ENT Flashcards
Management of septal haematoma of nose
Urgent drainage to prevent AVN of septal cartilage
Management of fractured nose
Analgesia
Exclude septal haematoma
Review in ENT clinic in 5-7d
What cell type is hypo-pharyngeal ca?
Squamous cell carcinoma
Arises from pharyngeal walls, epiglottis, pyro form fossa or upper oesophagus
What is Patterson-Brown-Kelly syndrome (Plummer-Vinson synd)
Triad of
- dysphasia
- glossitis
- iron deficiency anaemia
Causes of lymphadenopathy
Bacterial - pyogenic infection, TB, brucellosis Viral- EBV, CMV, HIV Protozoa - toxoplasmosis Lymphoma Metastases Collagen disease Sarcoidosis Amyloidosis
Causes of dysphagia
Neurological - MG, MND, MS foreign body Pharyngeal pouch Post-cricoid web Globus pharyngis
Cell type of laryngeal carcinoma
Squamous cell carcinoma
Features of laryngeal carcinoma
Hoarse voice
Airway obstruction
Hemoptysis
What is a thyroglossal cyst
Develops from thyroglossal ducts which usually disappear on development
Mid-line swelling
Above upper border of thyroid cartilage
Moves on swallowing and tongue protrusion
Causes of nasal obstruction
Rhinitis Septal deviation Nasal polyps Foreign body Sinonasal malignancy
What are nasal polyps
Oedematous paranasal sinus mucosa protruding through sinus ostia.
Single or multiple
Temporary improvement with steroids
Surgical removal
Causes of anosmia
URTI Nasal polyps Sinonasal disease Old age Drug tx Head injury / trauma
What is sinusitis + causative organisms
Infection of a sinus causing facial pain
Strep pneumonia
H. Influenzae
Infection from dental abscess
Types of sinus tumour
Squamous cell
Adenocarcinoma in furniture of workers
Maxillary and ethmoid most commonly
Most common site of epistaxis
Littles area
Management of anterior nose bleed
Pressure on anterior septum
+/- adrenaline application
What is a common cause of nosebleeds in older patients
Arteriosclerotic vessel further back
Use balloon compression or packing
What is otorrhoea
Ear discharge
Usually from infection of outer or middle ear
What is otitis externa + how do you tx it
Inflammation of skin of ear canal
Bacterial, viral or fungal
Tx = remove debris, regular cleansing + antibiotic ear drops
Define cholesteatoma
Keratinising squamous epithelium of middle ear
Tympanic membrane defect containing white material - can erode local structures.
Surgery to remove the sac.
Causes of perforated tympanic membrane
Trauma
Chronic middle ear disease
Symptoms of perforated tympanic membrane
Decreased hearing
Whistling sound
What is otitis media + common organisms
Bacterial infection of middle ear
H. Influenzae
Strep pneumoniae
Symptoms of otitis media
Otalgia
Fever
Malaise
What is OME (glue ear)
Fluid in middle ear
Common in children
Syx = hearing loss, interference of language acquisition
What is Otosclerosis
Stapes becomes fixed by new bone formation
F>M
Surgical tx
Features of vocal cord nodule
Bilateral
Free edge of vocal cord
Prevents full closure
Breathy harsh voice
What is Reinke’s oedema
Oedema of the vocal cord
Caused by irritation
Causes = Smoking, voice abuse, acid reflux, hypothyroidism
Risk factors for larangeal carcinoma
SMOKING Excess alcohol Male Low socio-economic status >55 yo
Symptoms of laryngeal carcinoma
Hoarseness / voice change Neck lump Sore throat Persistent cough Stridor Halitosis Otalgia
Common organisms of tonsillitis
Bacterial - beta-haemolytic streptococcus
Viral - adeno, rhino, flu, resp syncytial virus
Symptoms of tonsillitis
Fever Sore throat Dysphagia Lymphadenopathy Malaise
Symptoms of glandular fever
Sore throat Fever Fatigue Weight loss Malaise Vomiting Petechiae Decreased appetite
Signs of glandular fever
Fever Lymphadenopathy Splenomegally Hepatitis Haemolysis
Define Trismus
Inability to normally open the mouth
Define quinsy
Collection of pus outside of the capsule of the tonsil.
