ENT Flashcards
Criteria for antibiotics in otitis media
symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal
symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal are conditions for
giving antibiotics in otitis media
if antibiotics required to treat otitis media what is given?
amoxicillin, erythromycin/clarithromycin if penicillin allergic
amoxicillin, erythromycin/clarithromycin if penicillin allergic are given for
otitis media
common organisms causung otitis media
rhinovirus, staphylococcus, haemophilus, moroxella
rhinovirus, staphylococcus, haemophilus, moroxella are common organisms causing
otitis media
vertigo is defined as
the false sensation that the body or environemnt
the false sensation that the body or environemnt is moving defines
vertigo
causes of vertigo
viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin
viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin are causes of
vertigo
viral labyrinthitis
vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected
vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected in
viral labyrinthitis
vestibular neuronitis
recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss
recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss in
vestibular neuronitis
benign paroxysmal positional vertigo
gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds
gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds in
benign paroxysmal positional vertigo
Meniere’s disease
middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral
middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral in
Meniere’s disease
vertebrobasilar ischaemia
elderly patient, vertigo, dizziness on neck extension
elderly patient, vertigo, dizziness on neck extension in
vertebrobasilar ischaemia
acoustic neuroma
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex (important sign)
cranial nerve VII: facial palsy
bilateral associated with neurofibromatosis type 2
hearing loss, vertigo, tinnitus, absent corneal reflex, facial palsy, associated with neurofibromatosis type 2 is
acoustic neuroma
three most common causes of hearing loss
ear wax, otitis media, otitis externa
ear wax, otitis media, otitis externa are the three most common causes of
deafness
presbycusis
age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss
age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss describes
presbycusis
otosclerosis
autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, ‘flamingo tinge’ to tympanic membrane, positive family history
autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, ‘flamingo tinge’ to tympanic membrane, positive family history describes
otosclerosis
glue ear/otitis media with effusion
peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems
peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems describes
glue ear/otitis media with effusion
drugs causing ototoxicity
aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents
aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents are drugs which cause
ototoxicity
noise damage
workers in heavy industries, bilateral, 4000Hz notch on audiogram, sensorineural hearing loss
workers in heavy industries, notch on audiogram at 4000Hz, sensorineural hearing loss
noise damage
acoustic neuroma is more correctly called
vestibular schwannoma
vestibular schwannoma
is the correct name for acoustic neuroma
reactive lymphadenopathy
most common cause of neck swelling, history of local infection, generalised viral illness
most common cause of neck swelling, history of local infection, generalised viral illness describes
reactive lymphadenopathy
lymphoma
rubbery, painless, lymphadenopathy, night sweats, splenomegaly
rubbery, painless, lymphadenopathy, night sweats, splenomegaly describes
lymphoma
thyroid swelling
moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism
moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism
thyroid swelling
thyroglossal cyst
more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected
more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected describes
thyroglossal cyst
isthmus of the thyroid
the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders
hyoid bone
top bone under the chin, above the Adam’s apple
the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders
isthmus
top bone under the chin, above the Adam’s apple
hyoid bone
pharyngeal pouch
more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough
more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough describe
