ENT Flashcards
Name the types of hearing loss
conductive
sensorineural
Describe conductive hearing loss
problem with sound travelling from the environment to the inner ear. The sensory system may be working correctly, but the sound is not reaching it.
Describe sensorineural hearing loss
problem with the sensory system or vestibulocochlear nerve in the inner ear
Name 3 parts of the ear
outer ear
middle ear
inner ear
name the structures of the ear
- The pinna is the external portion of the ear
- The external auditory canal is the tube into the ear
- The tympanic membrane is the eardrum
- The Eustachian tube connects the middle ear with the throat to equalise pressure
- The malleus, incus and stapes are the small bones in the middle ear that connect the tympanic membrane to the structures of the inner ear
- The semicircular canals sense head movement (the vestibular system)
- The cochlea converts the sound vibration into a nervous signal
- The vestibulocochlear nerve transmits nerve signals from the semicircular canals and cochlea to the brain
Associated sx with hearing loss
- tinnitus
- vertigo
- pain
- discharge
- neurological sx
Causes of sensorineural hearing loss
- sudden sensorineural hearing loss
- presbycusis (age related)
- noise exposure
- meniere’s disease
- labyrinthitis
- acoustic neuroma
- neurological conditions (stroke, MS, brain tumours)
- infections (meningitis)
- medications (loop diuretic, gentamicin, chemotherapy drugs)
Causes of conductive hearing loss
- ear wax
- infection (otitis media/externa)
- fluid in the middle ear (effusion)
- eustachian tube dysfunction
- perforated tympanic membrane
- osteosclerosis
- cholesteatoma
- exostoses
- tumours
Describe audiogram in sensorineural hearing loss
both air and bone conduction readings more than 20dB below the 20dB line on the chart
Describe audiogram in conductive hearing loss
bone conduction readings will be normal but air conduction will be greater than 20dB below the 20dB line.
Define presbycusis
age related hearing loss
what type of hearing loss is prescbycusis
sensorineural - affects higher pitched first and more
RFs for presbycusis
- age
- male
- FH
- loud noise exposure
- diabetes
- hypertension
- ototoxic medications
- smoking
how to diagnose presbycusis
audiometry
Mx of presbycusis
- optimise environment
- hearing aids
- cochlear implants
Describe sudden sensorineural hearing loss (SSNHL)
hearing loss <72hrs unexplained by other causes
EMERGENCY
Causes of SSNHL
- 90% idiopathic
- infection (meningitis, HIV, mumps)
- meniere’s disease
- ototoxic medications
- MS
- migraine
- stroke
- acoustic neuroma
- Cogan’s syndrome (rare)
Ix for SSNHL
audiometry
MRI/CT head if suspecting stroke or acoustic neuroma
Mx SSNHL
immediate ENT referral within 24hrs
idiopathic- steroids (oral or intra-tympanic)
other: treat cause
Define eustachian tube dysfunction
When the tube between the middle ear and throat is not functioning properly
function of eustachian tube
equalise air pressure in the middle ear and drain fluid from the middle ear
What can eustachian tube dysfunction be related to?