Pushes the uvula across
Needs urgent ENT referral
Indications for tonsillectomy
Suspected malignancy
OSA due to tonsilar hypertrophy
Recurrent tonsillitis (5/yr for 2yrs)
Quinsy + recurrent tonsillitis
What are adenoids
Lymphoid tissue in the nasopharynx of children.
Increase in size until 4 then disappear in adulthood.
Cell types of tonsil tumours
Younger pts - lymphoma (smooth)
Older pts - squamous cell ca. (Ulcerated)
What is a pharyngeal pouch
Mucosal herniation through the pharyngeal musculature because cricopharyngeus doesn’t relax.
Dysphagia for solids + regurgitation
What causes Ménière’s disease
Distension of the membranous labyrinth by accumulation of endolymph
What is benign paroxysmal positional vertigo
Secondary to degeneration of utricular neuroepithelium in semicircular canals.
Spontaneous or after head injury.
Free floating material affects endolymph flow
Symptoms of benign paroxysmal positional vertigo
Attacks of vertigo - precipitated by head movement
Management of benign paroxysmal positional vertigo
Steady resolution over weeks
Most cases can be treated by - Epley manouvre
What drugs can cause ototoxicity
Gentamicin
Streptomycin
Quinine
High dose aspirin
What is Ramsay hunt syndrome and what are its symptoms
Herpes zoster infection of the geniculate ganglion
Affects facial nerve and vestibulocochlear nerve
Facial muscle paralysis
Herpetic eruption on ear canal (shingles)
+/- tinnitus, hearing loss, vertigo
What is labyrinthitis and what causes it
AKA vestibular neuronitis
Most common cause of vertigo
Sudden severe vertigo, vomiting and ataxia
No tinnitus, no hearing loss
May be viral in origin
Management of labyrinthitis
Antiemetics - often prochlorperazine
Syx settle over few days
Symptoms of vestibular neuronitis
unsteadiness,
nausea and vomiting.
Feels like room is rotating.
Moving the head aggravates symptoms.
Examination findings in vestibular neuronitis
Spontaneous, unidirectional, horizontal nystagmus
fast direction towards the healthy ear.
On walking / in Romberg’s test, the patient tends to fall towards the affected side.
Management of vestibular neuronitis
antiemetic
prochlorperazine (vestibular suppressant) may be useful short term.
Promethazine and domperidone may be useful.
3 days steroids
Early activity encouraged - promote vestibular compensation.
What is an acoustic neuroma
tumour of the vestibulocochlear nerve
Schwannoma
benign and slow growing
symptoms due to mass effect
Risk factors for acoustic neuroma
Neurofibromatosis.
High-dose ionising radiation to head and neck
Presentation of acoustic neuroma
unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise.
Unilateral tinnitus.
Impaired facial sensation.
Balance problems without other explanation.
What is a quinsy
Collection of pus outside the capsule of the tonsil
Deviates the uvula
Needs urgent ENT referal
What is trismus
Inability to normally open mouth
Symptoms of tonsillitis
Fever Sore throat Dysphagia Lymphadenopathy Malaise
Common organisms of tonsillitis
Viruses - adeno / rhino / influenza / resp syncytial
Bacterial - beta-haemolytic / streptococcus
Symptoms of layngeal cancer
Hoarseness Voice change Neck lump Odynophagia Persistent cough Stridor Halitosis Otalgia
Risk factors for laryngeal carcinoma
**Smoking** Excess alcohol Male Low socio-economic status >55yo
What is reinke’s oedema
Oedema of the vocal cord
Treatment of epistaxis from littles area
Apply pressure to lower nose
Lean head forward
What makes sinusitis pain worse
Bending
Coughing
What is swimmers ear
Acute otitis externa