pharyngeal pouch
cystic hernia/lymphangioma
congenital lymphatic lesion, left side, present before 2 years
congenital lymphatic lesion, left side, present before 2 years describes
cystic hernia/lymphangioma
branchial cyst
oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood
oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood describes
branchial cyst
cervical rib
adult females, can lead to thoracic outlet syndrome
adult females, can lead to thoracic outlet syndrome
cervical rib
thoracic outlet syndrome
when the blood vessels between clavicle and first rib get compressed
when the blood vessels between clavicle and first rib get compressed describes
thoracic outlet syndrome
carotid aneurysm
pulsatile, lateral, doesn’t move on swallowing
pulsatile, lateral, doesn’t move on swallowing describes
carotid aneurysm
mnemonic to remember how to describe a lump
5 Students and 3 Teachers went to build a CAMPFIRE
5 Students and 3 Teachers went to build a CAMPFIRE to remember
how to describe a lump
5 students to comment on when you find a lump
site - from a specific landmark size shape skin scar
3 teachers to comment on when you find a lump
tenderness - pain on touching
temperature - feel with back of hand
transillumination - especially for testicular masses
campfire to comment on when you find a lump
consistency - soft, spongy, firm
attachment - identify between which layers it is by moving the skin, then muscle etc over it
mobility - try to move lump horizontally and vertically
pulsatile - assess with two fingers, transmitted vs expansile
fluctuance - tap lump with fingers either side, fluctuant will displace fingers
irr/
reducible
enlarged lymph nodes
cause of Meniere’s disease
unknown
site of Meniere’s disease
inner ear
inner ear is the site of what disease
Meniere’s
Meniere’s disease is characterised by
the progressive dilation of the endolymphatic system
the progressive dilation of the endolymphatic system characterises
Meniere’s disease
the natural history of Meniere’s disease
symptoms resolve after 5-10 years, degree of residual hearing loss (sensorineural), psychological distress
symptoms resolve after 5-10 years, degree of residual hearing loss, psychological distress describes the natural history of
Meniere’s disease
management of Meniere’s disease
ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention
ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention describes the management of
Meniere’s disease
prochlorperazine
dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere’s disease attacks, extrapyramidal side effects
dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere’s disease attacks, extrapyramidal side effects
prochlorperazine
betahistine
used in the prevention of the symptoms of Meniere’s disease
used in the prevention of the symptoms of Meniere’s disease
betahistine
the effusion in glue ear is a transudate or an exudate?
transudate (systemic, low protein)
glue ear is caused by a
dysfunction eustatian tube
a dysfunctional eustation tube in children causes
glue ear/otitis media with effusion
otitis externa orgnaisms
staphylococcus, streptococcus, pseudomonas
staphylococcus, streptococcus, pseudomonas are common causative orgnaisms of
otitis externa
middle ear bones in order
malleus, incus, stapes
adult with glue ear think
nasopharyngeal cancer
think of nasopharyngeal cancer in
adults with glue ear/otitis media with effusion
sodium bicarbonate ear drops
softens ear wax
ear drops used to softens ear wax
sodium bicarbonate
obstructive sleep apnoea in young children may be caused by enlarged
tonsils and adenoids
enlarged tonsils and adenoids in young children may cause
obstructive sleep apnoea
cholesteatoma
squamous cells in the middle ear causing local destruction
squamous cells in the middle ear causing local destruction describes
cholesteatoma
features of cholesteatoma
foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = ‘attick crust’ seen in uppermost part of eardrum
foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = ‘attick crust’ seen in uppermost part of eardrumare features of
cholesteatoma
management of cholesteatoma
ENT referral for surgical removal
ENT referral for surgical removal is the management for
cholesteatoma
cerebellopontine angle syndrome
caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs
caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs
cerebellopontine angle syndrome
normal on an audiogram
above 20dB
