ENT Flashcards
Describe diagnostic testing used for sinusitis.
- best initial test is CT if asked but rarely necessary
- most accurate test is biopsy but only needed if there are frequent recurrences or no response to empiric therapy
Describe the etiology, presentation, diagnosis, and treatment of cavernous sinus thrombosis.
- most often due to Staph, Strep, or anaerobic organisms that spread from the adjacent sinus
- presents with fever, headache, ptosis, proptosis, and abnormal ocular movements in someone with a history of recent sinusitis
- best initial test is a CT or MRI with contrast
- treat with vancomycin and ceftriaxone
What is Tolosa-Hunt syndrome and how is it diagnosed and treated?
- it is granulomatous inflammation of the cavernous sinus
- diagnosed with MRI
- treated with steroids
What is the difference between an anterior and a posterior epistaxis?
- anterior are far more common and bleeding is from Kiesselbach’s venous plexus
- posterior are less common but more dangerous because they are arterial bleeds
How is a posterior epistaxis treated?
- requires packing
- after bleeding is controlled, give cephalexin to prevent Staph toxic shock syndrome
Describe the presentation, diagnosis, and treatment of otitis media.
- presents with redness, immobility, bulging, and a decreased light reflex of the tympanic membrane
- in most cases it is a clinical diagnosis but tympanocentesis and culture is the most accurate for recurrent otitis media
- treat with amoxicillin or azithromycin
Describe the pathogenesis, presentation, and treatment of otitis externa.
- it is a cellulitis of the skin of the EAC caused by water exposure which raises the pH and facilitates bacterial growth
- presents with pain on moving the tragus and erythema or discharge within the EAC
- treat with topical neomycin-polymyxin, topical quinolones, or gentamicin; hydrocortisone drops will reduce pain
What is the treatment treatment for each fo the following ear infections:
- otitis media
- otitis externa
- malignant external otitis
- mastoiditis
- otitis media: amoxicillin or azithromycin
- otitis externa: topical neomycin-polymyxin, quinolones, or gentamicin
- malignant external otitis: ciprofloxacin, cefepime, or anti-pseudomonal penicillins like piperacillin
- mastoiditis: ceftriaxone or levofloxacin
What is the treatment for malignant external otitis?
it is typically due to pseudomonas so use ciprofloxacin, piperacillin, or cefepime
Describe the etiology, presentation, complications, diagnosis, and treatment of mastoiditis.
- due to the same organisms as otitis media: Strep pneumo, Hib, and Moraxella
- presents with mastoid tenderness
- may be complicated by hearing loss and meningitis
- initially diagnosis is with CT or MRI and it is treated with ceftriaxone or levofloxacin
- for recurrent or chronic infection, get a biopsy and treat with vancomycin and piperacillin
Describe the presentation, diagnosis, and treatment of labyrinthitis.
- presents with acute hearing loss, tinnitus, vertigo, and nystagmus in patients with a recent viral illness
- there are no specific diagnostic tests but a head impulse test will be positive
- treat with steroids and meclizine
Describe the presentation and treatment of Meniere disease.
- presents with chronic hearing loss, tinnitus, vertigo, nystagmus, and a feeling of fullness in the ear
- treat with sodium restriction and carbonic anhydrase inhibitors
Describe the pathophysiology, presentation, and treatment of perilymph fistula.
- it is a leaking hole in the oval window of the inner ear
- presents with nystagmus and vertigo in a patient with a history of barotrauma or exposure to explosions
- treat surgically
Describe the etiology, presentation, diagnosis, and treatment of Lemierre syndrome.
- it is an expansion of Fusobacterium necrophorum beyond the mouth to the neuromuscular bundle around the jugular vein
- this contributes to sepsis in a patient with recent ENT infection
- diagnosis is with CT of the neck
- treat with ampicillin/sulbactam or piperacillin/tazobactam
Describe the presentation, diagnosis, and treatment of Ludwig angina.
- it is a cellulitis of the floor of the mouth
- best initial test is CT of the neck
- treat with ampicillin/sulbactam or piperacillin/tazobactam