ENT Flashcards
What are the bones of the middle ear?
Maleus, incus, stapies
Define otalgia
Ear pain
What is the difference between primary and secondary otalgia
Primary is ear pain with an abnormal looking ear (often infection)
Secondary is ear pain with a normal looking ear (irritation to other nerves - trigeminal, facial, glossopharyngeal, vagus, spinal nerves)
Meniere’s disease
Cochlear issue. Increase in pressure of the
paralymph of the inner ear. Presents with vertigo, nausea, vomiting, hearing loss and tinnitus. If not all the symptoms are present, it is known as atypical menier’s disease
What is a VNG?
videonystagnography, eye test assessing for assessing vestibular system. It is a good test for vertigo. Hallpike test is a part of the screen.
What is Hallpike test?
test for vertigo caused by BPPV, patient is moved suddenly LG from upright seated position to lying position. If positive, nystagmus is seen
Ramsay Hunt Syndrome
Herpes Zoster infection of the 7th cranial nerve (facial)
How can you tell the difference between an UMN and LMN cause of a facial nerve palsy?
UMN is forehead sparing
Causes of stridor
Airway obstruction
Epiglottitis
Croup
Laryngeal carcinoma
List the causes of vertigo (HINT: think IMBALANCE)
Infection - eg: labyrinthitis, Ramsay Hunt (post-shingles)
Menier’s
Benign Paroxysmal Positional Vertigo (BPPV)
Aminoglycosides
Lymph - fistula berween inner and middle ears causing vertigo and sensorineural hearing loss
Arterial - eg: migraine, TIA, CVA
Nerve lesions - eg: acoustic neuroma, vestibular schwannoma
Central lesions - eg: demylination, tumour
Epilepsy
Define: otitis externa
Inflammation and infection of the external auditory canal, usually caused by staph / strep / pseudomonas - treated using topical antibiotics +/- topical steroids
What is malignant otitis externa?
Severe otitis external, usually caused by pseudomonas - associated with diabetes
Can be fatal - high risk of skull osteomyelitis leading to abscesses, meningitis, encephalitis and death
Define: otitis media
Inflammation and infection of the middle ear, usually secondary to an URTI
Name the four classifications of otitis media
(a) Acute otitis media
(b) Otitis media with effusion (glue ear)
(c) Chronic otitis media
(d) Chronic suppurative otitis media
What is “glue ear”
Otitis media with effusion
What causes the following type of discharge?
- Watery
eczema of ear canal, CSF, early otitis externa
What causes the following type of discharge?
- Purulent
acute otitis externa, furnunculosis, otitis media (following ear drum perforation)
What causes the following type of discharge?
- Mucoid
chronic suppurative otitis media with perforation
What causes the following type of discharge?
- Bloody
rauma, acute otitis media, carcinoma
What causes the following type of discharge?
- Foul smelling
cholesteatoma, chronic suppurative otitis media
What is the most common cause of conductive hearing loss in children?
OME - otitis media with effusion
What causes a flat trace tympanogram (usually in children)?
OME - otitis media with effusion
List some ototoxic drugs - do they result in permament or temporary hearing loss
Aminoglycosides (eg: vancomycin, gentamycin) - permanent
Chemotherapy (eg: cisplatin) - permanent
Salicylates (eg: aspirin) - temporary
Quinine - temporary
Loop diuretics (eg: furosemide) - temporary
List some causes of vertigo (HINT: think IMBALANCE)
Infection / Injury Meniere's disease Benign Positional Paroxysmal Vertigo Aminoglycosides Lymph / Labyrinthitis Arterial (eg: migraine, TIA, CVA) Nerve (eg: acoustic neuroma) Central lesion (eg: demyelination --> MS) Epilepsy
List some causes of conductive hearing loss (HINT: think WIDENING)
Wax Infection Drum - perforation Extra ossicles - otosclerosis Neoplasia INjury Granulomatous
List some causes of sensorineural hearing loss (HINT: think DIVINITY)
Developmental / Degenerative Infection Vascular Inflammation Neoplasia Injury Toxins lYmph
What is prebyacussis?
Age-related hearing loss
What is the difference between conductive and sensorineural hearing loss?
Conductive hearing loss = problem with structures of the ear (i.e. between auricle and round window - canal, drum, malleus, incus or stapes)
Sensorineural hearing loss = problem with the inner ear or nervous system (i.e. cochlear, cochlear nerve or brain)
Which tuning fork do you use for Rinne’s and Webber’s testing?
512 Hz
What is Rinne’s testing for?
Air v. bone conduction - i.e. conductive hearing loss
What are normal findings in Rinne’s test?
Air conduction lasts longer / is louder than bone conduction
What Rinne’s test findings are suggestive of conductive hearing loss?
Bone conduction is stronger than air conduction (i.e. noise heard louder with tuning fork placed on mastoid process than in front of external meatus)
What Rinne’s test findings are suggestive of sensorineural hearing loss?
NONE - Rinne’s test is NORMAL with sensorineural hearing loss
What is Webber’s testing for?
Localisation of hearing loss
What are normal findings in Webber’s test?
Sound is heard equally across both ears
What Webber’s test findings are suggestive of conductive hearing loss?
Sound is heard loudest in ABNORMAL ear
What Webber’s test findings are suggestive of sensorineural hearing loss?
Sound is heard loudest in NORMAL ear
If a patient has normal Rinne’s test and Webber’s test louder on the Right - what does that suggest?
Sensorineural hearing loss in LEFT ear
if a patient has abnormal Rinne’s test (on the R) and Webber’s test louder on the Right - what does that suggest?
Conductive hearing loss in the RIGHT ear
List some causes of tympanic membrane perforation?
Trauma
Barotrauma
Foreign body
Otitis media
Outline the management of nasal fractures
1) Stop bleeding, manage pain, ice
2) Do not reduce on first presentation
3) Check for boggy nasal septum - septal haematoma
4) Discharge with outpatient appointment for 1 week
5) MUA within two weeks with nose brace
What is the most serious complication of a nasal fracture? How is it managed?
Septal haematoma - risk of infection, septal necrosis, saddle nose deformity
Must be drained, give antibiotics and packing
What is the Centor Criteria?
Criteria for determining whether or not antibiotics are required for tonsillitis
What are the functions of the larynx?
Phonation (production of speech sounds)
Positive thoracic pressure (i.e. auto-PEEP)
Respiration
Prevention of aspiration
Describe the presentation of Bell’s Palsy
Sudden onset:
- Complete unilateral facial weakness (forehead involved)
- Dry eye (due to inability to close eye)
- Drooling
- Speech difficulty
- Ear pain
- Hyperacusis
- Ageusia (decreased taste)
Which cranial nerve is affected in Bell’s Palsy?
Facial - CN VII
Is the forehead involved in Bell’s Palsy?
YES
What is the immediate management of Bell’s Palsy
Eye protection + Prednisolone
Describe the presentation of Ramsay Hunt Syndrome
Onset of symptoms following ear pain
- Complete unilateral facial weakness (forehead involved)
- Vesicular rash in auditory canal
- Decreased taste
- Hyperacusis
- Vertigo
- Tinnitus
Is the forehead involved in Ramsay Hunt Syndrome?
YES
Why is the forehead involved in facial nerve palsies?
Because they are LMN lesions - the forehead is spared in UMN lesions
