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FPE > ENT > Flashcards

ENT Flashcards

1
Q

What nerves supply the external ear?

A

Upper lat - cn v3 auriculotemporal branch
Upper med - c2/c3 lesser occipital
Lower lat and med - c3 greater auricular
External auditory meatus - cn x auricular branch -

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2
Q

What is the complication and management of an external ear haemotoma?

A

Avascular cartilage necrosis leading to cauliflower ear. Drain any haemotoma and apply pressure dressing to prevent reaccumulation.

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3
Q

Advice and treatment in tympanic membrane perforation

A

Avoid swimming, keep clean, pain relief

Usually heals itself, if persisting >6 months can surgically fix (myringoplasty)

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4
Q

Causes of tympanic membrane perforation

A

Trauma (direct or indirect)

Otitis media

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5
Q

Symptoms of tympanic membrane perforation

A

Pain

Possible conductive deafness

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6
Q

What is haemotympanum associated with?

A

Temporal bone fracture

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7
Q

Presentation of otitis externa

A

Painful discharging ear, hearing may be muffled, may itch

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8
Q

Management of otitis externa including measures if it persists through initial measures

A

Topical abx
If fails swab and treat appropriately (bacteria vs fungal)
Wick can hold canal open and facilitate abx delivery

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9
Q

What external ear pathology can be a serious complication in diabetics? What is it? Presentation? Mortality? Tx?

A

Malignant otitis externa usually caused by p.aerogenosa, invades local tissues. Persisting pain and discharge in spite of tx, cn palsies esp. VII. Mortality 10%. Tx IV ABX as well as topical.

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10
Q

What types of infection tend to cause otitis externa and media? Why the difference?

A

Externa - skin commensals (its continuous with similar epithelium)
Media - s.pneumoniae, h.influenza (connects to pharynx and covered in pseudostratifed columnar epithelium)

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11
Q

Presentation of acute otitis media

A

Ear pain due to pressure then rupture causing relief of pain then discharge.
Fever

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12
Q

Tx of acute otitis media

A

Conservative with analgesia
Oral abx if persistent or severe
Grommet if recurrent

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13
Q

How can chronic otitis media be subdivided? (4 catagories). What are they?

A

Active squamous - discharging cholesteatoma
Inactive squamous - retraction pocket
Active mucosal - chronic discharge through perforation
Inactive mucosal - perforation but no active discharge

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14
Q

What is the suspected pathology behind active squamous chronic otitis media?

A

Introduction of keratinised squamous cells through perforation or retraction pocket

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15
Q

Management of active squamous chronic otits media

A

Surgical clearance often including mastoidectomy

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16
Q

Treatment of chronic otitis media without cholesteatoma

A

Topical antibiotics, aural toilet

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17
Q

What is otitis media with effusion?

A

Conductive hearing loss
Effusion in middle ear - seen on otoscopy
Overlying otitis media infection causing pain

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18
Q

Complication of otitis media with effusion in kids

A

Chronic hearing loss resulting in speech delays and problems at school.

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19
Q

What to look for in unilateral otitis media with effusion in adult

A

Nasal tumour blocking eustacan tube

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20
Q

Treatment of otitis media with effusion

A

Most cases settle spontaneously in 3 months
Hearing aid
Surgery - grommets +/- adenoidectomy

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21
Q

Patient presents with an exuisitily painful nodule on the ear. Its is small and ulcerated. Likely dx and tx?

A

Chondrodermatitis nodularis helicis

Avoid pressure on ear (sleep other side, use a protector ring). In some cases surgically excise.

22
Q

Treatment for impacted ear wax

A

Olive oil/sodium bicarbonate
Syringing
Microsuction
Aural toilet (excision with a hoop)

23
Q

Interpret weber and rinne tests

A

Weber - forhead. Localises to effected side means conductive. Localises to opposite side means sensorineural
Rinne - positive (air>bone) on effected side means sensorineural or normal. negative (bone>air) on effected side means conductive

24
Q

What is a pure tone audiogram. What would conductive and sensorineural hearing loss look like?

