ENT Flashcards
Bilateral hearing loss
Normal tympanic membrane
Audiometry: conductive hearing loss
Usually < 50yrs old
Otosclerosis
Treatment: Stapedectomy +/- hearing loss
What is the CENTOR criteria
-Tonsillar exudate
-Tender lymph nodes
-Fever
-No cough
(need 3+ to give antibiotics)
What is the typically protocol with a sore throat?
Supportive measures Check CENTOR: 3+ give ABs (penicillin/eryhtromycin) Worry if: - Cancer history - > 3 weeks dysphagia - Get ambulance if stridor
How is a perforated tympanic membrane dealt with?
Keep dry
Review in 4 weeks
ENT referral if not better (for myringoplasty)
Vesicles on tympanic membrane (or ant 2/3rds tongue)
facial weakness
Tinnitus
Vertigo hearing loss
Ramsay hunt syndrome ( Varicella Zoster Virus on genciculate ganglion)
Treatment: Oral aciclovir + corticosteroids
Vertigo Tinnitus 'fullness' in ear Audiometry: sensorineural hearing loss Recurrent attacks >20 mins each
Menieres (Imbalance in perilymph/endolymph)
Treatment: Therapy + steroids + gentamicin
Slow onset of hearing loss Usually bilateral Loss of high frequency first Otoscopy: Normal Tympanometry: normal middle ear with hearing loss Audiometry: Sensorineual hearing loss
Presbycusis (age-related deterioration of hearing)
Hearing loss: Baseline for normal is: >20db Sensorineural: \_\_\_ conduction is impaired Conductive: \_\_\_ conduction is impaired Mixed: \_\_\_ conduction is impaired
S: both
C: bone
M: Both (air more severe than bone)
Asian male Ear pain/dysfunction without any signs Sore throat Odynophagia Nasal discharge +/ nosebleeds Signs of cranial nerve palsy
Nasopharyngeal carcinoma
- SqCC
- EBV associations
Confirm with: CT and MRI
Treatment: Radiotherapy
Red, irritated ear
Debris and discharge
Otitis externa
Confirm organism with swab ( usually Staph aureus, P. aeruginosa/fungal)
Treatment:
Irrigate
gentamicin or ciprofloxacin (bacteria)/clotrimoxazole (fungal)
+ Steroids
Diabetic/ Immuno-compromised Severe ear pain Discharge Facial nerve dysfunction Hoarse voice
Malignant otitis externa
(P.aerunginosa infection that spreads to bone and causes osteomyelitis)
Confirm with CT
Treatment: IV ciprofloxacin
Patient with cleft palate Foul smelling discharge from ear Hearing loss Can have: -vertigo -facial nerve palsy Otoscopy: 'attic crust'
Cholesteatoma (trapped squamous epithelium causing local destruction)
Management: ENT referral
Sudden onset of vertigo when changing head position
Lasts about 20s
Tends to be >50s
Benign Paroxysmal
Positional vertigo
Confirm with: Dix-Hallpike manouvre Treatment: -Epley manouvre -Betahistine can help
Vertigo lasting hours
nausea and vomiting
Horizontal nystagmus
NO HEARING LOSS
Vestibular neuronitis (inner ear inflammation)
Treatment: Self-limiting
Haemorrhage 5-10 days post tonsillectomy warrants
IV antibiotics (wound infection)
Haemorrhage 6 hours post tonsillectomy warrants
Return to theatre
Short history of earache
hard of hearing
Bulging of eardrum
Acute otitis media ( viral URTI causing bacterial infection)
Usually resp pathogens (H.influenzae, S.pneumoniae, S. pyogenes)
Enlarged tonsils that meet in midline
White film
Systemically well
Acute bacterial tonsilitis
(GAS or ‘resp’ pathogens)
Treatment; Penicillin
Stubborn: Tonsillectomy
kid/teen presents with large tonsils that meet in midline
White patches on red-raw membrane
-Nodes: Anterior and posterior chain enlarged
-Fever
-Haemorrhages on oropharynx
-Systemic upset
(splenomegaly)
Infective mononucleosis
(EBV, CMV)
Diagnosis: FBC and Monospot
Management :
- Supportive
- Dont play sport
Aspirin insensitivity + asthma + nasal polyps indicates what triad?
