ENT Flashcards
Common organisms in acute otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Management of chronic suppurative otitis media
Discharge can be controlled by cleaning the ear and
introducing eardrops.
Risks of ototoxicity: drops should be used for a maximum of 2 weeks
There is a risk of dmamage to the ossicles - long process of incus most commonly
Myringoplasty performed to prevent discharge, improve healing or allow patient to swim
Causes of sensorineural deafness
Presbycusis
Aminoglycosides
Cisplatinum
Mumps
Rubella
Unilateral: Cerebellopontine angle tumour
Ménière’s disease
Fluctuating deafness, tinnitus and vertigo
Endolymphatic hydrops
Tx: betahistine
Procedures of last resort are surgical destruction of the labyrinth, or section of the vestibular nerve
Herpes zoster infection of the geniculate ganglion
Ramsay-Hunt
Herpes Zoster
Causes facial nerve palsy
Associated vertigo and deafness
Paranasal sinus tumours
Most common is squamous cell carcinoma
Adenocarcinomas seen in occupations with large wood-dust expsoure
Most common sites: Maxillary and ethmoid sinus
Adenoids
B-cell predominant lymphoid tissue
Enlargement causes:
- Glue ear
- Nasal obstruction
- Sleep apnoea
Carcinoma of the nasopharynx
Associated with EBV
Presentation:
- Middle ear effusion
- Nasal obstruction
- Epistaxis
- Cervical lymphadenopathy
Skull base invasion –> opthalmoplegia
Mx: Radiotherapy
Benign but locally invasive angiofibroma of the nasopharynx
Male adolescents
Presentation: nasal obstruction and epistaxis
Treated by (open or transnasal endoscopic) surgical excision.
Rannulas
Retention cysts inferior to the tongue
Blockage of the opening of minor mucous secreting glands
Caner of the tongue
Sqaumous cell carcinoma of the tongue is the most common
Lymphatic spread to submittal and deep cervical nodes
Treatment is with local excision if low stage or radiotherapy
If higher stage may need to resect with mandible
Indications for tonsillectomy
Episodes of sore throat are disabling
Seven or more clinically documented adequately treated sore throats in the preceding year
Five or more episodes of sore throat in each year for the preceding two years
Three or more episodes of sore throat in each year for the preceding three years
Cancer of the tonsils
B cell Lymphoma
Squamous cell
-HPV associated
Referred dysphagia
Level of obstruction is always the level below to that it is referred to
Paterson-Brown-Kelly syndrome
Iron deficiency anaemia, glossitis, stomatitis and post-cricoid web
Later develops into post-cricoid cancer
Lyryngomalacia
Congenital condition which most children grow out of by two
Aryepiglottic folds are high, soft and tend to collapse
Causes inspiratory stridor worsened during period of URTI
In severe of no resolving causes –> CO2 laser to reduce bulkiness of aryepiglottic folds
Reinke’s oedema
Build up of fluid deep to vocal cord epithelium
Seen in women smokers that have chronic laryngitis
Mx: Drainage
Recurrent laryngeal nerve injuries
More commonly right sided due to intra-thoracic course
e.g. invasive bronchial carcinoma
Unilateral lesion causes weak breathy voice
Mx: Injection of bulk or fat lateral to vocal cord
Bilateral –> stridor
Cancer of the larynx
Nearly all are squamous cell carcinomas
Smoking and drinking
Tumours of the glottis / true vocal cords present early due to hoarseness
-As they have little lymphatics they are usually T1 and respond well to laser resection
Larger lesions may grow into supraglottic space and present with airway obstruction
Mx early lesion: radiotherapy or laser resection
Later higher stage: resection of the larynx and creation ion end tracheostome
–> patients produce speech by air trapping or using a valve + surgically created oesophago-tracheal puncture
Site of a tracheostomy
Anterior tracheal wall at second - third TRACHEAL rings
Removal of a thyroglossal cyst
Removal of the persistent thyroglossal duct, cyst, part of the hyoid in continuity with section of tongue reduces recurrence
Branchial cysts
Lateral neck swellings
Remnant of second and third branchial arches
Contain opaque fluid and cholesterol crystals
Fistulas to skin and surrounding organs can develop
Cystic hygroma
Rare benign lymphangioma
Present in early life
Complete excision difficult
Dermoid cysts
Often midline neck swelling or submandibular
Contain dermal appendages so have hair etc.
-> unlike sebaceous cysts
Laryngoceole
Herniation of laryngeal mucosa into neck
Lateral
Become distended with valsalva
Superficial parotidectomy
Bening. neoplasma
Excision of benign lesion with a cuff of normal tissue
Reduces risk of damage to facial nerve
Most common salivary gland tumour
Pleomorphic adenomas
