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Y4 Neuro and Special Senses > ENT 2 > Flashcards

ENT 2 Flashcards

1
Q

What are the causes of otitis externa?

A

infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
seborrhoeic dermatitis
contact dermatitis (allergic and irritant)

recent swimming is a common trigger of otitis externa

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2
Q

How does otitis externa present? Mx?

A

ear pain, itch, discharge
otoscopy: red, swollen, or eczematous canal

Mx:
topical antibiotic / combined topical antibiotic with a steroid
if the canal is extensively swollen then an ear wick is sometimes inserted

Second-line:
oral antibiotics (flucloxacillin) if the infection is spreading
swab inside the ear canal

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3
Q

Malignant otitis externa is an uncommon type of otitis externa that is found in immunocompromised individuals.

Which patient group are commonly affected?

A

Diabetic patients

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4
Q

What causes malignant otitis externa?

A

most commonly caused by Pseudomonas aeruginosa

Infection starts in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal

Progresses to temporal bone osteomyelitis

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5
Q

How does malignant otitis externa present?

A

Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

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6
Q

How is malignant otitis externa investigated and managed?

A

Dx: CT scan is typically done

Managment:

non-resolving otitis externa with worsening pain should be referred urgently to ENT

Intravenous antibiotics that cover pseudomonal infections

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7
Q

Otosclerosis is an autosomal dominant condition that causes progressive conductive deafness in young adults.

How can it be managed?

A

hearing aid
stapedectomy - removal of the stapes bone

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8
Q

What are the most common location of salivary gland tumours?
What patient population do they largely effect?

A

80% of all salivary gland tumours occur in the parotid gland (and 80% of these are benign)

middle aged patients, with the exception of Warthins tumours, they are commoner in women than men

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9
Q

List the key benign parotid neoplasms

A

Benign pleomorphic adenoma or benign mixed tumor
Warthin tumor
Monomorphic adenoma
Haemangioma

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10
Q

What is the most common parotid neoplasm?
Outline its key features :

A

Benign pleomorphic adenoma

Slow growing, lobular, and not well encapsulated

Malignant degeneration occurring in 2-10%

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11
Q

What is a Warthin tumor?

A

Second most common benign parotid tumor
Most common bilateral benign neoplasm of the parotid
Occurs later in life
Presents as a lymphocytic infiltrate and cystic epithelial proliferation

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12
Q

What are the associations of Warthin tumours?

A

strongly associated with smoking
Marked male predominance

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13
Q

What is a Monomorphic adenoma of the parotid?

A

Slow growing benign tumour of the parotid gland
Consist of only one morphological cell type (hence term mono)

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14
Q

Outline the key features of a parotid Haemangioma

A

Accounts for 90% of parotid tumours in children less than 1 year of age
Hypervascular on imaging
Spontaneous regression may occur

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15
Q

List the key malignant parotid neoplasms

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Adenocarcinoma
Lymphoma

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16
Q

How may parotid tumours be investigated?

A

Plain x-rays to exclude calculi

Sialography to delineate ductal anatomy

FNAC is used in most cases

Superficial parotidectomy may be diagnostic/ therapeutic

CT/ MRI may be used in cases of malignancy for staging primary disease

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17
Q

Lymphoepithelial cysts associated with HIV occur almost exclusively in which gland?

A

the parotid

Typically presents as bilateral, multicystic, symmetrical swelling

Risk of malignant transformation is low and management usually conservative

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18
Q

What is Sjogren’s syndrome?

How does it present with regards to the parotid gland?
How is this managed?

A

Autoimmune disorder characterised by parotid enlargement, xerostomia and keratoconjunctivitis sicca

Bilateral, non tender enlargement of the gland is usual
Tx is supportive, there is risk of subsequent lymphoma

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19
Q

Parotid involvement occurs in 6% of patients with sarcoid. How does this present?

A

Bilateral in most cases
Gland is not tender
Xerostomia may occur
Management of isolated parotid disease is usually conservative

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20
Q

What is the most common cause of a perforated tympanic membrane?

A

Infection

other causes include barotrauma or direct trauma.

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21
Q

What is the risk of a perforated tympanic membrane? How can it be managed?

