ENT Flashcards
Name 3 predisposing factors for perichondritis of the pinna
Acute otitis externa, piercing, haematoma
What bacterium is usually associated with perichonidritis of the pinna?
Staph aureus, pseudomonas aeruginosa
How do you treat otitis externa?
Topical ear drops (antibiotic + steroid) plus analgesia
What type of hearing loss is associated with chronic wax build up?
Conductive
Name 3 functions of ear wax
Waterproofing, assists cleaning, some pretections against insects/bacteria/fungi
Name the ossicles (lateral-> medial)
Malleus, incus, stapes
Who is usually affected by acute otitis media with effusion? How common?
Aged 2 and 5 yrs
15-40% point prevalence from infancy 5
What does acute otitis media with effusion look like otoscopically? Treatment?
Tympanic membrane dull/opaque, fluid bubbles may be seen behind it
Usually settles without intervention
Otherwise: antibiotics, steroids, decongestants, autoinflation, gromits
What is a cholesteatoma?
Squamous epithelium trapped in skull base, that can erode or destroy important structures within the temporal bone
Usually affects attic area
How does a cholesteatoma present?
Intermittent painless offensive othorhea, conductive hearing loss, dizziness
Treatment of cholesteatoma + risks
Surgery
Labyrinthine fistula, brain herniation, bleeding
Severe complications of chronic cholesteatoma
Sigmoid sinus thrombosis, epidural abscess, meningitis, long term vertigo
Give 2 ways perforation of the tympanic membrane presents
Audible whistling sounds during sneezing, otorrhea. If painful: cholestaetoma or infection
What surgery is used to treat a perforated tympanic membrane?
Fat plug tympanoplasty
What is tinnitus?
Perception of sound without stimulus
What is vertigo?
Sensation that the world is spinning.whirling
Give three ways in which an acoustic neuroma may present to an ENT surgeon
Facial nerve palsy, hearing loss, tinnitus, balance disturbance
What is the gold standard investigation for an acoustic neuroma?
Gadolinium enhanced MRI
What is Meniere’s?
Triad of symptoms
Vertigo, hearing loss, tinnitus
What is BPPV? Treatment?
Benign paroxysmal positional vertigo
Caused by a grain of calcium dislodged in the semicircular canal
Vertigo when they turn to a specific side in bed
Epley manoeuvre
What is an exostosis?
Bony outgrowths into the ear canal (eg surfer’s ear)
What should you worry about with excessive ear pain ?
Malignant otitis externa
Necrotic bony infection, seen in the immunocompromised
Treatment of labrinthitis
Exercise helps
Antiemetics only acute treatment
Why do the elderly present with dizziness?
Visual loss, poor muscle tone, vestibular degeneration, brain ischaemic changes, benzodiazepines. Give them exercise!
What is Ramsay Hunt syndrome?
Herpes zoster infection
Rash in ear canal or back of mouth
Dizzy/deaf
Early acyclovir
Between what frequencies is a pure tone audiogram commonly measured?
0-25db
What do circles and triangles mean on an audiogram?
Circles: air conduction
Triangles: bone conduction
Masked bone conduction is represented how on an audiogram?
Filled in shapes
Name 3 investigative hearing tests
Pure tone audiogram
Speech audiometry
Acoustic reflex testing
What is the major cause of hearing loss in adults? What type of loss?
Age related hearing loss
Sloping loss of upper frequencies
5 categories of hearing ability
Normal, mild, moderate, severe, profound
Which side should an unmasked bone conduction test be on?
Doesn’t matter
Skull is a fused bone so sound travels to both ears
What 3 things does a tympanogram measure?
Compliance of ear drum
Volume of ear canal
Middle ear pressure
4 causes of tinnitus?
Meniere’s
Damage to the inner canal
Otosclerosis
Salicylate poisoning
How do you test the hearing of an newborn and 18 months old?
