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ENT Flashcards

1
Q

Progressive unilateral sensorineural hearing loss, associated vertigo. Diagnosis?

A

Acoustic neuroma (vestibular schwannoma)

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2
Q

Cranial nerves affected by acoustic neuroma

A

VIII: hearing loss, vertigo, tinnitus
V: absent corneal reflex
VII: facial nerve palsy

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3
Q

Investigation for suspected acoustic neuroma

A

MRI of cerebellopontine angle

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4
Q

Describe the features of vestibular neuronitis

A

Often develops following a viral infection

  • recurrent vertigo attacks lasting hrs or days
  • N+V may be present
  • horizontal nystagmus
  • NO hearing loss or tinnitus
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5
Q

Management of vestibular neuronitis

A

Vestibular rehab exercises if chronic symptoms

Betahistine is often used although the evidence base suggests it’s less effective than rehab

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6
Q

When would you prescribe ABx in otitis media?

A
  • symptoms >4d or not improving
  • systemically unwell but not requiring admission
  • immunocompromise or high risk complications 2’ to heart, lung, kidney, liver or NM disease
  • <2yo with bilateral otitis media
  • with perforation and/or discharge in the ear
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7
Q

Describe the vertigo seen in Meniere’s disease, and compare to BPPV

A

Meniere’s - vertigo is spontaneous + last mins to hrs with accompanied unilateral hearing loss + tinnitus
BPPV - vertigo is provoked by a change in position + lasts for seconds (no hearing change)

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8
Q

Management of Ménière’s disease

A

ENT assessment to confirm diagnosis
Patients should inform the DVLA - cease driving until satisfactory control of symptoms
Acute attacks - buccal/IM prochlorperazine
Prevention - betahistine and vestibular rehab

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9
Q

Features of cholesteatoma

A

Foul-smelling discharge
Hearing loss
May also have features of local invasion - vertigo, facial n palsy, cerebellopontine angle syndrome

On otoscopy, an ‘attic crust’ may be seen in the uppermost part of the ear drum

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10
Q

Audiogram findings in sensorineural hearing loss

A

Both air and bone conduction is impaired

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11
Q

Audiogram findings in conductive hearing loss

A

Only air conduction is impaired

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12
Q

Audiogram findings in mixed hearing loss

A

Both air and bone conduction are impaired, with air conduction worse than bone

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13
Q

What is Ramsay Hunt syndrome? Outline the features and management

A

Herpes zoster oticus - caused by the reactivation of the varicella zoster virus in the geniculate ganglion of CN VII

Features - auricular pain, facial n palsy, vesicular rash around the ear, vertigo, tinnitus

Management - oral aciclovir and corticosteroids

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14
Q

Differential diagnoses for vertigo

A

Viral labyrinthitis - recurrent viral infection, sudden, N+V, hearing may be affected
Vestibular neuronitis - recurrent viral infection, recurrent vertigo (h-d), no hearing loss
BPPV - gradual, triggered by change in head position (10-20s)
Meniere’s - hearing loss, tinnitus, feeling of pressure in ear(s)
Vertebrobasilar ischaemia - elderly pt, dizziness on ext of neck
Acoustic neuroma - hearing loss, vertigo, tinnitus, absent corneal reflex

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15
Q

Common causative organism of otitis media

A

H. influenzae

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16
Q

Features and management of Quinsy

A

Quinsy is the development of a local abscess after bacterial tonsillitis
Features - unilateral tonsillar swelling, fever, severe pain, uvula deviated to unaffected side, dec neck mobility
IV ABx and surgical drainage usually resolves symptoms

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17
Q

Outline Rinne’s test and what the results mean

A

Tuning fork placed on mastoid process until sound no longer heard, followed by repositioning just over external acoustic meatus
AC usually better than BC
If BC > AC then conductive deafnes

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18
Q

Outline Weber’s test and what the results mean

A

Tuning fork is placed in middle of forehead, pt is asked which side is loudest
In unilateral sensorineural deafness, sound localises to unaffected side
In unilateral conductive deafness, sound localises to affected side

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19
Q

Describe the anatomy of the tympanic membrane

A

Central umbo with manubrium of malleus pointing towards pt’s face (R hand side in R ear, L hand side in L ear)
Cone of light is seen at 5 o’clock in R ear, 7 o’clock in L
Pars tensa below umbo
Pars flaccida above manubrium of malleus

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20
Q

What are you looking at in otoscopy

A

Identify the pars tensa, pars flaccida, handle of malleus, and cone of light (points to toes)
Note colour, translucency, any bulging or retraction, and perforations