above 20dB on an audiogram
normal
audiogram of sensorineural hearing loss
both bone (arrowheads) and air (circles or crosses) are >20dB
both bone (arrowheads) and air (circles or crosses) are >20dB on audiogram indicates
sensorineural hearing loss
audiogram of conductive hearing loss
only air (circles or crosses) are >20dB
only circles or crosses are >20dB
conductive hearing loss
audiogram of mixed hearing loss
both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone
both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone
mixed hearing loss
chronology of symptoms in otitis media acute
pain, pop, discharge
pain, pop, discharge is the chronology of
otitis media acute
what route to give antibiotics for otitis media acute
orally/systemically
what route to give antibiotice for otitis externa
topical/drops
chronology of events for otitis externa
pus, pain
pus, pain is the chronology of events for
otitis externa
stapes connects with
oval window
the cochlea is filled with
perilymph
perilymph lines the
cochlea
metaplasia
when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli (occurs in otitis media with effusion)
when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli describes
metaplasia
window of opportunity to develop speech
<6 years old
<6 years old is the window of opportunity
to develop speech, after that a cochlear implant will only enable the perception of sounds as Wernike’s + Broca’s areas haven’t developed
transient evoked otoacoustic emissions
used in newborn screening hearing test
used in newborn screening hearing test
transient evoked otoacoustic emissions
automated brainstem responce
secondary testing if neonates scores low on the transient evoked otoacoustic emission, hearing version of an EEG
secondary testing if neonates scores low on the transient evoked otoacoustic emission
automated brainstem response
management of glue ear/otitis media with effusion
grommets or hearing aids
grommets or hearing aids id the management of
glue ear/otitis media with effusion
caution with grommets
don’t get water in the ear - no swimming, wear plugs when showering, will fall out in 7-9/12
“water precautions”
water precautions must be adhered to when
domeone has grommets in their ears, or when a perforation is healing
mild hearing loss
20-40dB
20-40dB
mild hearing loss
moderate hearing loss
40-70dB
40-70dB
moderate hearing loss
severe hearing loss
70-90dB
70-90dB
severe hearing loss
profound hearing loss
> 90dB
> 90dB
profound hearing loss, required cochlear implant
range of frequencies of human ear
20-20000Hz
20-20000Hz
range of frequencies of the human ear
range of frequencies of speech
250-8000Hz
250-8000Hz
range of frequencies of speech
5-10dB differnce between ears/air and bone conduction
insignificant, can say symetrical
insignificant, can say symetrical audiometry difference
5-10dB
carhart notch
at 2000Hz, indicated otosclerosis
at 2000Hz, indicated otosclerosis
cahart notch
management of otosclerosis
stapedectomy and prosthesis
stapedectomy and prosthesis is the management for
otosclerosis
Meniere’s hearing loss is worse at which frequencies
lower
hearing loss worse at lower frequencies indicates
Meniere’s disease
tympanometry
test of middle ear relative pressure
test of middle ear relative pressure
tympanometry
microtia
congenital malformation of pinna
congenital malformation of pinna
microtia
types of hearing aids
post auricular, bone conduction, cochlear implant, bone anchored hearing aid
post auricular, bone conduction, cochlear implant, bone anchored are
types of hearing aid
tachyphylaxis definition
increasing dose required to achieve same effect
increasing dose required to achieve same effect
tachyphylaxis
prolonged periods of using topical nasal decongestants can lead to
tachyphylexis
tachyphylexis can develop when
using topical nasal decongestants e.g. oxymetazoline
types of allergic rhinitis
seasonal e.g. hayfever, perennial (all year round) e.g. house mites, occupational
seasonal, perennial, occupational are types of
allergic rhinitis
first line management of allergic rhinitis
oral/intranasal antihistamines
oral/intranasal antihistamines are first line management for
allergic rhinitis
otalgia
ear pain
ear pain
otalgia
small bilateral nasal polyps
can be treated in primary care with saline nasal douche and intranasal steroids
can be treated in primary care with saline nasal douche and intranasal steroids
small bilateral nasal polyps
polyps due to rhinosinusitis are usually unilateral or bilateral?