viral URTI
allergies (hayfever)
smoking
Presentation of eustachian tube dysfunction
- reduced/altering hearing
- popping noises/sensation in ear
- fullness sensation in ear
- pain/discomfort
- tinnitus
- sx worsen when flying, climb, diving
Ix in eustachian tube dysfunction
- otoscopy may appear normal
If persistent - tympanometry
audiometry
nasopharyngoscopy - CT
What is tympanometry
put device into ear canal and test different pressures
In ETB, new air cannot get through the tympanic membrane to equalise pressures so will show peak admittance (most sound absorbed) and negative ear canal pressure
if issue shows conductive loss
Mx of eustachian tube dysfunction
- self-limiting
- valsalva manoeuvre
- decongestant nasal spray (1 week)
- antihistamines and steroid nasal spray
- surgery
Surgical mx for ETB
- Treat any pathology that might be causing sx, e.g. adenoidectomy (removal of the adenoids)
- Grommets
- Balloon dilatation Eustachian tuboplasty
Define otosclerosis
remodelling of the small bones in the middle ear, leading to conductive hearing loss
demographic for otosclerosis
<40 y/o
Autosomal dominant inheritance
cause mix of genetic/environment
F>M
can be precipitated by pregnancy
pathophysiology of otosclerosis
abnormal bone formation in usually stapes causing stiffness –> prevent transmission of sound through cochlea
presentation of otosclerosis
< 40 y/o
bilateral hearing loss
tinnitus
affects lower-pitched sounds more than higher (reverse of presbycusis)
conductive loss therefore perceive voice louder than env. so talk quietly
Mx of otosclerosis
Conservative: hearing aids
Surgery: stapedectomy/sapedotomy
Define otitis media
infection of the middle ear (between tympanic membrane and inner ear)
Causes of otitis media
2/3 cases viral
1/3 bacteria (strep pneuomniae MC, but also haemophilus influenzae, staph A)
presentation of otits media
- pain
- reduced hearing in affected ear
- unwell: fever
- URTI
- balance issues and vertigo if affects vestibular system
- discharge if TM is perforated
Otoscopy in otitis media
bulging red inflamed TM
discharge/hole in perforation
Mx of otitis media
self-resolving 3/7-7/7
analgesia
antibiotics if systemically unwell
delayed prescription if no improvement
abx (amoxicillin, calrithromycin, erythromycin)
complications of otitis media
- mastoiditis (rare)
- otitis media with effusion
- temporary hearing loss
- perforated TM
- labyrinthitis
- abscess
- facial nerve palsy
- meningitis
most common causative organism in mastoiditis
streptococcus pneumoniae
define otitis externa
inflammation of the skin in the external ear canal
causes of otitis externa
- swimming
- trauma
- bacterial infection (pseudomonas, staph A)
- fungal infection (asperg., candida)
Presentation of otitis externa
- ear pain
- discharge
- itching
- conductive hearing loss
- erythema, tenderness, pus in ear canal
- lymphadenopathy in neck/ear
Mx of otitis externa
- acetic acid 2%
- topical antibiotics and steroid drops (cipro and dex)
- can use ear (pope) wick if canal is stenosed
Life threatening form of otitis externa
malignant otitis externa
related to diabetes, HIV, chemo
signs of malignant otitis externa
- persistent headache, severe pain and fever
- Granulation tissue at the junction between the bone and cartilage in the ear canal
Emergency
- IV abx, CT/MRI, admission
complications of malignant otitis externa
facial nerve palsy
CN involvement
meningitis
intracranial thrombosis
death
signs of impacted ear wax
- Conductive hearing loss
- Discomfort in the ear
- A feeling of fullness
- Pain
- Tinnitus
Mx of ear wax
- usually nothing
- ear drops
- ear irrigation
- microsuction
define tinnitus
persistent addition sound that is heard but is not present in the surrounding environment
ringing, buzzing, hissing, humming
causes of tinnitus
primary- nil
secondary
- Impacted ear wax
- Ear infection
- Ménière’s disease
- Noise exposure
- Koop diuretics, gentamicin and chemotherapy drugs
- Acoustic neuroma
- Multiple sclerosis
- Trauma
- Depression
systemic conditions associated with tinnitus
- Anaemia
- Diabetes
- Hypothyroidism or hyperthyroidism
- Hyperlipidaemia
objective tinnitus causes
- Carotid artery stenosis (pulsatile carotid bruit)
- Aortic stenosis (radiating pulsatile murmur sounds)
- Arteriovenous malformations (pulsatile)
- Eustachian tube dysfunction (popping or clicking noises)
Red flags for tinnitus
- Unilateral tinnitus
- Pulsatile tinnitus
- Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
- Unilateral hearing loss
- Sudden onset hearing loss
- Vertigo or dizziness
- Headaches or visual symptoms
- Neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
- Suicidal ideation related to the tinnitus
Mx of tinnitus
- self limiting
- hearing aids
- sound therapy
- CBT
define vertigo
movement between the patient and their environment
what is vertigo associated with
nausea, vomiting, sweating and feeling generally unwell
causes of vertigo
peripheral: vestibular system
central: brainstem/cerebellum
peripheral (vestibular) causes of vertigo
Benign paroxysmal positional vertigo
Ménière’s disease
Vestibular neuronitis
Labyrinthitis
what is BPPV
crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
Often symptoms occur over several weeks and then resolve, then can reoccur weeks or months later.
