ENT Flashcards
Summarise the epidemiology of epiglottitis
Classically: 2-4y However, HiB vaccination means it is presenting more often in adults
(NICE)
Define epiglottitis
Rapidly progressive cellulitis of the epiglottis, usually due to infection with haemophilus influenza B (HiB)
In adults, it is called supraglottitis
Summarise the prognosis for patients with epiglottitis
Mortality: adults <3%, children <1%
(UpToDate)
Recognise the presenting symptoms of epiglottitis
Fever, hoarse ‘hot potato’ voice, inspiratory stridor, toxic, drooling, tripod position, painful swallowing
Identify the possible complications of epiglottitis
- Upper airway obstruction
- Epiglottic abscess
- Necrotizing epiglottis
- Secondary infection
- Death
(UpToDate)
Generate a management plan for epiglottitis in the community
If ? epiglottitis in GP, call 999 immediately. Important not to upset child as there is risk of upper airway obstruction so do not examine throat, only ‘waft’ O2 at them
Generate a management plan for epiglottitis in A&E
- Medical (ABCDE):
- Call for help: anaethetic, ITU, ENT
- A: intubation may be necessary (anaesthetist ideally, with surgeon ready for surgical airway)
- IV antibiotics (3rd gen cef)
- Nebulized adrenaline (1:1000): under consultant guidance
- PO steroids (dexamethasone /6h)
- Analgesia
(BMJ)
Summarise the indications for a tracheostomy
1) emergency: to secure a definitive airway in upper airway obstruction
2) elective: to wean a pt off ventilation
Identify the possible complications of a tracheostomy
- Acute
- Obstruction: by the membranous posterior trachea wall
- Subcutaneous emphysema
- Pneumothorax
- Chronic
- Tracheal stenosis
- Tracheoarterial fistula
- Loss of phonation
(UpToDate)
Epistaxis: 90% of cases involve bleeding from what area? What is the vascular supply?
Little’s area (aka Kiesselbach’s triangle, anterioinferior nasal septum)
- Anterior ethmoidal artery
- Sphenopalatine artery
- Greater palatine artery
Epistaxis: management
In commmunity
- Head forward, external compression, spit out blood
- Call 999 after 10 mins if old/anticoagulated. 25 mins if young/well
In A&E
- Packing (provides internal pressure to tamponade bleed). Either
- Merocel (nasal tampon) - lubricate before
- Rapid Rhino - can be deflated so removed with less trauma. Keep in for 24-72h (no longer as risk toxic shock syndrome and pressure necrosis of nasal folds)
- If bleeding stops on pressure:
- identify bleeding point (using thudicum)
- cauterize - silver nitrate (LA + adrenaline before)
- If bleeding does no stop on pressure:
- surgery: shenopalatine artery (SPA) ligation
Epistaxis: causes
Common:
- Trauma
- Infection
- Anticoagulation
DDx:
- Angiofibroma
- Nasopharyngeal carcinoma (>50y)
- Leukaemia (<2y, acute lymphoblastic)
- Hereditary haemorrhagic telangiectasia
Epistaxis: red flags
- Age <2y or >50y
- Nasal obstruction
- Facial pain
- Hearing loss
- Proptosis
- Diplopia
- Lymphadenopathy
- Wt loss
What are the complications of a surgical mastoidectomy?
- Conductive hearing loss
- Meningitis
- Venous sinus thrombosis
- Cerebral abscess
What test on examination idetifies benign positional paroxysmal vertigo?
Dix-Hallpike test (O/E): hyperextend neck and then move to side. Look in eye for nystagmus. +ve in BPPV
Recognise the presenting symptoms of Meniere’s disease
Triad:
hearing loss / tinnitus
vertigo
sensation of fullness in the ear
Episodic, usually unilateral
Generate a management plan for Meniere’s disease
- Conservative: low salt diet
- Medical:
- Diuretics
- Intratympanic gentamicin (kills ear, so only used after severe hearing loss to stop vertigo)
- Surgical
- Decompression of semicircular canals
Identify the possible complications of Meniere’s disease
Profound hearing loss
Falls
Summarise the prognosis for patients with Meniere’s disease
Slowly progressive, but with periods of remission
Summarise the epidemiology of acoustic neuroma
1 / 100 000 incidence
3:2 F:M
Define acoustic neuroma
benign, slow growing tumour extending from the vestibulocochlear nerve, extending into the cerebellopontine angle
aka. vestibular schwannoma
* (BMJ)*
Recognise the presenting symptoms of acoustic neuroma
Asymmetrical hearing loss (tinnitus, difficulty localising sounds)
Facial numbness
Progressive episodes of dizziness
(BMJ)
Identify the possible complications of acoustic neuroma
Compression:
Facial nerve palsy
Brainstem –> blown pupil (III CN compression) –> death
Surgical: infection, stroke, VII CN damage
What are the indications for tonsillectomy?
Indications for tonsillectomy:
- meets all of these criteria
- sore throats are due to tonsillitis
- 5+ episodes of sore throat /y
- sx occuring for at least 1y
- episodes of sore throat are disabling (prevent normal functioning)
- recurrent febrile convulsions secondary to tonsillitis
- obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
- peritonsilar abscess (quinsy), if unresponsive to standard tx
(Passmedicine, NICE)
Define cholesteatoma
A cholesteatoma consists of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years.
(passmedicine)
What are the main features of cholesteatoma
Main features
- foul smelling discharge
- hearing loss
Other features are determined by local invasion:
- vertigo
- facial nerve palsy
- cerebellopontine angle syndrome
‘Attic crust’ on otoscopy
(passmedicine)