Otoacoustic emissions at birth
Auditory brainstem response
4 roles of the nose
Humidify, warm and filter air
Primary immune response (lysozyme/adenoid tonsils)
Taste and smell
To breathe
Name the 4 paranasal sinuses
Frontal
Ethmoid
Maxillary
Sphenoid
Name the type of mucosa found in the paranasal sinuses
Ciliated pseudostratified columnar epithelium
How can you determine nasal air flow?
Metal tongue depressor under nose, breathe normally, comment on misting
Where do nose bleeds usually come from?
Little’s area
Name 3 techniques for the management of epistaxis
Cauterisation (silver nitrate/diathermy/laser)
Pressure on tip of nose
Packing (nasal tampon/gauze)
Endoscopic SPA ligation
Name the arteries that meet in Little’s area
Sphenopalatine artery
Posterior and anterior ethmoidal arteries
Greater palatine
Superior labial artery
What is loss of sense of small called?
Anosmia
4 common causes of anosmia
Polyps
Trauma
Cocaine abuse
Old age
Unilateral foul nasal discharge in a child..
Is a foreign body until proved otherwise
Unilateral nasal discharge in an adult..
Foreign body, rhinolith, tumour
4 common aero-allergens associated with allergic rhinitis
Pollen, fungal spores, dog and cat fur, house dust mites
Treatment of allergic rhinitis
Avoidance of allergen
Antihistamines
Nasal douches
What is SMR?
Submucous resection of the septum
SMR vs septoplasty
SMR: older technique. Preserves bilateral mucoperichondrial flaps and cartilaginous supports.
Septoplasty: correction of the deflected nasal septum, minimal removal of septal cartilage and/or bone
SMD?
Submucous diathermy of turbinates
What is a nasal polyp? Treatment?
Swelling of the lining of the nose, due to allergic inflammation. They contain inflammatory fluid and are non sensate.
Nasal steroid spray
Unilateral nasal polyps are significant because..
Could be a tumour or foreign body
What is the triad that includes nasal polyps?
Rhinosinusitis, bronchial asthma and nasal polyps
What is the most common cause of obstructive sleep apnoea syndrome (OSAS) in children vs adults?
Children: Enlarged adenoids and tonsils
Adults: Obesity
How do you investigate obstructive sleep apnoea? Treatment?
Polysomnography
Nasal CPAP at night for children. Lose weight and don’t sleep on front in adults
Most common infective agent for epiglottitis?
Haemophilus influenza B (HiB)
Rare now due to HiB vaccine
Croup/laryngotracheal bronchitis infective agents
Parainfluenza 1/2/3
Adenovirus
Respiratory syncytial virus
Treatment of epiglottitis?
Humidified oxygen, being ready to intubate or perform cricothyroidotomy if needed
Treatment of larynotracheal bronchitis
Corticosteroids and nebulised adrenaline, oxygenation and monitoring
Most common infective agent for tonsilitis
Group B haemolytic streptococcus pyogenes
How many episodes of tonsilitis is needed to warrant tonsilectomy?
7/1 year
5/2 consecutive years
3/ 3 consecutive years
What is quinsy? Treatment?
Peritonsillar abscess
Aspiration, incision and drainage
Antibiotics
Cause of glandular fever? Presentation?
EBV (epstein barr virus)
Lymphadenopathy, sore throat, pharyngitis, palatal petechiae, fungal looking tonsilitis
Where are the adenoids?
Above soft palate
Posterior wall of nasopharynx
What is stertor?
Noisy inspiration due to obstruction above the larynx
What is stridor?
Noise from obstruction at level of larynx
Can be inspiratory, expiratory & biphasic
3 signs associated with acute mastoiditis
Mastoid area erythema, proptosis of auricle, fever
4 aetiological agents in head and neck cancer
Sun damage
Smoking
Alcohol
Betul chewing
What type of carcinoma is most common in head and neck malignancy?