Test to diagnose BPPV
Dix-Hallpike manoeuvre
(also see rotary nystagmus)
Mx of BPPV
Epley manoeuvre
what is ménière’s disease
excessive buildup of endolymph in the semicircular canals causing a higher pressure than normal, disrupting sensory signals
sx of meniere’s
attacks (couple of hours) of triad:
1. hearing loss
2. tinnitus
3. unilateral vertigo and a sensation of fullness in the ear at random
- 40-50
- not associated with movement
- spontaneous unidirectional nystagmus
- gradual deterioration in hearing
- unexplained falls without LOC
- imbalance after vertigo resolves
- can vomit
what is acute vestibular neuronitis
inflammation of the vestibular nerve
sx of acute vestibular neuronitis
- due to viral infection
- acute onset of vertigo that improves within a few weeks
- nausea and vomiting
- balance problems
- eyes will saccade (horizontal nystagmus)
- no hearing loss or tinnitus
what is Labyrinthitis
inflammation of the structures of the inner ear
sx of labyrinthitis
- attributed to a viral infection
- acute onset of vertigo that improves within a few weeks.
- Labyrinthitis can cause hearing loss, which distinguishes it from vestibular neuronitis
- tinnitus
causes of central cause of vertigo
- Posterior circulation infarction (stroke)
- Tumour
- Multiple sclerosis
- Vestibular migraine
what is posterior circulation infarction
sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms
symptoms of vestibular migraine
sx lasting minutes to hours
associated with aura and headache
attacks + dizziness triggered by:
- Stress
- Bright lights
- Strong smells
- Certain foods (e.g. chocolate, cheese and caffeine)
- Dehydration
- Menstruation
- Abnormal sleep patterns
ways to differentiate causes of vertigo
- Recent viral illness (labyrinthitis or vestibular neuronitis)
- Headache (vestibular migraine, cerebrovascular accident or brain tumour)
- Typical triggers (vestibular migraine)
- Ear symptoms, such as pain or discharge (infection)
- Acute onset neurological symptoms (stroke)
what do you need to rule out with vertigo
stroke
Mx of central vertigo
Imaging (CT/MRI)
Mx peripheral vertigo
- prochlorperazine for 3 days
- antihistamines
Mx of Meniere’s
Acute:
- Prochlorperazine
- Antihistamines
Prophylaxis
betahistine
Mx of vestibular neuronitis and labyrinthitis
- Prochlorperazine (3 days)
- Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
What can develop after vestibular neuronitis
BPPV
what is the bony labyrinth made up of?
inner ear ( semicircular canals, vestibule)
cochlea
Complication of meningitis
hearing loss
what is an acoustic neuroma
benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear
what are acoustic neuromas also called
vestibular schwannoma
where do acoustic neuromas occur?
cerebellopontine angle
what does Bilateral acoustic neuromas indicate?
neurofibromatosis type II
presentation of acoustic neuroma
40-60 y/o
gradual onset of:
- Unilateral sensorineural hearing loss (often the first symptom)
- Unilateral tinnitus
- Vertigo
- A sensation of fullness in the ear
- can also be assoc w FN palsy
- absent corneal reflex
how to diagnose acoustic neuroma
MRI of internal acoustic meatus/CT
Mx of acoustic neuroma
- Conservative: monitor if no sx or treatment inappropriate
- Surgery: partial or total removal
- Radiotherapy: reduce growth
Complications of treatment of acoustic neuroma
- Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
- Facial nerve injury, with facial weakness
define cholesteatoma
benign collection of skin (squamous eip cells) in middle ear
Presentation of cholesteatoma
- FOUL discharge from the ear
- Unilateral conductive hearing loss
Ix for cholesteatoma
CT head
MRI
Branches of the facia nerve
- temporal
- zygomatic
- Buccal
- Marginal
- mandibular
- Cervical
Function of the facial nerve
Motor: muscles of facial expression, the stapedius in the inner ear and the posterior digastric, stylohyoid and platysma muscles in the neck.
Sensory: taste from the anterior 2/3 of the tongue.
