ENT Flashcards
Ménière’s disease:
Presentation
Fluctuating hearing loss that starts unilaterally
Aural fullness
Attacks that last minutes to hours
Diagnosis needs: x2 attacks lasting at least 20 mins, tinnitus/fullness, sensorineural hearing loss
Ramsay Hunt Syndrome
Facial nerve herpes zoster
Causing facial paralysis, loss of tastes vestibulocochlear dysfunction, pain
Ramsay hunt syndrome:
Tx
Immediate steroids and anti vitals to prevent facial paralysis or hearing loss
Tympanic perforation:
Tx
None - will self heal 6-8 weeks
Tympanic perforation from otitis media:
Tx
Abx
Rinnes test:
Positive
Air conduction is better which is normal
Rinnes test:
Negative
Can hear through bone better than through air, which implies conductive hearing loss
Webers test:
Sensorineural deafness
Lateralises to unaffected side
Webers test:
Conductive deafness
Lateralises to affected side
Otitis media:
Presentation and Tx
Bulging tympanic membrane
Abx only if
Indications for ABx in sore throat
Systemic upset Unilateral peritonsilitis Hx rheumatic fever DM/ immunodeficiency 3 or more centor: tonsilar exudate, lymphadenopathy, fever, no cough
Ménière’s disease
Build up of fluid in labyrinth causing vertigo, hearing loss
Presbycusis
Age-related sensorineural hearing loss.
Audiometer shows bilateral high frequency loss
Otosclerosis
Autosomal dominant Normal bone replaced by spongey vascular bone 20-40 year olds Conductive deafness Tinnitus Flamingo tympanic membrane
Grommet criteria
Bilateral OME lasting 3 months+ with hearing of 25-30 I’m better ear
Nasal polyps:
Signs and symptoms
Vary with season or URTI Rhinitis and sinusitis Nasal obstruction Pale/grey No sensation Mobile Unilateral is malignant until proven otherwise
Nasal polyps:
Tx
Steroids - Betamethasone 2 weeks, then fluticasone 3 months
Large polyps:
Oral steroids 30mg OD 1 week then fluticasone 3w
Surgery - FESS
Rhinitis:
Ix
Rhinoscopy/endoscopy
Skin prick
RAST
Rhinitis:
Types
Allergic Infective Idiopathic Drug-induced (aspirin, NSAIDS, contraceptives, beta blockers) Pregnancy Auto-immune: SLE, RA, AIDS,
Anosmia:
Causes
Obstructive: polpys, tumor, bony deformity
Mucositis (infective): rhinitis, sinusitis
Neurological: MS, aneurysm, surgery, trauma, Parkinson’s
Cholesteatoma
Tissue collection middle ear
Can be congenital, or acquired due to Eustachian tube dysfunction, tympanic membrane trauma, acute otitis media
Progressive conductive hearing loss ottorhea +-vertigo, headache, facial nerve palsy, neck abscess, meningitis
Tx tympanoplasty/mastoidectomy
Can often recur
If left will invade local structure and can cause permanent deafness, facial weakness, brain abcess, death
Hoarse voice:
Causes
URTI laryngeal cancer Laryngeal palsy Vocal nodules Reflux pharyngitis
Laryngeal cancer:
Signs/ risk factors
Smoking Referred pain to ear - constant Neck lump Progressive Pain
Cystic hygroma
From jugular venous sac
Embryological remnant
In posterior triangle usually
Always on the left
BPPV
Debris in semicircular canal
Disturbed by head movement, lasts few seconds
Nystagmus seen on hall pike manouevre
Treat with epley manouevre
Acoustic neuroma (vestibular schwannoma)
Unilateral hearing loss followed by vertigo
Can start to affect other nerves going through auditory canal (5,6,9,10)
Don’t always need removing
