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Phase 3B > ENT > Flashcards

ENT Flashcards

1
Q

What is otitis media and who does it commonly affect?

A
  • Infection of the middle ear

- Usually affects children

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2
Q

What are the common causative organisms for acute otitis media?

A
  • Pneumococcus
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Other strep and staph spp
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3
Q

What are the risk factors for otitis media?

A
  • URTI
  • Bottle feeding
  • Passive smoking
  • Use of dummy
  • Presence of adenoids
  • Asthma
  • Malformation ie cleft palate
  • In adults: GORD, ^BMI
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4
Q

What are the clinical features of acute otitis media?

A
  • Rapid onset ear pain
  • Fever
  • Irritability
  • Anorexia
  • Vomiting
  • Preceding viral URTI - secondary bacterial infection is common
  • Hearing loss
  • Discharge from ear.
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5
Q

How is otitis media investigated and what are some clinical signs you’d see?

A
  • Otoscopy: bulging tympanic membrane/purulent discharge if ear drum has perforated
  • Light reflection moves in otoscopy because of the bulge
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6
Q

Management of acute otitis media?

A

-Analgesia
-Most resolve in 24hrs with abx
-Decongestants
*consider abx if systemically unwell, immunocomprimised, no improvement >4/7
>Amoxicillin for 5/7

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7
Q

What are the complications of acute otitis media?

A 
-Intracranial:
>Meningitis
>Intra-cranial abscess
>Petrositis
>Labyrithitis
-Extracranial
>Mastoiditis
>Facial nerve palsy
>Tympanic membrane perforation
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8
Q

What is otitis media with effusion?

A

-GLUE EAR
>an effusion is present after the regression of the symptoms of acute OM
-Main cause of hearing loss in children

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9
Q

What are the causes/associations of otitis media with effusion in children?

A
  • URTI
  • Oversized adenoids
  • Narrow nasopharyngeal dimensions
  • Bacterial biofilms on adenoids
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10
Q

What is an important cause of OME to exclude in adults?

A

-Post-nasal space tumour

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11
Q

What are some risk factors for OME?

A
  • Male
  • Down’s syndrome
  • Cleft palate
  • Winter season
  • Atopy
  • Children of smokers
  • Primary ciliary dyskinesia
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12
Q

What are the clinical features of otitis media with effusion?

A

-Hearing impairment
>Often leads to behavioural/developmental issues
-Can have no ear pain, can go unnoticed for a long time

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13
Q

What investigations need to be performed for OME?

A
  • Otoscopy
  • Hearing assessment
  • Audiograms (conductive deafness)
  • Tympanometry
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14
Q

What signs would be seen on otoscopy for OME?

A
  • Fluid level or bubbles behind the ear drum
  • Retracted drum
  • Bulging drum
  • Dull, grey or yellow drum
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15
Q

How is OME treated?

A
  • Usually mild and resolves spontaneously
  • Observe for 3/12 to maximise child’s hearing
  • Auto-inflation of Eustachian tube (popping ears)
  • Surgery: Grommets
  • Hearing aid (if surgery not an option, and bilateral hearing loss)
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16
Q

What advice would you give to parents to help maximise child’s hearing if they have OME?

A
  • Reduce background noise
  • Sit at child’s level
  • Short, simple instructions
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17
Q

What’s the definition of chronic otitis media?

A

-Defined as chronic infections plus a perforated tympanic membrane

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18
Q

What are the symptoms of chronic otitis media?

A
  • Hearing loss
  • Otorrhoea
  • Feeling of fullness in the ear
  • Otalgia
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19
Q

What is the treatment for chonic otitis media?

A
  • Topical/systemic abx
  • Aural cleaning
  • Water precautions
  • May require surgery: myringoplasty/mastoidectomy
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20
Q

What are the complications of chronic otitis media?

A

-Cholesteatoma

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21
Q

What is cholesteatoma and the pathology behind it?

A
  • Abnormal skin growth that develops in the middle ear behind the ear drum
  • Develops as a cyst
  • Prolonged low middle ear pressure allows development of retraction picket in ear drum which enlarges allowing squamous epithelium to build up and no longer escape the neck of the sack
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22
Q

What are the symptoms of cholesteatoma?

A
  • Foul discharge +/- deafness
  • Headache
  • Pain
  • Facial paralysis
  • Vertigo
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23
Q

Treatment for cholesteatoma?

