ENT Flashcards
What are 3 important complications of neck surgery?
Recurrent laryngeal nerve palsy (hoarseness: unilateral)
Bleeding (haematomas can rapidly cause respiratory compromise due to laryngeal oedema in confined space)
Damage to parathyroids (hypocalcaemia)
Management of acute otitis media
Analgesia
Amoxicillin if over 48h
Average duration about 4 days
Mx Eustachian tube dysfunction
Regular warm drinks +/- decongestants
Steroid nasal spray
Mx otitis externa
Keep dry
Abx ear drops/ spray
Mx perforated ear drum
Consider amoxicillin 1 week, refer if not improving (2-6 weeks)
Mx temoromandibular joint pain
analgesia, reassurance, relaxation
dentist if persists
Red flags for tinnitus
Unilateral
Head injury/ evidence of raised ICP
Suicidal ideation: chronic tinnitus is risk factor
Mx suspected dental abscess
See dentist
5-7 days amox if suspect abscess/ root canal infection
Add metronidazole if severe infection suspected
What is the FeverPAIN score?
Likelihood of strep infection causing tonsillitis:
Fever Purulence Attend within 3 days Inflamed tonsils ++ No cough/ coryzal sx
Abx for strep throat
Pen V
reduces symptoms by 1 day!
Referral for tonsillectomy criteria
7 in 1 year
5 per year for 2 years
3 per year for 3 years
Most common bug causing otitis externa
Pseudomonas (swimmer’s ear) - can be other bacteria or herpes
Signs otitis externa
Otalgia
Swelling/ erythema: external ear, ear canal
Pain on manipulation of auricle
Debris in canal/ otorrhea
Mx otitis externa
KEEP EAR DRY
Mild: cleaning, dilute ascetic acid drops
Most: topical abx
What is malignant otitis externa?
Fulminant bacterial otitis externa
Who tends to get malignant otitis externa?
elderly with DM (doesnt seem to affect others with immunosuppression)
Which bug commonly causes malignant otitis externa?
Pseudomonas aeruginosa
Signs of malignant otitis externa
Classic feature: nub of granulation tissue on floor of external ear canal at bony-cartilaginous junction
Severe pain - excessive purulent d/c - maybe exposed bone
Mx malignant otitis externa
Monitor DM
extensive debridement
IV abx
Complications malignant otitis externa
Invasion of surrounding tissue to produce cellulitis
Osteomyelitis of temporal bone
Mastoiditis
Later: facial nerve palsy, meningitis, brain abscess
What does CT show in malignant otitis externa?
temporal bone erosion and inflammation
What tumours mos commonly form on the ear/ ear canal?
SCC
Sometimes BCC/ melanoma
Mx perf ear drum
Keep dry
Use systemic abx if signs of infection/ contamination
otherwise, most heal spontaneously
What is a cholesteatoma?
Epidermal inclusion cyst of the middle ear/ mastoid, containing desquamated keratin debris (may be acquired or congenital)
Complications of cholesteatomas
Ossicular erosion (conductive hearing loss)
local invasion, causing vertigo and sensorineural hearing loss
facial paralysis
CNS dysfunction/ infection
Mx cholesteatoma
surgery aiming to reconstruct ossicular chain
Microbe causes of acute otitis media
usually Strep pneumoniae (33%)
H. influenzae
other shit
Inheritance of otosclerosis
AD
What kind of signs in otosclerosis?
Conductive hearing loss with normal TM
Schwartze’s sign: erythema around stapes from hypervascularity
Most common causes of sensorineural hearing loss
PRESBYCUSIS - leading cause
acoustic injury from loud noises
congenital (TORCHES: maternal toxoplasmosis, rubella, MMV, herpes, syphilis)
In kids, most common cause is bacterial meningitis
Anterior epistaxis vessels
Kiesselbach’s plexus (more common ~90%, usually associated with trauma)
Posterior epistaxis vessels
Sphenopalatine artery (elderly, HTN, tumour, anticoag)
Mx epistaxis
Anterior packing for epistaxis
Posterior packing
Next steps
ABCDE
Pressure, head forward
A: gauze strips
P: Foley catheter
Silver nitrate (need LA, stings) Embolisation or ligation of arteries
Early + late signs nasal ca
Early: nasal obstruction, blood-tinged mucus, epistaxis
Late: localised pain, cranial nerve deficits, facial/ palate asymmetry, loose teeth
Complications of tonsillitis
Peritonsillar abscess (quinsy)
Retropharyngeal abscess (causing airway compromise)
Rheumatic fever
Post-strep GN
Signs of quinsy
fever, odonophagia, hot potato voice
cervical lymmphadenopathy
Bulging, erythematous tonsillar pillar
swelling of the uvula and displacement
Mx quinsy
IV abx
surgical excavation
Which salivary glands most commonly involved in pathology
Parotid and submandibular
Sublingual rarely affected
Which glands commonly affected by calculi?
Submandibular
How does calculi present?
Pain before and during eating
How is calculi confirmed?
can maybe palpate
duct may be erythematous with purulent d/c
visible on x-ray
(mx by excising)
Signs and symptoms of mandibular fracture?
Pain!
Disfigurement, malocclusion
lacerations of gingiva
haematoma in floor of mouth
Which nasal fractures need to go to theatre?
Septal haematoma: boggy painful bilateral swelling which is compressible
cartilage can become ischaemic leading to saddle nose (cartilage loss)
How many parathyroid glands?
4
Common tumour marker for parathyroid carcinoma
beta-HCG
Signs suggesting parathyroid carcinoma
palpable mass + hypercalcaemia + PTH
Describe thyroglossal cyst
Mid-line, under hyoid bone
Connected to base of tongue
Cyst may become infected or dscharge
Why is radioiodine uptake necessary before removing thyroglossal cyst?
May contain some/ all thyroid tissue
Rule of 80 re neck lumps
80% in children are benign
80% in adults over 40 are malignant
What is branchial cyst?
congenital abnormality - usually not apparent until adult life when an infection may precipitate problems
upper anterior border of SCM
mx aspiration (contains cholesterol crystals)
What level of hearing is normal on audiogram
anything above 20 dB
mx sinusitis
steroid spray
abx only if systemically unwell
causes of conductive hearing loss
wax, perf, OmE, Eustachian tube blockage
BPPV test and mx
Dix-Hallpike = test Epley = mx
Sx BPPV
seconds of dizziness, usually due to moving head
no hearing loss
no tinnitus
Sx acute labyrinthitis
sudden onset vertigo
can be severe with N&V
no hearing loss
no tinnitus
Sx menieres
progressive
vertigo with nausea, tinnitus, progressive hearing loss, ear fullness
acoustic neuroma sx
unilateral hearing loss vertigo focal deficits sx raised ICP associated with neurofibromatosis type 2
