ENT Flashcards
What is PTA,
PTA - headphones deliver tone at different frequencies and strengths in a sound proofed room - pt indicate when sound appears and disappears
Mastoid vibrator used to test bone conduction
Tympanometry?
Measures stiffness of ear drum
–> Evaluates middle ear function
Flat tympanogram: Mid ear fluid or perforation
Shifted tympanogram: +- mid ear pressure
(look up diagrams)
Evoked response audiometry?
Auditory stimulus + measurement of elicited brain stem response by surfance electrode.
Used for neonatal screening (If otoacoustic emission testing negative)
Otitis externa organisms + management?
- Mainly pseudomonas
- Staph aures
Mx: Aural toilet with drops - Betamethasone for non-infected eczematous OE - Betamethasone + neomycin drops - hydrocortisone + gentamicin drops
Otitis externa: PC + causes?
PC:
watery discharge
Itch
Pain and tragal tenderness
Causes:
- Moisture (swimming)
- Trauma
- Absence of wax
- Hearing Aid
Malignant otitis externa?
Life threatening infection which can lead to skull osteomyelitis
- 90% pts diabetic/immunocomp
PC
- Severe otalgia, worse at night
- Copious otorrhoea
- granulation tissue in canal
Mx:
- Surgical debridement
- Systemic Abx
Bullous myringitis?
Organisms?
Painful haemorrhagic blisters (Bubbles filled with blood) form on the surface of the ear drum and burst, effusing blood.
- Most commonly caused by strep pneumoniae
- Commonly associated with mycoplasma pneumoniae & influenza infection
TMJ dysfunction: Symptoms, signs and Mx
Sx:
- Ear ache (referred from auriculotemporal nerve)
- Facial pain
- Joint clicking/popping
- Teeth grinding (bruxism)
- Stress (c depression)
Signs: Joint tenderness exacerbated by lateral movements of an open jaw.
Ix: MRI
Mx: NSAIDs
Stabilising orthodontic occlusal prostheses
Otitis media types?
Acute
Glue ear/ Otitis media with effusion
Chronic: Effusion > 3mo if bilateral or 6mo if unilateral
Chronic suppurative OM: Ear discharge with hearing loss and evidence of central drum perforation
Otitis Media organisms?
Viral
Pneumococcus
Haemophilus
Moraxella
Acute Otitis Media Pc + Mx
PC: Usually children post viral URTI Rapid onset ear pain + Tugging at ear Irritability, anorexia and vomiting Purulent discharge if drum perforates
O/E:
- Bulging red TM
- Fever
Mx: Antipyretic analgesia + observe - Oral amoxicillin > Augmention - If complicated: IV ABx myringotomy/drainage > MCS
Acute Otitis Media: Complications
Intratemporal:
- OME
- Perforation of TM
- Mastoiditis
- Facial N.palsy
Intracranial:
- Meningitis/ encephalitis
- Brain abscess
- Sub/epidural abscess
Systemic:
- Bacteraemia
- Septic arthritis
- IE
OME PC, IX + RX
P/C:
Inattention at school
Poor speech development
Hearing impairment
O/e
Retracted dull TM
Fluid level
Ix:
- Audiometry: Flat tympanogram
Rx:
Conservative
- Usually resolves spontaneously : Wat & wait. Seasonal, self limiting.
Medical: Otovent; Hearing Aid
Surgical:
- Consider grommets if persistent hearing loss (>30DB)
- -> SE: Infections/tympanosclerosis
Chronic suppurative OM?
Painless discharge + hearing loss
O/E : TM perforation
Rx: Aural toilet
Abx/ steroid ear drops
Complication: Cholesteatoma
Mastoiditis?
Middle ear inflammation –> Destruction of mastoid air cells and abscess formation
PC:
- Fever
- Mastoid tenderness
- Protruding auricle
Ix: CT
Rx:
- IV ABx
- Myringotomy +- mastoidectomy
Cholesteatoma + Complications
Locally destructive expansion of the stratified squamous epithelium within the middle ear
Complications:
- Deafness (Ossicle destruction)
- Meningitis
- Cerebral abscess
Cholesteatoma classification, PC + Mx
classification:
1) Congenital
2) Acquired 2ndry to perforation in chronic suppurative OM
P/c: Foul smelling white discharge Headache, pain CN involvement: --> Vertigo --> Deafness --> Facial paralysis
O/E:
- Appears pearly white with surrounding inflammation
Mx: Surgery
Tinnitus define + Hx
Sensation of sound w/o external sound stimulation. Very common 1 in 10
Hx:
Character: Constant, Pulsatile?
Unilateral? - Acoustic neuroma
FH: Otosclerosis?
Alleviating/exacerbating factors, worse at night?
Cause? Head injury, noise, drugs, FH
Associations:
- Vertigo –> Meniere’s/Acoustic neuroma
- Deafness: Meniere’s, acoustic neuroma
Tinnitis Causes
Specific:
- Meniere’s
- Acoustic neuroma
- Otosclerosis
- Noise induced
- Head injury
- Hearing loss (presbyacsus) –> Most common bilateral
General:
- Increased BP
- Decreased HB
Drugs:
- Aspirin
- Aminoglycosides
- Loop diuretics
- EtOH
Vertigo Causes?
The illusion of movement
Peripheral/vestibular:
- Meniere’s (hours)
- BPV (minutes)
- Labyrinthitis (weeks)
Central:
- Acoustic neuroma
- MS
- Vertebrobasilar insufficiency/stroke
- Head injury
- Inner ear syphilis
Drugs:
- Gentamicin
- Loop diuretics
- Metronidazole
- Co-trimoxazole
Meniere’s disease?
Endolymphatic oedema
PC: Progressive SNHL + vertigo + tinitius
- Aural fullness
- N/V
- Attacks occur in clusters and last up to 12h
Ix: Audiometry shoes low-freq SNHL which fluctuates
Mx:
Medical: Vertigo - Cyclizine
Surgical:
- Gentamicin instillation via grommets
- Saccus decompression
Vestibular neuronitis/ viral labrynthitis PC + Rx
PC:
- Follows febrile illness (URTI)
- Sudden vomiting
- Severe vertigo exacerbated by head movement
Rx:
- Cyclizine
- Improvement in days
BPV?
Displacement of otoliths in semicircular canals, common after head injury
PC:
- Sudden rotational vertigo Provoked by head turning
- Nystagmus
Dx: Hallpike manoeuvre + observe for rotational nystagmus (towards affected year)
Mx:
- Self limiting - good prognosis and usually resolves spontaneously after a few weeks to months.
Symptomatic relief by:
- Epley manoeuvre (successful in around 80%) of cases)
- Teaching pt exercises they can do themselves at home eg. Brandt-Daroff exercises
- Betahistine: Histamine analogue
BPV causes?
1) Idiopathic
2) Head Injury
3) Otosclerosis
4) Post-viral