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Electrolyte Disorders > ENT > Flashcards

ENT Flashcards

1
Q

Where does the pinna develop from?

A

The 1st and 2nd branchial arches, from the 6 hillocks

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2
Q

Name some methods in which to test for hearing loss?

A

Tuning fork test - Rinne’s + Weber’s

Audiometry - most commonly used as it quantifies hearing loss

Tympanometry - objective way of establishing cause of conductive hearing loss

Audiological brainstem responses

Otoacoustic emissions

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3
Q

What are the symtoms of Otitis Externa? (inflammation of outer ear)

A

Discharge, itch, pain, tragal tenderness

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4
Q

What is the main organism causing Otitis Externa?

A

Pseudomonas followed by Staph Aureus

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5
Q

How do you treat OE?

A

Mild = hydrocortisone cream

Moderate = swab, topical abx, steroid drops (c/i if grommets or perforated TM) - Clotrimazole

Severe = occluded EAC so requires careful cleansing

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6
Q

What is malignant otitis externa?

A

Aggressive , life-threatening infection, 90% of pts have underlying diabetes, resistant to normal treatment

Usually caused by Pseudomonas Aeuriginosa (also Proteus and Klebsiella)

Treat with surgical debridement, systemic abx and Ig’s

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7
Q

What is Furunculosis?

A

Painful staphylococcal abscess in the hair follical of the ear canal, treat with flucloxacillin.

Diabetes predisposes you to this.

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8
Q

What methods can be used to clean the External auditory canal?

A

Syringing/ irrigation
Dry mopping - Jobson Horne probe
Micro-suction - used in ENT not primary care

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9
Q

How do you treat TMJ dysfunction?

A

Splinting, physiotherapy, CBT

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10
Q

Which nerves result in referred pain to the ear?

A

V = auriculotemporal branch of trigeminal nerve

VII = sensory branch of facial nerve (ramsey hunt)

IX = tympanic branch of glossopharyngeal nerve

X = auricular branch from the vagus

C2 + 3 = great auricular nerve that supplies lower 1/2 of pinna

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11
Q

What defines the outer ear, middle ear and inner ear?

A

Outer ear = up to the tympanic membrane
Middle ear = tympanic membrane to cochlea
Inner ear = cochlea and eustachian tube

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12
Q

What is acute otitis media (AOM)?

A

Middle ear inflammation
Rapid onset pain, fever, irritability, vomiting
Often after a viral URTI

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13
Q

What common organisms cause otitis media?

A

Pneumococcus, Haemophilus

Same as what causes RTIs

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14
Q

How do you treat AOM?

A

Analgesia - usually resolves in 48h days

Consider abx if systemically unwell, no improvement after 4 days or are immuno compromised

Amoxicillin for 5 days (Erythromycin if allergic)

Rare complication of AOM is mastoiditis

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15
Q

What is Chronic Otitis Media (COM) ?

A

Ear with a tympanic perforation in the setting of a chronic infection

Symptoms include hearing loss, otorrheoa, otalgia

Treat with abx, cleaning and potentially surgery

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16
Q

What are the complications of COM?

A

Development of a cholesteatoma

17
Q

What is a cholesteatoma?

A

Rare, not made of cholesterol and not a tumour

Foul discharge, deafness, headache, pain, vertigo

Complications are meningitis, cerebral abscess, mastoiditis, facial nerve dysfunction

Treat with mastoid surgery (mastoidectomy)

18
Q

What is mastoiditis?

A

Middle ear infection can lead to destruction of air in mastoid bone causing abscess formation

Fever, tenderness, redness behind the pinna

Prevent by giving abx for AOM

If still occurs, admit for IV abx + myringotomy +/- mastoidectomy

19
Q

What are the RFs for otitis media?

A 
URTI (winter)
Bottle feeding
Passive smoking
Asthma
Malformations (cleft palate)
Dummys
GORD / raised BMI in adults
20
Q

What is a myringoplasty vs tympanoplasty?

A

Repair of the tympanic membrane alone = Myringoplasty

Repair of tympanic + ossicles = Tympanoplasty

21
Q

What is glue ear?

A

It is Otitis Media with Effusion (OME)

Hearing impairment due to dysfunction of eustachian tube

No known cause, higher in males, winter, RTIs, smokers, cleft palate, Down’s

22
Q

What findings on history/examination of OME?

A

Poor listening, poor speech, poor attention, language delay

Tympanic membrane can be bulging or retracted

23
Q

How do you treat OME?

A

Usually conservative, resolves spontaneously, give advice re reducing background noise, speak in short sentences. Repeat hearing test after 3 months

Autoinflation of eustachian tube

Surgery if no improvement over 3 months (grommets)

Hearing aids if surgery not accepted

24
Q

What test would you order for OME?

A

Formal assessment of hearing via:

Audiogram - shows conductive hearing loss
Tympanometry - will be flat

25
Q

What would you see on an audiogram of someone with genetic deafness?

A

Cookie bite appearance

26
Q

Name some causes of genetic hearing losses

A

Conductive -

Congenital abnormalities of the pinna/ EEC/ drum/ osicles
Pierre-Robin

Sensorineural -

Waardenburg Syndrome, Alport syndrome
Usher’s
Turners

27
Q

Name some non-genetic childhood hearing loss

A

TORCH infection (Toxoplasmosis, Other (PVB19, syphillus), Rubella, CMV, Herpes )

Prematurity, Hypoxia, Kernicterus

Birth trauma

28
Q

What is in the universal newborn hearing screening?

A

Otoacoustic emissions +/- Audiological brainstem responses (if they fail OAE)

29
Q

What is the next line of treatment if hearing aids are not beneficial?

A

Cochlear implants - however, a normal cochlear is necessary

30
Q

When would you use BAHA (Bone Anchored Hearing Aid) ?

A

Sound is transmitted via bone conduction
Used when normal HA are intolerated
Children - as it is not felt by the child

C/I is poor hygiene and non-compliance

31
Q

Name some causes of conductive hearing loss in adults

A

Ear wax//debris/pus
Perforated ear drum
Otosclerosis

32
Q

Name some causes of sensorineural hearing loss in adults

A

Drugs - Strepto/Vanco/Gentamycin, Chloroquine
Post-infective - measles, mumps, herpes
Meniere’s
Acoustic Neuroma

33
Q

What is otosclerosis?

A

A new bone forming around the stapes leading to conductive hearing loss
Autosomal Dominant - 50% have +ve FH and 80% are bilateral

34
Q

What are the symptoms of otosclerosis?

A

Usually start in adult life, made worse by pregnancy
Tinnitus
Mild vertigo
Hearing is better with background noise (typical of conductive hearing loss)
10% have Shwartz sign - pink tinge to the ear drum
Cahart’s notch on audiogram

35
Q

How do you treat otosclerosis?

A

Hearing aid

Surgery - stepedectomy or stepedotomy

36
Q

What is presbyacusis?

A

Age related, bilateral high-frequency SNHL

Deafness is gradual and is only noticed when speech is affected

37
Q

What is the treatment for presbyacusis?

A

Hearing aids

Electrolyte Disorders (6 decks)

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