ENT Flashcards
Viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Vestibular neuritis
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss
BPPV
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
Meniere’s disease
Associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears
Acoustic neuroma
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2
Vertebrobasilar ischaemia
Elderly patient
Dizziness on extension of neck
Presbycusis
Presbycusis describes age-related sensorineural hearing loss. Patients may describe difficulty following conversations
Audiometry shows bilateral high-frequency hearing loss
Otosclerosis
Autosomal dominant, replacement of normal bone by vascular spongy bone. Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
tympanic membrane - 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
positive family history
Glue ear
Also known as otitis media with effusion
peaks at 2 years of age
hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
Drug ototoxicity
Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
Benign pleomorphic adenoma
Most common parotid neoplasm (80%)
Proliferation of epithelial and myoepithelial cells of the ducts and an increase in stromal components
Slow growing, lobular, and not well encapsulated
Recurrence rate of 1-5% with appropriate excision (parotidectomy)
Recurrence possibly secondary to capsular disruption during surgery
Malignant degeneration occurring in 2-10% of adenomas observed for long periods, with carcinoma ex-pleomorphic adenoma occurring most frequently as adenocarcinoma
Warthin tumour
Second most common benign parotid tumor (5%)
Most common bilateral benign neoplasm of the parotid
Marked male as compared to female predominance
Occurs later in life (sixth and seventh decades)
Presents as a lymphocytic infiltrate and cystic epithelial proliferation
May represent heterotopic salivary gland epithelial tissue trapped within intraparotid lymph nodes
Incidence of bilaterality and multicentricity of 10%
Malignant transformation rare (almost unheard of)
Otitis externa mx
Flucloxacillin
Malignant otitis externa mx
Ciprofloxacin
Drugs causing ototoxicity
Ototoxic medicines include gentamicin, quinine, furosemide, aspirin and some chemotherapy agents. Quinine may be given for nocturnal leg cramps or as an antimalarial. Other side effects of quinine include tinnitus, sweating, low platelets and increased sweating.
Reactive lymphadenopathy
By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness
Lymphoma
Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly
Thyroid swelling
May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing
Thyroglossal cyst
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
Pharyngeal pouch
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
Cystic hygroma
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
Branchial cyst
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Cervical rib
More common in adult females
Around 10% develop thoracic outlet syndrome
Carotid aneurysm
Pulsatile lateral neck mass which doesn’t move on swallowing
Menieres mx
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
