ENT 4 Flashcards
The complications of tonsillitis:
Quinsy:
- Trismus
- Fever
- Muffled voice
Para- pharyngeal abscess
- Swelling of the anterior and posterior SCM muscle
- fever
- Rupture of the internal carotid
Lemierre syndrome
- thrombophlebitis of the internal jugular with septic emboli to the lungs
Scarlet fever
- sandpaper rash across chest
- strawberry tongue
Post - Step glomerulonephritis
What is your management for Bell’s palsy?
Eye protection
- dark glasses
- artificial tears
- Taped closed
Prednisolone 60mg if in the first 72 hours
What is the name of the operation called to fix a perforated ear drum?
Myringoplasty
What kind of drainage is needed following a thyroidectomy?
Suction
- this is because of the rapid complications of airway compromise
What is ludwig’s angina?
This is also a submandibular abscess between the mylohyoid muscle and floor of the mouth
- history of dental pain
- floor of mouth oedema and pain
- tongue pushed posteriorly with airway compromise
Due to:
- usually from dental sepsis
- typically caused by S. Pneumonia
Treatment:
- IV antibiotics
- Needle aspiration
What does a positive test in Rinne’s mean?
It means that air conduction is louder than bone conduction
- a normal examination
What two examinations can be done to test the vestibular spinal reflexes?
Romberg’s test
- patient stands with eyes closed and arm by side
- patient will fall to side of an uncompensated lesion
Unterberger’s test
- a patient marches on the spot with arms outstretched
and eyes closed for 30 secs.
*abnormal is inward rotation of 30 degrees.
What is the underlying is the underlying pathology of presbycusis?
Reduction in the number of inner and outer hair cells
Why must pinna haematomas be drained?
The blood build up can lead to restriction of blood to the cartilage causing deformation
- cauliflower ear
What is the main bony prominence seen on otoscopy?
Head of the malleus
What is histological difference between the pars tensa and pars flacida?
Organisation of the fibrous tissue.
Pars tensa is organised fibrous tissue with peripheral thickening creating the annulus that is around the tympanic membrane.
The pars flaccida is poorly organised fibrous tissue
Physiologically how much do the ossicles increase sound vibrations?
1:21
in practice it is 1:14 usually
What are the most common causative agents to middle ear infections? What is the typically management?
S. Pneumona
H. Influenza
Management:
- Amoxicillin PO
What is it called when there is chronic otitis media and discharge? and where does the perforation usually occur? How is it treated?
Chronic Mucosal discharge
- called mucosal because the epithelial cells within the middle ear undergo change into mucus producing cells
usually occurs in the pars tensa
Management:
- aural toileting
- topical steroids
- Tympanoplasty
What are the signs of glue ear?
Conductive hearing loss
Otalgia
Cracking sensation
- retraction of ear drum (due to air reabsorption)
- loss of light reflex
Investigations: - otoscopy - pure tone audiometry - tympanogram (adults ENT referral, flexible nasoscopy)
Treatment:
- Grommet insertion
- adenoidectomy may be indicated as well
What other procedure should a child with recurrent glue ear be considered for out with grommet insertion?
Adenoidectomy
What advice should be given to a child with a grommet insertion?
Avoid getting soapy water in the ear
What type of operation(s) are used to treat cholestomas?
Atticotomy
or
Radical mastoidectomy
Complications:
- facial nerve injury
- CSF leak
- Vertigo
What type of epithelium line the nasal passages?
Columnar ciliated
When is a nasal fracture realigned?
2 weeks after the initial injury
What is the surgery for nasal polyps?
Functional endoscopic nasal surgery
What are some malignant tumours that can occur in the nasal cavity?
Squamous cell carcinomas (smoking risk factor)
Anaplastic
Lymphomas
Adenocarcinomas
What are the symptoms of a paraphyaryngeal abscess?
Peristonilar abscess
- trismus
- paalate oedema
- throat swelling
Swelling behind the upper posterior mastoid
Complications:
- carotid artery rupture
- jugular vein thrombosis
What is the difference between radical neck dissection and modified neck dissection?
modified retains:
- jugular veins
- sternocleidomastoid
- accessory nerve
What are some complications of tonsillitis?
Peritonsillar abscess
- quinsy
Parapharyngeal abscess
Acute otits media
Lemierre syndrome
- internal jugular thrombophlebitis
Scarlet fever
- sandpaper rash (develops from ears and across chest)
- strawberry tongue
What are the indications for tonsillectomy?
