ENT 3 Flashcards
Where else in someone with suspected glandular fever should you examine other than just the throat? and what additional blood tests would you consider?
Abdomen for hepatosplenomegaly
LFTs
Monospot test
What is the management for quinsy?
Drainage - aspiration/ incision
- under LA
IV antibiotics
- metronidazole
- Penicillin V
Dexamethasone
IV fluids
Analgesia
*tonsillectomy if >1 episode
Other a parapharyngeal abscess name two other deep neck spaces which can become infected in complications of tonsillitis:
Submental
pre-vertabral
*requires max fax input and may require tracheostomy
Outline your immediate management of someone with epiglottitis or supraglottis:
- High flow oxygen
- Senior help
- Nebulised adrenaline 1:1000 1mg in 5ml solution
- IV dexamethasone 6.6mg
- IV ceftriaxone 2mg
What is supraglottis?
Inflammation of epiglottis and aryepiglottic folds
- *note the patient may actually look relatively well, and only have abnormal findings on examination
- there is an impeding airway compromise coming
Name a clinic finding when examining the throat that may suggest epiglottitis:
Cherry red swelling
What is the most common pathogen of otitis externa?
Pseudomonas aeruginosa
As well as examining the ear on an otoscopy, which other place should you examine and why?
Finger nails
- long dirty nails may be used for picking which harbour bacteria
If the patients ear canal is too thin for drops what can be done?
ENT referral and a Pope Wick can be inserted
What are the key symptoms of necrotising otitis externa? What may be seen on otoscopy?
What other neurological signs may be seen?
Ear pain that keeps patient up at night
Continual discharge despite antibiotic therapy
- granulation tissue on floor of ear canal
Neuro:
- facial nerve palsy
- Abducens nerve palsy
What is treatment for otitis media?
paracetamol if stable
If unstable or:
- <2 years old
- co-morbities
Amoxicillin
A complication of otitis media is intracerebral abscess, how is this identified and how is it scanned for?
CT with contrast
Ring enhanced lesion
What is the differential for pina cellulitis and how doe sit differ?
perichondritis
- infection of cartilage
- the lobe will be spared as no cartilage there.
much more serious and can lead to long term deformity cutting of blood supply to cartilage
What blood vessels make up Kiesselbach’s plexus in Littles area?
GASS
- Greater palatine
- Anterior ethmoid
- Sphenopalatine
- Superior labial
If there is a posterior nose bleed, which artery is it most likely to be?
Sphenopalatine
What would you expect to see on a tympanogram with someone with a grommet or perforated ear drum? and what about with a middle ear effusion?
High volume
- Type B
Type B
- Low volume
What does a type C tympanogram suggest?
Eustachian tube dysfunction
*tympanogram still has a small peak but is pulled more to the left showing it is negative and thus.
What is the underlying pathology of otosclerosis?
Abnormal bone formation around stapes leading to its fixation
What is the definition of tinnitus and how is it differentiated from an auditory hallucination?
Sound perceived for >5mins in the absence of any external acoustical or electrical stimulus. and does not occur after loud noise.
differentiated from hallucination as it has no organised content. i.e. voice
Define objective and subjective tinnitus:
Objective is when both patient and practitioner can hear the tinnitus.
- usually vascular pathology
- hyperdynamic states
- myoclonus of the middle ear muscles
Subjective is when only the patient can hear the tinnitus
- meiners
- presbycusis
- ototoxic drugs
When should tinnitus be referred?
Pulsatile tinnitus
- CT angio
Unilateral
- MRI head
Focal neurology
Asymmetric hearing loss
- MRI head
What may present with tinnitus, pulsatile mass and hypertension?
Glomus tumours
- paragangliomas in middle ear usually of carotid decent which can release catecholamines
Name a risk factor for more intrusive tinnitus:
Depression
List the symptoms of allergic rhinitis and describe what may be seen on nasoscopy:
Itchy eyes
Blocked nose
Runny nose
Sneezing
Pale large Turbinates
In allergic rhinitis what medication is recommend when there is also asthma and what other circumstances is this medication useful?
Leukotriene receptor antagonists
Useful in:
- exercise induced
- Aspirin
What are the causes of non- allergic rhinitis? and what is the treatment?
Air pollutants
Smoke
Odours
Food
Saline douche
In nasal trauma what should you inspect for and when is imaging required?
Bilateral/ unilateral ecchymosis
Swelling over nasal bridge (develops within 2 hours)
Visible deformity
Anterior Rhinoscopy:
- Epistaxis
- septal deviation
- Septal haematoma (requires immediate ENT)
Imaging:
- maxilla or skull fracture suspected
What is the management of a septal haematoma?
Incision and drainage
Antibiotics
How many days following a nasal fracture should an ENT assessment take place?