A

-Mastoid surgery

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24
Q

What are some serious but rare complications of cholesteatoma?

A
  • Meningitis
  • Cerebral abscess
  • Hearing loss
  • Mastoiditis
  • Facial nerve dysfunction
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25
Q

What is mastoiditis?

A

-Infection of the mastoid bone
>often follows ear infection
-Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation

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26
Q

What causes mastoiditis?

A

-Follows otitis media infection

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27
Q

What are the clinical features of mastoiditis?

A
  • Recent URTI
  • Ear discharge
  • Blunting of postural sulcus
  • Fluctuant tender swelling
  • Pyrexia
  • Ear looks pushed forwards from the front - protruding auricle
  • Facial nerve palsy
  • Tragal tenderness
  • Swelling and redness behind the pinna
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28
Q

Management for mastoiditis?

A
  • Systemic antibiotics (IV - needs admitting)
  • Analgesia
  • Urgent ENT for ?surgical drainage
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29
Q

What are the complications of mastoiditis?

A
  • Intracranial extension

- Meningitis

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30
Q

What is otitis externa?

A

-Infection of the outer ear canal
>Swimmer’s ear
-DDx: contact dermatitis

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31
Q

What causes otitis externa?

A
  • Excess canal moisture ie swimming, going on holiday
  • Trauma ie itching with fingernails of eczema etc
  • High humidity
  • Absence of wax from self cleaning
  • Narrow ear canal
  • Hearing aids
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32
Q

What are common infecting organisms in otitis externa?

A
  • Usually pseudomonas

- Staph. aureus and E.coli

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33
Q

What are some risk factors of otitis externa?

A

-Eczema/dermatitis
-Frequent swimming
-Cotton buds
-Diabetics/immune suppressed
>at risk of malignant/necrotising otitis externa

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34
Q

What are the symptoms of otitis externa?

A
  • Discharge
  • Itch
  • Pain
  • Tragal tenderness
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35
Q

What investigations would you do on someone with otitis externa?

A
  • Otoscopy

- Swab for microscopy if moderate/severe

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36
Q

What signs may be seen on otoscopy in someone with otitis externa?

A
  • Mild: scaly skin with some erythema, External Auditory Canal normal diameter
  • Moderate: painful ear, narrow EAC with smelly, creamy discharge
  • Severe: EAC completely occluded
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37
Q

How do you treat mild otitis externa?

A
  • Clear the external auditory canal
  • Keep ears free of water during treatment
  • Hydrocortisone cream
  • ‘Ear calm’ spray: antifungal and antibacterial
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38
Q

How do you treat moderate otitis externa?

A

-Clear EAC
-Keep ears free from water
-Topical abx: gentamycin
> +/- steroid drops

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39
Q

How do you treat severe otitis externa?

A
  • Clear EAC
  • Ears kept free of water during treatment
  • Ear wick with aluminium acetate
  • ENT referral
  • After few days, meatus open up enough for micro suction or careful cleansing
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40
Q

What needs to be done with otitis externa which is resistant to treatment?

A

Biopsy

>May be at risk of SCC

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41
Q

Why is it important to refer otitis externa to ENT?

A
  • Non-responsive treatment
  • Oedematous canal
  • Can’t get drops down
  • Suspicious of malignant OE
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42
Q

What is malignant OE?

A

-Necrotising otitis externa
>invasive
-Aggressive, life threatening infection of the external ear

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43
Q

What are some risk factors for necrotising otitis externa?

A
  • Diabetes
  • Elderly
  • Immunosuppression
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44
Q

What are the most common causative organisms of necrotising otitis externa?

A
  • Most common: pseudomona aeruginosa
  • Proteus
  • Klebsiella
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45
Q

What are the clincical features of necrotising otitis externa?

A
  • Disproportionately severe pain >opioid dependent pain killers required
  • Granulomatous polypoid otitis externa
  • CN involvement
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46
Q

What cranial nerves may be involved in necrotising otitis externa?

A
  • CN VII: facial nerve
  • CN IX: glossopharyngeal nerve
  • CN X: vagus nerve
  • CN XI: accessory nerve
  • CN XII: hypoglossal nerve
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47
Q

What are some complications of necrotising otitis externa?

A
  • Can lead to temporal bone destruction
  • Base of skill osteomyelitis
  • Bone infiltration
  • Sepsis
  • Death
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48
Q

What investigations need to be done for necrotising otitis externa?

