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
Conductive hearing loss causes?
Impaired conduction anywhere between auricle and round window
1) External canal obstruction:
- Wax
- Pus
- Foreign body
2) TM perforation:
- Trauma
- Infection
3) Ossicle defects
- Otosclerosis
- Infection
- Trauma
+ inadequate eustachian tube ventiliation of middle ear
Sensorineural hearing loss causes?
Defects of cochlea, cochlear N or brain
1) Drugs:
- Aminoglycosides
- Vancomycin
2) Post-infective
- Meningitis
- Measles
- Mumps
- Herpes
3) Misc:
- Meniere’s
- Trauma
- MS
- CPA lesion (acoustic neuroma)
- Reduced b12
Acoustic neuroma
Mx?
AKA vestibular schwannoma
Benign, slow growing tumour of superior vestibular N
- Acts as SOL –> CPA syndrome (Accounts for 80% of CPA tumours)
- Associated with NF2
Mx:
- Gamma knife
- Surgery (risk of hearing loss)
Acoustic neuroma triad & differentials?
PC:
- Slow onset unilateral SNHL + Tinnitus + veritgo
- Headache (increased ICP)
- CN plasies: 5, 7, 8 (CPA)
- Cerebellar signs
Differentials:
- Meningioma
- cerebellar astrocytoma
- Mets
Otosclerosis?
Autosomal dominant
Characterised by fixation of stapes the at oval window
F>M 2:1
PC:
- Begins in early adult life
- Bilateral conductive deafness + tinnitus
- HL improved in noisy places: Willis paracousis
- Worsened by pregnancy
Presbyacussis?
Age-related hearing loss
Presentation: >65 Bilateral Slow onset \+- tinnitus
Ix: PTA
Rx: Hearing aid
Congenital conductive hearing loss in kids?
Conductive:
- Anomalies of pinna, external auditory canal, TM, or ossicles
- Congenital cholesteatoma
- Pierre-robin sequence
Congenital SNHL
SNHL:
AD: Waaredenburgs: SNHL, heterochromia + telecanthus
AR:
- Alports (SNHL + Haematuria)
- Jewell-Lange-Nielson: SNHL + Long QT
X-linked:
Alports
Infection: CMV, rubella, HSV, toxo, GBS
Ototoxic drugs
Perinatal causes of hearing loss ?
Anoxia Cerebral palsy Kernicterus Infection: Meningitis ?--> Congenital rubella syndrome?
Acquired causes of childhood hearing loss?
OM/OME
Infection: meningitis/measles
Head injury
Cauliflower ears?
Blunt trauma -> subperichondrial haematoma (Pinna haematoma)
Can lead to ischaemic necrosis of cartilage and subsequent fibrosis leads to cauliflower ears
Mx: Aspiration + firm packing to auricle contour
Exostoses?
Smooth symmetrical bony narrowing of external canals
Causes of TM perforation?
OM
Foreign body
Barotrauma
Trauma
Allergic rhinosinusitis signs + symptoms + Ix
seasonal (hay-fever) vs perennial
Pathoologgy: T1 HS IgE mediated inflammation from allergen exposure lead to mediator release from mast cells
Sx: Sneezing, pruritis, rhinorrhoea
Signs: Swollen, pale, boggy turbinates
- Nasal polyps
Ix:
- Skin prick testing to find allergens
- RAST tests
Allergic rhinosinusitis Mx
Allergen avoidance:
- Regular washing bedding (inc toys) on high heat
- Avoid going outside when pollen content high
1st line:
- Anti-histamines: Cetirazine
OR beclometasone/chromoglycate nasal spray
2nd line:
Intranasal steroids + anti-histamines
3rd line: Zafirlukast
4th line: Immunotherapy:
- Aim to induce desensitisation to allergen
Adjuvants:
- Nasal decongestants eg. pseudoephrine
Sinusitis: Pathophys + Organisms
Causes?
Viruses –> Mucosal oedema and reduced mucosal ciliary action –> Mucus retention + secondary bacterial infection
Acute: Pneumococcus, haemophilus , Moraxella
Chronic: S.aureus, anaerobes
Causes:
- Majority are bacterial infection secondary to viral
- 5% secondary to dental root infection
- Diving/swimming in infected water
- Anatomical susceptibility; deviated septum, polyps
- Systemic disease:
- -> Kartagener’s
- -> Immunodeficiency
Sinusitis Symptoms:
Pain (1-5(
- Maxillary (cheek/teeth)
- Ethmoidal (between eyes)
- Increased on bending/straining
Discharge from nose - post nasal drip with foul taste
Nasal obstruction/congestion
Anosmia/ cacosmia
Systemic symptoms: fever
NB. Most important symptoms are actually discharge and congestion
Sinusitis Ix + Mx
Ix: Nasendoscopy + CT
Mx: Acute/single episode: - Bed rest, decongestants, analgesia - Nasal douching + topical steroids - Abx (clarithro) of uncertain benefit
Chronic/recurrent:
- Usually a structural or drainage problem
- Stop smoking + Fluticasone nasal spray
- Functional endoscopic sinus surgery if failed medical therapy
Sinusitis complications?