Parasympathetic supply to the:
Submandibular and sublingual salivary glands
Lacrimal gland (stimulating tear production)
UMN v LMN lesion
UMN= forehead sparing
Where do unilateral upper motor neurone lesions occur?
- Cerebrovascular accidents (strokes)
- Tumours
Where do bilateral upper motor neurone lesions occur? (rare)
- Pseudobulbar palsies
- Motor neurone disease
What is Bell’s Palsy?
- idiopathic
- unilateral lower motor neurone facial nerve palsy
how long to recover from Bell’s palsy
- majority of patients fully recover over several weeks, but recovery may take up to 12 months.
- A third are left with some residual weakness
mx of Bell’s Palsy
Present within 72 hours = prednisolone
50mg for 10 days
OR
60mg for 5 days followed by a 5-day reducing regime of 10mg a day
- lubricating eye drops and tape to prevent corneal ulceration
what is Ramsay-Hunt Syndrome
- varicella zoster virus (VZV)
- unilateral lower motor neurone facial nerve palsy
- painful and tender vesicular rash in the ear canal, pinna and around the ear on the affected side. ca extend to anterior two-thirds of the tongue and hard palate
Mx of Ramsay Hunt syndrome
Initiate within 72 hours.
- Prednisolone
- Aciclovir
- lubricating eye drops
Other causes of LMN facial nerve palsy
Infection:
- Otitis media/ Malignant otitis externa
- HIV & Lyme’s disease
Systemic disease:
- Diabetes
- Sarcoidosis
- Leukaemia
- MS & GBS
Tumours:
- Acoustic neuroma
- Parotid tumours
- Cholesteatomas
Trauma:
- Direct nerve trauma
- Base of skull fractures
Where does epistaxis originate?
Kiesselbach’s plexus, located in Little’s area
In young people in retrocolumellar vein
Causes of epistaxis
- Nose picking
- Colds & Sinusitis
- Trauma
- Changes in the weather
- Coagulation disorders (thrombocytopenia or VWD)
- Anticoagulant medication (aspirin, DOACs, warfarin)
- Snorting cocaine
- Tumours (e.g., squamous cell carcinoma)
- nasal cannulae
- young and old
Bleeding pattern in epistaxis
usually unilateral. Bleeding from both nostrils may indicate bleeding posteriorly in the nose
Mx of epistaxis
- self-resolve
- pinch end of nose
- cauterise with silver nitrate sticks
- pack with tampon/inflatable pack
- naseptin cream post blood QDS 10 days
what is sinusitis
inflammation of the paranasal sinuses in the face
what is rhinosinusitis
inflammation of the nasal cavity
name the paranasal sinuses
- Frontal sinuses
- Maxillary sinuses
- Ethmoid sinuses
- Sphenoid sinuses
Causes of sinusitis
- Infection: viral URTI
- Allergies
- Foreign body
- Trauma or polyps
- Smoking
most common sinus to drain through osetomeatal complex
maxillary
patient bends forward, gravity causes the accumulated pus or mucus to drain out through the osteomeatal complex into the nasal cavity.
