ENT Flashcards
Otitis externa
A: Inflammatiom of the skin of the external auditory meatus, usually bacterial or funghal.
S: Ear canal oedema, debris and erythema.
Otalgia (ear ache), deafness, discharge.
D: Swab
T: Aural toilet (manual cleaning), antibiotic-steroid drops, keep ear dry.
Pinna haematoma
A: Traumatic, collection of blood between the pinna perichondrium and cartilage.
S: Fluid filled swelling, pain.
D: -
T: Aspiration, incision and drainage.
If untreated, can lead to cauliflower ear.
Acute otitis media
A: Inflammation of the middle ear, can be viral or bacterial. May be following URTI.
S: Dull, hyperaemic, bulging tympanic membrane, fluid, fever. Otalgia, deafness.
D: Otoscope
T: Rest, oral antibiotics if not recovering, analgesia.
Inflammation can lead to effusion (otitis media with effusion), leading to a deafness (conductive), learning difficulties and speech delay. May need surgical implantation of grommets.
Cholesteatoma
A: Acquired or congenital abnormal growth of the skin in the middle ear (squamous epithelial cells).
S: Attic scorpe, pearly white mass on otoscope. Cause a foul-smelling discharge and gradual hearing loss.
Can lead to tinnitus, vertigo, permanent hearing loss and facial nerve damage.
D: Audiometry (conductive or sensorineural loss), CT/MRI.
T: Aural toilet, surgical mastoidectomy/tympanoplasty
Otosclerosis
A: Autosomal dominant osseous dyscrasia of temporal bone
S: Normal tympanic membrane that may have Schwartze sign (pink membrane).
Slowly progressing conductive hearing loss, tinnitus, dizziness, paracusis of Willis (hearing improves with background noise).
D: Pure tone audiogram: conductive deafness
T: Hearing aid, stapedotomy, bone-anchoring hearing aid (BAHA).
Vestibular neuronitis
A: Acute vestibular failure, often predisposed by URTI.
S: Sudden onset vertigo lasting days. Nystagmus, positive Romberg’s test (stand feet together and eye closed), positive Unterberger’s test (walks with eyes closed)
D: MRI to rule out central cause, pure tone audiometry may be normal.
T: Bed rest, vestibular sedatives, vestibular exercises
Benign paroxysmal positional vertigo
A: Semicircular canal lithiasis
S: Nystagmus, acute positional rotational vertigo.
D: Pure tone audiometry, Dix-Hallpike manoeuvre
T: Epley manoeuvre, vestibular exercises.
Meniere’s disease
A: Dilated labyrinth in inner ear
S: Normal ear examination, nystagmus during attacks.
Fluctuating ear loss, tinnitus, rotatory vertigo, usually unilateral.
D: Unilateral sensorineural hearing loss on PTA, MRI to exclude tumour
T: Salt restriction, betahistine, prochlorperazine, diuretics, intatympanic steroids or gentamicin.
Surgical: Vestibular nerve section, labyrinthectomy, endolymphatic sac decompression.
Mastoiditis
A: Inflammation of the mastoid air cells, often a progression from untreated acute otitis media.
S: Post-auricular swelling, erythema and tenderness, protruding pinna.
Fever, pain, rarely facial weakness.
D: CT head to rule our intracranial spread.
T: Urgent broad-spectrum antibiotics, if it fails to resolve it may need mastoidectomy and grommet insertion.
Drug induce ototoxicity
A: Can be aminoglycosides (eg gentamicin), macrolides (eryhthromycin), furosemide, cisplatin, vincristine, aspirin (high doses), heavy metals (eg mercury, lead), quinine.
Acute rhinosinusitis
A: Viral, bacterial
S: Nasal discharge, nasal congestion, facial pain, altered smell.
D: Rarely needed, puss culture
T: Oral antibiotics, steroid nasal spray, nasal decongestant. Rarely surgery.
Chronic presents similarly but less severe and has similar treatment options.
Nasal polyps
A: Tend to occur with eosinophil dominate chronic rhinosinusitis.
S: Nasal blockage and discharge, headache, anosmia.
D: Flexible nasendoscopy, CT
T: Topical steroids, antibiotics
Surgical: Functional endoscopic sinus surgery.
Fractured nose
T: Manipulation under anaesthetic 7-10 days after injury
Tonsillitis
T: IV penicillin and admission if unable to swallow, dexamethasone if airway concern, tonsillectomy
Never give ampicillin-containing antibiotics, as if patient has glandular fever it will cause a generalised maculopapular rash.
Quinsy
T: Incision and drainage under local anaesthetic, tonsillectomy under GA, IV penicillin and metronidazole.
