ENT Flashcards
Weber test
fork on center of head and see if sound laterizes
Conductive Hl–> lateralizes to affected ear
Sensory neural–> lateralizes to to unaffected ear
Rinne test
fork on mastoid until vibrations no longer felt and up to ear ( should continue to hear)
bone-> air= CHL
Air > bone = SNHL
conductive hearing loss
etiologies
dz of external ear canal, TM, or ossicles
causes: cerumen impaction, eustachian tube dysfunction with URI, AOM/middle ear effusion, TM perforation,
cholesteatoma
upper flaccid portion of TM is drawn inward from chronic pressure d/t eustachian tube dysfunction –> keratinization of middle ear and chronic infection
PE: retractions in the TM, perforation with keratin
complication with chronic OM
TX: refer to ENT for surgical repar
otoscleoris
abn growth of bone on stapes
females > males
hereditary
tx; refer to ENT
SNHL
why its happens
deterioration of cochlear hair cells or lesions CN 8 pathway
causes: hight frequency age-related hearing loss
trauma, ototoxic ( van com, cisplatin), Menier syndrome, auto immune ( lupus)
acoustic neuroma
CN 8 - bening intracranial tumor causes hearing loss unilateral , gradual do mRI tx: refer to ENT for observation , excision, radiotherapy
barotrauma
injury to ear
scuuba diver, pilots
prevent with yawning, auto inflation, swelling, decongestant
tx: via myringotomy
dysfunction of eustachian tubes
frequent with URI/ allergic
popping/ cracking, aural fullness
PE: retracted RM with decreased mobility
tx: anti-histamin/ anti-inflammatory
foreign body
h/o : otalgia, CHL
tx: animate: mineral oral or lidocaine and extract object
inanimate object: attempt to removal or may refer to ENT for microscopic removal
auricular hematoma
blunt trauma erythema, swelling at pinna tx; I and D followed by compression dressing f/u to ensure complex hematoma anti-staph abx complication: destruction of cartilage
mastoiditis
infection of mastoid cells after untreated AOM
- s. pneumo, h/ flu
s/s: fever, post auricular erythema, pain
testing: myringotomy for culture of middle ear fluid
CT
tx; IV cefazolin +/- surgery for drainage
TM perforation
trauma, impact
s/sx: otalgia, hearing loss, d/c bleeding, dizziness
spontaneous, monitor for infection
refer to eNT if continued dizziness, delayed TM healing
tinnitus
abn persistent ear or head noises check for hearing loss evolution; audiometry r/o HL pulsatile- check for aneurysm MRI tx: avoid excessive noise avoid ototoxic med music nortripyline
vertigo
sensation of movement without movement or exaggerated response to body movement
evaluation; full neuro exam 9 Rhomber, gai, nystagmus, Dix-Halpike)
if cause from peripheral source–> ENT
don’t miss cerebella ischemia
tx: base on underlying etiology
acute sxs: meclizine, diazepam, scopolamine
central vertigo
causes: brainstem vascular issues, AV malformation, MS, vertebrobasiliar migraine
sxs; more gradual onset and vertical nystagmus
no auditory sxs
commonly with motor/sensory /cerelbellar deficit
peripheral vertigo
causes: labyrinthitis, BPPV, endolymphatic hypos, vestibular neuritis
sxs; sudden onset, n/v, hearing loss, and nystagmus ( horizontal with rotary component)
labyrinthitis- type of peripheral vertigo
acute, continuous, severe vertigo associated with HL and tinnitus
sxs resolve over weeks
tx: mezclizine
Menieresyndrome
endolymph compartment of inner ear
sxs: episodis vertigo, low frequency HL, unilateral aural pressure
tx: decrease sodium, HCTZ, meclizine
BPPV
recurrent episodes associated with changes in position, n/v
tx; meclizine/ diazepam
acute sinusitis
pathophys and common bacteria
viral URI, allergic
inflammation from URI causes obstruction and infected
bacterial: strep pneuma. . H. flu, M catarrhalis, s. aura
acute bacterial sinusitis
sx: URI sxs, purulent rhinorrhea, tooth pain
signs: nasal cavity, turinate team
testing: plain films, CT in sever cases
tx; analgesics, neti pot, intranasal steroids X 5 days, abx tx> 7 days, worsen
immunoscomprimised status
1st line; amor, bacterium, doxycycline
levaquin/ augmentin
2n line: augmentin
complication: osteomyelitis, meningitis, epidural/ subdural abscesses
allergic rhinitis
IGE mediated–> histamine
