ENT Flashcards
sensorineural hearing loss is a problem with
the vestibulocochlear nerve or the sensory system in the inner ear
the eustahian tube connects
the middle ear to the throat
role of cochlea
transmitting sound vibrations to a nervous signal
in webers test, if there is sensorineural hearing loss the sound is heard louder in
the normal ear
in webers test, if there is conductive hearing loss the sound is heard louder in
the affected ear
rinnes test positive means
air conduction is louder than bone
this is normal
rinnes test negative means
bone conduction is better than air
this suggests conductive hearing loss
drugs that cause sensorineural hearing loss
aminoglycosides
chemotherapy
loop diuretics
above what on an audiogram is normal
20 dB
sensorineural hearing loss on an audiogram
both air and bone conduction over 20 dB (lower down)
conductive hearing loss on an audiogram
air conduction readings will be over 20 dB
mixed hearing loss on an audiogram
both air and bone conduction will be over 20 dB
there will be a difference of 15 dB between them
what is age related hearing loss called
presbycusis
whats presbycusis
age related hearing loss
affects high pitched sounds first
what type of hearing loss is presbycusis
sensorineural
sudden onset sensorineural hearing loss mx
immediate referral to ENT
steroids
what is the role of the eustachian tube
to equalise the pressure between the middle ear and throat
to drain fluid from the middle ear
what is eustachian tube dysfunction associated with
viral URTI
allergies
smoking
pressure in middle ear compared to ambient air in eustachian tube dysfunction
lower- negative ear canal pressure on tympanogram
where are grommets inserted
into the tympanic membrane
role of grommets
allows air or fluid to drain from the middle ear through the tympanic membrane
what type of hearing loss occurs in otosclerosis
conductive
what is otosclerosis
remodelling and hardening of the auditory ossicles, most commonly the base of the stapes
presentation of otosclerosis
hearing loss and tinnitus in under 40 yrs old
affects lower pitched sounds
how to patients hear their voice in otosclerosis
louder than the environment
this might lead to them speaking more quietly
what will tympanomentry show in otosclerosis
reduced admittance
mx of otoslcerosis
conservative with the use of hearing aids
stapedectomy or stapedotomy
most common bacteria causing otitis media
strep pneumoniae
otitis media is an infection where
between the tympanic membrane and inner ear
what does a normal tympanic membrane look like
pearly grey and translucent
abx for otitis media
usually sx resolve in 3 days so consider waiting till then or giving a delayed prescription
amoxicillin 5-7days
clarithromycin if penicillin allergic
erythromycin if pregnant and penicillin allergic
complications of otitis media
temporary hearing loss
perforated tympanic membrane
labyrinthitis
mastoiditis
abscess
meningitis
what should you consider in someone with otitis externa that doesnt respond to multiple abx
fungal infection
what is otitis externa associated with
swimming
common bacteria causing otitis externa
pseudomonas aerunginosa
staph aureus
pseudomonas aerunginosa is what type of bacteria
gram negative aerobic rod
pseudomonas aerunginosa mx
aminoglycosides
quinolones
mild otitis externa mx
topical 2% acetic acid
moderate otitis externa
topical abx and steroid
commonly otomize spray
what do you need to rule out before giving aminoglycosides in otitis externa
a perforated tympanic membrane
aminoglycosides can cause hearing loss sometimes if they get past the membrane
what is malignant otitis externa
when the infection spread to the bones- osteomyelitis of the temporal bone
sign of malignant otitis externa
granulation tissue at junction between bone and cartilage
emthods for removing ear wax
drops (olive oil or sodium bicarb)
irrigation
microsuction
causes of tinnitus
impacted ear wax
ear infection
menieres disease
medications
acoustic neuroma
systemic conditions: diabetes, hypothyroidism, anaemia
aortic stenosis
carotid artery stenosis
eustachian tube dysfunction
where is the vestibular apparatus found
the inner ear
what is in the vestibular apparatus
semicircular cannals filled with endolymph
where is the vestibular nucleus found
the brainstem and the cerebellum
4 main causes of peripheral vertigo
BPPV
menieres disease
vestibular neuronitis
labyrinthitis
what type of stroke causes vertigo
posterior circulation infarct
how does central vertigo differ from peripheral vertigo
sustained
non positional
gradual onset (apart from stroke)
usually no hearing loss or tinnitus
impaired coordination
nausea is milder
components of the HINTS examination
head impulse test
nystagmus
test of skew
head impulse test and results
patient looks at examiners nose, their head is jerked in one direction multiple times then the other direction
if the patients eyes saccade as trying to fix on the nose this suggests a peripheral cause of vertigo
unilateral horizontal nystagmus indicates
peripheral vertigo
bilateral or vertical nystagmus indicates
central vertigo
(vertical like looking up the to brain which is the central nervous system)
test of skew and results
the examiner covers the eyes with their hands, alternating between each eye and the patient is asked to fix their gaze on the examiners nose
vertical movement to fix indicates central vertigo
