ENT Flashcards
Otitis externa management?
Consider cleaning
Analgesia (paracetamol + ibuprofen)
Consider TOPICAL antibiotic + steroid
If perforated ear drum = quinolone
Who to admit for acute otitis media?
< 3 months and fever > 38C
Patients with acute complications
Treatment for acute otitis media (without effusion)
Treat pain and fever
Paracetamol
OR
NSAID
When to prescribe antibiotic for otitis media (without effusion)
Symptoms > 4 days (and not improving)
Systemically unwell
High risk of complications
Management of acute otitis media with effusion?
Active observation (6-12 weeks) No antibiotics
(children with Down’s syndrome or cleft palate - immediate ENT referral)
Diagnosing chronic suppurative otitis media
- Painless ear examination with perforated tympanic membrane
- Ear discharge > 2 weeks without pain/fever
- History of:
Acute otitis media
OME/Grommets
Ear trauma
Cholesteatoma - when to arrange ROUTINE ENT referral?
Characteristic cholesteatoma
OR
Persistent occlusion of external auditory canal with purulent discharge
Cholesteatoma - when to arrange EMERGENCY ENT referral?
Facial nerve palsy Neuro symptoms (indicative of intracranial abscess or meningitis)
Allergic rhinitis - as required treatment?
Intranasal azelastine
Oral antihistamine (cetirizine or loratidine) IF: Conjuncitivitis present Children aged 2 - 5 Or they prefer oral treatment
Test for BPPV?
Dix- Hallpike manoeuvre
Treat BPPV?
Epley manoeuvre
Home treatment for BPPV?
Brandt-Daroff exercises
When to remove earwax?
When canal is full and anyone of: Hearing loss Earache Tinnitus Vertigo Cough thought to be due to wax
Meniere’s disease characteristics?
Tinnitus Vertigo Intermittent hearing loss Aural fullness Attacks last minutes to hours (2-3hrs)
Drug to prevent recurrent attacks in Meniere’s?
Betahistine
Acute sinusitis summary?
98% people have a virus - 2.5 weeks self limiting Paracetamol/Ibuprofen Nasal decongestant Saline nasal irrigation Fluids
Subjective and objective tinnitus?
Is it heard through stethoscope - if yes, objective +vice versa
Causes of unilateral subjective tinnitus
Acoustic neuroma
Meniere’s disease
Causes of bilateral subjective tinnitus
Noise-induced hearing loss
Age related hearing loss
Drug induced ototoxicity
Vestibular neuronitis and labrynthitis patient?
Young, middle aged, previously well adults
Features of vestibular neuronitis and labrynthitis?
Vertigo - occurs spontaneously
Nausea and vomiting
Nystagmus
NB Hearing loss (and tinnitus) is associated with labrynthitis
Treatment for vestibular neuronitis?
Usually settles, but if vomiting and nausea a problem:
Prochlorperazine
- buccal or deep IM if needed to rapidly alleviate
OR
- 3 days then PRN
Acute necrotizing ulcerative gingivitis treatment?
Metronidazole
Paracetamol/ibuprofen
Chlorhexidine mouthwash
See dentist urgently
Acoustic neuroma nerve impacts?
CNVIII - hearing loss, tinnitus, vertigo
CNVII - facial palsy
CNV- absent corneal reflex
