ENT Flashcards

1
Q

Name the sinuses.

A
  • frontal sinuses
  • ethmoidal air cells
  • sphenoidal sinuses
  • maxillary sinuses
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2
Q

describe the common presentation of a pt with acute sinusitis

A

Symptoms:

  • non-resolving cold
  • facial pain/pressure over affected sinus, worse on bending forwards
  • nasal obstruction or purulent nasal discharge
  • +/- headache, fatigue, dental pain, cough…

Signs:

  • pain on palpation of sinus
  • pyrexia
  • +/- erythema and oedema of nasal mucosa
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3
Q

how would you manage a pt with with acute sinusitis?

A
  1. Reassurance - generally self-resolving viral infection, improves in about 2.5 wks
  2. Symptom relief: paracetamol or ibuprofen for pain/fever, intranasal decongestant (max. 1 wk), nasal irrigation with warm saline solution…

If pt unwell for 10+ days with no improvement, consider:
3. High-dose nasal corticosteroid for 14 days or deferred antibiotic prescription, e.g. phenoxymethylpenicllin or co-amoxiclav

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4
Q

suggest possible complications of sinusitis

A

Rare but can include

  • orbital cellulitis
  • meningitis or brain abscess
  • osteomyelitis
  • cavernous sinus thrombosis
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5
Q

describe the common presentation of acute otitis media

A

Symptoms:

  • ear pain
  • fever
  • malaise, vomiting

Signs:

  • pyrexia
  • red bulging tympanic membrane (+ air-fluid level behind it)
  • +/- discharge in auditory canal secondary to TM perforation
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6
Q

how do infecting organisms reach middle ear?

A

From nasopharynx via Eustachian tube - children more at risk as ET shorter and more horizontal

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7
Q

what is the prognosis for acute otitis media?

A
  • usually self-resolving within 3 days (80%).
  • slowly resolving AOM may develop into otitis media with effusion (glue ear) - build up of fluid and negative pressure behind TM due to ET dysfunction. Most resolve spontaneously within 2-3 mths but some may require tympanostomy tube.
  • possible complications inc. TM perforation, mastoiditis and cholesteatoma.
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8
Q

how would you manage a pt with acute otitis media?

A
  1. Usually conservative - paracetamol/ibuprofen - with no antibiotics.
  2. Delayed antibiotic prescription if lasting 4+ days or significant worsening.
  3. 5 day course of AMOXICILLIN if children systemically unwell, immunocompromise, perforation and/or discharge or bilateral AOM in children <2 yrs
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9
Q

what is mastoiditis? describe presentation

A

Spread of infection via mastoid antrum into mastoid bone.

  • severe otalgia and pain behind ear
  • swelling
  • redness or tender mass behind ear
  • external ear may protrude forwards
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10
Q

what is cholesteatoma? describe presentation

A

Abnormal skin growth into middle ear behind TM, expands and erodes into structures, e.g. ossicles, mastoid bone, cochlea.

  • painless often smelly otorrhea
  • +/- hearing loss
  • crusting of superior TM and TM retraction (negative pressure due to blockage of ET)
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