ENT Flashcards
Ear Pain
DDx
Acute otitis media
Acute otitis externa
Referred pain - dental, TMJ, herpes zoster
Ear Discharge
DDx
Acute otitis media with perforation
Otitis externa with discharge
Acute otitis media
Pain, fever, occasionally vomiting
Eustachian tube dysfunction leads to stasis of fluid in the middle ear with a secondary
Complications are rare
Normally viral - treat with paracetamol and ibuprofen, watchful waiting
Bacterial causes - Strep. pneumonia, H. influenzae, Moraxella catarrhalis (amoxycillin)
Acute otitis media
Who should have antibiotics
Children ≤2 years Severe pain Perforation Fever >48hrs Toxic Aboriginal and torres strait islanders
Otitis externa
(Swimmer’s ear)
Causes
Bacterial (staph, pseudomonas)
Fungal (candida, aspergillus)
Dermatological (eczema, psoriasis)
Cotton bud abuser
Otitis externa
Treatment
Pain relief
Keep dry
Aural toilet
Ear drops (antibiotic and steroid combination) for 2 weeks
Oral antibiotics if associated cellulitis
Otitis media
Complications
Spontaneous resolution (most) TM perforation Chronic otitis media with effusion (COME) leading to glue ear Chronic suppurative otitis media Mastoiditis Very rarely intracranial complications
Cholesteatoma
Accumulation of keratinising squamous epithelium in the middle ear
Unknown cause
Resorbs underlying bone
Cholesteatoma
Complications
Damage to the ossicles resulting in conductive hearing loss
Chronic infection with discharge
Mastoid bone erosion with damage to the facial nerve
Blocked ear
DDx
Ear wax
Mild otic barotrauma/Eustachian tube dysfunction
Conductive deafness
Causes
Ear wax Middle ear fluid Otitis media ± perforation Otosclerosis Glue ear Barotrauma
Sensorineural deafness
Causes
Noise induced Age related (prebyacusis) Acoustic neuroma (unilateral) Meniere's disease Drugs (gentamycin) Congenital - TORCH infections (toxoplasmosis, other aka syphilis/parovirus/hiv, rubella, cmv, hsv)
Acoustic Neuroma
Benign tumour of schwann cells of the vestibular nerve
Unilateral hearing loss and tinnitus
Mild imbalance
Rarely VII palsy
Vertigo (illusion of movement)
DDx
BPPV (seconds) Meniere's disease (hours) Vestibular neuronitis (days) CVA Acoustic neuroma
BPPV
Brief recurrent attacks
Provoked by changes in head position (top shelf vertigo)
Idiopathic but dislodged free floating particles
High spontaneous cure rate within weeks or months
Tx - Epley manoeuver
Meniere’s disease
Unknown cause - excess of fluid in the endolymphatic compartment in the inner ear
Incidence in 30s-40s
Usually unilateral but may become bilateral
Disabling veritgo with nausea and vomiting
Hearing loss (revers to normal between episodes)
Roaring tinnitus
Meniere’s disease
Treatment
Stemetil acutely
Maintenance - lifestyle changes, salt reduction, betahistine hydrochloride regularly, vestibular rehabilitation
Surgery (rarely)
Vestibular neuronitis
Acute inflammation of the vestibular nerve Unknown cause Young-middle aged Incapacitating sustained vertigo Sudden onset Very unwell and lie still in bed Nausea and vomiting No tinnitus or deafness
Vestibular neuronitis
Treatment
Reassurance and explanation
Stemetil in first few days
Resolution after 2-5 days over period of 6-12 weeks
Tinnitus
DDx
Conductive hearing loss - ear wax, middle ear fluid, tympanic membrane perforation, otosclerosis
Sensorineural hearing loss - presbyacusis, meniere’s disease, noise induced hearing loss
Acoustic neuroma
Vascular malformations
Tinnitus
Management
Reassurance Hearing test and aids if required No drugs Audiologist/ENT referral Sound therapy for distraction CBT and relaxation techniques Self-help
Bell’s palsy
Management
Protect the eye
Prednisolone 10 days - start in the first 72 hours
Antivirals?
Resolution in 85% of patients within 4-6 weeks
Psychological counselling and physiotherapy
Ramsey Hunt syndrome
Herpes zoster oticus
Vesicles on areas of skin or mucous innervated by facial nerve
Very painful with pain preceding the facial palsy
Unilateral hearing loss
Steroids and antivirals within 72hrs - 60% resolve
Blocked nose
DDx
Acute viral rhinitis (common cold) Rhinosinusitis Allergic rhinitis Nasal polyps Rhinitis medicamentosa Septal deviation following nasal trauma Nasal tumours (rare)
Nasal polyps
Often bilateral - if unilateral neoplastic until confirmed otherwise
Tx - medical (topical steroid drops for 6 weeks), surgical (polpectomy or ethmoidectomy)
Rhinitis medicamentosa
Inappropriate use of vasoconstrictor nasal drops to relieve nasal congestion
Rebound secondary vasodilatation
Sore throat
DDx
Pharyngitis (viral usually) Tonsillitis (viral or bacterial) Glandular fever Quinsy Aphthous ulcer
Centor criteria for strep
(need 3 or 4): Temp >38 Tonsillar exudate Tender anterior cervical lymph nodes Absence of cough
Glandular fever (infectious mononucleosis)
“Kissing disease”
30-50 day incubation period
Lymphocytosis
Monospot test
Quinsy (peri-tonsillar abscess)
Deviation of the ubula
Trismus (reduced opening of the jaws due to irritation of the pterygoid muscles)
Lateralising pain
Fullness of the soft palate on the affected side
Often due to group A strep
Drain
Tonsillectomy
Indications
Recurrent tonsillitis (5 attacks in one year with significant time off school/work)
Quinsy (one or more)
OSA
Suspected malignancy
Cricopharyngeal spasm
Feeling of lump in the throat
Painless
Symptoms improved by swallowing food
Rule out serious pathology with nasendoscopy
Laryngeal carcinoma
Hoarseness persisting for more than 4 weeks is a laryngeal carcinoma until proven otherwise
Conductive loss
Audiogram
Air < bone
Age related hearing loss
Audiogram
Loss at high frequencies
Conductive and sensorineural are the same
Otitis media with bulging eardrum
Tympanogram
Decrease in compliance with increase in pressure
Eustachian tube dysfunction
Tympanogram
Normal compliance but a shift in pressure
Ear drum still moves but the baseline pressure is less
Solids sticking to bottom of gullet
Oesophageal stricture
Lump in throat resolved by swallowing
Cricopharyngeal spasm
