ENT Flashcards
What are the two commonest causes of hearing loss in adults?
Wax and Presbyacusis
Name causes of conductive hearing loss
Blocked ear canal (wax, pus, debris, foreign body)
Ear drum perforations (from trauma or AOM)
Middle ear effusions (e.g. glue ear)
Otosclerosis
Name causes of sensorineural hearing loss
Presbyacusis Noise exposure Perilymph fistula Ototoxicity Acoustic neuroma Inflammatory diseases e.g. measles, mumps, meningitis
What does ‘Rinne’s test -ve’ indicate?
A conductive hearing loss in the tested ear (bone conduction better than air conduction)
In which ear will sound localise to in Weber’s test if there is conductive hearing loss?
Sound will localise to the affected ear
In which ear will sound localise to in Weber’s test if there is sensorineural hearing loss?
Sound will localise to the unaffected ear
Above which decibel line is considered normal in an audiogram?
Above 20dB line
What is the commonest cause of hearing loss in children?
Otitis media with effusion/ Glue Ear
What are some risk factors for glue ear?
Male sex, downs syndrome, cleft palate, atopy, children of smokers, primary ciliary dyskinesia
What signs would you see in OME?
Retracted ear drum
Bubbles or a fluid level
What does an audiogram show in OME?
Conductive hearing loss
What does a tympanogram look like in OME?
Flat tympanogram - ‘Type B’
How long should you initially observe OME for?
12 weeks - most cases resolve themself in this time
What surgery is done for OME?
Myringotomy + fluid aspiration + grommet insertion
+/- adenoidectomy
How long will grommets be in for?
Usually fall out themselves in 3-12 months due to growth of the tympanic membrane
1 in 3 children will need reinsertion of grommets
What condition is characterised by inflammation of the outer ear canal and causes symptoms such as redness, swelling, itch and increased wax?
Otitis Externa
How is otitis externa treated?
Aural toilet
If mild –> acetic acid 2%
If moderate –> otomize (acetic acid, neomycine and dexamethasone)
What causes acute otitis media?
Usually an URTI involving the middle ear via extension of infection via the eustachian tube
What are the main organisms causing acute otitis media?
Haemophilus Influenzae
Pneumococcus
Moraxella
Strep Pyogenes
Do all cases of acute otitis media need antibiotics?
No - 80% resolve within 4 days by themselves
When would you consider antibiotics for acute otitis media?
If otorrhoea is present
What antibiotic is used for acute otitis media?
Amoxicillin 500mg TDS 5 days
If allergic - Clarithromycin 500mg BD 5 days
What condition commonly presents as severe facial pain worse on bending, nasal discharge/congestion and fever?
Acute sinusitis
What organisms cause acute sinusitis?
Haemophilus Influenzae
Strep Pneumoniae
Strep Pyogenes
When should antibiotics be given for sinusitis?
For severe/deteriorating cases which have been ongoing for more than 7-10 days
What antibiotics are given for acute sinusitis?
Penicillin V 500mg QDS/1g BD for 7 days
If allergic - doxycycline
What type of organism causes the majority of sore throats?
Viruses
What causes a severe sore throat with a greyish white membrane on the pharynx?
Diptheria
What condition presents as white patches on red raw mucous membranes?
Oral thrush
What is the treatment of oral thrush?
Miconazole gel QDS (7 days)
What condition presents as fever, enlarged lymph nodes, sore throat, malaise, lethargy and enlarged spleen?
Infectious Mononucleosis
What is the causative organism of infectious mononucleosis?
Epstein-Barr Virus
How is infectious mononucleosis treated?
Supportive - bed rest, paracetamol, fluids. Avoid sport to prevent splenic rupture.
What causes symptoms in Menieres disease?
Build up of fluid in the inner ear, resulting in dilatation of the endolymphatic spaces of the membranous labyrinth
What condition presents as recurrent, spontaneous episodes of vertigo with associated tinnitus, sensorineural hearing loss and an aural fullness?