who is more likely ot suffer from sinusitis
asthma pts
Presentation of sinusitis
- Nasal congestion
- Nasal discharge
- Facial pain/headache
- Facial pressure
- Facial swelling over the affected areas
- Loss of smell
- worse leaning forward
Ix for sinusitis
- nil
- persistent= nasal endoscopy and CT
Mx acute sinusitis
- systemic= admission
- after 10 days can give steroid nasal spray and delayed antibiotic prescriptoin
Mx chronic sinusitis
- Saline nasal irrigation
- Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
- Functional endoscopic sinus surgery (FESS)
Define nasal polyp
growths of the nasal mucosa that can occur in the nasal cavity or sinuses
assoc w inflammation
presentation of nasal polyps
- bilateral
- snoring
- chronic rhinosinusitis
- discharge
- anosmia
- difficulty breathing through the nose
- pale grey/yellow growths
red flags for nasal polyps
unilateral
associations of nasal polyps
- Chronic rhinitis or sinusitis
- Asthma
- Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy)
- Cystic fibrosis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Mx of nasal polyps
- intranasal topical steroid drops or spray
Surgical if medical fails:
- Intranasal polypectomy
- Endoscopic nasal polypectomy
Define OSA
- collapse of the pharyngeal airway
- episodes of apnoea
RFs for OSA
- Middle age
- Male
- Obesity
- Alcohol
- Smoking
Presentation of OSA
- Episodes of apnoea during sleep
- Snoring
- Morning headache
- Waking up unrefreshed from sleep
- Daytime sleepiness
- Concentration problems
- Reduced oxygen saturation during sleep
how to assess OSA
Epworth Sleepiness Scale
Mx of OSA
- refer to ENT specialist or sleep clinic for sleep studies
- CPAP
- Surgery: uvulopalatopharyngoplasty (UPPP
Define tonsillitis
inflammation of the tonsils
causes of tonsillitis
- most common= viral
bacterial: - group A streptococcus (MC)
- streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Staph aureus
which tonsils are usually affected in tonsillitis
palatine tonsils
presentation of tonsillitis
- Sore throat
- Fever (above 38°C)
- Pain on swallowing
- red. enlarged tonsils
- +/- exudate
- cervical lymphadenopathy
- NO COUGH
how to diagnose tonsillitis
Centor or FeverPAIN score
Mx of tonsillitis
- viral: nothing
- prescribe abx of Centor= 3 or above or FeverPAIN= 4 or more
- admit if very unwell
Abx for tonsillitis
Penicillin V for 10 days
Clarithromycin if allergy
Complications of tonsillitis
- Peritonsillar abscess (quinsy)
- Otitis media
- Scarlet fever
- Rheumatic fever
- Post-streptococcal glomerulonephritis
- Post-streptococcal reactive arthritis
Define Quinsy
Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils
Presentation of Quinsy
similar sx to tonsillitis
- Sore throat
- Painful swallowing
- Fever
- Neck pain
- Referred ear pain
- Swollen tender lymph nodes
Triad for Quinsy
- trismus (unable to open their mouth more than 3 fingers)
- hot potato voice
- swelling and erythema behind tonsils
Uvula in quinsy
deviated away fro abscess
causes of quinsy
bacterial (streptococcus pyogenes)
can also be staph A and haemophilus influenzae
ho does quinsy form
tonsillitis –>peritonsillar cellulitis –> quinsy
Mx of quinsy
- needle aspiration/surgical incision and drainage
- Abx before and after (co-amoxiclav)
indication for tonsillectomy
No. of times pt has had tonsillitis:
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
- recurrent tonsillar abscesses (2)
- airway obstruction
complications of tonsillectomy
- Sore throat where the tonsillar tissue has been removed (this can last 2 weeks)
- Damage to teeth
- Infection
- Post-tonsillectomy bleeding
- Risks associated with a general anaesthetic
Mx of post-tonsillectomy bleeding
- ENT registrar
- V access and send bloods including an FBC, clotting screen, group and save and crossmatch
- sit up
- nil by mouth
- IV fluids
- hydrogen peroxide gargle
- adrenalin soaked swab
Risk of post-tonsillectomy bleed
aspiration, can be life threatening
Borders of anterior triangle of the neck
- Mandible (superior border)
Midline of the neck (medial border)
Sternocleidomastoid (lateral border)
Borders of the posterior triangle of the neck
- Clavicle (inferior border)
Trapezius (posterior border)
Sternocleidomastoid (lateral border)
DDx of neck lumps in adults
- Normal structures (e.g., bony prominence)
- Skin abscess
- Lymphadenopathy
- Tumour (e.g., squamous cell carcinoma or sarcoma)
- Lipoma
- Goitre or thyroid nodules
- Salivary gland stones or infection
- Carotid body tumour
- Haematoma
- Thyroglossal cysts
- Branchial cysts
DDx of neck lumps in children
- Cystic hygromas
- Dermoid cysts
- Haemangiomas
- Venous malformation
Neck lump red flags
- An unexplained neck lump in someone aged 45 or above
- A persistent unexplained neck lump at any age
- Need urgent USS
Cause of infectious mononucleosis
EBV
presentation of infectious mononucleosis
Fever
Sore throat
Fatigue
Lymphadenopathy (cervical, inguinal, axillary)
Itchy maculopapular petechial rash
Mx of infectious mononucleosis
supporive
avoid alcohol and contact sports
Staging for lymphoma
Ann Arbor staging
Histology in Hodgkin’s lymphoma
reed-sternberg cells
locations of the salivary glands
- Parotid glands
- Submandibular glands
- Sublingual glands
what is a branchial cyst
congenital abnormality that arises when the second branchial cleft fails to form properly during fetal development
Presentation of branchial cyst
round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck.
