ENT Flashcards
Benign pleomorphic adenoma
most common benign tumour of parotid gland
Benign pleomorphic adenoma- features
gradual onset, painless unilateral swelling of the parotid gland
typically movable on examination rather than fixed
Benign pleomorphic adenoma- treatment
surgical excision- due to risk of malignant transformation
red flag symptoms chronic sinusitis
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis
Drugs causing tinnitus
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
suspected laryngeal cancer referral guidelines
Aged >45 and:
persistent unexplained hoarseness or
An unexplained lump in the neck.
treatment for chronic symptoms in vestibular neuronitis
Vestibular rehabilitation exercises
Otitis externa: Poor response to topical antibiotics
should be referred to ENT- microsuction and insertion of a pope wick
Globus, hoarseness and no red flags
laryngopharyngeal reflux
laryngopharyngeal reflux Tx
PPI and lifestyle advice
Unilateral middle ear effusion in adult
especially in smokers and people of Chinese or South-East Asian origin
?nasopharyngeal cancer
2ww referral
‘metastatic SCC in a lymph node’ in posterior triangle of neck
nasopharyngeal cancer
Branchial cysts
congenital abnormalities associated with the formation of a neck lump located in the anterior triangle
cholesterol crystals
Otalgia in the absence of any ear signs
is a red flag for head and neck malignancy
sialadenitis
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct
Rhinitis medicamentosa
is a condition of rebound nasal congestion brought on by extended use of topical decongestants
(tachyphylaxis)
perforated tympanic membrane Tx
should resolve spontaneously in 6-8 weeks
myringoplasty may be performed if the tympanic membrane does not heal by itself
Elderly patient dizzy on extending neck
Vertebrobasilar ischaemia
contraindications to cochlear implant
Lesions of cranial nerve VIII or in the brain stem causing deafness
Chronic infective otitis media, mastoid cavity or tympanic membrane perforation
Cochlear aplasia
Ludwig’s angina features
neck swelling
dysphagia
fever
what is Ludwig’s angina
progressive cellulitis that invades the floor of the mouth and soft tissues of the neck,
Most cases result from odontogenic infections which spread into the submandibular space.
Ludwig’s angina Tx
airway management
intravenous antibiotics
Most common cause of Sudden onset SNHL
idiopathic
most common bacterial causes of otitis media
Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.
vestibular neuronitis vs viral labyrinthitis
hearing normal in vestibular neuronitis
Septal haematoma Tx
urgent referral to ENT for incision and drainage and antibiotics
if left untreated –> irreversible septal necrosis may develop within 3-4 days.
thyroid surgery complications
anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.
acute OM otoscopy
bulging tympanic membrane → loss of light reflex
otitis externa with spreading erythema
oral Flucloxacillin is first-line.
acoustic neuroma- cranial nerves affected and symptoms
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
acute necrotising ulcerative gingivitis Tx
Paracetamol + oral metronidazole + chlorhexidine mouthwash
Gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers and AML
acute otitis media otoscopy
The tympanic membrane appears erythematous, inflamed
Bulging
otitis media with effusion otoscopy
Tympanic membrane discolouration - e.g. yellowing
Air/fluid level, or bubbles behind the TM
Retracted TM (indrawn due to pressure)
Blunting of light reflex
chronic suppurative otitis media otoscopy
Perforated tympanic membrane
Dried discharge or debris in ear canal
chronic suppurative otitis media
A complication of AOM in which there is chronic inflammation within the middle ear, resulting in recurrent otorrhoea through a perforated tympanic membrane.
otitis media with effusion
The accumulation of fluid (effusion) within the middle ear
~ glue ear
Unilateral glue ear in an adult
needs evaluation for a posterior nasal space tumour
Otitis media with perforation and/or discharge in the canal
oral amoxicillin 5 days
review in 6 weeks
Treatment of Ramsay Hunt syndrome consists of
oral aciclovir and corticosteroids
HiNTS exam consists of
Head impulse
Nystagmus
Test of Skew
Hearing
otitis media with perforation
If there is perforation, there may be discharge in the canal
difficulty fixating on the examiner’s nose during the head impulse test, and a corrective saccade is observed
positive –> peripheral cause of vertigo