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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
Q

What test can help differentiate between causes of altered pressure in the middle ear? Types of pattern and explanation.

A

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
Q

Differentiate effusion from perforation on tympanometry with type b pattern

A

Look at canal volume by graph. Increased in perforation as counting middle ear as well.

27
Q

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?

A

Otosclerosis

Pink tympanic membrane

28
Q

What is the characteristic diagnostic finding in otosclerosis?

A

Pure tone audiogram showing conductive loss with a characteristic notch at 2000hz where bone decreases in acuity and air increases

29
Q

Treatment of otosclerosis

A

Hearing aid or stapedectomy

30
Q

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?

A

Tretcher collins
Causes absent or small ear with malformed ossicles
Dominant or recessive depending on mutation

31
Q

How could you test a newborns hearing? What about a 7 month old? A 3 year old?

A

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
Q

A patient presents with sudden sensioneural hearing loss to a gp what should they do?

A

Refer! This is an emergency

33
Q

Prognosis of sudden sensioneural hearing loss?

A

1/3 recover
1/3 some recovery
1/3 no recovery

34
Q

Causes of sensioneural hearing loss?

A 
Idiopathic
Ototoxic drugs
Acoustic neuroma
Presbyacusis
Post infective
Meniere's
35
Q

Someone presents with tinnitus and sensioneural hearing loss for several weeks What test should be done to rule out a serious illness?

A

Mri to check for acoustic neuroma

36
Q

Is an acoustic neuroma usually benign or malignant? Ddx?

A

Benign

Meningioma

37
Q

What is presbyacusis? Characteristic pattern?

A

Age related sensorineural hearing loss from environmental noise toxicity
Loss of high frequency sounds

38
Q

Infections that can cause sensorineural hearing loss

A 
Meningitis
Measles
Mumps
Flu
Hsv
Syphallis
39
Q

Causes of central vertigo?

A 
Stroke
Migraine
Ms
Neoplasia 
Drugs
40
Q

Hints that vertigo may be central

A 
No peripheral signs
Asymmetric cerebellar signs
Cn lesions
Vertical nystagmus
Headache
Nystagmus different in each eye.
41
Q

Causes of peripheral vertigo?

A

Bppv
Menieres
Vestibular neuronitis / labrynthitis

42
Q

Presentation of menieres

A 
Episodic vertigo for hours
Tinnitus
Fluctuating sensorineural hearing loss becoming perminent
Aural fullness
Nausea and vomiting
43
Q

How can menieres progress?

A

Hearing loss becomes permanent
Can become unbalanced between attacks as system burns itself out concominately reducing acute vertigo
Can become bilateral

44
Q

Long term treatment of menieres disease

A

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
Q

Differentiate vestibular neuronitis from labrynthitis

A

Labrynthitis has hearing loss as well as vertigo

46
Q

Presentation of vestibular neuronitis and labrythitis

A

Sudden debilitating vertigo and n+v
Hearing loss in labrythitis
Often follows urti

47
Q

How should labrythitis and vestibular neuronitis progress?

A

Start to improve after 3-7 days
Residual balance issues after vertigo passed for several weeks
20% long term balance issues

48
Q

Treatment of labrythitis or vestibular neuronitis?

A

Betahistine

If long term balance problems use exercises

49
Q

Things to exclude in tinnitus

A 
Hearing loss
Systemic illness
Drugs
Psychological
Acustic neuroma
50
Q

Drugs that cause tinnitus

A

Aspirin
Furosomide
Aminoglycosides
Etoh

51
Q

Systemic problems that cause tinnitus and charateristic presentation

A

Pulsetyle tinnitus

Htn, anaemia, chf, thyroid (all increase output)

52
Q

Generic tx of tinnitus

A

Group therapy
Music
Consider melatonin if sleep disturbance
Consider intratympanic dexamethasone

FPE (11 decks)

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