ENT Flashcards
name some causes of acute otitis media
viral (common)- rhinovirus/ enterovirus/ RSV
bacterial- haem influenzae/ strep pneumoniae
what would you see on examination of AOM?
bulging tympanic membrane +/- pus +/- perforated ear drum
name some red flags in AOM that would warrant referral
Cellulitis of the outer ear or surrounding skin
Mastoiditis (tender mastoid, often with cellulitis looking ear and ear appears to be pressed forwards)
Headache
Facial palsy
Fever in child under 3 months old
antibiotics for AOM
amoxicillin 5 days may improve symptoms earlier but often not used for risk of resistance/ GI upset ?delayed script
in AOM if TM rupture, when should you follow up?
2 weeks
when should you refer AOM to ENT non-urgently
> = 6 episodes in 12 months
Persisting OME for >3 months (bilateral) or >6 months unilateral
what does hearing loss in AOM suggest?
otitis media with effusion
how does OME appear on examination?
opaque ear drum
Loss of light reflex
Indrawn or retracted TM – rarely can be bulging
Bubbles in fluid behind TM / fluid level visible behind TM
how long for OME to resolve?
up to 1 year 90% resolved
indications for surgery in OME
Persistent bilateral OME lasting >3 months, OR
Hearing loss >25dB in the best ear, OR
Language, education or social developmental delay
what are indications for surgical treatment of OME
grommets
adenoidectomy
what level of hearing loss is significant in OME
> 25dB
name 3 RFs for developing OME
cleft palate
chronic sinusitis in adults
parents who smoke
name 3 RFs for otitis externa
swimming
humidity
hearing aids
OE with out of proportion pain, in immunocompromised patient
necrotising (malignant) OE, infection has spread to mastoid/ temporal bones
OE with severe pain, vesicles + crusting, facial palsy
ramsay hunt syndrome, caused by herpes zoster infection
first line for OE
topical ABx- aminoglycosides/ ciprofloxacin if TM ruptured +/- steroids. May need wick. aural toileting e.g. micro-suction
what are some causes of SNHL in adults?
idiopathic hearing loss presbyacusis noise exposure inflammatory disease ototoxic drugs tumours
what is presbyacusis?
Loss of hair cells on cochlear as increase in age, High frequencies lost first, low frequencies stay in normal range, no increased air-bone gap
noticed after 60, no tx- aural hearing aids
which infections can cause HL
measles
mumps
meningitis
which drugs can cause HL
systemic aminoglycosides
cytotoxic agents- cisplatin
salicylate/ quinine (reversible)
what are some causes of conductive hearing loss in adults?
external- wax/ exostoses
eardrum- TM rupture
middle ear- otosclerosis
what is otosclerosis?
AD inherited condition. New bone growth in middle ear causes fusion of stapes footplate to oval window causing conductive HL
Abnormal result on Weber’s test
SNHL- louder in normal ear
CHL- louder in abnormal ear
abnormal result in Rinne’s
normal/ SNHL- AC>BC
CHL BC>AC
name some causes of dizziness
CVD- AF/ arrhythmias, postural hypotension
neuro- head inj, MS, tumours
otological- meniere’s BPPV, vestibular neuritis,
others- migraines
what is a positive Dix- Hallpike test?
nystagmus, diagnostic of BPPV
which manoeuvre can be used to treat BPPV?
Epley’s
A 50 year old woman with type 2 neurofibromatosis visits her GP with a 2 month history of headaches and dizziness. On examination, she has reduced hearing in one ear.
aoustic neuroma (benign tumour of schwann cells of vestibulocochlear nerve)- ipsilateral CN V, VI, IX and X may be affected ?signs of raised ICP
What is meniere’s disease?
long term, progressive condition affecting the balance and hearing parts of the inner ear. Symptoms are acute attacks of vertigo, fluctuating tinnitus, increasing deafness, and a feeling of pressure in the ear. ?due to excess fluid in inner ear (endolymphatic hydrops)
what is vertigo?
the hallucination of rotation due to the abnormal stimulation of the hair cells of the vestibular system.
what can be used in acute attacks of meniere’s
Antihistamine
what can be used to relieve symptoms in vestibular neuronitis?
vestibular sedatives such as Prochlorperazine
what is a cholesteatoma?
non-cancerous skin growth in middle ear, usually as a result of multiple infections
which area is most likely to be the cause of epistaxis?
Little’s area
name some RFs for epistaxis
local- nose picking, dry mucosa (nasal O2/ nasal sprays)
systemic- clotting disorders, HTN, Hereditary Haemorrhagic Telangiectasia (AD, also causes oral telangectasia)
management of epistaxis
ABCDE
pressure 20 mins, head forward.
anterior bleed-> cautery/ merocel nasal pack
posterior-> balloon catheter
how would a septal haematoma present and why is it important?
bilateral intra-nostril cherry red swelling following trauma. stops blood supply to septum therefore needs emergency incision and drainage
name some causes other than allergic of rhinitis?
occupational drug induced- aspirin, ACEIs pregnancy idiopathic rhinitis medicamentosa (lots of OTC vasoconstrictor sprays)
first line management for rhinitis
antihistamine spray +/- steroid (if main symptom blockage)
where would you palpate frontal sinuses?
press upwards beneath medial side of supraorbital ridge
where would you palpate maxillary sinuses?
below inferior orbital margin
where would you palpate ethmoidal sinuses?
medial against medial wall of orbit
what is typical of sinusitis pain?
pain/ pressure increased on bending forward
most common cause of tonsillitis
viral (70%)
most common bacterial cause of tonsillitis
Group A strep
4 points on Centor criteria
tonsilar exudate temp >38 no cough tender cerviacal lymphadenopathy If all 4 = 50% chance of bacterial cause, give ABx
what ABx for tonsillitis
Pen V, not amoxicillin as can cause rash in glandular fever
what is Quinsy?
this is a peritonsillar abscess
what causes glandular fever
EBV
When should you consider tonsilectomy?
> 5 episode tonsillitis in one calendar year
Symptoms ongoing for >1 year
Episodes are disabling and prevent normal function
Tonsillitis is known to be the cause of the sore throats!
which organism causes epiglottitis?
HiB
which organism causes croup?
parainfluenza virus
what level indicates impaired hearing on audiogram?
above 20dB
what on audiogram indicates SNHL?
both air and bone conduction impaired
what on audiogram indicates CHL?
only air conduction impaired
what on audiogram indicates mixed HL?
both air and bone impaired but air worse than bone
