ENT Flashcards
This is defined as sensorineural hearing loss that occurs with aging. It is typically first noticed in the sixth decade of life and characteristically begins with symmetrical, high-frequency hearing impairment. Patients often complain of difficulty hearing in crowded or noisy environment
Presbycusis
This type of chronic conductive hearing loss is associated with bony overgrowth of the stapes. It typically begins with low-frequence hearing loss and is often found in middle aged individuals
Otosclerosis
This presents with episodes of tinnitus, vertigo, and sensorineural hearing loss
Meniere’s disease
Most patients with this have a history of nocturnal teeth grinding, and patients interpret the pain as coming from the ear due to anatomic proximity. The pain is characteristically worsened with chewing. Can have audible clicks or crepitus but not seen in all patients
TMJ dysfunction
This is a form of herpes zoster infection that causes Bell’s palsy. In this condition, vesicles are typically seen on the outer ear
Ramsay Hunt syndrome
This is a condition in which patients experience intermittent, severe, stabbing pain in areas innervated by cranial nerves IX and X, which includes the ear
Glossopharyngeal neuralgia
This usually results in ear discharge and pain with pulling on the pinna
Otitis externa
The presence of a white granular patch or plaque over the buccal mucosa in a patient with a hx of alcohol and tobacco use is most consistent with what?
Oral Leukoplakia . . this is a reactive precancerous lesion that represents hyperplasia of the squamous epithelium
If oral leukoplakia is found, the development of areas with induration and/or ulceration should prompt what?
biopsy to rule out malignant transformation of the lesion
This refers to localized, shallow, painful ulcers with a gray base
Aphthous stomatitis
In contrast to Leukoplakia, the plaques of this can usually be scraped off with a tongue depressor
oral candidiasis or thrush
This cap present with multiple vesicular lesions with an erythematous and inflammatory base and erythematous border within the oral cavity and perioral area
HSV1 . . gingivostomatitis
This presents as persistent nodular erosive, or ulcerative lesions with surrounding erythema or induration. Regional lymphadenopathy can be present as well.
Squamous cell carcinoma
There are a large number of ototoxic medications that can cause senorineural hearing loss, including what?
- Aminoglycoside antibiotics
- Chemotherapeutic agents
- Aspirin
- Loop diuretics
Ear related side effects of Aspirin
- usually causes tinnitus
- In very higher doses (6 to 8 grams/day) it can cause hearing loss
Side effects of hydrochlorothiazide
- orthostatic hypotension
- Photosensitivity
- Hypercalcemia
What is the most common middle ear pathology in patients with acquired immunodeficiency syndrome and what is it due to?
- Serous otitis media
- due to the auditory tube dysfunction arising from HIV lymphadenopathy or obstructing lymphomas
Serous otitis media is defined as the presence of a middle ear effusion without signs of an active infection. Examination commonly reveals what?
A dull tympanic membrane that is hypomobile on pneumatic otoscopy
Patient has nontender enlargement of the submandibular glands, which is consistent with sialedenosis. Sialedenosis is commonly found in what patients?
- Found in patients with advanced liver disease (eg, alcoholic and nonalcoholic cirrhosis)
- It is also seen in patients with altered dietary patterns or malnutition
Describe the pathophysiology of Sialadenosis
- Benign, NONinflammatory swelling of the salivary glands
- Associated with abnormal autonomic innervation of the glands, with accumulation of secretory granules in acinar cells
What is the differential diagnosis in Sialedenosis and distinguishing features of each
- SialadenITIS: focal tenderness, erythema, fever
- salivary gland stones: glandular swelling and pain with meals
- malignance
This is a benign neoplasm affecting the salivary glands that presents as a firm nodule
Pleomorphic adenoma
This is characterized by autoimmune sialedenitis and presents with dry mouth associated with enlargement of the parotid and submandibular glands. The lacrimal glands are also usually affected
Sjogren syndome
A patient with a history of wheezing following the ingestion of naproxen as well as symptoms of rhinitis and post-nasal drainage are highly suggestive of what?
