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Phase 3B > ENT > Flashcards

ENT Flashcards

1
Q

Name the three ossicles.

A

Malleus
Incus
Stapes

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2
Q

What is conductive hearing loss?

A

Problem transferring sound waves to the ear canal/middle ear

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3
Q

Name three causes of conductive hearing loss.

A 
Cerumen
Ruptured eardrum
Otosclerosis
Glue ear
Middle ear effusion
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4
Q

What is otosclerosis?

A

Increased bone turnover –> sclerosis –> ankylosis of stapes footplate in oval window of cochlea
May be precipitated by pregnancy if genetically predisposed (incomplete penetrance so may skip generations)
Causes fixation of the stapes bone

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5
Q

How does conductive hearing loss present?

A

All sounds are faint and muffled

Worse in lower frequencies

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6
Q

What tests are used to diagnose deafness?

A

Otoscopy
Rinne/Weber test
Tympanometry
Pure tone audiometry

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7
Q

What conductive hearing loss causes are treated with surgery?

A

Middle ear effusion
Ototsclerosis
Cholesteatoma

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8
Q

What is presbyacusis?

A

Hearing loss of older people

Loss of outer hair cells in cochlea

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9
Q

What is sensorineural hearing loss?

A

Deafness due to a problem with the cochlea or vestibulocochlear nerve.

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10
Q

What are the causes of sensorineural hearing loss?

A

Presbyacusis
Noise induced hearing loss (permanent increased stimuli threshold for outer hair cells in cochlea)
Head injury/acoustic neuroma/Meniere’s/viral infection

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11
Q

What is a treatment of sensorineural hearing loss?

A

Cochlear implants

Hearing aids

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12
Q

Name three causes of childhood conductive hearing loss.

A

Treacher Collins syndrome
Pierre Robin syndrome
Congenital cholesteatoma

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13
Q

Nam three causes of childhood sensorineural hearing loss.

A

Idiopathic
Alport/Turner syndrome
Ototoxic drugs
Infection with CMV, HSV, syphilis, rubella, toxoplasmosis, group B strep sepsis

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14
Q

What are some peri/postnatal causes of childhood deafness?

A

Cerebral palsy
Meningitis
Birth trauma

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15
Q

The perception of sound in the ears or head where no external source of the sound exists is called what?

A

Tinnitus

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16
Q

In examination of a patient with tinnitus, what is important to check for?

A

Impacted cerumen and otitis media
Carotid bruit
CN defects
Masses or glands in neck

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17
Q

What is the treatment of tinnitus?

A

Relaxation techniques, tinnitus retraining therapy, and masking devices.

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18
Q

Give five subjective causes of tinnitus.

A 
Meniere's disease
Deafness - all types
Acoustic neuroma
MS
Head injury
Ear infection
Drugs: aminoglycosides, quinine, aspirin, loop diuretics
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19
Q

What is mastoiditis?

A

Rare complication of acute otitis media

Acute inflammation of the mastoid with colliquation of the air filled mastoidal bone

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20
Q

Where is the mastoid process?

A

An inferior extension of the petrous temporal bone

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21
Q

How does mastoiditis occur?

A

A suppurative infection extends from the middle ear to the mastoid air cells, leading to inflammation and bony destruction.

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22
Q

What organisms are implicated in mastoiditis?

A

Strep pneumoniae
Strep pyogenes
Staph
Pseudomonas aeruginosa

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23
Q

What are the risk factors for development of mastoiditis?

A

Pre-existing cholesteatoma
Young children
Immune deficiency
Intellectual impairments

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24
Q

How does acute mastoiditis differ from chronic mastoiditis?

A

Patients will have intense otalgia and fever at present, rather than recurrent bouts with an insidious onset.

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25
Q

What is seen when examining an inflamed mastoid process?

A

Swelling and redness
Boggy tender mass behind ear
External ear may protrude forwards
Ear discharge and erythematous tympanic membrane

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26
Q

How is mastoiditis diagnosed?

A

Leukocytosis and increased ESR
Blood cultures
Tympanocentesis for staining and culture
Skull XR - clouding of mastoid air cells

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27
Q

How is mastoiditis managed?