Samters triad
Vertigo Hearing loss Nerve palsy: V: absent corneal reflex affected side VII: facial palsy VIII: hearing loss, vertigo, tinnitus Verocay bodies on histology
Acoustic neuroma (vestibular schwannoma)
Ix: ‘Ice cream cone’ CT
Treatment: Removal
Severe throat pain
Deviation of uvula to unaffected side
Opening mouth is difficult
Quinsy (peri-tonsillar abscess)
Treatment: ENT specialist
Needle aspiration under anaesthesia
-IV antibiotics
Intermittent discharge
Perforation of pars tensa/flaccida
Chronic otitis media
Can co-exist with cholesteatoma
Leave for 4 weeks and review
Myrinngoplasty if severe
If flaccida then mastoidectomy
Sensorineural loss
Patient on chemo/antibiotics/NSAIDS
Drug induced hearing loss (ABs: Gentamicin and Aminoglycosides)
Stop drugs and give cochlear implant
Infection/comes on in summer
Blockage
Loss of smell
Post nasal drip
Rhinitis If allergic: 1 Cetrizine (anti-histamine) 2. IN steroids (corticosteroid) 3. Oxymetazoline (a agonist)
old Man complains of:
Blocked/runny nose
poor taste and smell
Nasal polyps
Investigate: Oral steroids and CT sinuses
Treatment: topical corticosteroids
What is done if suspected nasal polyps are unilateral/bleding?
Refer to ENT immediately
Patient with trauma to face pain runny nose bilateral red swelling Boggy on pressing
Nasal septal haematoma (haematoma between cartilage and perichondrium)
Drainage
IV antibiotics
Bleeding from nose
Epistaxis
Ant: kiesselbach’s (ethmoidal)
Post: posterior inferior venous plexus
Investigate: 30 degree rigid endoscopy
Treatment:
Lean forward and pinch nose
Vasoconstrictors (lignocaine)
Cautery/ligate after 15 mins
What are the 3 grades of LeFort fracture
I: horizontal
II: Pyramidal
III: Transverse
Treat: surgery
Nasal blockage
saddle nose
eye involvement
Strawberry gingivitis
GPA c-ANCA +ve Mild: MTX + Steroids Moderate: cyclophosphamide and steroids Severe: Rituximab + Steroids
which ENT tumour is related to HPV 6 and 11?
Squamous papilloma
40-60 year old
single Slow growing lump near parotid
Benign pleomorphic adenoma (most common)
Biopsy: increased epithelial and stromal components
60-70 year old
Bilateral and multicentric tumour near parotid
Warthins tumour
Biopsy: cystic spaces with uniform epithelium
Whats the most common malignant tumour of the parotid?
muco-epidermoid (encapsulated and affects all ages)
Whats the most malignant tumour of the palate?
Adenoid cystic carcinoma
Painful and perineural invasion
cold sores
Local lymphadenopathy
HSV I infection
Investigate: Swab for PCT
Management: Aciclovir
Soft palate vesicles
Sore throat
Fever
Herpangina
Investigation: PCR (coxsackie)
Treatment: Self-limiting
Farmer
Lesions on hand, feet and mouth
Hand foot and mouth
(Coxsackie)
Investigate: PCR
Self-limiting
Young patient who sleeps around
painless ulcers at mouth/groin
lymphadenopathy
Progresses to a rash
Syphilis
Investigate: Microscopy (spirochetes)
Treatment:
IM Penicillin/doxycycline
Round ulcers with halo around them
Aphthous ulcers
Self limiting
Severe sore throat
Grey-white membrane
Diphtheria C.Diptheriae Management: Antitoxin Supportive Sometimes antibiotics