HiNTS exam results
head impulse test- positive= peripheral vertigo
nystagmus- unilateral/horizontal= peripheral vertigo
bilateral/vertical= central vertigo
test of skew- vertical movement to fix= central vertigo
central vertigo mx
further imaging for causes eg CT/MRI
peripheral vertigo mx
prochlorperazine
antihistamines
what medication is used to reduce attacks in menieres disease
betahistine
DVLA rules for vertigo
patients shouldnt drive if they get sudden attacks of vertigo
vestibular migraine mx
avoid triggers
triptans for acute sx
propanolol, topiramate, amitriptyline to avoid attacks
BPPV pathophysiology
calcium carbonate crystals become displaced most commonly in the posterior semicircular canal, disrupting the flow of endolymph
what is triggered in the dix hallpike manouevre if someone has BPPV
rotational nystagmus
clockwise if left ear
anti clockwise if right ear
what exercises can be used to improve sx of BPPV
brandt daroff exercises
what is vestibular neuronitis
inflammation of the vestibular nerve
what part of the HiNTs exam will be abnormal in peripheral vertigo
head impulse test
the eyes will saccade
what parts of the hints exam are abnormal in peripheral vertigo
head impulse test (eyes will saccade)
nystagmus (unilateral horizontal)
what parts of the hints exam will be abnormal in central vertigo
nystagmus (bilateral and vertical)
test of skew (vertical movements to fix)
vestibular neuronitis mx
prochlorperazine or antihistamines for 3 days
vestibular rehabilitation therapy if sx unresolved after 1-6 weeks
how to differentiate labyrinthitis from vestibular neuronitits
in labyrinthitis you get hearing loss and tinnitus
labyrinthitis mx
prochlorperazine or antihistamine for 3 days
abx if bacterial
menieres disease pathophysiology
build up of endolymph in the labyrinth of the inner ear
menieres disease sx
hearing loss
vertigo
tinnitus
fullness in the ear
drop attacks (falls but no LOC)
imbalance
acoustic neuromas are also known as
vestibular schwannomas
what is an acoustic neuroma
a benign tumor of the schwann cells surrounding the vestibulococchlear nerve
bilateral acoustic neuromas are associated with
MEN II
acoustic neuroma sx
unilateral hearing loss
sensation of fullness
unilateral tinnitus
dizziness/imbalance
facial palsy
what type of facial palsy is seen in acoustic neuroma
non forehead sparing as its lower motor neurone
acoustic neuroma mx
surgical removal
radiotherapy to shrink
if asymptomatic no mx needed
what is cholesteatoma
an abnormal non cancerous collection of squamous epithelial cells in the middle ear
cholesteatoma sx
foul smelling discharge
unilateral conductive hearing loss
path of the fcial nerve
exits brainstem at cerebellopontine angle
travels through temporal bone and parotid gland
functions of the facial nerve
motor- supples muscles of facial expression, stylohyoid and platyama muscles as well as the stapes
sensory- taste to anterior 2/3 of tongue
parasympathetic- to submandibular and sublingual salivary glands and lacrimal gland
how is forehead affected in UMN lesions
spared
as there is supply from UMN from both sides of the brain
how is forehead affected in LMN lesions
not spared
how do you check for forehead sparing
can they raise their eyebrows
what type of facial nerve palsy is bells palsy
unilateral lower motor neurone lesion
steroid dose in bells palsy
50mg prednisolone for 10 days
cause of bells palsy
idiopathic
what type of facial nerve palsy is ramsay hunt syndrome
unilateral lower motor neurone lesions
most common location of bleed in epistaxis
kiesselbachs plexus located in littles area
what can be prescribed after acute epistaxis and who cant have it
naseptin (for reducing crusting, infection and inflammation)
contraindicated if there is a peanut/soya allergy
what type of nasal polyp is concerning
unilateral
what is used to examine nasal polyps
a nasal speculum
causes of nasal polyps
churg strauss
CF
asthma
chronic rhinitis
nasal polyp mx
intranasal steroid drops or spray
polypectomy
most common cause of tonsillitis
viral infection
what does fever pain score assess for
if tonsillitis is baterial
what fever pain score indicates abx
4 or above
how many episodes of tonsillitis for tonsillectomy
7 in 1 yr
5 per year for 2 years
3 per year for 3 years
2 episodes of abscess
SOB, swallowing difficulty or snoring
what time frame comprises post tonsillectomy bleeding
2 weeks
if post tonsillectomy bleed is less severe what can be done
hydrogen peroxide gargle
adrenaline soaked swab
red flags for neck lump referral
over 45 and unexplained neck lump
persistent neck lump any age
how are growing lumps imaged
ultrasound
within 48 hrs if under 25
within 2 weeks if over 25
bloods for neck lumps
FBC
monospot test/EBV antibodies
ANA for SLE
TFTs
HIV
first line test for infectious mono
monospot test
hodgkins lymphoma is a proliferation of
lymphocytes
lymph node biopsy in hodgkins lymphoma
reed sternberg cell
what does the carotid body contain
chemoreceptors that detect blood oxygen, co2 and pH
carotid body tumor sx
neck lump- painless, pulsatile, mobile side to side but not up and down
can cause nerve palsy including horners
how does a thyroglossal cyst form
when part of the thyroglossal duct doesnt disappear and fluid fills inside it
where are branchial cysts found
anterior triangle of the neck
where does a branchial cyst originate
second branchial cleft
