ENT Flashcards
in CHL Weber test lateralizes to what ear? What is the Rinne finding?
Affected ear for Weber. BC>AC for Rinne
In SNHL what are the Weber and Rinne findings?
Weber - lateralizes to unaffected ear, Rinne AC>BC
Retraction of TM or a perforation with visible keratin coming out or granulomatous tisse. What is is caused by? Tx?
Cholesteatoma. Chronic OM with effusion. Refer for surgical repair
Abnl growth of bone on stapes causing CHL first then SNHL - often hereditary
Otosclerosis
Anatomic cause of SNHL
Detioration of cholear hair cells or lesions in CN8 pathway
What meds are ototoxic?
Aminogylcosides, Vancomycin, Lasix, Cisplatin, ASA
Unilateral hearing loss (gradual or sudden), tinnitis and continuous disequilibrium
Acoustic Neuroma
Presents with TM perforation, vertigo, hemotympanum or SNHL. Pt was just on a flight or scuba diver
Barotrauma
How to prevent barotrauma
yawning, autoinflation, swallowing
or topical/systemic decongestants
Pt presents with popping/crackling, aural fullness, mild-moderat hearing loss and suffers from allergies or just had a cold. How does TM look on exam? Tx?
Eustachian tube dysfunction. Retracted TM, tx with antihistamines and anti-inflammatoy meds
Tx of foregn body in ear canal?
Animate - mineral oil or lidocaine and extract
Inanimate - attempt removal or refer to ENT for removal
Tx of auricular hematoma?
I&D and compression
Complication of repeat trauma to ear cartilidge
Cauliflower ear
Pathogens for mastoiditis
Typically S. pneumoniae / H. influenza (related to AOM) or S. pyogenes
(related to pharyngitis)
Infection of mastoid air cells that typically occurs after
untreated AOM
Mastoiditis
presents with fever, postauricular erythema, and pain. What test to order?
Mastoiditis - CT scan reveals coalescence of mastoid air cells due to destruction of
their bony septa
Presents with otalgia, hearing loss, discharge, bleeding, dizziness or nystagmus (depending on extent of injury) Tx?
TM perforation - Usually heal spontaneously, monitor for secondary infection
How do you evaluate and tx tinnitis?
Audiometry, MRI +/- venography,
Tx - avoid noise or ototoxic agents, hearing aid may help
What med can be used for tinnitis?
Oral antidepressants (nortriptyline)
Acute onset of continuous, severe vertigo lasting days to
weeks with hearing loss and tinnitus - usually following a URI
Labyrinthitis
Tx of Labyrinthitis
Symptoms typically resolve over weeks, however hearing loss may be permanent.
Tx - supportive measures – meclizine or promethazine
Distention of endolymph compartment of inner ear
Meriere Syndrome
Episodic vertigo (20 min to several hours), low
frequency SNHL, tinnitus and sensation of unilateral
aural pressure
Meniere Syndrome
Tx of Meriere Syndrome
Treatment:
– Decrease dietary sodium
– HCTZ and meclizine
– Referral to ENT
Recurrent episodes of vertigo; associated with changes in
position of head and possibly nausea/vomiting; gait
instability
BPPV
Tx of BPPV
Meclizine and diazepam
Pathogens for acute Sinusitis
• Bacteria pathogens – S. pneumoniae, H. influenza, M.
catarrhalis and S. aureus
• Viral: rhinoviruses, adenoviruses,
influenza/parainfluena
Most commonly caused by viral infections associated with viral URI, but may follow an allergy exacerbation
Acute sinusitis
URI symptoms: purulent rhinorrhea, maxillary tooth pain,
nasal obstruction, facial pain,(pressure or fullness)
Nasal cavity/turbinate edema
Acute Sinusitis
Test for sinusitis
– Plain films have poor sensitivity and specificity
– CT helpful in severe cases
Tx of acute sinusitis
Symptomatic
– Pain management (NSAIDS, APAP, or opioid)
– Nasal saline (Neti pot)
– Intranasal steroids in the first 5 days
– Short course nasal or systemic decongestants
May use anitbiotics:
May be considered in patients with:
• Acute sinusitis that does not improve within 7 days or that worsens at any
time
• Moderate to severe pain or T ≥ 101° F
• Immunocompromised patients
First line tx for acute sinusitis
1st line (7-10 days)
• Amoxicillin
• TMP-SMZ or Doxycycline (PCN allergic)
Second line tx for acute sinusitis
2nd line (10 days) – if no improvement
• Amoxicillin-clavulanate (after 3 days of 1st line)
• Moxifloxacin (after 3 days of 1st line)
Complications of Acute Sinusitis
• Bony complications – Osteomyelitis (frontal sinus osteomyelitis – Pott Puffy Tumor) • Orbital complications – Preseptal/periorbital/orbital cellulitis – Cavernous sinus thrombosis • Intracranial complications – Meningitis – Epidural/subdural/cerebral abscesses
Presents with H/A, nasal congestion, sneezing or pruritis, clear rhinorrhea and increased lacrimation in the spring
allergic rhinitis
Tx of allergic rhinitis
1st line: Intranasal steroids – (ex. Fluticasone (Flonase), mometasone (Nasonex)
2nd line options - combination therapy may be indicated for severe/persistent symptoms
• Oral antihistamines (1st generation – diphenhydramine, 2nd generation –
loratidine, desloratidine, fexofenadine)
• Intranasal antihistamines
– Azelastine (Astelin) and olopatidine (Patanase) currently available
• Sympathomimetics (decongestants)
– Topical not recommended due to possibility of rhinitis medicamentosa (tachyphylaxis & rebound nasal congestion)
• Intranasal cromolyn
• Montelukast (Singulair)
• Immunotherapy
Epistaxis occurs from trauma to what?