Mucoceles –> Pyoceles (Mucus retention cysts)
Orbital cellulitis/abscess
Osteomyelitis eg. staph in frontal bone
Intracranial infection:
- Meningitis, encephalitis
- Abscess
- Cavernous sinus thrombosis
Nasal polyps: Sites + Symptoms
Pt: Males, >40
Sites:
- Middle turbinates
- Middle meatus
- Ethmoids
Sx:
- Watery, anterior rhinorrhoea
- Purulent post-nasal drip
- Nasal obstruction
- Sinusitis
- Headaches
- Snoring
Signs: Mobile, pale, insensitive
Nasal polyps associations
Associations: - Allergic/non-allergic rhinitis - CF Aspirin hypersensitivity - Asthma
Single unliateral polyp
May be a sign of rare but sinister pathology:
- Nasopharyngeal Ca
- Glioma
- Lymphoma
- Neuroblastoma
- Sarcoma
Do CT and get histology
Nasal polyps in children?
polyp Mx?
Rare Betamethasone drops for 2/7
- Short course of oral steroids
Endoscopic polypectomy
Fractured nose: Ix & Mx?
Upper 3rd of nose has bony support
Lower 2/3 and septum are cartilaginous
–> cartilaginous injury won’t show and radiographs don’t alter Mx
Mx:
- Exclude septal haematoma
- Re-examine after 1 wk (reduced swelling)
- Reduction under GA + post-op splinting best w/i 2 weeks
Septal haematoma?
Septal necrosis + Nasal collapse if untreated
–> Cartilage blood supply comes from mucosa
Boggy swelling and nasal obstructon
Needs evacuation under GA with packing +- suturing
Epistaxis causes?
80% idiopathic
Trauma: Nose picking, #s
Local infection: URTI
Pyogenic granuloma: overgrowth of tissue on
Little’s area due to irritation or hormonal factors
Osler-weber-rendu/ HHT
Coagulopathy: Warfarin, NSAIDs, Haemophilia, reduced platelets, vWD, EToH
Neoplasm
Epistaxis: Initial Mx
nb in primary care: Naseptin nasal cream massaged onto area twice a day for 2 weeks is as effective as cautery
1) Wear PPE
2) Assess for shock and resuscitate appropriately
3) If not shocked:
- Sit up, head tilted down
- Compress nasal cartilage for 15 minutes
4) If bleeding not controlled - remove clots with suction or by blowing and try to visualise bleed by rhinoscopy
Anterior Epistaxis
Usually septal haemorrhage from Little’s area (Kisselbach’s plexus)
Insert gauze soaked in vasoconstrictor + LA
- Xylometazoline + 2% lignocaine for 5 min
Bleeds can be cauterised with silver nitrate sticks
Persistent bleed should be packed with merocel pack
- Refer to ENT if this fails or if you can’t visualise the bleeding point
- They may insert a posterior pack or take pt to theatre for endoscopic control
Posterior / Major epistaxis
Posterior packing (+ anterior pack)
- -> Pass 18g Foley catheter through the nose into the nasopharnyx, inflate with 10ml water and pull forward until it lodges
- Admit pt and leave for 48 hrs
Gold standard: Endoscopic visualisation + direct control eg. by cautery or ligation
After epistaxis advice:
1) Don’t pick nose
2) Sit upright, out of sun
3) Avoid bending, lifting or straining
4) Sneeze through mouth
5) NO hot food or drink
6) Avoid EtOH and tobacco
Osler-weber-Rendu/HHT?
Inheritance + features?