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21
Q

Common causes of otitis externa

A

Pseudomonas

Staph aureus

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22
Q

Differential diagnosis for otitis externa

A

Contact eczema

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23
Q

Presentation, investigations and management of temporomanibular joint dysfunction

A

Symptoms - earache, facial pain, joint clicking/popping, teeth grinding, stress
Signs - joint tenderness exacerbated by lateral movement of the open jaw, or trigger points in pterygoids

Imaging - MRI
Rx - NSAIDs, CBT, physio, surgery

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24
Q

Causes of discharge from the ear

A

Otitis externa/media
Cholesteatoma
CSF otorrhoea

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25
Q

Describe the symptoms and causes of acute otitis media and give the treatment

A

Middle ear infection - presents with rapid onset pain, fever, irritability, anorexia, vomiting

Common organisms - pneumococcus, haemophilus, moraxella, streps and staphs

Treat with analgesia +/- co-amoxiclav (only if unwell!)

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26
Q

Complications of acute otitis media

A 
Mastoiditis
Petrositis
Labyrinthitis
Facial n palsy
Meningitis
IC abscesses
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27
Q

Management of chronic otitis media

A 
Topical/systemic ABx
Aural cleaning
Water precautions
FU
Surgery may be required
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28
Q

Complications of cholesteatoma

A

Rare, but serious - meningitis, cerebral abscess, hearing loss, mastoiditis, facial n dysfunction

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29
Q

Presentation and management of cholesteatoma

A

Foul discharge +/- deafness, headache, pain, facial paralysis, vertigo

Rx - mastoid surgery

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30
Q

Causes, presentation, investigations and treatment of mastoiditis

A

Middle ear inflammation leads to destruction of air cells in mastoid bone +/- abscess formation.

Presentation - fever, tenderness, swelling + redness behind pinna
Imaging - CT
Rx - admit for IV ABx, myringotomy +/- mastoidectomy

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31
Q

Risk factors for otitis media

A 
URTI
Bottle-feeding
Passive smoking
Dummy
Presence of adenoids
Asthma
Malformations
GOR/inc BMI in adults
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32
Q

Outline a typical history and exam in a child with glue ear

A

Hx - poor listening and speech, language delay, inattention, poor behaviour, hearing fluctuation, ear infections, URTIs, balance problems

O/E - may be retracted or bulging, can look dull, grey or yellow. May be bubbles or a clear fluid level

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33
Q

Management of glue ear

A

Active observation for 3m

Surgery if persistent OME -> grommets

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34
Q

Define conductive hearing loss. Give some causes

A

Impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes

Causes - external canal obstruction, drum perforation, problems with ossicular chain, inadequate Eustachian tube ventilation of middle ear

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35
Q

Define sensorineural hearing loss. Give some causes

A

Results from defects central to the oval window in the cochlea, cochlear nerve, or more central pathways.

Causes - ototoxic drugs (vanc, gent), postinfective (meningitis, MM), cochlear vascular disease, Meniere’s, trauma

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36
Q

Causes of tinnitus

A

Disorders causing SNHL - noise-induced HL, Meniere’s
Ototoxic drugs - cisplatin, aminoglycosides
OME
Hyper/hypothyroidism, DM and MS
Acoustic neuroma
Trauma to head or neck

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37
Q

Management of tinnitus

A

Treat underlying cause. If none found:

  • hearing aids (if hearing loss >35dB)
  • psychological support
  • CBT
38
Q

Define acoustic neuroma. How do they typically present?

A

Aka vestibular schwannomas

Benign subarachnoid tumours that cause problems by local pressure, and behave as SOL

39
Q

Presentation and management of acoustic neuromas

A

Progressive ipsilateral tinnitus +/- SNHL
Large tumours may give ipsilateral cerebellar or rICP signs
Giddiness is common, vertigo rare

Management - surgery (but difficult and often not needed)

40
Q

Describe noise-induced HL

A

May be one-time exposure to an intense sound or continuous exposure to loud sounds.
Rupture of the drum and ossicular fracture may occur.

Usually bilateral SNHL +/- tinnitus

41
Q

Define vertigo. What is vestibular vertigo?

