ENT Flashcards
What is the definition of tonsillitis?
Sore throat + lymphadenopathy
What is the main cause of tonsillitis?
Group A streps
What criteria should be present to give patients with tonsillitis antibiotics?
Centor criteria:
pyrexia, pus on tonsils, no cough, cervical adenopathy
What are the complications of tonsillitis?
Retrophayngeal abscess -
rare, in children typically has extended stiff neck, refuses to eat and drink. the lateral xray shows soft tissue swelling.
Peritonsillar abscess (quinsy) - sore throat, dysphagia, peri tonsillar bulge, uvular dieviation, trismus (reduced mouth opening), muffled voice. Needs antibiotics and draining
Parapharyngeal and hypopharyngeal abscesses -
only need medical therapy
Lemierre’s syndrome -
Pharyngotonsillitis, internal jugular vein thrombophlebitis + septic emboli (lungs, bone, muscle, kidney, liver etc).
Caused by Fusobacterium necrophorum
What are the criteria for a tonsillectomy?
Sore throats that are actually due to tonsillitis
5+ episodes in a year
Symptoms for at lest a year
What are the complications of a tonsillectomy?
Bleeding - primary may need to return theatre, secondary due to infection.
Damage to teeth, TMJ, an posterior pharynegeal wall
What are some differentials for tonsillitis?
Peritonsillitis, Parhyngitits/ Parapharyngeal abscess Dental infection Infective mononucleosis Lymphoma Internal carotid artery aneurysm Salivary gland mass
How can epistaxis be classified?
Anterior or posterior
What is Little’s area?
Where a network of blood vessels are found (the Kiesselbach’s plexus) on the anterior portion of the nasal septum - it is the commonest site of bleeding in the anterior nasal cavity.
Feeds vessels from the superior labial, greater palatine and anterior ethmoid arteries.
Which blood vessels bleed in posterior epistaxis?
Branches of the sphenopalatine artery
What are the causes of epistaxis?
Local: idiopathic local trauma - nose picking, # iatrogenic - NG tube, Infection Neoplasia septal perforation or deviation vascular abnormalities foreign body irritants
Systemic:
HTN
bleeding disorders - haemophilia, platelet dysfunction,
leukaemia
liver disease
medications - NSAIDs, aspirin, heparin, warfarin
What medications are used to stop epistaxis?
Lidocaine
Phenyleprine - vasoconstrictor
Silver nitrate - cauterizes
What is the definition of stridor?
The noise heard in INSPIRATION due to partial obstruction at the larynx or large airways
What are the causes of stridor?
Congenital:
Laryngmalacia (85% resolve by 2yrs)
Web/ stenosis
Vascular rings
Inflammation: Laryngitis Epiglottitis Laryngotracheobronchtis (croup) Anaphylaxis
Tumours:
Haemangiomas or papillomas
Trauma
Other:
Foreign body
Compression (thyroid disease)
Vocal cord palsy
What are the most common organisms responsible for Croup?
Parainfulenza virus
Bacteria are rare
What organism is responsible for acute epiglottitis?
Haemophilus inluenzae B
Strep pyogenes
MUST NOT EXAMINE THROAT IF SUSPECTING AS IT MAY CLOSE UP COMPLETELY
What is the course of the facial nerve?
Arises in medulla, emerges between pons and medulla, the then passes through the posterior fossa and runs through the middle ear before emerging from the stylomastoid foramen to pass into the parotid.
What are the causes of facial nerve palsy?
Intracranial:
Brain stem tumour (UMN), strokes (UMN), polio (UMN), MS (UMN), cerebellopontin angle lesions (acoustic neuroma LMN)
Intratemporal (LMN):
Otitis media, Ramsey Hunt syndrome (herpes of facial n), cholesteatoma
Infratemporal (LMN):
Parotid tumours, trauma
Others (LMN):
Lymes disease, sarcoid, Guillain - Barre, diabetes, Bell’s Palsy.
How can you tell the difference between UMN and LMN lesions?
LMN lesions will cause paralysis of one side of the face
UMN lesions will cause paralysis of one side of the face but the forehead will be spared.
What is the prognosis of Bell’s Palsy?
1/3 recover
1/3 incomplete recovery of facial motor function
rest have permanent neurological and cosmetic abnormalities
When taking a brief history before examining a neck what questions are important to ask?
Pain
Hoarseness
Swallowing problems
Neck swelling
When taking a brief history before examining the nose what questions are important to ask?
Obstruction Discharge Pain Bleeding Sense of smell
When taking a brief history before examining the ears what questions are important to ask?
Pain Discharge Hearing loss Tinnitus Vertigo
What are the two scars to look out for around the ear?
Endural and postaural - very difficult to see as they heal really well
What tuning forks do you use for the weber or rinnes test?
256 or 512 hz
Explain webers test…
Strike tuning fork on your elbow
Place on a midline bony prominence - forehead
Ask patient which ear they hear it loudest in
It lateralises towards a conductive hearing loss of >15 dB
It lateralises away from a sensorineural hearing loss
Explain the Rinne test
Test each ear individually
Ask patient to compare loudness of tuning fork placed on mastoid process vs 2cm from external auditory meatus.
Rinne positive test = normal (or sensorineural loss where webers lateralised away from that ear). Air conduction is better than bone conduction
Rinne negative = abnormal. Bone conduction is better than air. Conductive hearing loss >20dB
What are the complications of acute otitis media?
Extra cranial Perforated tympanic membrane Labyrinthitis Mastoiditis - most common and most important. Give a protruding ear. Needs surgery if abscess (grommet insertion, drainage of abscess and then drill out the infected bone) Facial paralysis Neck abscess
Intra cranial
Cerebral abscess, subdural abscess, venous sinus thrombosis
What are the causes of hearing loss?
Conductive: Wax impaction (has to be ++ wax so don't assume its just wax) Otitis media with effusion Perforation Cholesteatoma Ossicular abnormality
Sensory neural: Congential Presbyacuis Drugs Tumours Autoimmune conditions
What is an exostoses?
Smooth bilateral swellings of the boney canals. Only a problem if they are encrouchig on the lumen of the ear canal causing a build up of wax and skin etc
What is cholesteatoma?
A serious condition like chronic otitis media. It is a locally destructive process around the pars flaccida. There is crusting and white debris in the attic of the ear. Can result in hearing loss
What do bubbles behind the ear drum signify?
Glue ear - otitis media with effusion.
How is otoscerlosis inherited?
Autosomal dominant with incomplete penetrance.
Vascular spongy bone replaces the normal bone that fixes the stapes footplate.
What are the causes of tinnitus?
Hearing loss, presbyacusis, noise induced, head injury, otosclerosis, Meniere’s
HTN, anaemia, heart failure
Asprin, loop duiretics, aminoglycosides, quinine, alcohol excess,
What are the symptoms associated with acoustic neuroma?
Progressive ipsilateral tinnitus, sensorineural deafness
Cerebellar signs, trigeminal compression leading to numb face.
What are the causes of vertigo?
Peripheral - Menieres disease Benign positional vertigo Vestibular failure Labyrinthitis Cholesteatoma
Central- Acoustic neuroma MS Head injury Inner ear syphilis Vertebrobasilar insuffiencey
Drugs- Gent Duiretics Co trimoxazole Metronidazole
What is Menieres disease?
Dilatiation of the endolymphatic spaces of the membranous labyrinth causing vertigo for >12hrs with prostation, N+V, tinnitus and sensory neural deafness