Autosomal DOMINANT
- 5 genetic subtypes
Telangiectasias in mucosa:
- Recurrent spontaneous epistaxis
- GI bleed (usually painless)
Internal telangiectasias and AVMs:
- Lungs
- Liver
- Brain
Rarer:
- Pulmonary HTN
- Colon polyps: may –> CRC
Tonsilitis Organisms + Signs
Viruses are most common (consider EBV)
GAS : Pyogenes
Staphs
Moraxella
Signs:
- Lymphadeopathy esp. Juguludigastric node
- Inflamed tonsils and oropharynx
- Exudates
Centor Criteria
Guideline for admin of Abx in acute sore throat/ tonsillitis/ pharnygitis
1 point for each of:
1) Fever
2) Tonsillar exudates
3) Tender anterior cervical adenopathy
4) No Cough
Mx: 0-1 no Abx (risk of strep or equal 3: Abx (Pen V 250mg QDS or erythromycin for 5/7)
Tonsilitis Mx:
Swabbing of superficial bacteria is irrelevant and can lead to overdiagnosis
Analgesia: ibuprofen/Paracetamol + Difflam gargle (Local anesthetic/NSAID)
Consider Abx only with CENTOR
- Pen V 250mg PO QDS (125mg TDS in children) or erythromycin for 5/7
NOT amoxicillin: MACPAP RASH IN EBV
Tonsillectomy indications?
Recurrent tonsilitis if all the below criteria are met:
- Caused by tonsilitis
- 5+ episodes/yr
- Symptoms for >1yr
- Episodes are disabling and prevent normal function
Airway obstruction eg. OSA IN children
Quinsy
Suspicious of Ca: Unilateral enlargement or ulceration
Tonsillectomy: Methods + complications?
Methods: - Cold steel
- Cautery
Complications:
- Reactive haemorrhage
- Tonsillar gag may dmg teeth, TMJ or posterior pharngeal wall
Kisselbach’s plexus arteries?
Anterior ethmoidal artery
Spenopalatine Artery
Facial Artery
Strep throat complications
Peritonsillar abscess (quinsy)
Retropharyngeal abscess
Lemierre’s syndrome
Scarlet Fever
Rheumatic Fever
Post-streptococcal Glomerulonephritis
Peritonsillar Abscess?
Typically occurs in adults
Symptoms:
- Trismus (jaw tetanus)
- Odonophagia
- Halitosis
Signs:
- Tonsillitis
- Unilateral tonsillar enlargement
- Contralateral uvula displacement
- Cervical lymphadenopathy
Rx:
Admit
IV ABC
I&D under LA or tonsillectomy under GA
Retropharyngeal abscess
Rare
PC:
Unwell child with stiff, extended neck who refuses to eat or drink
Fails to improve with IV ABx
Unilateral swelling of tonsil and neck
Ix:
Lat. neck x-rays shows soft tissue swelling
CT from skull-base to diaphragm
Rx:
IV Abx
I&D
Lemierre’s syndrome
IJV thrombophlebitis with septic emboli, most commonly affecting the lungs
Organism: Fusobacterium necrophorum
Rx:
IV Abx: Pen G, Clinamycin, metro
Scarlet fever?
‘Sandpaper’ like rash on chest, axillae or behind ears, 12-48hrs after pharyngotonsillitis
Circumoral pallor
Strawberry tongue
Rx: Start Pen V/G and notify HPA
Rheumatic fever features
Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Sydenham’s chorea
PSGN
Malaise and smokey urine 1-2 weeks after pharyngitis
Laryngitis?
Usually viral and self-limiting
Secondary bacterial infection may develop
Symptoms: Pain, hoarseness and fever
O/E: Redness & Swelling of vocal cords
Rx: Supportive, Pen V if necessary
Laryngeal papilloma
Pedunculated vocal cord swellings caused by HPV
Presents with hoarseness
Usually occur in children
Rx: Laser removal
Recurrent laryngeal N.palsy
Supplies all intrinsic muscles of larynx except cricothyroideus (Ext. branch of sup laryngeal n)
- Responsible for ab and adduction of vocal cord
Sx: - Hoarseness - Breathy voice with bovine cough - Repeated coughing from aspiration (reduced supraglottic sensation) Exertional dyspnoea (narrow glottis)
Causes:
- 30% cancers: Larynx, thyroid, oesophagus, hypopharynx, bronchus
- 25% iatrogenic: para/thyroidectomy, carotid endartectomy
- Other: Aortic aneurysm, bulbar/pseudobulbar palsy
Laryngeal SCC
2000/yr UK, associated with smoking/EtOH
PC: Male smoker, with progressive hoarseness –> Stridor.
