ENT Flashcards
Sx of viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Sx of Vestibular neuronitis
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss
Sx of BPPV
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
Sx of Meniere’s disease
Associated with SN hearing loss
Tinnitus
sensation of fullness or pressure in one or both ears
Sx of Acoustic neuroma
SN Hearing loss Vertigo Tinnitus Absent corneal reflex Associated with neurofibromatosis type 2
Ix for BPPV
Hallpike manoeuvre
Mx for BPPV
Epley manoeuvre
Betahistine
what type of hearing loss is Presbycusis
age-related SNHL
Audiometry shows bilateral high-frequency hearing loss
what type of hearing loss is otosclerosis
Autosomal dominant, replacement of normal bone by vascular spongy bone
Conductive HL
Tinnitus
Family History
what type of HL is glue ear
conductive
ototoxic drugs
gentamicin
quinine
furosemide
aspirin
how can you differentiate between a facial nerve palsy that is UMN or LMN
LMN - forehead involved
UMN - forehead spared
i.e. stroke
how does Bell’s palsy present and Tx
Abrupt onset –eg overnight, unilateral facial weakness, decreased taste, hyperacusis
Tx - prednisolone if they present within 72 hours
how does Ramsay Hunt present
Severe otalgia, elderly, facial nerve palsy, vesicles in the ear canal +/- soft palate, deafness, vertigo
how does parotid tumour present
Pain, swelling, palsy
Tx of Ramsay Hunt syndrome
Aciclovir/valaciclovir and prednisolone
what is the usual organism for bacterial tonsillitis and Tx
Group A strep
Mx = Penicillin V and Analgesia.
Admit for IV fluids, steroids and Benzylpenicllin if unable to swallow
what is Ix for viral tonsillitis
EBV ix IgM on Monospot/ Paul-Bunnell tests
LFTs
FBC
Tx for viral tonsillitis
avoid alcohol/hepatotxic drugs/contact sports,
analgesia
how does quincy present
peri-tonsillar abscess
Thick' or 'hot potato' voice Stertor Trismus Inability to swallow Pain worse on one side (+/- otalgia)
Mx of peri-tonsillar abscess
Drainage Antibiotics IV fluids Dexamethasone Analgesia
escalation cascade of Tx for epistaxis
1 - External pressure to the nose and ice to neck
2 - Silver nitrate Cautery
3 - Nasal packing: Rapid Rhino
4 - Ligation of the sphenopalatine artery (supplies lateral wall of the nose and ligation risks include continued bleeding, visual disturbance and CSF leak)
5 - Ligation of the external carotid
6 - Embolisation
what is the most common histological-type of head and neck cancer and what are the risk factors
Squamous
Age
Alcohol and tobacco
Deprivation, comorbidities
HPV 16 and 18
what is the most common type of thyroid cancer
papillary
what should be in your head when a Q on weird kid neck lumps
Congenital Dermoid Cyst.
Cystic hygroma
what should be in your head when a Q on weird adult neck lumps
Branchial Cyst
Carotid body tumour
what should be in your head when a Q on weird elderly neck lumps
Malignant cervical lymphadenopathy due to laryngeal/pharyngeal/bronchial carcinoma
Pharyngeal pouch
A 5-year-old boy presents with his mother to the GP surgery with a 5 day history of right-sided otalgia and reduced hearing. On examination, he has a temperature of 38.5ºC and a heart rate of 120 bpm. There is swelling around his right ear and the ear appears to be displaced anteriorly. The canal appears normal however the tympanic membrane is red and bulging. What treatment should be initiated?
Refer to secondary care
- has signs of mastoiditis
A 55-year-old man from Hong Kong presents with left sided otalgia and recurrent episodes of epistaxis. On examination his pharynx appears normal. Examination of his neck reveals left sided cervical lymphadenopathy. What is the most likely underlying diagnosis?
nasopharyngeal carcinoma
A 59-year-old man presents with a severe pain deep within his right ear. He feels dizzy and reports that the room ‘is spinning’. Clinical examination shows a partial facial nerve palsy on the right side and vesicular lesions on the anterior two-thirds of his tongue. What is the most likely diagnosis?
Ramsay-Hunt Syndrome
- Whilst vesicular lesions are more classically seen in the external auditory canal and pinna they may also be seen on the anterior 2/3rds of the tongue and the soft palate.
A 45-old-woman comes to see you in the GP surgery complaining of foul smelling discharge from her right ear for the past 3 weeks. She also thinks she has a slight deafness in her right ear and is wondering if she has some wax. However, on examination there is no wax but a crust on the upper part of the tympanic membrane. What is the most likely diagnosis?
Cholesteatoma
The combination of unilateral foul smelling discharge and deafness should always raise the question of a cholesteatoma. If on examination you suspect a cholesteatoma then an ENT referral is needed.
Urgent referral needed