Meniere’s disease
How long do episodes of Meniere’s last?
A few hours
What conservative management options are there for Menieres?
Reduce salt, caffeine and alcohol intake
Reduce stress
Stop smoking
What is the medical management of Menieres?
Acute - prochlorperazine
Prevention - betahistine
What condition is characterised by sudden attacks of rotational vertigo caused by turning the head?
Benign Positional Paroxysmal Vertigo (BPPV)
How long does the vertigo last in BPPV?
<30 seconds
What test is used to investigate BPPV?
Dix - Hallpike test
What is a positive Dix-Hallpike test?
A reproduction of vertigo symptoms and rotational nystagmus towards the affected side for 30secs
How is BPPV treated?
Epley Manoevre - dislodges the crystals thought to be causing symptoms
What condition causes sudden onset vertigo lasting days with associated hearing loss and tinnitus?
Labyrinthitis
What condition causes sudden onset vertigo lasting days with NO associated hearing loss and tinnitus?
Vestibular Neuronitis
What genetic condition is acoustic neuroma associated with?
Neurofibromatosis Type 2
Where (anatomically) do 90% of nosebleeds occur?
Anteriorly in the anterioinferior nasal septum
What is the name of the area where most nosebleeds occur?
Kiesselbach’s Plexus / Little’s Area
What are the main arteries that form Littles area?
Ophthlamic artery (anterior and posterior ethmoidal arteries) Maxillary artery (spehnopalatine and greater palatine arteries) Facial artery (septal branch of superior labial artery)
Name some local causes of epistaxis
Idiopathic, infection, trauma, neoplasia, iatrogenic
In children remember juvenile angiofibromas
Name some systemic causes of epistaxis
Von Willebrands, Haemophilia, anti-coagulant drugs, Hereditary Haemorrhagic Telangastasia
What is the initial first aid management of epistaxis?
Get patient to sit forward with mouth open to reduce blood flow to the area and allow blood to get spat out
Pinch the soft part of the nose firmly for 10-15 mins
Suck an ice cub to induce vasoconstriction
Which patients with epistaxis should be sent to A&E?
Patients who are deemed to be haemodynamically unstable
Patients with posterior nosebleeds
If bleeding stops with first aid measures, what should be given to prevent crusting?
Naseptin cream
If bleeding does not stop with first aid measures in 10-15 minutes, what should be done next?
Nasal Cautery (silver nitrate applied to bleeding point for 10-15 secs) If cautery ineffective or cannot locate bleeding point - Nasal Packing.
If nasal cautery or packing does not work for epistaxis, what should be done next?
EUA and arterial ligation
If this does not work, radiological arterial embolization
What is the commonest cause of neck lumps?
Lymphadenopathy
What neck swellings move upwards when swallowing?
Thyroid swellings
What neck lump is an embryological remnant of thyroid descent and moves upwards with tongue protrusion?
Thyroglossal cyst
What would you suspect in a patient with dysphagia, regurgitation and aspiration and a neck lump that gurgles on palpation?
Pharyngeal pouch
Where is a cystic hygroma found on the neck?
Between the sternocleidomastoid muscle and the side of the neck. Classically on the left side. Most of them are present at birth.
What is an oval, mobile cystic mass found between the sternocleidomastoid and the pharynx?
Branchial cyst
What causes a branchial cyst?
Failure of obliteration of the 2nd branchial cleft in embryonic development
What would be the cause of a pulsatile lateral mass that does not move on swallowing?
Carotid aneurysm
Where do the majority of salivary lumps occur?
In the parotid (80%), 80% of which are benign and 80% of these are pleomorphic adenomas
When do pleomorphic adenomas occur in life?
Occur in middle age and are slow growing
Are pleomorphic adenomas malignant?
No they are benign but DO have malignant potential
Which salivary tumour is cystic with abundant lymphocytes with germinal centres?
Warthin’s tumour - usually occurs in elderly male smokers
What are some features of malignant salivary tumours?
Rapid growth, painful, fixation of skin, facial nerve palsies