Dys/odonophagia
Wt loss
Ix: Laryngoscopy + biopsy
MRI staging
Mx: Based on stage Radiotherapy/ laryngectomy
After total laryngectomy:
- Pts have permanent tracheostomy
- Speech valve
- Electrolarynx
- Oesophageal speech (Swallowed air)
Laryngomalacia
Immature and floppy aryeepiglottic folds and glottis lead to laryngeal collapse on inspiration
PC: Stridor, PC w/i first weeks of life
Noticeable @ certain times
- Lying on back
- Feeding
- Excited/upset
Problems can occur with concurrent laryngeal infections or with feeding
Mx: Usually no Mx required, but severe cases may warrant surgery
Epiglottitits
Sx:
Sudden onset continuous stridor
Drooling
Toxic
Pathogens: Haemophilus B (HIB), GAS
Rx:
Don’t examine throat
Consult with anaesthetists and ENT surgeons
02 + Nebulised adrenaline
IV dexamethasone
Cefotaxime
Take to theatre to secure airway by intubation
Foreign body
Sudden onset stridor in a previously normal child
- BLS
- Needle cricothyrotomy in children
- Can only exclude foreign body in bronchus by bronchoscopy
Subglottic stenosis
Subglottis - narrowest part of resp tract in children
Symptoms: Stridor + FTT
Causes:
- Prolonged intubation
- Congenital abnormalities
Wax management?
GP:
Olive oil drops
Irrigation to syringe wax out
Secondary care:
- Microsuction
‘educate pt about wax’
- not dirty
- Self cleaning
Most common causes of hearing loss?
Congenital:
Intrauterine infection: German measles, toxo, rubella
Acquired: Meningitis
ENT tuning fork?
512hz (smallest one)
Bells palsy Mx
Early prednisolone (lot’s of RCT evidence)
Some people think it’s viral so would consider aciclovir, however evidence for this is very weak
Adenoid facies
Overbite underdeveloped thin nostrils short upper lip prominent upper teeth crowded teeth narrow upper alveolus high-arched palate hypoplastic maxilla
Samter’s triad?
Association of asthma, aspirin sensitivity and nasal polyposis
Meniere’s Mx?
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine may be of benefit
Acute Attacks: Buccal prochlorperazine
Prevention: Betahistadine
Thyroid malignancy - Commonest subtype?
Papillary carcinoma :
Commonest sub-type
Accurately diagnosed on fine needle aspiration cytology
Histologically they may demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei
They typically metastasise via the lymphatics and thus laterally located apparently ectopic thyroid tissue is usually a metastasis from a well differentiated papillary carcinoma.
In which thyroid cancer is calcitonin raised?
These are tumours of the parafollicular cells ( C Cells) and are of neural crest origin.
The serum calcitonin may be elevated which is of use when monitoring for recurrence.
They may be familial and occur as part of the MEN -2A disease spectrum.
Spread may be either lymphatic or haematogenous and as these tumours are not derived primarily from thyroid cells they are not responsive to radioiodine.
Acute necrotizing ulcerative gingivitis Mx?
refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia
Absent corneal reflex + dizziness & right sided hearing loss?
Loss of corneal reflex - Think acoustic neuroma
Otosclerosis?
Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults
Onset is usually at 20-40 years - features include: conductive deafness tinnitus normal tympanic membrane* positive family history
Management
hearing aid
stapedectomy
*10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
Pseudophedrine - CI with which med?
MAOi - could potentially cause a hypertensive crisis
Tonsillitis first line Tx?
7/10 day course of Phenoxymethylpenicillin
Erythromycin if pen allergic
IF 3 or more of Centor, 40-60% sore throat is caused by Group A Beta-haemolytic strep
Motion sickness mx?
Motion sickness describes the nausea and vomiting which occurs when an apparent discrepancy exists between visually perceived movement and the vestibular systems sense of movement
Management
the BNF recommends hyoscine (e.g. transdermal patch) as being the most effective treatment. Use is limited due to side-effects
non-sedating antihistamines such as cyclizine or cinnarizine are recommended in preference to sedating preparation such as promethazine
EBV associated malignancies?
Burkitt’s
Hodgkin’s
Nasopharyngeal carcinoma
Trigeminal neuralgia - first line Tx?
Carbemazepine
- Failure to respond to tx or atypical features (
Pharyngeal pouch?
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
Cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
Branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Rinne positive/negative
Rinne positive if Air>bone (Normal)
Rinne negative if Bone > Air (Abnormal) - CHL
How long do the following RTIs last? Acute otitis media Acute tonsillitis Common cold Acute rhinosinusitis Acute cough/bronchitis
acute otitis media: 4 days acute sore throat/acute pharyngitis/acute tonsillitis: 1 week common cold: 1 1/2 weeks acute rhinosinusitis: 2 1/2 weeks acute cough/acute bronchitis: 3 weeks
Otitis externa Mx
Initially: topical antibiotic/ combined topical antibiotic + steroid
Secondline: Oral abx if infection spreading - oral fluclox