A
  • Monitor CRP
  • Monitor pain levels
  • BM for diabetics
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49
Q

How is necrotising otitis externa treated?

A
  • Admit to hospital
  • Topical abx
  • Aural toilet
  • IV abx: 6/52 (pseudomal cover)
  • Opioid analgesia
  • Surgical debridement
  • Specific immunoglobulins
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50
Q

What is Ramsay-Hunt syndrome?

A
  • aka Herpes zoster oticus

- Herpes zoster infection of the facial nerve

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51
Q

Which group of pts is Ramsay Hunt syndrome common in?

A
  • Elderly

- Immunocompromised

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52
Q

What are the clinical features of Ramsay Hunt syndrome?

A
  • Severe otalgia
  • 7th Nerve palsy
  • Herpes zoster vesicles (in and around the ear)
  • Sometimes: vertigo, tinnitus, deafness
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53
Q

Which other cranial nerves may be sometimes involved in Ramsay Hunt syndrome?

A
  • V
  • VI
  • VII
  • XI
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54
Q

How is Ramsay Hunt syndrome treated?

A

-Acyclovir and prednisolone

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55
Q

Define furunculosis?

A

-Very painful abscess arising from a hair follicle within the ear canal

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56
Q

What is the most common causative organism of furunculosis?

A

-Staph

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57
Q

What is the most common predisposing factor for furunculosis?

A

-Diabetes mellitus

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58
Q

How is furunculosis managed?

A
  • Consider lancing (cut open to releive abscess)

- Cellulitis of the pinna: oral abx ie flucloxacillin

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59
Q

What is peri-chondrial cellulitis and how is it managed?

A
  • Cellulitis of the pinna of the ear

- Treat with systemic abx: flucloxacillin

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60
Q

What is sub-perichondrial haematoma and who does it commonly affect?

A
  • Blood underneath the pinna of the ear

- Perichondrium lifted and bleeds usually caused by sheer force trauma ie rugby players

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61
Q

How is sub-perichondrial haematoma treated and why is it important to treat?

A

-Needs draining
>to avoid cauliflower ear
-If left untreated: heamatoma turns to fibrous tissue and doesn’t break down properly

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62
Q

How do you attempt to removea foreign body from ear?

A
  • Ask for help if not sure
  • Syrginge with warm water
  • If living object: drown in olive oil/water -> syringe
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63
Q

What are some causes of referred ear pain?

A
  • Dental disease
  • Ramsay Hunt syndrome: sensory branch of facial nerve
  • Primary glossopharyngeal neuralgia: CN9, induced by talking/swallowing
  • Throat/laryngeal cancer: CN9/10
  • Tonsilitis or quinsy: CN 9/10
  • Post tonsillectomy
  • Cervical spondylosis/arthritis or soft tissue injury of the neck: CN 2/3
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64
Q

What is conductive deafness?

A

-Deafness which is caused by anything which may obstruct the sound entering the ear

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65
Q

What is the most common cause of conductive deafness in children?

A

-Otitis media with effusion

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66
Q

What is the most common cause of conductive deafness in adults?

A

-Otosclerosis (ossicles of the ear becoming spongy with age)

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67
Q

What are some genetic causes of conductive deafness?

A
  • Congenital structural abnormalities on the pinna, external ear canal, ear drum, ossicles
  • Treacher-Collins syndrome
  • Pierre Robin syndrome
  • Goldenhar syndrome
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68
Q

What investigations are performed for conductive deafness?

A
  • Neonatal hearing tests within 1st few weeks of life > otoacoustic emissions test
  • Subjective hearing tests in older children ie distraction testing
  • Adults: audiometry
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69
Q

How is conductive deafness managed?

A
  • Children with glue ear: grommets
  • Watch and wait: conductive problem may self resolve
  • Mild otosclerosis: hearing aid
  • Moderate to severe otosclerosis: surgery
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70
Q

What is a stapdectomy procedure and what is it used to treat?

A
  • A prosthetic device inserted into a middle ear to bypass the abdormal bone and permited sound waves to travel into the inner ear
  • Used for moderate-severe otosclerosis
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71
Q

What is sensorineural deafness?