perenial- dust, dander, molds
seasonal: pollens, grasses, ragweed
sx: h/a nasal congestion, clear rhinorrhea, eye testing
signs; pale violaceous boggy turbinates
tx; avoid allergens, pt education, evaluate for asthma,
tx: fluticasone, mometasone daily
2ndline: oral anti histamines, decongestants, singular immunotherapy
epistaxis
trauma
think cocaine, sinusitis, leukemia, coag disorders
recurrent: consider abc, pt/ put, bleeding time
anterior: unlit, continuous, can be visualized by exam tx; remove clot, blow nose apply vasconstrictor- lidocaine direct pressure silver nitrate, packing
posterior: brisk flow into pharynx
tx; packing
consult ENT
must admit and observe
nasal foreign body
kids 2-5
presentation: history by parent
halitosis, sinusitis, stridor, wheezing
tx; mechanical removal and caution to not displace or other offices
nasal polyps
yellowish, boggy masses of hypertrophic mucosa, nasal congestion and decrease send of smell
in kids- consider CF
tx: intranasal steroids
refer to ENT
viral pharyngitis
adenovirus, EBC, HSV, rhinovirus, enterovirus
bacterial GABSH, myopiasma, gonoccocal
strep pharyngitis
5-15 yrs
s/sxs: fever, acute sore throat, adenopathy
Centor criteria: fever > 38F tender anterior CA tonsilar exudate lack of cough
3 or 5 criteria--> tx 0- d/c without abx in between--> rapid sure tx: Pen V K or cefuroxime augmentin or erythromycin
peritonsilar abscess
s/sx: severe ST, muffled voice, truisms
tx; Aspiration and drainage an abx- amox, clindamycin
tonsillectomy
epiglottitis
decrease due to Hib vaccine seen in adults with DM s/s: fever, throat pain with swelling kids; appear toxic, tripod position diagnostic; cherry red swollen epiglottis on laryngoscope kids: keep kids calm, OR, BC, IV ( ceftriazoxon) adults: scope at bedside, IV abx, iV steroids, admit
apthlous ulcers
single or multiple shallow lesions with yellow/ gray center seen in mouth
tx; viscus lidocaine, coricosteroids
cimetidine
orla thrush
seen in pt with dentures, DM,, cancer pt
sxs: burning pain on tongue/ buccal mucose
lesions can be scarped off and underlying tissue is friable
tx: anti fungal meds- troche, swish , etc
oral herpes simplex
hsv 1-acquired by childhood
hsv 2- sexually acquired
presentation: grouped vesicular lesions on erythematous base, erosion into shallow ulcer
burning , shining
tx; immunocompetent; none
immunocompromised; systemic agents - valtrex 7-10 days
oral leukoplakia
small white lesions on mucosal surface
does not scape off
seen in denture wearer
all need to get a bx to r/o oral cancer
oral squamous cell carcinoma
early lesions look like leukoplakia
RF: tobacco/ ETOH
Tx:
geographic tongue
erythema in manlike distribution caused by filiform papillae of the tongue
removes on own
glossitis
red smooth surface tongue
lack of niacin, riboflavin, chemo, adverse med rxn.
tx: tx underlying cause
gingivitis
inflame of gingiva causing redness/ swelling of gum line
RF: poor oral hygiene, dry mouth, tobacco
tx: dental hygiene
6 month cleaning
necrotizing ulcerative gingitivits
young adults, stress
s/s: gingiva inflammation, bleeding, fever, halitosis, CVA
tx: salt water/ peroxide rinses, oral hygiene, ora PCN
dental access
starts from cavity
s/s: pain over are of tooth, localized swelling.
tooth sensitive
tx: referral to dentist with I and D, extraction
acute laryngitis
causes hoarseness
almost always viral
sxs last > 1 week after URI sxs subsided
tx: vocal cord rest mandatory
sx tx
laryngeal squamous cell carcinoma
> 2 week hoarseness with smoking hx
ear/ throat pain, neck pass
RF: tobacco, HPV
dx: laryngoscope and bx
CT/ MRI
tx: rad and tx
advanced: chemo, rad , tx
siladenitis
salivary gland affected, parotid is common
- associated with dehydration and chronic illness causing ductal obstruction
s/s: acute swelling, increased pain an, d swelling with eating
bug: s. aureus
tx: rehydration, wam compressie, sialogogue, massage and abx ( clinda, augmentin)
sialolithiasis
calculus formation in salivary glans: Wharton’s duct most common
postprandial pain with localized swelling
tx: refer to ENT for stone extraction
salivary gland tumors
80% occur in parodic glad
Ct/ MRI
refer to ENT
