ENT Flashcards
what are the role of the sinuses?
mucus production- for immune response
air filtration
cilia to trap bacteria/ move mucus
what would be the immune response shown by sinuses?
nasal congestion or secretion (runny nose) or running of secretion into sinuses ( blocked nose)- processes of what is causing them is the same
what is the most likely causes of sinus inflamation?
viral cause/ cold
- if it self limiting
upper resp tract infections
what are the treatments for sinus inflamation?
antihistamines
what is nasal congestion?
Excessive nasal secretions
•Inflamed and swollen nasal mucosa
what are the role of histamine receptors?
- Mediator of allergic/ inflammatory reactions
- Antihistamines competitive antagonism at histamine receptors
how many histamine receptors are there and what are they used for?
- 4 different types
- Both h1 and h4- involved in allergic inflammation
- Only use h1 for target rec for drugs- antihistamines
- H2- in gastric mucous- gastric acid sec
- H3- brain- for sleep and wake cycle
- H1- in smooth muscle in resp tract- keep blood vessels dilated/ bronchoconstriction/ mucous secretion
what effect does histamine have on smooth muscle?
Bronchial SM H1receptor activation produces bronchoconstriction
Activation inc Ca2+ in SM leading to SM contraction
what receptors are histamine coupled to?
- Coupled to g proteins- main function is to transmit and extracellular stimulate and transfer to intracellular stimuli
what are histamines effects on blood vessels?
- H1 – causes influx of calcium ions
- This causes release of certain mediators like nitric oxide-stim cGMP- smooth muscle relaxaction
how do decongestants work?
- Work on alpha 1 receptors
- Bind in upper resp tract
- Cause vasoconstriction- reverse effect of histamine
what are the 2 types of decongestants?
Adrenergics–Largest group–Sympathomimetics
•Anticholinergics–Less commonly used–Parasympatholytics
what is relief of nasal congestion associated with?
–Acute rhinitis–Common cold–Sinusitis–Hay fever–Reduce swelling of the nasal passage and facilitate visualization of the nasal/pharyngeal membranes
are oral decongestants fast acting?
no delayed action as they have to be absorbed from GI tract but longer duration of action
what is rebound congestion?
it is associated with topical decongestants when they are overused and when taken off medication they have congestion still present
what are 3 examples of oral decongestants?
–Pseudoephedrine (Sudafed)
–Phenylephrine (no better than placebo in many trials)
–Ephedrine
when may you not give oral decongestants to someone?
depends what medication they are on as some are CNS stimulants- so inc hr / bp- so not to hypertensives
what are topical decongestants called? and how do they work?
Adrenergics–- Work by constricting blood vessels in upp resp tract- any nasal sec can drain better
what are 2 examples of topical decongestants?
Oxymetazoline–Xylometazoline
how do nasal steroids work and when may they be given?
Anti-inflammatory effect
–Work to turn off the immune system cellsinvolved in the inflammatory response
–Decreased inflammation results in decreased congestion
work for long term- hayfever that is seasonal
what are two examples of nasal steroids?
Beclomethasone dipropionate nasal spray (BeconaseHayfever)
•Fluticasone nasal spray (PirinaseHayfeverRelief)
what are the potential abuses present with pseudoephridine and ephidine?
can be converted to meth
what does the outer ear consist of?
pina ( what you can see) and ear canal-
what does the middle ear consist of?
- Middle ear= ear drum to ossicles( smallest bones in body)- sound waves will hit ear drum and vibrate- tipanic membrane
what does the inner ear consist of?
- Ustasion tube-
not sure
what is Otitis media?
Middle ear inflammation
•It occurs in the area between the tympanic membrane and the inner ear
•It is one of the most common causes of earache•Often preceded by upper respiratory symptoms, including a cough and rhinorrhoea.
When the middle ear becomes acutely infected (bacterial, viral or fungal), pressure builds up behind the eardrum causing intense pain (otalgia), fever, hearing loss
what are the treatments for oitis media?
Antibiotics are not necessarily useful for most children with acute otitis media
•Cochrane review found that antibiotics did not alter pain within the first day, only slightly reduced it in the few days following
Analgesics should be the mainstay of treatment
•Paracetamol preferred treatment -both adults & children.
•Ibuprofen
are antihistamines and decongestants recommended for otitis media?
no- they do not work
what is Otitis media with effusion?
Glue ear” inflammation of the middle ear accompanied by accumulation of fluid…blockage of the eustachian tube
why may ptitis media with effusion be more serious in young children?
can lead to behavioural issues because inability to hear and inturprut info
what is Otitis Externa also known as?
swimming ear- as thrives in moist environemnt
what is the treatment for Otitis Externa?
Treat infection and return ear canal to healthy state–Dilute acetic acid (Earcalm)..useful if infection is superficial–Steroid drops and antibacterial drops (POM)
what causes Pharyngitis/Acute tonsilitis?
Normally a symptom of a bacterial (group A streptococcus) or viral infection (EBV)
what other symptoms may someone with a sore throat have?
–Headache–Muscle aches–Cough–Dysphagia
Inflammation (redness and swelling) and exudate in the throat
how do you diagnose a throat problem?
Symptoms and examination
•PoC-Rapidstrep testinvolves swabbing thethroatand running ateston the swab. Thetestquickly shows if group Astrepis causing the illness allowing antibiotics
what are some topical treatments for sore throats?
lozenges/throat sprays:–Menthol/local anaesthetics eglidocaine
•Mechanism of action:–local anaesthetic effect on nerve receptors in the pharynx
aim to numb throat/ lubricate
what do lozenges contain?
Often also often contain hexylresorcinol or amylmetacresol which are antiseptic agents
when do you refer a sore throat?
Most sore throats are self limiting and pass within 3-7 days
a persistent high temperature above 38°C not reduced by medication–symptoms do not improve after two weeks–Recurrent sore throats
what can sore throat be another sign of?
–weakened immune system for example because of HIV and AIDS–take certain medications e.g. disease-modifying anti-rheumatic drugs (DMARDs), cancer chemotherapy