A

-hearing loss associated with damage or abnormality to the vestibulocochlear nerve

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72
Q

Name some causes of bilateral sensorineural hearnig loss

A
  • Drug use: ototoxic abx, chemo
  • Infection: measles, meningitis, mumps
  • Noise exposure
  • Head trauma
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73
Q

Name some unilateral causes of sensoirneural hearing loss

A

-Meniere’s disease
-Acoustic neuroma/vestibular schwannoma
>require MRI

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74
Q

Name some causes of sudden sensorineural hearing loss?

A
  • Trauma

- Viral infections

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75
Q

Name some genetic causes of sensorineural hearing loss

A
  • AD: Waardenburg syndrome
  • AR: Pendred syndrome
  • X lined: Alport syndrome, Turner’s syndrome
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76
Q

Name some non-genetic causes of sensorineural hearing loss

A
  • Intrauterine TORCH infections
  • Perinatal causes
  • Infections
  • Ototoxic drugs
  • Acoustic or cranial trauma
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77
Q

What are the different TORCH infections?

A
  • Toxoplasmosis
  • Other (syphilis, HIV)
  • Rubella
  • CMV
  • Herpes
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78
Q

What are the perinatal causes of sensorinerual hearing loss?

A
  • Prematurity
  • Hypoxia
  • IVH
  • Kernicterus
  • Infection
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79
Q

What are the infective causes of sensorineural hearing loss?

A
  • Meningitis
  • Encephalitis
  • Measles
  • Mumps
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80
Q

How is sensorinerual deafness treated?

A
  • Hearing aids

- Cochlear implants (usually before 1)

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81
Q

Define tinnitus?

A

-Perception of sound in the absence of auditory stimulation

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82
Q

How can the character of tinnitus help identify the cause?

A
  • Unilateral
  • Bilateral
  • Pulsatile
  • Non-pulsatile
  • Ringing, hissing, buzzing (inner ear or central cause)
  • Popping or clicking (external ear, middle ear or palate
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83
Q

What is the difference between objective and subjective tinnitus?

A
  • Objective: audible to examiner

- Subjective: audible only to pt

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84
Q

What are the causes of objective tinnitus?

A
  • Vascular disorders (AV malformations, carotid pathology)
  • High output cardiac states (Pagets, hyperthyroidism, anaemia)
  • Myoclonus or palatal or strapedius/tensor tympanic muscles
  • Patulous Eustacian tube
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85
Q

What are the causes of subjective tinnitus?

A

-Commonly associated with disorders that cause SNHL
>Presbyacusis (age-related hearing loss)
>Noise induced hearing loss
>Meniere’s disease
-Ototoxic drugs (cause bilateral tinnitus with associated hearing loss)
>cisplatin, aminoglycosides
>aspirin, NSAIDs, quinine, macrolides, loop diuretics

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86
Q

What investigations should be performed for tinnitus?

A
  • Audiometry
  • Tympanogram
  • Investigate unilateral tinnitus to exclude acoustic neuroma - MRI
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87
Q

How is tinnitus managed?

A
  • Treat underlying cause
  • Take time to explain tinnitus
  • Psych support
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88
Q

What is acoustic neuroma?

A
  • Histological benign subarachnoid tumour
  • Causes problems by local pressure
  • Arise from superior vestibular Schwanna cell layer
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89
Q

Which age group is affected by acoustic neuroma?

A

Adults aged 30-60

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90
Q

What cause acoustic neuroma?

A
  • Though to be malfunctioning gene on chromosome 22
  • Normally this gene produces a tumour suppressor protein that helps control the growth of Schwann cells covering the nerves
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91
Q

Name a risk factor for acoustic neuroma

A

-Neurofibromatosis type 2

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92
Q

What are the clinical features of acoustic neuroma?

A

-Progressive ipsilateral tinnitus
>+/- sensorinueral deafness (cochlear nerve compression)
-Large tumours may have ipsilateral cerebella signs or signs of raised ICP
-Giddiness common
-Numb face (trigeminal compression above the tumour)

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93
Q

What investigations should be done for suspected acoustic neuroma?

A

-MRI for unilateral hearing loss/tinnitus

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94
Q

How is acoustic neuroma managed?

A
  • Leave alone and monitor yearly (slow growing)
  • Scan sooner if symptoms getting worse
  • Surgery if necc. but not normally
  • Stereotactic radiosurgery
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95
Q

Risk factors for noise induced hearing loss?

