ENT Flashcards
ACOUSTIC NEUROMA
what are the symptoms?
- unilateral sensorineural hearing loss
- tinnitus
- unsteadiness
- facial numbness
- facial weakness
- dry eyes/mouth
- dysarthria/dysphagia
BPPV
what are the risk factors?
- increasing age
- female
- head trauma
- inflammation (labyrinthitis + vestibular neuritis)
- migraines
BPPV
what is the management?
1st line
- conservative management
- Epley manoeuvre (contraindicated in neck injury + carotid stenosis)
2nd line
- vestibular suppressant medications (prochlorperazine/betahistine)
- vestibular rehab
refer to ENT
surgery
EPISTAXIS
how can you distinguish whether the nose-bleed is anterior or posterior?
ANTERIOR
- visible source of bleed
- minor bleed
- initially unilateral bleed
- history of picking
- first aid controls bleed
POSTERIOR
- no visible source
- bleeding down back of mouth + throat
- bleeding initially bilateral
- visible blood in posterior pharynx
EPISTAXIS
what is the management of anterior epistaxis?
1st line = first aid measures
2nd line = nasal cautery
3rd line = anterior nasal packing for 24-48 hours + admit
OTITIS EXTERNA
what microorganisms most commonly cause it?
pseudomonas aeruginosa
s.aureus
OTITIS EXTERNA
what is the management?
INITIAL MANAGEMENT
- analgesia (paracetamol, ibuprofen)
- topical antibiotic or combined topical antibiotic + steroid
SEVERE
- oral antibiotics (FLUCLOXACILLIN) if infection spreads
if topical antibiotics fail, refer to ENT
OTITIS EXTERNA
what does it indicate if there is recurrent otitis externa despite numerous antibiotic treatments?
raises suspicion of candida infection (treat with empirical antifungals)
OTITIS EXTERNA
what are the complications?
- pinna cellulitis
- chronic otitis externa
- myringitis
- necrotising otitis externa
OTITIS MEDIA
what are the most common causative pathogens?
BACTERIA
- s.pneumoniae
- H.influenzae
VIRUSES
- RSV
- rhinovirus
- adenovirus
OTITIS MEDIA
when should you consider antibiotics?
absolute indications
- systemically unwell
- signs and symptoms of more serious illness
- high risk of complications
- otorrhoea in child/young person
- age <2 with bilateral AOM
OTITIS MEDIA
which antibiotics may be prescribed?
5-7 day course
1st line = amoxicillin
2nd line = co-amoxiclav
penicillin allergy = clarithromycin/erythromycin
OTITIS MEDIA
what are the complications?
- glue ear
- tympanic membrane perforation
- mastoiditis
- meningitis
- facial nerve palsy
- chronic or recurrent infection
- hearing loss
TONSILLITIS
what is the CENTOR criteria?
- presence of tonsillar exudate
- tender anterior cervical lymph nodes
- history of fever
- absence of cough
1 point each
TONSILLITIS
what does the CENTOR score mean?
0-2 = 3-17% strep infection
3-4 = 32-56%
TONSILLITIS
what is the feverPAIN criteria?
- fever (during last 24 hrs)
- pus on tonsils
- attend rapidly (within 3 days of symptom onset)
- inflamed tonsils (severe)
- no cough or coryza
1 point each
TONSILLITIS
what do the scores for feverPAIN criteria mean?
likelihood of strep infection
0-1 = 13-18%
2-3 = 34-40%
4-5 = 62-65%
TONSILLITIS
what is the management?
ALL PATIENTS
- paracetamol + ibuprofen
- fluid intake
low feverPAIN (0-1) or centor (0-2) = no antibiotics
high feverPAIN (4-5) or centor (3-4) = antibiotics
- phenoxymethylpenicillin for 5-10 days
- clarithromycin for 5 days if penicillin allergic
MENIERES DISEASE
what is the pathophysiology?
it is characterised by endolymphatic hydrops - distention + distortion of membranous endolymph system due to abnormal fluctuations in endolymph
MENIERES DISEASE
what are the risk factors?
- caucasian
- family history
- migraines
- autoimmune diseases e.g. SLE, rheumatoid arthritis
- head trauma
- viral infection
MENIERES DISEASE
what are the clinical features?
- vertigo (spinning/rocking)
- tinnitus
- fluctuating hearing loss
- aural fullness
- unsteadiness on feet
- nystagmus (unidirectional, horizontal-torsional)
- positive rombergs sign
ACUTE SINUSITIS
what is the management?
- analgesia
- intranasal decongestants (limited evidence)
- intranasal corticosteroids (only if symptoms have persisted for >10 days)
- antibiotics if severe (phenoxymethylpenicillin or co-amoxiclav if systemically unwell)
SINUSITIS
what are the risk factors?
Allergies
Smoking
Asthma
Nasal polyps
Immunodeficiency
CHRONIC RHINOSINUSITIS
what is the management?
- Avoid allergen
- intranasal corticosteroids
- nasal irrigations with saline solution
LABYRINTHITIS
what are the clinical features?
- vertigo
- N+V
- hearing loss
- tinnitus
- imbalance
- nystagmus
- positive rombergs sign
LABYRINTHITIS
what is the management?
- prochloperazine
- rest and rehydration
- antibiotics if bacterial
- corticosteroids if vasculitis-induced
VESTIBULAR NEURITIS
what are the clinical features?
- recurrent vertigo attacks
- horizontal nystagmus
- nausea and vomiting
NO HEARING LOSS OR TINNITUS
VESTIBULAR NEURITIS
what is the management?
- vestibular rehabilitation therapy (VRT)
- prochlorperazine
OBSTRUCTIVE SLEEP APNOEA
what are the risk factors?
- increasing age
- male
- obesity
- family history of OSA
- nasopharyngeal obstruction
- craniofacial abnormalities
- macroglossia
- neuromuscular disorders
- smoking
VERTIGO
what are the causes of central vertigo?
- posterior circulation infarction (stroke)
- tumour
- MS
- vestibular migraine
VERTIGO
what is the difference in presentation of peripheral vs central vertigo?
PERIPHERAL
- sudden onset
- short (seconds/minutes)
- hearing loss/tinnitus present
- coordination intact
more severe nausea
CENTRAL
- gradual onset (except stroke)
- persistent
- no hearing loss/tinnitus
- coordination impaired
- only mild nausea
VERTIGO
what is the management?
CENTRAL
- referral for further investigation (CT or MRI head)
PERIPHERAL
- prochlorperazine
- antihistamines (cyclizine, cinnarizine and promethazine)
- if menieres disease = betahistine
if BPPV = epley manoeuvre
- vestibular migraine = triptans for acute, propranolol, topiramate or amitriptyline for prevention
PRESBYCUSIS
what is it?
type of sensorineural hearing loss that affects elderly
typically effects high frequency hearing bilaterally
OTOSCLEROSIS
what is the inheritance pattern?
autosomal dominant
VERTIGO
how can labyrinthitis and vestibular neuronitis be differentiated clinically?
tinnitus + hearing loss are seen in labyrinthitis but are not features of vestibular neuronitis
EAR ANATOMY
what are the 3 main structures of the inner ear?
semicircular canals
vestibule
cochlear
MENIERES
what is the pathophysiology?
- excessive build up of endolymph in the labyrinth of the inner ear
- increases the pressure and disrupts sensory signals
MENIERES
what type of hearing loss is associated with menieres?
sensorineural
MENIERES
what medication can be used as prophylaxis?
betahistine