A

Sensation that you, or the world around you, is moving or spinning

Vestibular vertigo is often severe, there may be loss of balance, N+V, HL, tinnitus, nystagmus, diaphoresis

42
Q

Peripheral and central causes of vertigo

A

Peripheral - Meniere’s, BPPV, vestibular failure, labyrinthitis
Central - acoustic neuroma, MS, head injury, migraine associated dizziness

43
Q

Describe benign paroxysmal positional vertigo. Give causes and management

A

Commonest cause of peripheral vertigo
Attacks of sudden rotational vertigo lasting >30s are provoked by head turning

Causes - idiopathic or head injury
Treat - usually self-limiting, can try Epley manoeuvre

44
Q

Describe Meniere’s disease. Give investigations and management

A

Sudden attacks of vertigo lasting 2-4h.
Nystagmus is always present
Inc fullness in ear +/- tinnitus followed by vertigo
Unknown cause

Investigation - electrocochleograpy, post fossa MRI
Treat - acute = procloperazine, prophylaxis = betahistine

45
Q

Describe acute vestibular failure. Give presentation and management

A

Aka vestibular neuronitis/labyrinthitis
Sudden attacks of unilateral vertigo and vomiting in a prev well person

Signs - nystagmus away from affected side
Treat - vestibular suppressants (cyclizine)

46
Q

Define rhinosinusitis

A

Inflammation in nose and paranasal sinuses with >2 symptoms:

  • nasal congestion
  • nasal discharge
  • facial pain/pressure
  • dec sense of smell
  • endoscopic or CT signs
47
Q

Non-infective/allergic causes of nasal congestion

A

Children - large adenoids, postnasal space tumour, foreign body
Adult - deviated nasal septum, granuloma

48
Q

Presentation of chronic rhinosinusitis with polyps. Give investigations and management

A

Watery ant rhinorrhoea, sneezing, purulent post-nasal drip, nasal obstruction, sinusitis, mouth-breathing, snoring, headaches

Investigations - rhinoscopy or endoscopy
Treat:
- medical -> betamethasone spray
- surgical -> endoscopic sinus surgery

49
Q

Define acute bacterial rhinosinusitis

A

Presence of at least 3 symptoms/signs:

  • discoloured discharge and purulent secretion in nasal cavity
  • severe local pain
  • fever
  • elevated ESR/CRP
50
Q

Differentials for sinusitis

A 
Migraine
TMJ dysfunction
Dental pain
Neuropathic pain
Temporal arteritis
Herpes zoster
51
Q

Causes of bacterial sinusitis. Which organisms?

A

Most follow viral infection. Others:

  • direct spread
  • odd anatomy (septal deviation, polyps)
  • ITU causes (venilation, NG tubes)
  • systemic cause (Kartagener’s)
  • biofilms

Strep pneumoniae, H influenzae, S aureus

52
Q

Management of bacterial sinusitis

A

Acute/single episode - simple analgesia, amoxicillin or doxy

Recurrent - as above, plus imaging/surgery

53
Q

Causes and management of CSF rhinorrhoea

A

Ethmoid fractures that disrupt the dura and arachnoid.

Manage conservatively

54
Q

Management of septal perforation

A

Saline nasa irrigation
Vaseline
Surgical closure may be needed

55
Q

Management of epistaxis

A

Resus as needed
Apply pressure by squeezing lower part of nose for 20min
Ice pack on dorsum of nose
Apply cotton ball soaked in 1:200,000 adrenaline for 2m
Cauterise with silver nitrate
Anterior nasal pack
Postnasal pack

56
Q

Causes of epistaxis

A 
Local trauma (nose picking)
Facial trauma
Dry/cold weather
Haemophilia
Septal perforation
57
Q

Which arteries are involved in anterior epistaxis?

A

Kiesselbach’s plexus - ant ethmoidal, sphenopalatine, facial arteries, sup labial

58
Q

Causes of a sore throat

A

Viral - rhinovirus, parainfluenza virus
Bacterial - GABHS
Rarer - HIB

59
Q

Complications of tonsillitis

A 
Otitis media
Sinusitis
Peritonsillar abscess (quinsy)
Parapharyngeal abscess
Lemierre syndrome
60
Q

Cause, presentation, and management of scarlet fever

A

Caused by exotoxins released from Strep pyrogenes (a GABHS)
Rash often develops on chest, axillary, or behind ears
Facial flushing with circumoral pallor
Strawberry tongue

Treat - penicillin V

61
Q

Define stridor

A

High-pitched noise heard in inspiration from partial obstruction at larynx or large airways

62
Q

Define stertor

A

Inspiratory snoring noise, coming from obstruction of the pharynx

63
Q

Causes of stridor

A

Congenital - laryngomalacia, stenosis
Inflammation - laryngitis, epiglottitis, croup, anaphylaxis
Tumours - haemangiomas or papillomas
Trauma - thermal/chemical

64
Q

Describe croup. Give the management

A

Leading cause of stridor with a barking cough

Treat - single dose of dexamethasone
Admit if severe, or moderate that isn’t settling

65
Q

Describe laryngomalacia

A

Main congenital anomaly of the airway
Often noticed within hrs of birth
Excessive collapse and indrawing of supraglottic airways during inspiration, leading to stridor

66
Q

Define dysphonia. Give some causes. When would you investigate?