Mx of branchial cyst
Conservative
Surgical excision if recurrent infections
Most common type of head and neck cancer
squamous cell carcinoma
potential areas for H&N cancer
- Nasal cavity
- Paranasal sinuses
- Mouth
- Salivary glands
- Pharynx (throat)
- Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)
RFs for H&N cancer
- Smoking
- Chewing tobacco
- Chewing betel quid (paan)
- Alcohol
- HPV 16
- Epstein–Barr virus
Red lags of H&N cancer
- Lump in the mouth or on the lip
- Unexplained ulceration in the mouth lasting more than 3 weeks
- Erythroplakia or erythroleukoplakia
- Persistent neck lump
- Unexplained hoarseness of voice
- Unexplained thyroid lump
Monoclonal antibody to treat squamous cell carcinoma
Cetuximab
Define glottitis
inflamed tongue
Presentation of glottitis
- red, sore and swollen tongue
- The papillae of the tongue atrophy, giving the tongue a smooth appearance. - It is sometimes described as “beefy”
Causes of glottitis
- Iron deficiency anaemia
- B12 deficiency
- Folate deficiency
- Coeliac disease
- Injury or irritant exposure
define angioedema
fluid accumulating in the tissues, resulting in swelling
causes of angioedema
- Allergic reactions
- ACE inhibitors
- C1 esterase inhibitor deficiency (hereditary angioedema)
define oral candidiasis
oral thrush
overgrowth of candida
RFs for candidiasis
- Inhaled corticosteroids
- Antibiotics (disrupt the normal bacterial flora giving candida a chance to thrive)
- Diabetes
- Immunodeficiency (consider HIV)
- Smoking
Mx of candidiasis
- Miconazole gel
- Nystatin suspension
- Fluconazole tablets (in severe or recurrent cases)
Define geographic tongue
inflammatory condition where patches of the tongue’s surface lose the epithelium and papillae. The patches form irregular shapes on the tongue, resembling a map, with countries and oceans bordering each other
causes of geographic tongue
unknown
could be related to:
- Stress and mental illness
- Psoriasis
- Atopy (asthma, hayfever and eczema)
- Diabetes
Define strawberry tongue
ongue becomes swollen and red, and the papillae become enlarged, white and prominent.
Causes of strawberry tongue
- Scarlet fever
- Kawasaki disease
define black hairy tongue
decreased shedding (exfoliation) of keratin from the tongue’s surface.
bacteria and food cause dark pigmentation
Causes of black hairy tongue
dehydration, a dry mouth, poor oral hygiene and smoking.
Mx of black hairy tongue
adequate hydration, gentle brushing of the tongue and stopping smoking
Define leukoplakia
white patches in the mouth, often on the tongue or insides of the cheeks (buccal mucosa)
precancerous
Presentation of leukoplakia
patches are asymptomatic, irregular and slightly raised. They are fixed in place, meaning they cannot be scraped off.
need biopsy
Mx of leukoplakia
stopping smoking, reducing alcohol intake, close monitoring and potentially laser removal or surgical excision
define erythroplakia
- similar to leukoplakia
- lesions that are a mixture of red and white
- Both erythroplakia and erythroleukoplakia are associated with a high risk of squamous cell carcinoma and should be referred urgently to exclude cancer.
Define lichen planus
autoimmune condition that causes localised chronic inflammation of the skin
Presentation of lichen planus
- skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.
- > 45 y/o
- F>M
Mx of lichen planus
good oral hygiene, stop smoking and topical steroids
define gingivitis
inflammation of the gums
Presentation of gingivitis
- swollen gums
- bleeding after brushing
- painful gums
- bad breath (halitosis)
- Gingivitis can lead to periodontitis if not adequately managed.
What is peridontitis
severe and chronic inflammation of the gums and the tissues that support the teeth. This often leads to loss of teeth.
