ENT Flashcards by claudia franco

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

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Rinne test

fork on mastoid until vibrations no longer felt and up to ear ( should continue to hear)

bone-> air= CHL
Air > bone = SNHL

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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,

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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

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otoscleoris

abn growth of bone on stapes
females > males
hereditary
tx; refer to ENT

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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)

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acoustic neuroma

CN 8 - bening intracranial tumor 
causes hearing loss 
unilateral , gradual
do mRI 
tx: refer to ENT for observation , excision, radiotherapy

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barotrauma

injury to ear
scuuba diver, pilots
prevent with yawning, auto inflation, swelling, decongestant
tx: via myringotomy

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dysfunction of eustachian tubes

frequent with URI/ allergic
popping/ cracking, aural fullness
PE: retracted RM with decreased mobility
tx: anti-histamin/ anti-inflammatory

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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

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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

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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

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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

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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

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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

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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

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peripheral vertigo

causes: labyrinthitis, BPPV, endolymphatic hypos, vestibular neuritis

sxs; sudden onset, n/v, hearing loss, and nystagmus ( horizontal with rotary component)

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labyrinthitis- type of peripheral vertigo

acute, continuous, severe vertigo associated with HL and tinnitus
sxs resolve over weeks
tx: mezclizine

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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