ENT Flashcards
Sensorineural Hearing Loss Causes
Problems of the inner ear.
Nerve-related hearing loss.
*Exposure to loud noise
*Aging (Presbycusis)
*Ménière’s disease
*Head trauma
Virus or Disease
Autoimmune inner ear disease
*Heredity
Malformation of the inner ear
Tumors
Conductive Hearing Loss Causes
Problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles).
Cold / Allergies / *Ear Infection (*Otitis Media – accumulation of fluid may interfere with the movement of the eardrum and ossicles) Poor Eustachian tube function *Perforated eardrum *Otosclerosis Benign Tumors Impacted Earwax Foreign object in the ear
+ve Rinne
Air conduction is perceived louder than bone conduction. Normal
-ve Rinne
Conductive Hearing loss
Sound from mastoid is herd louder
Otitis Externa
Inflammation of Skin of external auditory meatus Swimmers Ear (water trapped causing bacteria growth) Pseudomonas Aeruginosa, Staphylococcus
Irritation, Pain, discharge and deafness
Tenderness on moving, moist debris which when removed reveals erethymatous canal
Microsuction, Abx Topically, Steroid Drops
Otitis Media
Common in Children
Can follow an URTI
Strep Pneu, Moraxella Catarhallis, Haemoph, Influenza
Otalgia (Pain relieved by tympanic membrane perforation and pus release), Hearing Decreases
Fever, red tympanic membrane, fluid level visible
Abx, Analgesia
Cx Mastoiditis, Meningitis, ICA,
Thyroglossal cyst
Dilatation of thyroglossal duct remnant May become infected MIDLINE; grows with age Moves on tongue protrusion Chance of reccurence
Thyroid mass
Examples
Solitary nodule
Diffuse enlargement
Multi-nodular goitre
Solitary thyroid nodule
Cyst: due to localised haemorrhage Adenoma: benign follicular tissue Carcinoma Lymphoma Prominent nodule in multi-nodular goitre
F>M
30-40 years
10% malignant in middle-aged, 50% malignant in young
Investigate by fine-needle aspiration cytology (FNAC) AND ultrasound scanning
CANNOT distinguish bw follicular adenoma + carcinoma
Therefore tissue required for histological diagnosis
THYROID LOBECTOMY
Thyroid Cancer
Papillary-lymphatic metastasis
Follicular-haematogenous metastasis
Medullary-familial association 10%, arise from parafollicular C cells
Anaplastic-aggressive, local spread, very old, poor prognosis
Diffuse thyroid enlargement
Colloid goitre: due to gland hyperplasia
iodine deficiency
puberty, pregnancy, lactation
Grave’s disease
Thyroiditis
Grave’s disease
F>M
Auto-antibodies against thyroid-stimulating hormone receptor stimulate receptor
Hyperthyroidism results
Thyroid eye disease, acropachy/clubbing, pre-tibial myxoedema
Treatement: anti-thyroids, beta-blockade, radio-iodine & surgery
Thyroidectomy
Indications
Airway obstruction Malignancy or suspected malignancy Thyrotoxicosis Cosmesis Retrosternal extension
Multi-nodular goitre
Due to Grave’s disease OR toxic goitre GRAVES Women Middle-aged Over-activity→hyperthyroidism
TOXIC GOITRE: Older, no eye signs, atrial fibrillation
Thyroid function tests, FNAC, chest x-ray
Stridor and RX
Clinical sign of airway obstruction
Inspiratory - laryngeal
Expiratory - tracheobronchial
Biphasic – glottic/subglottic
Treat with O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management
