ENT Flashcards
Acute Otitis Media
kid with pacifier/ smoker in house gets URTI, which blocks eustachian tube and lets bacteria grow in there ( usually spneumo) = TM is buldging/ erythematous. If there is decreased mobility, think fluid effusion. issue is pneumo, h influenza, M catarrhalis. R?O Otitis Externa/ malignancy. tx high dose amox if under 6 months. If over, watch and wait. tympanostomy tubes if multiple AOM issues. if amox fails, use amox clav. watch carefully, kid could get meningitis
Otitis externa
Hx of q tips/ swimming/ headphones causes cerumin to build up, creates alkaline ear prone to infxn with psuedomonas/ staph epi/staph aureus. Px: pt wont let you pull pinna, extremely painful. Ix: TM normal, canals are erythematous. Tx : anti pseudomonal drops/ cipro +- topical steroids Pope wick.
otosclerosis
hx: pregnant woman can’t hear bilaterally, her mom had it too. No dizziness. Patho: her stapes is ossified/ ankylosed. Px: Weber: lateralizes to affect ear, rhine confirms ear ( bone conduction is better than air conduction, as stapes is no longer responding to the air waves). AudiogramL carharts Notch. tx: conservative- f/u hearing tests 2) hearing aids 3) surgery . this is an example of conductive hearing loss ( air conduction doesnt work)
persbycusis
An example of sensineuronal hearing loss, due to age related loss of hair cells/ straie vascularis 9 makes endolymph). hx: man from loud working environment cant hear high frequencies. He says, ‘speak up, quit mumbling!” px: weber lateralizes to the good ear. Rhine shows no difference, because the bone and air conduct equally well, and its the nerve behind that is the problem. tx: hearing aids, auditory rehabilitation
BPPV vs Menieres vs Vestibular Neuronitis vs Labrythintis
BPPV- onset and resolution in seconds when tossing in bed
Menieres - too much endolymph, minuts- hrs dizziness
vestib. neuronitis- vertigo over days 2ndary to viral infxn
labyrhnthitis- “whistling tinnitis”2ndary to bacterial/viral infxn
BPPV story
hs quick onset dizziness with tossing in bed/ stooping. Px: normal. ix: none. Tx; Dix hallpike maneuver to rearrange the calcium otoliths that are displaced
menieres story
vertigo/dizzy due to endolymph build up. Vertigo leaves but hearing loss remains. px: N. ix> none? tx: antimetics, bed rest, gentmycin ( kill ear).
epistaxis
kid has recurrent nosebleeds in winter once the central air conditioning has gone on. Probably anterior nosebled from kiesselbachs plexus, but r/o Foreign body, trauma, recurrent posterior bleeds can be carotid artery aneurysm. px ABCS, full head and neck, nasopharyngoscopy. ix: CBC, PTT. INR corssmatch, if massive hemmorhage. tx: conservative- pressure. Surg- cautery, nasal packing, angio embolization. Lastly, ligation of anterior ethmoid artery
rhinitis- what are the two big classifications?
Allergic vs Non Allergic Rhinitis aka is it allergies or is it inflammatory/ some congental problem with your sinues
Allergic rhinits
kid under 2 years old has eye itching, sneezing, nasal obstruction + atopy+ eczema allergic salute. px: nasal boginess. ix:clinical dx, may need allergy testing tx:allergen avoidace, saline irrigation, intranasal steroids/ antihistamines
Non allergic rhinitis
older kid/ adult with constant nasal congestion with headaches and decreased smell. R/o nasal rumour and CSF rhinorrhea ( CSF leak due to skull fracture - ask hx head injury!/ impacts). Diagnosis of exclusion, tx: nasal saline, intranasal glucocorticoids/ antihistamines
laryngeal carcinoma
man who smokes, drinks alcohol, with lots of throat infections and HPV comes in saying his voice is horse ( progressive hoarseness), he cant swallow food properly ( dysphagia), ear pain, and SOB (dyspnea) + wt loss/ fatigue. Ix: laryngoscopy, looking if its just laryngitis, reflux, irritants, some mass compression of laryngeal nerve causing the hoarseness. Find mass - biopsy. Stage : CT, U/s. tx: surgery/chemo/radiation. Glottis has good prognosis, subglottis has low cure rates.
acoustic neuromas
schwannomas of the 8th cranial nerve + facial palsy, + dizziness/ heainrg loss. Seen as an elderly person with unilateral tinnitis ( ringing) or sensorineural hearing loss. its cancer until proven otherwise. Ear infxn in an adult is also cancer until proven otherwise.
DDX things in the throat
laryngeal carcinoma, retropharyngeal abscess, laryngopharyngeal reflux, foreign body nose.ear,
Foreing body nose
UNILATERAL foul-smelling and purulent rhinorrhea ( unilaterla = its not cold/ a sinus infxn). may also present with snoring/ epistaxis. Px: ABCs! esp A. ix: visualize tx: removal either in OR or with baloon catheter ( coat small ballowwn with lidocaine, slip past the the FB, inflate, and retrat both out at once).