bilateral
complications of tonsillitis
otitis media, quinsy, rheumatic fever, glomerulonephritis
otitis media, quinsy, rheumatic fever, glomerulonephritis are complications of
tonsillitis
quinsy
peritonsillar abscess
peritonsillar abscess is called
quinsy
indications for tonsillectomy - NICE recommends meeting all of these
disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year
disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year are
what NICE recommends need to be met (all) in order to justify a tonsillectomy
other established indications for tonsillectomy
recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment
recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment are
other established indications for a tonsillectomy
tonsillectomy complications
primary (within 24h) = haemorrhage, secondary = haemorrhage, pain, infection
Ramsey Hunt syndrome also known as
herpes zoster oticus
herpes zoster oticus also known as
Ramsey Hunt syndrome
features of Ramsey Hunt syndrome/herpes zoster oticus
auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus
auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus are features of
Ramsey Hunt syndrome/herpes zoster oticus
management of Ramsey Hunt syndrome/herpes zoster oticus
oral aciclovir + corticosteroids
oral aciclovir + corticosteroids given in
Ramsey Hunt syndrome/herpes zoster oticus
sialadenitis
inflammation of the salivary gland
inflammation of the salivary gland
sialadenitis
sialadenitis is often secondary to a
stone impacted in the duct
a stone impacted in the salivary duct can lead to
sialadenitis
three main salivary glands
parotid, submandibular, sublingual
parotid, submandibular, sublingual describe
the three main salivary glands
otoscopy L vs R ear
half with cone of light + maleolus process (i.e. L/R) is same half as the ear (i.e. L/R ear)
ear wax impaction
excessive build up of ear wax in canal, conductive hearing loss, sometimes pain
excessive build up of ear wax in canal, conductive hearing loss, sometimes pain
ear wax impaction
myringosclerosis
thickening + calcification of the tympanic membrane 2’ to inflammation, usually asymptomatic
thickening + calcification of the tympanic membrane 2’ to inflammation, usually asymptomatic
myringosclerosis
nosebleed management
- local compression over Little’s area
- nasal cautery (chemical or electrical)
- nasal packing - uncomfortable for PT, risks of P necrosis, post migration into the airway + aspiration of blood clots
- ligation of sphenopalatine a (life threatening haemorrhage)
salivary duct calculus
Ca, submandibular gland > affected due to longer duct, antigravity drainage + > vicous secretions, pain + swelling when eating
salivary duck calculus management
siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy
siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy describes the managementof
salivary duck calculus
tuning fork for hearing test
512Hz
parts of the eardrum
pars tensa (lower part), pars flaccida (upper part)
inspection of the ear
examine face for palsy/m weakness, , scars inflammation, trauma, pits/sinuses around pinna
palpation of the ear
mastoid tip, mastoid bone, pinna, parotid, temperomandibular joint area
otoscopy
inspect the meatus, tympanic menbrane
doccument fondings from otoscopy
draw a picture of the tympanic menbrane
Rinne’s test
512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder
+ve Rinne’s test
air > bone conduction, indicated N hearing or SNHL
-ve Rinne’s test
bone > air, conductive HL
false -ve Rinne’s test
v severe unilateral SNHL so much so that when tuning fork is placed on the mastoid it conducts round + is detected by the other cochlear
Weber’s test
512Hz tuning fork - placed in centre of forehead, equal or localises to one ear
equal hearing in Weber’s indicates
N hearing or equal SNHL/CHL
Weber’s localises to
good ear in SNHL, bad ear in CHL
512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder
Rinne’s
air conduction > bone condutcion
+ve Rinne’s test
bone conduciton > air conduciton
-ve Rinne’s test
512Hz tuning fork - placed in centre of forehead, equal or localises to one ear
Webber’s
inspecting the nose
inspect from all angles, size of nostrils, size of septum
test of airway patency (nose)
cold Lack’s depressor under nostrils + ask PT to exhale through nose
otoscopy
comment on nasal septum, nose floor, lateral turbinate
mouth inspection
lip border, (head torch/good light source) stick out tongue, Lack’s tongue depressors, inspect contents, hard, soft palate, tonsils, upper teeth, lateral mouth, tongue, floor of mouth, lower teeth, lower lateral buccal area
number of adult teeth
32
mouth palpation
bimanual, submanibuilar gland, mucosa, check for thickening, abnormalities, stones, cysts, ulcers
