ENT Flashcards
What are the symptoms of acoustic neuroma/vestibular schwannoma?
Sensorineural hearing loss, tinnitus, vertigo
+ V1 affected usually (loss of sensation face, loss of corneal reflex)
+ VII affected (face weakness)
Benign tumour of VIII, which affects V and VII as it grows
What is the gold standard investigation for acoustic neuroma/vestibular schwannoma?
MRI with contrast
Vertigo only, following URTI?
Vestibular neuronitis
Vertigo plus hearing loss or tinnitus after URTI?
Labyrinthitis
Triad of sensorineural hearing loss, vertigo, tinnitus plus feeling of ear fullness?
Ménière’s disease
Conductive hearing loss, discharge and small mass top of tympanic membrane?
Cholesteatoma
What is glue ear?
Otitis media with effusion
Common in 2 year olds, insert grommet if persists
Mx of perforated ear drum?
Watch and wait for 6 weeks, avoid water
If no improvement, ENT referral
ABx only given if caused by otitis media
what is the prognosis of Ménière’s disease?
attacks last mins-hours
Disease has relatively long course - lasts for 5-10 years
Most patients left with degree of hearing loss :(
What is the Mx of Meniere’s?
Buccal/IM prochlorperazine
ENT referral for diagnosis
when is a HINTS exam indicated?
in cases of vertigo and nystagmus when neuro exam is otherwise all normal, it’s used to differentiate the cause of acute vestibular syndrome being central (STROKE) vs peripheral (e.g. vestibular neuronitis).
What would HINTS exam show in vestibular neuronitis?
Head impulse - abnormal
Nystagmus - unidirectional to affected side
Skew test - negative
In stroke, impulse normal, nystagmus bidirectional and skew test positive.
What is the difference clinically between OE and OM?
Externa - ear pain, itchy, discharge, red ear canal
Media - ear pain, fever, potential hearing loss, bulging TM (loss of light reflex). Preceding URTI.
Common consequences of OM?
TM perforation
CSOM (when following perforation, there’s ongoing discharge for 6 weeks)
Labyrinthitis
Complications of OM?
Meningitis, Brain abscess, mastoiditis, hearing loss
Otitis externa bacteria
S.Aureus and Pseudomonas
OM bacteria
HMS
HiB
Moraxella
Streptococcus pneumoniae
What should you do if you find unilateral nasal polyp?
ENT 2ww referral
which specific pathogen are diabetics susceptible to?
Pseudomonas Aeruginosa
Otitis externa + immunosuppression/diabetes?
Malignant otitis externa (spreading infection)
Treat with IV Ciprofloxacin to cover pseudomonas
When is Abx treatment indicated in OM?
after 3 days
if bilateral and under 3yrs
if systemically unwell/any complications
Which nerve can be affected in parotid gland and/or ear pathology?
Facial nerve!
Runs through parotid
parotid tumour or its removal can affect facial nerve
Parotid glands - 80% of
salivary gland tumours
Submandibular glands - 80% of
salivary gland stones
Triad of fever, sore throat and cervical lymphadenopathy?
What might happen if you give Abx?
GLANDULAR FEVER
Abx may cause maculopapular rash
What is the 2ww referral criteria for oral lesions?
unexplained oral ulceration for 3 weeks
unexplained white or red painful areas
persistent unexplained sore throat
unexplained or change in previously undiagnosed neck lump
unilateral head/neck pain that’s been going on for more than 4 weeks
Medication to prevent attacks of Meniere’s?
Betahistine
(whereas prochlorperazine used for relief of acute attacks
Different types of neck lumps and features?
Moves upwards with swallowing - thyroid
Moves with protrusion of tongue - thyroglossal cyst
Bilateral swelling - likely reactive lymphadenopathy
Rubbery swellings - lymphoma
Fluctuant cyst between SCM and pharynx = Branchial cyst
Features of CENTOR score?
Cough absent
Swollen OR tender anterior cervical lymphadenopathy
Temp >38
Tonsillar exudate
When do you prescribe antibiotics in otitis media?
If lasting >3 days / systemically unwell / bilateral otitis media and less than 2yrs old / TM perforation / high risk (i.e. immunosuppressed or comorbid)
What are the causes of conductive hearing loss?
Essentially 1) stuff in ear canal 2) TM issue 3) stuff in middle ear 4) issue with ear bones
Therefore,
Wax, foreign material
Perforated TM
Middle ear effusion
Otosclerosis
What is otosclerosis?
Bilateral conductive hearing loss, which is autosomal dominant.
The ear bones turn from solid to spongy.
What are the causes of hoarse voice?
And when should you refer to 2ww ENT?
Benign causes include infection, overuse of voice, smoking, acid reflux
Serious causes - laryngeal cancer, lung cancer
Therefore, if hoarse voice unexplained and persistent for 3 weeks in 45 years or older -> 2ww ENT
What are the complications of thyroid surgery?
Damage to nerve, blood vessels or parathyroid gland
Recurrent laryngeal nerve damage / bleeding / parathyroid damage causing hypocalcaemia (remember Karim Meehan’s apprehension regarding thyroidectomy)
Following nasal trauma, aside from fracture, which other important complication must you exclude?
Septal haematoma, which if untreated, can cause septal necrosis within 3-4 days and permanent saddle nose deformity
What does septal haematoma look like? Where is the blood collected?
Bilateral red boggy swelling seen from the septal midline (can differentiate from ‘deviated septum’ which is hard on palpation)
The blood is collected between the septum and the perichondrium. This issue is that this build up can exert pressure on the septum, causing ischaemia and necrosis.
1st line management of chronic rhino sinusitis?
Saline nasal irrigation
Can also try 3 month course of nasal steroid spray
Which Abx used in otitis media if indicated?
Amoxicillin
Why is penicillin V preferred to amoxicillin for bacterial throat infections?
Because amoxicillin causes maculopapular rash if glandular fever
Causes of parotid swelling?
Bilateral - infection, inflammation
(mumps, sarcoidosis, Sjogren’s)
Unilateral - tumour, stones
(if parotid, more likely to be tumour, whereas submandibular salivary gland swelling more likely to be stone)
What are the red flags for URTI which require ENT evaluation?
Unable to swallow, breathe
Trismus
Septic
(this raises concern of deeper infection - e.g. supraglottitis)
