ENT Flashcards
Why may a patient with quinsy complain of earache as well as a soar throat?
The glossopharyngeal nerve supplies sensation to the throat but also the ear.
Referred Otalgia
What percentage of patients with chronic rhinosinusitis also have asthma?
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.
What population does otitis media effect?
Children 2 years or younger
What are some key features of otitis media?
OTALGIA
Discharge
Bulging tympanic membrane
Vomiting, fever, ongoing viral respiratory infection
What is otitis externa and what are the key features?
Inflammation of the ear canal
Discharge
Itching
Fullness
w or w/o Hearing Loss
What is cholesteatoma and what structures may it affect?
Accumulation of SQUAMOUS epithelium and KERATIN
Involves the MIDDLE EAR and MASTOID
usually BENIGN
What is cholesteatoma and what are the key features of it?
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)
What is the most common fungal infection causing otitis externa?
Aspergillus Niger
What is the most common bacteria responsible for otitis externa?
Staph Aureus
What is perichondritis? What is a common cause and, if left untreated, is a complication?
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
What serious otological condition may be present in patients with comorbid diabetes or immunosuppression?
Osteomyelitis of the temporal bone
Symptoms mimic that of otitis externa but will not resolve with treatment of drops within 2 weeks.
What causes holes to appear in the tympanic membrane?
Trauma
Iatrogenic (surgery, gromet)
Recurrent infection
What key questions need asking in an otological history?
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)
What is the definitive surgical treatment of a cholesteatoma?
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.
What associated features should you inquire about in the history of hearing loss?
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
What should you ask about in the social history of hearing loss?
Hobbies? Loud music, rock concerts
Work? loud noises
What are the key features of otosclerosis?
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
What are the key features of presbycusis?
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
What is the general management of hearing loss?
Review meds
Avoid loud noises (concerts) and occupational hazards
What is the management of ear wax?
Ear drops
Irrigation
Microsuction
What is the management of glue ear?
Watchful waiting
Consider Adenoidectomy and Grommets (if prolonged history of >3 months)
What is the management of tympanic membrane perforation?
Watchful waiting
Antibiotics if infected
Tympanoplasty if symptomatic or failing to heal itself
What is the management of otosclerosis?
Hearing aids
Surgery: Stapedectomy or Stapedotomy
What is the management of cholesteatoma?
Topical antibiotics
Surgery to remove tumour
What is the management of Meniere’s disease?
INFORM THE DVLA
Anti-emetics for acute attacks Betahistine as prophylaxis Low salt diet Reassurance Avoid caffeine, alcohol and tobacco Hearing aids