neck inspection
fully exposed, swellings, skin lesions, skin discolouration, scars, lumps: size, site, shape, overlying skin (scar/colour), surface,margin, pulsatile, cross fluctiation
neck palpation
from behind, start with abnormality (single/multiple, discrete/diffuse, surface, edge, T’c, consistency, fluctuation, compressibility, reducibility, pulsatility, fixation), stick out tongue
nasendoscopy is used to examine the
nose, pharynx, larynx
epistaxis
nosebleed
types of epistaxis
1’ (majority of epistaxis, no obvious causal factor), 2’ (due to an identifiable cause), childhood, adult, acute, recurrent
2’ causes of epistaxis
EtOH, aspirin, NSAIDs, antiplatelets (clopidogrel), anticoagulants (warfarin), herbal remidies (St John’s wort, fish oil), blood dyscrasias (thrombocytopaenia), coagulopathy (haemophillia, vWD), trauma (nasal #), tumour, Sx, septal perforation
childhood epistaxis
common, tends to be 1’, ant inf bleeding of nasal septum (Little’s area)
susceptibility to childhood epistaxis
nose picking, infection
management of childhood epistaxis
pinch Little’s area (Hippocratic manoeuvre), examine nose (good light) once bleeding stopped, spray bleeds with LA + vasoconstrictor (lignocaine + phenylephrine), chemical cautery, diathermy
prescribed to prevent recurrence of childhood epistaxis
course of chlorhexidine-neomycin cream
adult 1’ epistaxis
> posteriorly than in children, > bleeding
management of adult 1’ epistaxis
Hippocratic manoeuvre, IV access, contact ENT, examination, cautery of bleed, diathermy
failure to control bleeding in 1’ adult epistaxis within
24h warrents referral to specialist rhinologist (endoscopy under GA, diathermy, ligation)
2’ epistaxis management
identificaion/treatment of cause, Hippocratic manoeuvre
pharmacological causes of 2’ epistaxis
NSAIDs, clopidogrel, aspirin, warfarin, herbal remidies, EtOH - loss of control, OD
2’ epistaxis by trauma
craniofacial trauma required ENT referral, risk = ethmoidal #
ethmoidal # presentation
black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis
ethmoidal # management
ENT referral, assessment, Sx ligation, angiography
ux, bloodstained discharge indication for
urgent ENT referral, ?malignancy
ux nasal obstruction + epistaxis in pubertal/adolescent male think
juvenile nasopharyngeal angiofibroma (rare)
hereditary haemorrhagic telangectasia
rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM
course of chlorhexidine-neomycin cream is used to
prevent recurrence of childhood epistaxis
black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis
ethmoidal #
juvenile nasopharyngeal angiofibroma (rare) presentation
ux nasal obstruction + epistaxis in pubertal/adolescent male
rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM
hereditary haemorrhagic telangectasia
examples of congenital SNHL
syndromic, non-syndromic, gestational infection
what types of gestational infection could cause congenital SNHL
TORCH infections (toxo, rubella, CMV, herpes)
examples of acquired SNHL
perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere’s, presbycusis
what’s baro-trauma
injuries caused by increasing air/water P e.g. scuba diving, flights
examples of congenital CHL
ossicular abnormality, microtia, anotia, external auditory canal atresia
anotia is
absence of external ear
examples of acquired CHL
wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption
suddent SNHL is defined as
SNHL over 3/7, >30dD, in 3 contiguous frequencies
suddent SNHL presentation
50-60 y.o., ux > bx
sudden SNHL management
steroids, may resolve spontaneously
syndromic, non-syndromic, gestational infection are examples of
congenital SNHL
perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere’s, presbycusis are examples of
acquired SNHL
ossicular abnormality, microtia, anotia, external auditory canal atresia are examples of
congenital CHL
absence of external ear is called
anotia
wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption are examples of
acquired CHL
SNHL over 3/7, >30dD, in 3 contiguous frequencies describes
sudden SNHL
the most common complication of meningitis is
SNHL
facial palsy UMN vs LMN
forehead is spared in UMN lesion as it has supply from both hemispheres
facial n palsy presentation
ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek
idiopathic facial n palsy aka
Bell’s palsy
causes of facial n palsy
stroke (UMN), cholesteatoma, ear malignancy, parotid lesions, head injury (basal skull #), HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic (Bell’s palsy, LMN)
management of Bell’s palsy
eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals
ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek describes the presentation of
facial palsy
Bell’s palsy aka
idiopathic facial n palsy