A

Admit to hospital

Broad spectrum IV abx with third gen cephalosporin

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28
Q

What are three complications of mastoiditis?

A

Hearing loss
Osteomyelitis
Labyrinthitis

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29
Q

What are the symptoms of TMJ disorders?

A

TMJ pain that may be referred to head, neck, and ear
Restricted jaw motion
Joint noise
Locking episodes

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30
Q

What are some TMJ disorders?

A 
TMJ hypermobility
TMJ osteoarthritis
Chronic pain syndrome
Orofacial dystonias
Dental malocclusion
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31
Q

How are TMJ disorders managed?

A

TMJ rest
Bite guards
Physio
Analgesics/anti-depressants

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32
Q

Defined the following:

1) Sialadenitis
2) Sialectasis
3) Sialolithiasis

A

1) inflammation of a salivary gland
2) Dilation of salivary duct
3) Stone related disease within salivary gland ducts

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33
Q

What are five causes of parotid swelling?

A 
Viral parotitis - mumps
Sjogrens syndrome
Benign and malignant tumours
Sarcoidosis (with facial nerve palsy)
Acute and chronic bacterial parotitis
Salivary stones
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34
Q

What are salivary gland stones composed of and which gland do they usually affect?

A

Submandibular

Mucus, cellular debris, calcium, magnesium phosphates

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35
Q

How does sialolithiasis present?

A

Colicky post prandial swelling of the gland

USS - hyperechoic lines

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36
Q

How is obstruction salivary gland disease managed?

A

Many stones pass spontaneously

Otherwise dilation and incision

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37
Q

What are some general symptoms of salivary gland swelling?

A 
Painful, tender swelling
Dry mouth
Abnormal tastes
Facial pain
Decreased mouth opening
Fever
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38
Q

What blood tests are important in a patient presenting with salivary gland swelling?

A

FBC, CRP/ESR, UEs, Cultures, Viral serology/salivary antibody testing

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39
Q

What investigations are important in a patient presenting with salivary gland swelling?

A

Pus swab for culture and sensitivity
Sialography
Later - US, fine needle aspirate

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40
Q

Name two benign tumours of the salivary gland.

A

Pleomorphic adenoma

Warthin’s tumour

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41
Q

What percentage of salivary gland tumours are malignant?

A

20%

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42
Q

What is the most common cause of vertigo?

A

Benign paroxysmal positional vertigo

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43
Q

What is the cause of BPPV?

A

Otoliths become detached from the macula into the semi-circular canals
Hair cells embedded in the otoliths are stimulated as they are pushed by endolymph through the canals during head movement.
Detached otoliths may continue to move after the head has stopped moving - vertigo results from conflicting sensation of ongoing movement.

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44
Q

Apart from idiopathic (60%), what are the other causes of BPPV?

A

Head injury
Post viral illness (viral neuronitis)
Chronic middle ear disease

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45
Q

What are the symptoms of BPPV?

A

Episodes of vertigo provoked by head movement
Symptoms worse when head is tilted.
Nausea not vomiting
Worse in the mornings

46
Q

How is BPPV assessed?

A

Dix-Hallpike test - reproduces symptoms/nystagmus

47
Q

How is BPPV managed?

A

Self limiting

Epley’s manoeuvre

48
Q

How does Epley’s manoeuvre treat BPPV?

A

Repositions otoliths back into utricles from posterior semi-circular canals

49
Q

What is Meniere’s disease?

A

Disorder of the inner ear caused by increased fluid volume of the labyrinth, injuring the vestibular system or cochlea.

50
Q

What are three risk factors of Meniere’s disease?

A

Allergy
Migraine
Genetic susceptibility
Viral illness

51
Q

What are the core symptoms of Meniere’s disease?

A

Vertigo
Tinnitus
Fluctuating hearing loss with a sensation of aural pressure

52
Q

How are the attacks of Meniere’s disease distributed?

A

Occur in clusters
6-11 per year
Last a few hours

53
Q

What tests are used in the diagnosis of Meniere’s disease?