RFs for gingivitis
- Plaque build-up on the teeth (inadequate brushing)
- Smoking
- Diabetes
- Malnutrition
- Stress
Mx for gingivitis
- Good oral hygiene
- Stopping smoking
- Remove plaque and tartar
- Chlorhexidine mouth wash
- Antibiotics for acute necrotising ulcerative gingivitis (e.g., metronidazole)
- Dental surgery if required
What is gingival hyperplasia
abnormal growth of the gums
causes of gingival hyperplasia
- Gingivitis
- Pregnancy
- Scurvy
- Acute myeloid leukaemia
- Medications, particularly calcium channel blockers, phenytoin and ciclosporin
What are aphthous ulcers
- very common, small, painful ulcers of the mucosa in the mouth
- well-circumscribed, punched-out, white appearance.
causes of aphthous ulcers
- stress
- trauma
- food
- IBD
- Coeliac disease
- Behçet disease
- Vitamin deficiency (e.g., iron, B12, folate and vitamin D)
- HIV
Mx of aphthous ulcers
- self-limiting for 2 weeks
Topical treatments:
- Bonjela
- Benzydamine
- lidocaine
Topical steroids
- Hydrocortisone buccal tablets applied to the lesion
- Betamethasone soluble tablets applied to the lesion
- Beclomethasone inhaler sprayed directly onto the lesion
are most parotid tumours benign or malignant?
80% benign
name benign tumours of the parotid glands?
- Benign pleomorphic adenoma or benign mixed tumour
- Warthin tumor (papillary cystadenoma lymphoma or adenolymphoma)
- Monomorphic adenoma
- haemangioma
name malignant tumours of the parotids
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
- Mixed tumours
- Acinic cell carcinoma
- Adenocarcinoma
- Lymphoma
what is Benign pleomorphic adenoma or benign mixed tumour?
- Most common parotid neoplasm (80%)
- Proliferation of epithelial and myoepithelial cells of the ducts and an increase in stromal components
- Slow growing, lobular, not well encapsulated
Recurrence rate of 1-5% with parotidectomy
Mx- routine surgical excision
what is Warthin tumour?
- Second most common benign parotid tumour (5%)
- strongly associated with smoking
- Most common bilateral benign neoplasm of the parotid
- M > F
- Occurs later in life (6th-7th decades)
- lymphocytic infiltrate and cystic epithelial proliferation
- Malignant transformation rare
what is Monomorphic adenoma?
- < 5% of tumours
- Slow growing
- only one cell type
- Include; basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas
what is haemangioma?
- 90% of parotid tumours in children <1 y/o
- Hypervascular on imaging
- Spontaneous regression may occur and malignant transformation rare
what is Mucoepidermoid carcinoma
- 30% of all parotid malignancies
- low potential for local invasiveness and metastasis
what is Adenoid cystic carcinoma
- Unpredictable growth pattern
- Tendency for perineural spread
- May have skip lesions resulting in incomplete excision
- Distant metastasis more common (visceral rather than nodal spread)
- 5 year survival 35%
what is mixed tumours?
- Often a malignancy occurring in a previously benign parotid lesion
what is Acinic cell carcinoma
- Intermediate grade malignancy
- May show perineural invasion
- Low potential for distant metastasis
- 5 year survival 80%
what is adenocarcinoma?
- Develops from secretory portion of gland
- Risk of regional nodal and distant metastasis
what is lymphoma?
- Large rubbery lesion, may occur in association with Warthins tumours
- Diagnosis should be based on regional nodal biopsy rather than parotid resection
- Mx is chemotherapy (+radiotherapy)
Sensitivity to what medication is assoc with nasal polyps?
aspirin
what is Samter’s triad
- asthma
- aspirin sensitivity
- nasal polyps
what is sialadenitis
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.
presentation of sialadenitis?
- foul taste in mouth
- usually submandibular mass
Mx of meniere’s
acute- prochlorperazine
prevention- betahistine and vestibular rehabilitation
nystagmus indications
horizontal= peripheral problem
pendular nystagmus, gait abnormality = cerebellar problem
medication cause of tinnitus
- NSAID
- aspirin
- loop diuretics
- aminoglycosides
