ENT Flashcards
Otitis externa | Clinical features & RFs
Otalgia Itching Tragal tenderness Otorrhoea Reduced hearing
RFs; swimming, skin conditions, local trauma, immunocompromised
Otitis externa | Management
Advice
Medical
[Advice] Keep ear dry No swimming Do not scratch the ear canal Do no use cotton buds Manage eczema/psoriasis
[Medical]
- Clean ear canal
- Topical abx; neomycin sulfate
- topical steroid; neomycin + pred/dex combos
Use for 7/7, should resolve within 1/52
Otitis externa | Complications
Perichondritis
Tx; PO flucloxacillin
Facial cellulitis
Osteomyelitis of temporal bone
Otomycosis
Ear canal stenosis with hearing loss
Otitis media | Clinical features & RFs
Glue ear
Acute onset within 24hrs-1/52 Otalgia, crescendo pain Purulent discharge if perforates Preceding URT sx Fever, irritability, sleep disturbance
RFs; children, recent URTI
[Glue ear]
Hearing loss
May see pus fluid level behind tympanic membrane
Otitis media | Management
Advice
Medical
Surgical
AOM complications
COM complications
Self-limiting, should resolve within 3/7
Complications are rare
Risk of giving abx outweighs the benefits, D&N
Delayed abx; amoxicillin
To use if no signs of improvement, sx persist for >3/7, or worsen
[Medical] 1. OTC analgesia; paracetamol/ibuprofen 2. PO amoxicillin; if complicated with fever, headache, pain, otorrhoea, bilateral, unresolving, or age <2yrs (Pen allergy; clarithromycin) Otorrhoea, ie. perforated
[Surgical]
Grommets; if persistent glue ear
[AOM complications] Labyrinthitis Mastoiditis Facial palsy Meningitis Intracranial abscess
[COM complications]
Perforation
Cholesteatoma
Perforation | Clinical features, RFs & Management
Conservative
Medical
Surgical
Painless intermittent discharge
Hearing loss
Tinnitus
Recurrent infections
Precipitated by swimming/water contact
Loud noise
Change in air pressure
[Conservative] Most resolve spontaneously Referral to ENT >6/52 Don't put anything in your ear Avoid getting water in ear Do not blow your nose too hard
[Medical]
Topical abx/steroid drops; Gentisone
[Surgical]
Myringoplasty; pars flaccida
Tympanoplasty
Cholesteatoma | Clinical features & RFs
Painless Chronic intermittent offensive discharge Hearing loss Tinnitus Keratin cyst in retraction pocket
RFs; eustachian tube dysfunction, chronic otitis media
Cholesteatoma | Management & Complications
Local
Systemic
Mastoidectomy; surgical removal of cholesteatoma in mastoid air cells
[Local] Dead ear Tinnitus, vertigo Facial nerve palsy Altered taste
[Systemic]
Meningitis
Intracranial abscess
Sigmoid sinus thrombosis
Neck Lumps | Differentials
Midline
Lateral
H&N cancers
[Midline] Lymphadenopathy Lymphoma Thyroglossal cyst Thyroid isthmus Dermoid cyst
[Lateral] Ant. triangle Submandibular swelling Branchial cyst; SCM, cholesterol Parotid Thyroid lobes Pharyngeal pouch; dysphagia, halitosis, gurgling
Post. triangle; cystic hygroma, 2yrs, transilluminates, lateral
Oropharyngeal SCC
Laryngeal SCC
Thyroid carcinoma
Acute rhinosinusitis | Clinical features & Management
Viral
Bacterial
Allergic
Advice
Association with asthma due to same epithelial lining
Purulent nasal discharge, rhinorrhoea
Nasal obstruction
Facial pain/pressure
Acute onset <4/52
Viral < 10days
Bacterial > 10days
Complete resolution of symptoms
Allergic ocular/nasal pruritus, sneezing
[Management]
Resolves by 2-3/52
No abx needed, SEs outweigh benefits, does not alter duration, D&N
{Supportive therapy}
OTC analgesia
Nasal decongestant; pseudoephedrine, ephedrine
Nasal corticosteroid; fluticasone/flixonase
Abx; phenoxymethylpenicillin
Chronic rhinosinusitis | Clinical features & Management
Medical
Surgical
Duration >3/12
Without
With polyposis
[Management]
Unilateral obstructive polyps, always urgently refer to ENT
- Nasal steroid; flixonase
- nasal saline irrigation
- PO prednisolone
Abx; PO amoxicillin
(Antihistamine)
(Allergen avoidance)
May be associated with aspirin sensitivity
[Surgical]
Endoscopic sinus surgery
Epistaxis | Management
Anterior
Posterior
Advice
[Anterior]
- Reuscitation
- Apply pressure
- Topical decongestant
- Silver nitrate cautery; never cauterise both sides of septum, risk of perforation
- Antiseptic ointment
- Anterior nasal packing/balloon catheter
[Posterior]
- Resuscitation
- Suction clots
- Apply pressure
- Silver nitrate cautery
- Anterior packing
- Admit to ward
- Posterior packing/balloon catheter
- Consider prophylactic abx if packing for >48hrs
- Surgical ligation; sphenopalatine/anterior ethmoidal arteries
[Advice] Avoid blowing your nose Do not pick your nose Avoid strenuous exercise for 2/52 Avoid hot baths/showers Avoid hot/spicy food/drink
Apply firm pressure for 15mins
Apply ice pack
Sit up and tilt head forwards to prevent swallowing of blood
Investigations | ENT
Ear
Nose
Throat
[Ear] Rinne's & Weber's Otoscope Ear swab Audiometry Tympanometry; pressure MR brain; for ?intracranial complications
[Nose] Flexible nasoendoscopy Coagulation profile, G&S Angiogram; epistaxis CT sinuses; for mastoid surgery only
[Throat] Flexible nasopharyngolaryngoscopy USS FNA and cytology Panendoscopy and biopsy MR CT neck and chest
Vertigo | Differentials
BPPV Labyrinthitis Meniere's disease Acoustic neuroma Herpes zoster oticus Head trauma
Vertigo; room is spinning
Lightheadedness; feel faint
Unsteadiness; imbalance
BPPV; triggered by turning head
Labyrinthitis; vertigo, nystagmus
Meniere’s disease; progressive hearing loss, cluster attacks of vertigo, tinnitus, aural fullness, triggers (caffeine, alcohol, smoking)
Acoustic neuroma; progressive episodes of vertigo, unilateral hearing loss, facial numbness, raised ICP
Herpes zoster oticus; painful blistered canal, facial nerve palsy, hearing loss, tinnitus
Head trauma; decreased consciousness
H&N cancer | RED FLAGS
Require urgent referral to ENT
New onset unilateral nosebleed with unilateral mass
Unilateral polyps
[Nasopharyngeal cancer]
Unilateral glue ear
Sore throat with earache
Oral cavity red/white patch; erythroleukoplakia
[Oropharyngeal cancer] Persistent ulceration Asymmetrical tonsils/mass Persistent hoarseness of voice Dysphagia, odynophagia Persistent foreign body sensation; feeling of a lump in the throat
Referred otalgia Cervical lymphadenopathy Stridor Haemoptysis Painless firm, irregular, fixed mass Weight loss