stroke, cholesteatoma, ear malignancy, parotid lesions, head injury, HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic are causes of
facial n palsy
eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals is the mangement of
Bell’s palsy
causes of hoarseness/dysphonia
chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke’s oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm
when to refer to ENT for hoarseness
3/52 w/o resolution
acute laryngitis is a common feature of
URTI
management of acute laryngitis
fluids, analgesia, anti-inflammatory drugs, voice rest (avoidance of whispering, shouting)
duration of acute laryngitis
2/52
causes of chronic laryngitis
smoking, EtOH, excessive/misuse of voice
management of chronic laryngitis
voice rest, smoking cessation, SALT
vocal cord palsy can lead to
hoarseness, aspiration
vocal cords are supplied by
recurrent laryngeal n, branches of the vagus n
causes of vocal cord paralysis
post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca
vocal cord nodules are caused by
repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis
management of vocal cord nodules
voice rest, SALT
m tendon dysphonia describes
uncoordinated laryngeal m leading to voice problems
management of m tendon dysphonia
SALT
chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke’s oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm are potential causes of
hoarseness/dysphonia
fluids, analgesia, anti-inflammatory drugs, voice rest describes the management of
acute laryngitis
smoking, EtOH, excessive/misuse of voice can cause
chronic laryngitis
voice rest, smoking cessation, SALT describes the management of
chronic laryngitis
recurrent laryngeal n + branches of the vagus n supply
vocal cords
post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca can cause
vocal cord paralysis
repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis which are called
vocal cord nodules
uncoordinated laryngeal m leading to voice problems is called
m tendon dysphonia
CVS causes of imbalance
hypotension, TIA, stroke, arrhythmia, vertebrobasillar insufficiency, atherosclerosis
iatrogenic causes of imbalance
vestibular sedatives, antihypertensives, aminoglycosides, EtOH
trauma causes of imbalance
brain injury, temporal bone #, Sx
ear causes of imbalance
BPPV, labrynthitis, Meniere’s DZ, middle ear DZ, perilymph fistula, impacted wax
CNS causes of imbalance
migraine, brainstem ischaemia, MS, ca, epilepsy
general medical causes of imbalance
ageing, degeneration, DM, anaemia, peripheral neuropathy, cervical spondylosis, psychiatric illness
lightheadedness describes
feeling faint
unsteadiness describes
gait abnormality
feeling faint describes
lightheadedness
gait abnormality describes
unsteadiness
blunt trauma to the pinna can cause a
hamatoma
management of a pinna haematoma
drainage, P dressing
if a pinna haematoma is not managed quickly it can lead to
necrosis becuase of P, causing unsightly deformity aka cauliflower ear
furunculosis is
infection of a hair folicle in the external ear
furunculous presentation
local swelling, tender, painful
malignant/necrotising OE presentation
severe, unremitting pain, not responding to simple analgesia
malignant/necrotising OE is
progressive osteomyelitis of the temporal bone, resulting from OE
PTs at risk of malignant/necrotising OE are
immunocompromised, DM
OM occurs > commonly in children becuase
shorter, wider, more horizontal Eustachian tube, more immature immune defences
OM presentation
otalgia (worse at night), fever, HL, otorrhoea
OM management
most cases will resolve on their own, criteria for ABx
infection of a hair folicle in the external ear describes
furunculosis
severe, unremitting pain, not responding to simple analgesia describes
malignant/necrotising OE
perforated tympanic membrane causes
infeciton, barotrauma, direct trauma
Mx of perforated tympanic membrane
6-8/52 to heal by itself (water precautions), myringoplasty if fails to resolve
most common tumour of parotid gland
pleomorphic adenoma (benign)
second most common parotid gland tumour
Warthian tumour (benign)
type of cancerous parotid tumour
adenocarcinoma
features of benign pleomorphic adenoma
most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration
most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration
benigm pleomorphic adenoma
complications of thyroid Sx
anatomical: recurrent laryngeal n damage
bleeding: haematomas can lead to resp compromise
parathyroid gland damage: hypocalcaemia
ABx in sinusitis
systemically unwell, signs of a > serious illness, at high risk of complications
sinusitis and any of: periorbital oedema, displaced eyeball, diplopia, reduced VA
refer to hospital
common causative agents for sinusitis
Strep pneumo, H. influenzae, rhinoviruses