When is the window for manipulation if needed?
and what i sthe surgery done if manipulation is unsuccessful and when?
5-7 days
7-21days - ideally within 14 days
Septorhinoplasty
- >6 months following initial injury
What investigations are wanted into laryngeal carcinoma?
Nasoendoscopy
FNA
- including cervical lymph nodes
Imaging - CT
Name two universal newborn hearing screening methods that can be conducted:
otoacoustic Emissions
- usually done first. Listening to outer hair cells for click of noise back
- conducted in the first three months
Audiological Brainstem responses
- Headphones on and monitoring for response
What imaging is used for rhinosinusitis and when is it implemented?
CT paranasal sinuses
- usually used for planning for surgery
When chronic or recurrent acute sinusitis
What differentiates acute and chronic rhinosinusitis?
Acute: <12 weeks
- most commonly due to cold
Chronic >4 episodes throughout the year
What investigations should be done into a child with hearing loss?
Audiometry
Tympanometry
- to assess for glue ear
Otoscopy
What is the management of glue ear?
Chronic otitis media with effusion in children requires:
- grommets
- hearing aid
What are the symptoms suggestive of bacterial rhinosinusitis?
Discoloured discharge Fever Severe pain Elevated CRP Double sickening
What are the complications of bacterial rhinosinusitis?
Orbital cellulitis / Abscess
Meningitis
Cerebral abscess
Osteomylitis
Pott’s puffy tumour
- subperiosteal abscess arising from osteomyelitis
What are the causes of otitis externa and what is the most common organism?
Swimming
Hearing aid
Finger picking
Lack of wax
Pseudomonas is most common, followed by Staph
What are the core symptoms of malignant otitis externa?
Severe otalgia
- worse at night
Continual discharge/ Copious otorrhea
Granulation tissue within the ear drum
What are the signs of TMJ dysfunction?
Pain on lateral movement of jaw
Signs of bruxism
Earache
- this is via the auriculotemporal nerve
Facial pain
What are the most common causes of Ottis media?
Pneumococcus
Haemophilus Influenza
How does otitis media with effusion/ glue ear, usually present and what may be seen on examination and what examinations can be conducted:
Inattention
Poor speech development
Hearing impairment
Examination:
- retraction of the ear drum
- loss of light reflex
Investigations:
- Audiogram
- Tympanogram (will be flat due to pressure within the middle ear restricting the amount of response of the tympanic membrane)
What are some of the causes of a type B tympanogram?
Otitis media with effusion
Perforation/ grommet in situ
Otosclerosis
Cholesteatoma
Highlight the common causes of hearing loss in an adult:
Conductive: External meatus obstruction: - wax - pus - foreign body
TM dysfunction:
- Infection
- trauma
Ossicles defects:
- otosclerosis
- infection
- trauma
Sensorineural:
Drugs:
- gent
- Vancomycin
Post infective:
- mumps
- measles
- meningitis
Neuro:
- Meniere’s disease
- acoustic neuroma
- MS
List some congenital causes of SNHL in children:
Waardenburg’s syndrome
- Hetrochromia
- telecanthus
- AD
Alport’s syndrome
- Haematuria
- AR
Congenital Rubella
What are the causes of bacterial sinusitis?
Bacterial infection secondary to viral infection
- most common cause
- double sick sign
Dental root infections
Direct contact with pathogens
- swimming
Anatomical susceptible
- deviated septum
Systemic disease
- primary ciliary dyskinesia
in recurrent sinusitis, what investigations should be done and what is usually the treatment?
Further investigations into the cause should be undertaken.
typically it is due to anatomical defects.
Investigations:
- flexible nasal endoscopy
- CT head and sinus
Treatment may include:
- functional endoscopic sinus surgery
What are the core symptoms of acute bacterial sinusitis?
Discoloured discharge Severe localised facial pain Pyrexia Raised CRP Prior viral infection
What are the symptoms of nasal polyps and how would you distinguish them from swollen turbinate’s? and what is the investigations that should be undertaken into a single nasal polyp?
Watery Rhinorrhoea Sneezing Nasal obstuction Mouth breathing Snoring
Differentiate because they are:
- pale
- mobile
- non tender when gentle palpation
Single:
- referral for endoscopy and biopsy to assess for malignancy
List some causes to epistaxis:
Local causes:
- idiopathic
- Trauma - nose picking
- Neoplasm
- bleeding polyp
Systemic:
- bleeding disorder - Primary haemostatic bleeding disorders (platelets)
- hypertension
- leukaemia - pancytopenia
What is the secondary haemorrhage of tonsillectomy and what is the management?
Bleeding >24 hours. usually in the 5-10day mark.
Medical Emergancy:
- contact anaesthetist
- contact ENT
- IV access
- Cross match/ bloods