A

may lead to hearing loss depending on the size and also increase the risk of otitis media

will usually heal spontaneously after 6-8 weeks
avoid getting water in the ear during this time
prescribe antibiotics for perforations which occur following an episode of acute otitis media

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22
Q

A peritonsillar abscess (quinsy) typically develops as a complication of bacterial tonsillitis.

How may it present?

A

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

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23
Q

How should quinsy be managed?

A

urgent review by an ENT specialist
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence

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24
Q

Pleomorphic adenoma (also known as a benign mixed tumour) is a benign tumour of the parotid gland. It is the most common tumour of the parotid gland and typically appears at the age of 40-60 years.

How does it appear on examination?
What is the prognosis?

A

gradual onset, painless unilateral swelling of the parotid gland

typically movable on examination rather than fixed

recurrence rate of 1-5% with appropriate excision (parotidectomy)
malignant transformation if not removed

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25
What are the main post operative complications of tonsillectomy?
Pain - may increase for 6 days post surgery Haemorrhage
26
How may post tonsillectomy haemorrhage be managed?
All should be reviewed by ENT Primary: 6-8 hours following surgery immediate return to theatre Secondary: 5 - 10 days after surgery often associated with a wound infection admission and antibiotics
27
Presbycusis is a type of sensorineural hearing loss (typically bilateral high frequency hearing loss) that affects elderly individuals. What can cause it?
Arteriosclerosis: diminished perfusion and oxygenation of the cochlea Diabetes: Acceleration of arteriosclerosis Accumulated exposure to noise Drug exposure (Salicylates, chemotherapy agents etc.) Stress Genetics
28
How may presbycusis present?
Speech becoming difficult to understand Need for increased volume on the television or radio Difficulty using the telephone Loss of directionality of sound Worsening of symptoms in noisy environments
29
How can presbycusis be investigated?
Otoscopy: Normal - to rule out otosclerosis, cholesteatoma and conductive hearing loss (Foreign body, impacted wax) Tympanometry: Normal middle ear function with hearing loss (Type A) Audiometry: Bilateral sensorineural pattern hearing loss Blood tests including inflammatory markers and specific antibodies: Normal.
30
Outline Rinne's test
tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus 'positive test': air conduction (AC) is normally better than bone conduction (BC) 'negative test': if BC > AC then conductive deafness
31
Outline Weber's test
tuning fork is placed in the middle of the forehead equidistant from the patient's ears the patient is then asked which side is loudest in unilateral sensorineural deafness, sound is localised to the unaffected side in unilateral conductive deafness, sound is localised to the affected side
32
How does conductive hearing loss present on Weber's and Rinne's tests?
Rinne's: Bone conduction > air conduction in affected ear Air conduction > bone conduction in unaffected ear Weber's: Lateralises to affected ear
33
How does sensorineural hearing loss present on Weber's and Rinne's tests?
Rinne's: Air conduction > bone conduction bilaterally Weber's: Lateralises to unaffected ear
34
What are the 3 pairs of salivary glands?
parotid (serous) - most tumours submandibular (mixed) - most stones sublingual (mucous)
35
What are the key features of salivary gland tumours? How about malignant salivary gland tumours?
tumours: '80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe malignant rare: short hx, painful, hot skin, hard, fixation, CN VII involvement
36
What is the main risk with superficial parotidectomy?
CN VII (facial nerve) damage
37
How do salivary gland stones present? How should they be investigated and managed?
recurrent unilateral pain & swelling on eating may become infected → Ludwig's angina 80% are submandibular Ix: plain x-rays; sialography Mx: surgical removal
38
Other than stones and tumours, what may cause salivary gland enlargement?
acute viral infection e.g. mumps acute bacterial infection sicca syndrome and Sjogren's (e.g. RA)
39
What are the Centor criteria for requirement of abx for tonsillitis?
3 of the following should be present to warrant abx for suspected tonsilitis: C – Cough absent E – Exudate N – Nodes T – temperature (fever) (OR – young OR old modifier)
40
What are the fever PAIN criteria for requirement of abx for tonsilitis?
Fever over 38°C Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Inflamed tonsils (severe) No cough or coryza
41
What abx can be given for tonsillitis?
phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) for 7 or 10 days
42
Give some complications of tonsillitis
