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ENT Flashcards

1
Q

Why may a patient with quinsy complain of earache as well as a soar throat?

A

The glossopharyngeal nerve supplies sensation to the throat but also the ear.

Referred Otalgia

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2
Q

What percentage of patients with chronic rhinosinusitis also have asthma?

A

30%

Always ask patients with this about any chest symptoms as they are a part of the same organ system.

Those who have asthma and are sensitive to aspirin can be very difficult to treat.

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3
Q

What population does otitis media effect?

A

Children 2 years or younger

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4
Q

What are some key features of otitis media?

A

OTALGIA
Discharge
Bulging tympanic membrane

Vomiting, fever, ongoing viral respiratory infection

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5
Q

What is otitis externa and what are the key features?

A

Inflammation of the ear canal

Discharge
Itching
Fullness
w or w/o Hearing Loss

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6
Q

What is cholesteatoma and what structures may it affect?

A

Accumulation of SQUAMOUS epithelium and KERATIN

Involves the MIDDLE EAR and MASTOID

usually BENIGN

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7
Q

What is cholesteatoma and what are the key features of it?

A

Invasive, non-malignant epithelial growth that has become infected. Can be congenital or acquired so ask about family history.

Progressive, UNILATERAL Hearing Loss / Tinitus

Chronic / Recurrent discharge unresponsive to antibiotic therapy

Discharge is malodourous

Usually NOT painful, but in advanced disease can present with otalgia and facial nerve palsy (also vertigo and headache)

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8
Q

What is the most common fungal infection causing otitis externa?

A

Aspergillus Niger

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9
Q

What is the most common bacteria responsible for otitis externa?

A

Staph Aureus

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10
Q

What is perichondritis? What is a common cause and, if left untreated, is a complication?

A

INFLAMMATION of the CARTILAGE of the ear

Known complication of otitis EXTERNA.
Can occur from other circumstances such as TRAUMA.

May result in NECROSIS of cartilage causing DEFORMITY.

aka. CAULIFLOWER EAR

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11
Q

What serious otological condition may be present in patients with comorbid diabetes or immunosuppression?

A

Osteomyelitis of the temporal bone

Symptoms mimic that of otitis externa but will not resolve with treatment of drops within 2 weeks.

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12
Q

What causes holes to appear in the tympanic membrane?

A

Trauma
Iatrogenic (surgery, gromet)
Recurrent infection

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13
Q

What key questions need asking in an otological history?

A

Frequency and duration?
Otalgia?
Discharge? Character of discharge
Tinnitus and hearing loss
Balance
Otological history (treatment, surgery, drops)
Hobbies particularly if involving ears / water in ears
Significant medical problems (diabetes, immune sys)

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14
Q

What is the definitive surgical treatment of a cholesteatoma?

A

Mastoidectomy

This involves opening the mastoid air cells, removing the cholesteatoma from the middle ear followed by reconstructing of the ossicles and tympanic membrane. This is the definitive treatment of cholesteatoma.

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15
Q

What associated features should you inquire about in the history of hearing loss?

A 
Vertigo
Discharge (colour, smelly?)
Foreign bodies (trauma, cotton bud?)

Balance
Sensory (numbness and tingling in face?)
Motor (weakness in face?)

Headaches
Infections (Post infective hearing loss HIS MMM: herpes, influensa, syphilis, measles, mumps, meningitis)

Weight loss

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16
Q

What should you ask about in the social history of hearing loss?

A

Hobbies? Loud music, rock concerts

Work? loud noises

17
Q

What are the key features of otosclerosis?

A

Hearing loss in EARLY ADULT LIFE

85% is BILATERAL
75% have TINITUS
50% have FAMILY HISTORY

Worse in MENSTRUATION, PREGNANCY, MENOPAUSE
Improves with BACKGROUND NOISE

18
Q

What are the key features of presbycusis?

A

Sensorineuronal hearing loss

GRADUAL, onset at age 30
HIGH FREQUENCY affected
BILATERAL
WORSE with BACKGROUND NOISE or when multiple people TALKING AT ONCE

Not a problem till later life when high frequency vocal sounds cannot be heard

19
Q

What is the general management of hearing loss?

A

Review meds

Avoid loud noises (concerts) and occupational hazards

20
Q

What is the management of ear wax?

A

Ear drops
Irrigation
Microsuction

21
Q

What is the management of glue ear?

A

Watchful waiting

Consider Adenoidectomy and Grommets (if prolonged history of >3 months)

22
Q

What is the management of tympanic membrane perforation?

A

Watchful waiting

Antibiotics if infected
Tympanoplasty if symptomatic or failing to heal itself

23
Q

What is the management of otosclerosis?

A

Hearing aids

Surgery: Stapedectomy or Stapedotomy

24
Q

What is the management of cholesteatoma?

A

Topical antibiotics

Surgery to remove tumour

25
Q

What is the management of Meniere’s disease?

A

INFORM THE DVLA

Anti-emetics for acute attacks
Betahistine as prophylaxis
Low salt diet
Reassurance
Avoid caffeine, alcohol and tobacco
Hearing aids

Revision (21 decks)

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