> 7 cases in one year
or
5 casers PER year over 2years
What are the most common types of oral cancer?
Squamous cell
What are the three phases of swallowing?
Oral phase
Pharyngeal phase
Oesophagus phase
Outline lymphatic drainage of the tongue:
Posterior 1/3rd:
- deep cervical
Anterior 2/3rds:
- Submandibular nodes to the deep cervical nodes
Tip of tongue
- submental
Which muscle opens the mouth?
Lateral pterygoid
Where does the two arteries to the thyroid come off?
Superior:
- external carotid
Inferior:
- Thyrocervical trunk
What is Trotter’s syndrome in relation to ENT?
Symptoms caused by nasopharyngeal cancer blocking the eustachian tube:
- Conductive deafness
- Dysfunctional soft palate (due to compression down on it)
- Trigeminal neuralgia (as the nerve compresses on it)
What management should be done prior to thyroid surgery?
With use of Carbimazole and beta blockers patient should be rendered euthyroid prior to surgery to prevent a thyroid crisis
What are the tumours that can develop in the salivary glands:
Benign:
Pleomorphic adenomas
Warthin’s tumour (lymph nodal)
Malignant:
- Adenoid cystic carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
What is a suggestive feature of a malignant parotid tumour?
Facial nerve palsy
What investigations are done into salivary gland tumours? and what is the general management?
CT scan
FNA
Management:
Facial nerve preservation::
- Tumour dissection with margin of macroscopically normal tissue
Non-Facial nerve preservation:
- total parotidectomy
What are some complications of parotid tumour surgery?
Haematoma
- can expand causing airway compromise
Facial nerve damage
Frey’s syndrome
- autonomic dysfunction causing sweeting and redness
List some causes of deafness in children:
Congenital Conductive:
- Down syndrome
- Treacher Collins syndrome
Acquired Conductive:
- Otis media with effusion
- wax build up
Congenital SNHL:
- Alport syndrome
- Waardenburg syndrome
- Congenital infections
Acquired SNHL:
- Meningitis
- Ototoxicity
What are the indications for antibiotics in acute media otitis and what is the antibiotics of choice if they are penicillin allergic?
> 4 days of symptoms
Systemic symptoms
Discharging ear
< 2 years of age with bilateral infection
*erythromycin if penicillin allergic
How long should a perforated ear drum be left to see if it heals up?
6 weeks
What is the most common symptom of laryngeal cancer? and in a total laryngectomy, what additional structures are removed:
hoarseness
Structures:
- thyroid
- Proximal trachea
What investigations are wanted for oropharyngeal cancers?
MRI
FNAC (fine needle aspiration and cytology)
What are the core symptoms of Meniere’s disease and how is it treated?
Tinnitus
Hearing loss
Aural fullness
Vertigo
Treatment:
- Reduce salt
- reduce caffeine
Acute attacks:
- Prochlorperazine (1st gen antipsychotic)
Prophylaxis:
- betahistine (anti-histamine)
Surgical:
- intratympanic gentamicin
What drug can be used for the treatment of vertigo in labyrinthnitis , vertibular neuritis and Menierre’s disease?
Prochloraperazine
Antihistamines can also be used such as:
- betahistine
- cyclizine
What is the outcome of a septal haematoma if not incised and drained?
Saddle nose deformity
- due to avascular necrosis of the cartilage
What is an important aspect to remember when cauterising a nose bleed?
Do not cauterise bilateral
- risk ischemic perforation
Outline your management of epitaxis:
ABCDE
- resuscitate as needed
- Pinch nose - sit forward
- Ice pack + encourage clot blowing
- Cotton ball soaked adrenalin (1:200,000)
- Cauterise (one side only)
- Nasal packs
*if bleed can’t be visualised call ENT
What is the Emergancy management that can be done in the case of a posterior nose bleed?
Insertion of a folate catheter
What are some options for voice restoration following a laryngectomy?
Trans-oesophageal puncture
- one way valve is placed between the trachea and the oesophageal/pharynx.
- patient occludes stoma which forces air through the valve up to mouth
Artificial larynx
- electrical vibration
How would mixed hearing loss present on audiogram?
Both will be under 20dB but conductive loss will usually be lower than neurosensory