otitis media quinsy - peritonsillar abscess rheumatic fever and glomerulonephritis very rarely
43
When is tonsillectomy indicated for patients with persistent sore throat?
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections) the person has five or more episodes of sore throat per year the episodes of sore throat are disabling and prevent normal functioning
44
80% of all salivary gland calculi occur in the submandibular gland. How are these composed? How do they present?
70% of these calculi are radio-opaque Stones are usually composed of calcium phosphate or calcium carbonate Patients typically develop colicky pain and post prandial swelling of the gland
45
What are the key features of submandibular gland sialadenitis?
Usually occurs as a result of Staphylococcus aureus infection Pus may be seen leaking from the duct, erythema may also be noted Development of a sub mandibular abscess is a serious complication as it may spread through the other deep fascial spaces and occlude the airway
46
Sudden onset sensorineural hearing loss (SSNHL) =
urgent referral to ENT for high dose steroids usually idiopathic
47
How should SSNHL be investigated and managed?
An MRI scan is usually performed to exclude a vestibular schwannoma. High-dose oral corticosteroids are used by ENT for all cases of SSNHL.
48
What are the main complications of thyroid surgery?
recurrent laryngeal nerve damage. bleeding - haematomas may rapidly lead to respiratory compromise (laryngeal oedema) damage to the parathyroid glands = hypocalcaemia
49
Tinnitus is the perception of sounds in the ears or head that do not come from an outside source. What may cause it?
Idiopathic Meniere's Disease Otosclerosis Acoustic neuroma Hearing loss Drugs Impacted ear wax
50
What drugs can cause tinnitus?
Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine
51
How should tinnitus be investigated?
audiological assessment to detect underlying hearing loss imaging: not all patients will require imaging pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used
52
How should tinnitus be managed?
investigate and treat any underlying cause amplification devices (more beneficial if associated hearing loss) psychological therapy (CBT and tinnitus support groups)
53
Spot diagnosis: Recent viral infection e.g URTI Sudden onset Vertigo Nausea and vomiting Hearing may be affected
Viral labyrinthitis
54
Spot diagnosis: Recent viral infection Recurrent vertigo attacks lasting hours or days No hearing loss or tinnitus
Vestibular neuronitis (Acute Labyrinthitis has ALl the symptoms whereas Vestibular neuronitis only has Vertigo)
55
Spot diagnosis: Vertigo Gradual onset Triggered by change in head position Each episode lasts 10-20 seconds
Benign paroxysmal positional vertigo BPPV
56
spot diagnosis: vertigo associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears
Meniere's disease
57
Spot diagnosis: Hearing loss, vertigo, tinnitus Absent corneal reflex is important sign Associated with neurofibromatosis type 2
Acoustic neuroma
58
give 4 less common causes of vertigo
posterior circulation stroke trauma multiple sclerosis ototoxicity e.g. gentamicin
59
Vestibular neuronitis is a cause of vertigo that often develops following a viral infection. How does it present?
recurrent vertigo attacks lasting hours or days nausea and vomiting may be present horizontal nystagmus is usually present no hearing loss or tinnitus
60
How can vestibular neuronitis be differentiated from a posterior circulation stroke?
the HiNTS exam
61
How can vestibular neuronitis be managed?
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
62
What is the main difference between labyrinthitis and vestibular neuritis?
Vestibular neuritis = only the vestibular nerve is involved, hence there is no hearing impairment Labyrinthitis = both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo AND hearing impairment.
63
Patients with acute labyrinthitis typically present with an acute onset of:
vertigo: not triggered by movement but exacerbated by movement nausea and vomiting hearing loss: may be unilateral or bilateral, with varying severity tinnitus preceding or concurrent symptoms of upper respiratory tract infection
64
What are the signs of labyrinthitis on examination?
spontaneous unidirectional horizontal nystagmus towards the unaffected side sensorineural hearing loss: shown by Rinne's test and Weber test abnormal head impulse test: signifies an impaired vestibulo-ocular reflex gait disturbance: the patient may fall towards the affected side
65
How can acute labyrinthitis be managed?
episodes are usually self-limiting prochlorperazine or antihistamines may help reduce the sensation of dizziness
66
Non-resolving otitis externa with worsening pain despite strong analgesia =
urgent ENT referral suggestive of malignant (necrotising) otitis externa
67
Tx for otitis externa in diabetics?
ciprofloxacin for pseudomonas cover

Y4 Neuro and Special Senses (21 decks)

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