A

Weber/Rinne’s test
Dix-Hallpike test
Bloods
Audiometry

54
Q

What is the treatment of an acute attack of Meniere’s disease?

A

Prochlorperazine or cyclizine

55
Q

What is the prophylactic treatment of choice for Meniere’s disease?

A

Betahistine TD

56
Q

What is vestibular neuronitis?

A

A vestibular neuropathy caused by a viral infection (hx of recent viral URTI)

57
Q

How does labyrinthitis differ from vestibular neuronitis?

A

Labyrinthitis - both vestibular nerve and labyrinth are involved.

L - hearing loss
VN - no hearing loss

Both self limiting, do not drive

58
Q

What triggers vestibular neuronitis?

A

Prior URTI

59
Q

How does vestibular neuronitis/labyrinthitis present?

A

Sudden severe constant vertigo
Not triggered by movement but may be exacerbated by movement.
Nausea and vomiting
Hearing loss/tinnitus in labyrinthitis

60
Q

What may be seen in the external ear in vestibular neuronitis?

A

Cholesteatoma

Vesicles suggestive of herpes zoster oticus

61
Q

What must be ruled out during examination of a patient with vertigo?

A

Mastoid tenderness
High fever
Nuchal rigidity
Basically, mastoiditis or meningitis

62
Q

Describe the gait of a person with vestibular neuronitis.

A

Patients fall towards the affected side.

63
Q

What is the management of vestibular neuronitis/labyrinthitis?

A

Prochlorperazine in the acute phase (if continued for duration of the illness it interferes with central rehabilitation processes)
Mobilisation and 2x daily vestibular rehabilitation exercises
Myringotomy and evacuation of effusion

64
Q

What is oral cancer a potential malignancy of?

A 
Buccal mucosa
Alveolus
Hard palate
Tongue
Tonsils
Lip
Mouth floor
65
Q

What is the name of a tumour of the vestibulocochlear nerve?

A

Acoustic neuroma

66
Q

What is the main risk factor for acoustic neuromas?

A

Neurofibromatosis type 2

67
Q

What are the symptoms of acoustic neuroma?

A

Asymmetrical hearing loss or tinnitus

Vestibular dysfunction - balance problems, ear ache

68
Q

Smoking is a risk factor for which ENT malignancies?

A

Oral
Laryngeal
Pharyngeal

69
Q

What type of cancer are oral, laryngeal, and pharyngeal cancers?

A

Squamous cell carcinomas

can have oral mucosal melanomas

70
Q

What are the classifications of salivary gland cancers?

A

Mucoepidermoid
Acinic cell
Adenoid cystic carcinomas

71
Q

Chronic hoarseness suggests which ENT malignancy?

A

Laryngeal

72
Q

What are the other symptoms of laryngeal cancer?

A

Dysphagia/sore throat
Lump in neck
Persistent cough

73
Q

How is laryngeal cancer diagnosed?

A

Urgent CXR
Flexible laryngoscopy
Fine needle aspiration of any neck masses

74
Q

What is the treatment of laryngeal cancer?

A

Total and partial laryngectomy

Transoral laser microsurgery

75
Q

What is the gold standard of diagnosis for salivary gland cancers?

A

Ultrasound

76
Q

What are the symptoms of salivary gland cancers?

A

Most slowly enlarging painless mass
Intermittent pain
Facial nerve palsy/paraesthesiae

77
Q

Name three pre-cancerous lesions of the oropharynx and oral cavity.

A

Leukoplakia
Erythroplakia
Mixed erythroleukoplakia

78
Q

Give some symptoms of naso-pharyngeal cancer.

A

Nasal obstruction
Deafness
Post nasal discharge

79
Q

What is otitis externa?

A

Inflammation of the outer ear

“Swimmers’ ear”

80
Q

What does the outer ear consist of?

A

Auricle, external auditory canal, eardrum

81
Q

What are the symptoms of otitis externa?

A

Otalgia and pain moving ear/jaw
Discharge
Itching
Deafness

82
Q

What is seen on examination in otitis externa?

A

Pre-auricular lymphadenopathy
Erythematous canal, oedema and exudate
Fever (<38)

83
Q

How is otitis externa managed, first line and second line?

