitis external
topical antibiotic or a combined topical antibiotic with a steroid
Mx of Ramsay Hunt sx
High dose aciclovir, high dose oral steroids and eye protection
BPPV diagnosis and mx
positive Dix-Hallpike manoeuvre
Tx Epley manoeuvre (successful in around 80% of cases)
medications is most useful for helping to prevent attacks of Meniere’s disease?
Betahistine