Kesselbach’s plexus in anterior septum
– Also think about cocaine use, sinusitis, leukemia, coagulation disorders
Yellowish, boggy masses of hypertrophic mucosa, nasal
congestion and decreased sense of smell
nasal polyps
- often in pt’s will atopy or allergies
- think CF in kids
Acute pharyngitis - viral vs bacterial causes
80% are viral in etiology viral: Rhinovirus, adenovirus, enterovirus, EBV and HSV bacterial: GABHS, mycoplasma, gonococcal
pt presents with fever, acute sore throat, adenopathy,
tonsillar edema, erythema and exudate, scarlatina rash
– Absence of conjunctivitis and cough
strep pharyngitis
Centor criteria for strep pharyngitis
Centor criteria – Fever over 38°C – Tender anterior cervical lymphadenopathy – Tonsillar exudate – Lack of a cough tx if 3-4 criteria rapid strep if 1-2 criteria
Tx of strep pharyngitis
PenVK or cefuroxime
• Azithromycin/Clarithromycin or erythromycin in penicillin allergic patients
Presents with severe sore throat, pain on swallowing or opening mouth (trismus), deviation of soft palate and uvula and a muffled voice Dx and tx?
Peritonsillar abscess
Tx: Aspiration and drainage, and
antibiotics – amoxicillin, amoxicillin-sulbactam,
and clindamycin
presents with fever, throat pain and pain with swallowing - sitting in sniffing position
Epiglottitis
“thumbprint sign” on Lateral ST neck film
Epiglottitis
Tx of epiglottitis
IV antibiotics, IV steroids,admit and possible intubation
Single or multiple small shallow ulcers with yellow grey fibrinoid centers with red halos found on labial and buccal mucosa
apthous ulcers
what causes apthous ulcers?
unknown but HSV 6
Tx of apthous ulcers
viscous lidocaine, topical or oral steroids
what med can be used for maintenance tx of apthous ulcers
cimetadine
white patches in mouth that can be scraped off
oral candidiasis
tx of oral candidiasis
oral antifungal
tx or oral HSV
oral antiviral
fixed white lesions that can’t be scraped off
oral leukoplakia
causes of oral leukoplakia
chronic irritation in tobacco users and denture wearers
leudkoplakia or erythroplakia think
oral squamous cell CA
pt’s at risk for oral squamous cell CA
tobacco users and use of alcohol
tx of benign migratory glossitis
goes away on it’s own
red smooth surfaced tongue
glossitis
causes of glossitis
nutritional deficiency (niacin, riboflavin, vit E), chemo, dehydration -if unsure of cause tx for nutritional deficiency
redness and swelling of gumline
gingivitis
tx of gingivitis
brush, floss, cleaning q 6 mths
dental abscess - cause, dx, tx
from a cavity, exam and Xray, refer to dentist - PCN or clindamycin
most common cause of hoarseness
acute laryngitis
cause of acute laryngitis
almost always viral - following an URI - like 1 week after
tx of acute laryngitis
rest vocal cords and symptomatic treatment
new and persistent hoarseness > 2 weeks (in a smoker), hemoptysis, persistent throat or ear pain with swallowing
laryngeal squamous cell CA
risk factors for laryngeal CA - dx, tx
smoking and HPV (non-smokers), bx and CT/MRI, radiation and surgery and possibly chemo
acute swelling, increased pain and swelling with eating
sialadentis
what glands most often affected with sialadentis
parotid
causes of sialadentis
dehydration and chronic illness
cause of sialadentis
s. aureus
tx of sialadentis
rehydration, warm compresses, massage, and antibiotics (nafcillin, clindamycin or augmentin
calculus in salivary gland
sialolithiasis
most common duct for sialolithiasis
Wharton’s duct (drains submandibular gland)
two ducts affected by sialolithiasis
Wharton’s and Stenson’s
what drains submandibular gland
Wharton’s duct
what drains parotid gland
Stenson’s duct
postprandial pain and localized swelling
sialolithiasis
tx of sialolithiasis
refer to ENT
most common location of salivary gland tumors
parotid gland (80%)
symptom of salivary gland tumor
asymptomatic swelling
tx of salivary gland tumor
refer to ENT
young person with gingival inflammation & necrosis,
bleeding, pain, halitosis, fever,
cervical lymphadenopathy
necrotizing ulerative gingivitis aka trench mouth
cause of necrotizing gingivitis and tx
caused by stress
tx: salt water +/- peroxide rinses, oral
hygiene, oral penicillin