A

Keep the ear dry
Topical drops. Mild - acetic acid. Severe - topical antibiotic with or without topical steroid

Severe = discharge, debris, deafness

Second line: PO flucloxacillin (ciprofloxacin for diabetics to cover pseudomonas)

84
Q

What are some risk factors for otitis externa?

A

Swimming
Diabetes
Low or high amounts of cerumen
Dermatitis

85
Q

What are some red flags that suggest a serious or other cause of trigeminal neuralgia?

A 
Sensory changes
Deafness
Poor response to carbamazepine
Onset under 40
Optic neuritis/FH of MS
86
Q

What is a surgical alternative to nerve decompression in trigeminal neuralgia?

A

Rhizotomy

87
Q

A dull, yellowing, retracted ear drum suggests what condition?

A

Recurrent otitis media with effusion (glue ear)

88
Q

What are the usual causative organisms of acute otitis media?

A

RSV
Rhinovirus

Hib
Strep pneumoniae
Moraxella catarrhalis

89
Q

What is a cholesteatoma

A

A destructive and expanding growth consisting of keratinizing squamous epithelium

90
Q

Where is a cholesteatoma found?

A

Middle ear or mastoid process - check attic

91
Q

What is the result of the cholesteatoma?

A

Destruction of the bones of the middle ear/growth through the base of the skull into the brain

92
Q

What is the name of the conditions where there is painful bleeding gums with halitosis and punched out ulcers?

A

Necrotizing ulcerative gingivitis

93
Q

What is the treatment of NUG?

A

Refer patient to a dentist
PO metronidazole 3d
Chlorhexidine mouthwash
Analgesia

94
Q

In left sided sensorineural deafness, what does Weber’s test show

A

Sound is localised to the right unaffected side

95
Q

Name an ototoxic drug.

A 
Gentamycin
Quinine
Aspirin
Furosemide
Chemotherapy
96
Q

What is a thyroglossal cyst?

A

Midline neck lump which moves upwards with protrusion of the tongue

97
Q

What is a cystic hygroma?

A

Congenital lymphangioma found on the left side of the neck. Fluctuates and transilluminates.

98
Q

What is a branchial cyst?

A

A cystic mass that develops between the sternocleidomastoid muscle and the pharynx.
Contains cholesterol crystals

99
Q

Which test forms part of the Newborn Hearing Screening Programme?

A

Otoacoustic emission test

100
Q

If the otoacoustic emission test is abnormal in a newborn, what is the next step?

A

Auditory brainstem response test

101
Q

What is the treatment of sinusitis?

A

Antipyretic, nasal saline/decongestants

Symptoms present for more than 10 days - antibiotics

102
Q

Name a red flag nasal symptom that warrants urgent referral to ENT.

A

Unilateral nasal polyp

103
Q

What is the initial treatment of epistaxis?

A

Sit leaning forwards with mouth open
Pinch the cartilaginous part of nose
If successful, use topical antiseptic such as Naseptin

104
Q

What is the treatment of continuing epistaxis?

A

Can’t see site of bleeding: anterior packing

Can see site of bleeding: cautery with silver nitrate

105
Q

What score is used to assess severity of tonsillitis and what is the threshold?

A

Centor/FEVERpain score >3

106
Q

What is the treatment of tonsillitis?

A

Centor score <3: regular analgesia

Centor score >3: phenoxymethylpenicillin 7 to 10d

107
Q

What are four associations of nasal polyps?

A

Asthma
Cystic fibrosis
Aspirin sensitivity
Infective sinusitis

108
Q

What is the treatment of otosclerosis?

A

Sodium fluoride

Stapedectomy

109
Q

What is the treatment of acoustic neuroma?

A

Watch and wait
Stereotactic radiosurgery
Microsurgery

110
Q

What is the treatment of chronic sinusitis?

A

Nasal corticosteroids

111
Q

Give three risk factors for sinusitis.

A 
URTI
Allergic rhinitis
GPA/Churg-Strauss
Asthma
Immunocompromised

Phase 3B (20 decks)

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