Aspirin exacerbated respiratory disease
Aspirin exacerbated respiratory disease is commonly associated with the development of what?
nasal polyps
Aspirin exacerbated repsiratory disease consists of what features
- Asthma
- Chronic rhinosinusitis with nasal polyposis
- Bronchospasm or nasal congestion following the ingestion of aspirin or NSAIDs
Symptoms of bland tasting food (secondary to anosmia) and recurrent nasal discharge/congestion are typical in patients with nasal polyps and exam should reveal what
the presence of bilateral, grey, glistening mucoid masses in her nasal cavities
management of nasal polyps
Surgery can often provide temporary relief, but the polyps tend to recur and ultimately treatment should be geared toward medical management of the underlying etiology
This is a rare, benign tumors of the nasopharynx that can cause nasal obstruction and nasal drainage, but also usually results in epistaxis . . also occurs almost exclusively in teenage males
Juvenile nasal angiofibroma
This is a tumor of unknown etiology that clinically presents with signs of unilateral nasal obstruction and/or epistaxis
Inverted papilloma
Patients with this often complain of nasal discomfort and obstruction with excess crusting and bleeding. It is often seen in patients who use intranasal cocaine
Perforated nasal septum
Pregnant women have an increased incidence of these on the anterior nasal septum. These highly vascular lesions are frequent sources of nose bleeds during pregnancy
Pyogenic granuloma
Physical exam findings in Allergic Rhinitis
- “Allergic shiners” (infraorbital edema and darkening)
- “Allergic salute” (transverse nasal crease)
- Pale, bluish, enlarged turbinates
- Pharyngeal cobblestoning
- “Allergic facies” (high-arched palate, open-mouth breathing)
Treatment of Allergic rhinitis
- Allergen avoidance
- Intranasal CORTICOSTEROIDS (eg, fluticasone, mometasone) . . Most effective single agent
- Oral antihistamines, antihistamine or cromolyn nasal sprays, and leukotriene modifiers can be considered based on the patients symptoms and drug tolerances
This is a severe infection typically seen in elderly diabetic patients that is most commonly caused by Pseudomonas auruginosa. Patients typically present with ear pain and ear drainage that is not responsive to topical meds. The granulation tissue seen within the ear canal in this patient is a characteristic manifestation of this. Progression of the infection can lead to osteomyelitis of the skull base and cranial nerve damage. The patient’s facial dropping, which is likely causing food to drop out of her mouth, is a result of damage to the left facial nerve.
Malignant Otitis externa
What confirms diagnosis of malignant otitis externa
CT or MRI
Treatment of Malignant Otitis externa
SYSTEMIC antibiotics that are effective against Pseudomonas aeruginosa, such as ciprofloxacin
What disorder and pathophysiology?
- Low frequency tinnitus in the affected ear, often accompanied by a feeling of fullness
- Episodic vertigo, commonly associated with lightheadedness, N/V
- Sensorineural hearing loss, variable in severity but usually worsening over time
- Meniere disease
- Disorder of the inner ear characterized by increased volume and pressure of endolymph (ENDOLYMPHATIC HYDROPS), likely due to defective resorption of endolymph
- The resulting distension of the endolymphatic system causes damage to the vestibular and cochlear components of the inner ear
Describe the management of Meniere disease
- Initial: restriction of sodium, caffeine, nicotine, and alcohol
- Benzodiazepines, antihistamines, and antiemetics can relieve acute symptoms
- Diuretics can be considers for long-term management
Like Meniere disease, this can cause vertigo, hearing loss, and tinnitus. However symptoms are typically acute and resolve within several weeks
Labrynthitis (Vestibular neuritis)
This causes brief, often intense episodes of vertigo triggered by changes in head position. Patients can have headaches or a feeling of ear fullness, but tinnitus and hearing loss are NOT typical
Benign paroxysmal positional vertigo . . .Loose calcium debris in the semicircular canal
- 3 day history of fever, chills, sore throat
- Muffled or “hot potato voice”
- Deviation of uvula
- typically prominent unilateral lymphadenopathy
Peritonsillar abscess secondary to tonsillitis
Describe prognosis and treatment of peritonsillar abscess
- Can be fatal seconary to either airway obstruction or spread of infection into the parapharyngeal space, which may lead to involvement of the carotid sheath
- Initial treatment consists of aspiration of the peritonsillar abscess and initiation of IV antibiotics
- Surgical intervention may be necessary if the purulent material cannot be removed with aspiration alone