A

Difficulty producing sound, with a change in voice pitch or quality
Majority are due to viral URTI

Investigate if lasting >3wk (esp in smokers)

67
Q

Differential diagnoses of dysphonia

A

Laryngeal cancer - progressive and persistent gruff voice
Vocal cord palsy - often due to cancer
Laryngitis - often viral and self-limiting
Reflux laryngitis

68
Q

Causes of dysphagia

A

Stricture (benign or malignant) - esp if solids worse than fluid
Motility disorders (achalasia) - if solids = fluids
Bulbar palsy - if difficult to initiate swallowing
Pharyngeal pouch - if neck bulges on drinking

69
Q

Define globes pharyngeus

A

Sensation of a lump in the throat that’s most noticed when swallowing saliva
May complain of mucous in the throat which they’re unable to clear

Cause is unclear - possibly due to muscle tension in pharynx or inc acid exposure

70
Q

What’s the most common type of cancer in the head and neck?

A

90% Squamous cell carcinoma (HNSCC)

71
Q

Causes/associations of HNSCC

A 
Cigarette smoking
Inc alcohol consumption
Vit A+C deficiency
HPV
GORD
72
Q

Signs and symptoms of oral cavity SCC

A 
Persistent, painful ulcers
White or red patches on the tongue, gums or mucosa
Otalgia
Odonophagia
Lymphadenopathy
73
Q

General symptoms of HNSCC

A 
Neck pain/lump
Hoarse voice >6wks
Sore throat >6wks
Mouth bleeding
Mouth numbness
Sore tongue
Painless ulcers
Patches in mouth
Earache/effusion
Lumps
Speech change
Dysphagia
74
Q

Causes of facial nerve palsy

A

Intracranial - brainstem tumours, strokes, polio, MS
Intratemporal - otitis media, cholesteatoma
Infratemporal - parotid tumours, trauma
Others - Lyme disease

75
Q

Signs of a facial nerve palsy

A

LMN lesions - paralyse all of one side of face

UMN lesions - forehead muscle and closing of the eyes may be intact

76
Q

Signs, complications, and management of xerostomia

A

Dry, atrophic, fissured oral mucosa
Discomfort, difficulty eating and speaking

Complications = dental caries, candida infection
Treat = inc oral fluids, good dental hygiene, saliva substitutes
77
Q

Causes of xerostomia

A 
Hypnotics + tricyclics
Antipsychotics
B-blockers, diuretics
Mouth breathing
Dehydration
ENT radio
Sjogren’s
SLE and scleroderma
Sarcoidosis
78
Q

Management of nasal polyps

A

All pts should be referred to ENT for full examination
-> urgently if unilateral (red flag for NP cancer)

Topical steroids shrink 80% of polyps

79
Q

What is presbycusis? What’s the underlying pathology?

A

SNHL affecting elderly individuals
High-freq hearing is affected bilaterally
Progresss slowly as sensory hair cells and cochlea neurons atrophy

80
Q

Signs and audiometry results in presbycusis

A

Weber’s may lateralise if SNHL is not completely bilateral.

Audiometry shows bilateral high-frequency SNHL pattern

81
Q

First-line ABx for otitis media

A

Amoxicillin

Co-amoxicillin is 2nd

82
Q

Neck lump in anterior triangle. Doesn’t transluminate, but is mobile and has cholesterol crystals in fluid

A

Branchial cyst

83
Q

Causes of gingival hyperplasia

A

Phenytoin
Ciclosporin
CCB
AML

84
Q

Vertigo + hearing loss + absent corneal reflex?

A

Acoustic neuroma

85
Q

Pathophysiology of otosclerosis

A

Replacement of normal bone by vascular spongy bone
Causes progressive CHL due to fixation of stapes at oval window.
AD and tends to affect young adults

86
Q

Features and management of otosclerosis

A 
Onset 20-40yr
CHL
Tinnitus
Normal tympanic membrane
\+ve FHx

Treat = hearing air, stapedectomy

87
Q

Describe the neck lump seen in lymphoma

A

Rubbery, painless lymphadenopathy

Associated night sweats and spleen omega

88
Q

Differentials for a neck lump that moves upwards on swallowing

A

Thyroid swelling

89
Q

Differentials for a neck lump that moves upwards with tongue protrusion

A

Thyroglossal cyst

90
Q

Differentials for a neck lump that is fluctuant but doesn’t transilluminate or move during swallwing

A

Branchial cyst

Finals (25 decks)

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