A

Frequency (x) vs decibels (y) in a soundproof booth. If bone heard better than air at all frequencies suggests conductive hearing loss. If both air and bone decrease as frequency increases suggests sensorineural hearing loss

25
What test can help differentiate between causes of altered pressure in the middle ear? Types of pattern and explanation.
Tympanometry - blocks eam and applies pressure to drum. Compliance of membrane peaks when pressure is equal to inner ear pressure. Type a - peaks at 0. Normal Type b - flat line. Suggests raised pressure or floppy membrane such as effusion or perforation Type c - peak below 0. Suggests eustachian tube blockage with low middle ear pressure.
26
Differentiate effusion from perforation on tympanometry with type b pattern
Look at canal volume by graph. Increased in perforation as counting middle ear as well.
27
A patient presents with progressive conductive hearing loss eith tinnitus. His father and grandfather also suffered with hearing loss at a young age. What is the likely dx? What is a rare 10% but specific sign?
Otosclerosis | Pink tympanic membrane
28
What is the characteristic diagnostic finding in otosclerosis?
Pure tone audiogram showing conductive loss with a characteristic notch at 2000hz where bone decreases in acuity and air increases
29
Treatment of otosclerosis
Hearing aid or stapedectomy
30
What syndrome causes conductive hearing loss in association with small jaw, underdeveloped cheeks, down sloping eyes and cleft palate? How does it effect hearing? How is it inherited?
Tretcher collins Causes absent or small ear with malformed ossicles Dominant or recessive depending on mutation
31
How could you test a newborns hearing? What about a 7 month old? A 3 year old?
Newborn - otoacoustic emissions test detecting cochlear movement in response to sound. If defective test brainstem response to sound with an electrode. 7 month - distraction testing (will they turn to a rattle out of sight) 3 years - speech discrimination (will they point to a tree or a key when tree is spoken?)
32
A patient presents with sudden sensioneural hearing loss to a gp what should they do?
Refer! This is an emergency
33
Prognosis of sudden sensioneural hearing loss?
1/3 recover 1/3 some recovery 1/3 no recovery
34
Causes of sensioneural hearing loss?
``` Idiopathic Ototoxic drugs Acoustic neuroma Presbyacusis Post infective Meniere's ```
35
Someone presents with tinnitus and sensioneural hearing loss for several weeks What test should be done to rule out a serious illness?
Mri to check for acoustic neuroma
36
Is an acoustic neuroma usually benign or malignant? Ddx?
Benign | Meningioma
37
What is presbyacusis? Characteristic pattern?
Age related sensorineural hearing loss from environmental noise toxicity Loss of high frequency sounds
38
Infections that can cause sensorineural hearing loss
``` Meningitis Measles Mumps Flu Hsv Syphallis ```
39
Causes of central vertigo?
``` Stroke Migraine Ms Neoplasia Drugs ```
40
Hints that vertigo may be central
``` No peripheral signs Asymmetric cerebellar signs Cn lesions Vertical nystagmus Headache Nystagmus different in each eye. ```
41
Causes of peripheral vertigo?
Bppv Menieres Vestibular neuronitis / labrynthitis
42
Presentation of menieres
``` Episodic vertigo for hours Tinnitus Fluctuating sensorineural hearing loss becoming perminent Aural fullness Nausea and vomiting ```
43
How can menieres progress?
Hearing loss becomes permanent Can become unbalanced between attacks as system burns itself out concominately reducing acute vertigo Can become bilateral
44
Long term treatment of menieres disease
Decrease salt alcohol and caffeine Betahistine (dilates system lowering pressure) Thiazide diuretic (decreases fluid lowering pressure) Surgical dexamethasone injection Surgical decompression Surgical destruction with gentamycin injection or labynthectomy
45
Differentiate vestibular neuronitis from labrynthitis
Labrynthitis has hearing loss as well as vertigo
46
Presentation of vestibular neuronitis and labrythitis
Sudden debilitating vertigo and n+v Hearing loss in labrythitis Often follows urti
47
How should labrythitis and vestibular neuronitis progress?
Start to improve after 3-7 days Residual balance issues after vertigo passed for several weeks 20% long term balance issues
48
Treatment of labrythitis or vestibular neuronitis?
Betahistine | If long term balance problems use exercises
49
Things to exclude in tinnitus
``` Hearing loss Systemic illness Drugs Psychological Acustic neuroma ```
50
Drugs that cause tinnitus
Aspirin Furosomide Aminoglycosides Etoh
51
Systemic problems that cause tinnitus and charateristic presentation
Pulsetyle tinnitus Htn, anaemia, chf, thyroid (all increase output)
52
Generic tx of tinnitus
Group therapy Music Consider melatonin if sleep disturbance Consider intratympanic dexamethasone

FPE (11 decks)

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