SCC
Earliest sign of a laryngeal malignancy
Hoarse voice
Worrying clinical signs/symptoms in head and neck malignancy
Difficulty swallowing
Hoarse voice
Chronic mouth ulcer
3 indications for a tracheostomy
Emergency airway management
ITU longterm ventilation
Mass in larynx
Common types of tracheostomy tubes
Non fenestrated single cannula tube with cuff: acute. Dual cannula tube with cuff for chronic. Made of polyurethane/PVC
Where does the parotid gland open?
Inner surface of cheek, opposite second molar
Most common type of tumour affects the parotid gland
Pleomorphic adenoma
Complications of a parotidectomy
Facial nerve palsy
Salivary fistula
What nerves are at risk in a submandibulectomy
Hypoglossal, lingual, ansa cervicalis
8 differentials of a neck lump
Enlarged lymph node, cyst, tumour, lymphoma, lipoma, thyroid swelling, aneurysm, abscess
Gold standard for investigation of a neck lump
Ultrasound guided fine needle aspiration with cytology
Describe the external auditory canal
2.5cm long
Outer 1/3 hairy, cartilage, secreted wax, non migratory
Inner 2/3 migratory skin, bone, thin sensitive skin
How do you know which ear you are looking at?
The umbo is the foot, the lateral malleolar process is the knee of a man on a horse
2 parts of tympanic membrane
Pars tensa, pars flaccida
Name the 3 parts of the cochlear
Vestibular canal
Cochlear duct
Tympanic canal
What senses sound?
Hair cell displacement-> cochlear neurones/ganglia = organ of corti
Tonotropic arrangement in cochlear
How do you differentiate between conductive/sensorineural hearing loss with tuning forks
Rinne test: mastoid and outside. Conductive hearing loss, bone conduction will be heard better.
Weber test: Sensorineural, sounds is perceived in good ear. In conductive hearing loss sound will be perceived in the affected ear. (primed for sensation)
Whats the vestibule?
Saccule and utricle
Balance organs
Function of semicircular canal
Detects angular acceleration in 3 different planes
Function of labyrinth
Sense of position in space and change in position
Helps maintain gaze (gyroscopic stabilisation of vision)
What is oscilopsia?
The world moves as I walk
Like video camera footage
What forms the nasal septum?
Ethmoid Nasal bone Septal cartilage Maxilla Palatine bone Vomer
What can nasal sinusitis lead to in children
Periorbital cellulitis-> vision affected/ brain abscess
What is found in the sphenoid sinus?
Internal carotid artery
Optic nerve
Cavernous sinus
CN II, IV, VI
Sinus functions
Vocal resonance
Decreased skull weight
Crumple zone to protect other structures
Name 2 ways of examining nose
Nasendoscope
Thudicum speculum
Name palpable neck anatomy
Hyoid bone
Thyroid cartilage
Cricoid cartilage
Trachea
Where do you palpate lymph nodes
Cervical chain Occipital Posterior auricular Parotid Submandibular Posterior triangle Supraclavicular
Time frame for neck lump/voice change/dysphagia
4-6 weeks-> 2 week wait referral
Describe the ladder of reconstruction
- Secondary healing (secondary intention, esp scalp and floor of mouth)
- Direct closure (crescent shape and suture)
- Skin graft (using planer, from thigh)
- Obturation and implants (eg for hard palate, must occlude hole)
- Local flaps
- Pedicled flaps (artery, vein and tissue supplied)
- Free flaps (esp bone from fibula)
Biggest risk factor for oral cancer
HPV
Branches of facial nerve
Temporal Zygomatic Buccal Mandibular Cervical (posterior auricular)
What is the problem with a total thyroidectomy
Gets rid of parathyroid glands too Hypocalcaemia Spasms, twitching Cardiac arrest Bone weakness later
How do you tell that hearing loss of sensorineural on audiometry?
Same hearing loss with bone conduction as with air conduction
Name the branches of the external carotid
Some anatomists like freaking out poor medical students Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
Give 3 causes of saddle nose deformity
Cauterisation of both sides of septum
Cocaine abuse
Granulomatous disease (wagner’s)
Trauma