A
  • Occupations with loud noises: builder, carpenter, armed forces
  • Repeated loud noise exposure ie DJs
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96
Q

Explain the process of noise induced hearing loss

A
  • Exposure to loud noise will cause damage to inner ear
  • One-time exposure to an intense sound
  • More commonly occupational: continuous exposure to loud sounds causes hearing loss
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97
Q

What are the clinical features of noise-induced hearing loss?

A
  • Bilateral symmetrical sensorineural hearing loss

- +/- tinnitus

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98
Q

How is noise-induced hearing loss managed?

A
  • Reduce risk of occupational exposure

- Hearing aids

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99
Q

Define vertigo

A

-Sensation that the person or the world around them is moving or spinning

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100
Q

What is vestibular vertigo?

A 
-Most common kind of vertigo
>severe
>may be accompanied by loss of balance
>Nausea
>Vomiting
>Decreased hearing
>Tinnitus
>Nystagmus (horizontal)
>Diaphoresis (massive sweating)
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101
Q

What is central vertigo?

A
  • Hearing loss and tinnitus is less common with vertigo symptoms
  • Nystagmus can be horizontal or vertical
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102
Q

What are some causes of peripheral (vestibular) vertigo?-

A
  • Meniere’s disease
  • BPPV
  • Vestibular failure
  • Labrinthitis
  • Superior semi-circular canal dehiscence (rupture)
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103
Q

What are some causes of ventral vertigo?

A
  • Acoustic neuroma
  • MS
  • Head injury
  • Migraine associated dizziness
  • Vertobrobasilar insufficiency
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104
Q

If vertigo symptoms last seconds to minutes, what’s the most likely cause?

A

-BPPV

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105
Q

If vertigo symptoms last 30mins-30hrs, what’s the most likely cause?

A
  • Meniere’s

- Migraine

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106
Q

If vertigo symptoms last 30hrs-tweeks, what’s the most likely cause?

A

-Acute vestibular failure

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107
Q

What is an important question to ask when someone reports dizziness?

A
  • Did the world seem to spin like getting off a playground roundabout?
  • Which direction are you spinning in? (people with vertigo always know which way, if no idea: further investigation required)
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108
Q

What symptoms could point towards another diagnosis?

A

-Light headedness +/- sense of collapse

>can be vascular, ocular, MSK, metabolic, claustrophobic

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109
Q

What examination should be done for someone with vertigo?

A
  • CNS exam and ears
  • Cerebellar function and reflexes
  • Assess: nystagmus, gait, Romberg’s test
  • Audiometry and MRI if unsure
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110
Q

How is Romberg’s test useful in vertigo?

A

-+ve if balance is worse when eyes are shut

>defective proprioception or vestibular input

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111
Q

Which specific provocation test can be used to diagnose BPPV?

A

-Dix-Hallpike maoeuvre

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112
Q

How is vertigo treated?

A

-Treat underlying cause

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113
Q

What is BPPV?

A

-Benign paroxysmal positional vertigo (most common type of peripheral vertigo)

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114
Q

What causes BPPV?

A

-Displacement of otoliths stimulating the semi-circular canals
>can be idiopathic or post head injury

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115
Q

What are the clinical features of BPPV?

A
  • Attacks of sudden rotational vertigo lasting >30 seconds
  • Provoked by head turning
  • Complain of vertigo when rolling over in bed
116
Q

What are some important ‘negative symptoms’ to establish if a pt presents with suspected BPPV?

A
  • No persistent vertigo
  • No speech, visual, motor or sensory problems
  • No tinnitus, headaches, ataxia, facial numbness or dysphagia
  • No vertical nystagmus
117
Q

How do you investigate suspected BPPV?

A

-Dix-Hallpike manouever test is positive

118
Q

How is BPPV treated?

A
  • Usually self limiting
  • Persistent: Epley manoeuvre
  • Home repositioning manoeuvres
119
Q

What are the quadrad of symptoms that makes up Meniere’s disease?

A
  • Vertigo
  • Tinnitus
  • Hearing loss
  • Feeling of fullness in the ears
120
Q

What causes Meniere’s disease?

A

-Unknown
-Pathology:
>dilatation of the endolymphatic spaces of the membranous labyrinth causes sudden attacks of vertigo lasting 2-4hrs

121
Q

What are the clinical features of Meniere’s disease?

A
  • Suddent attacks of vertigo lasting 2-4 hrs
  • Nystagmus always present
  • Increasing fullness in the ears +/- tinnitus and vertigo
  • Bilateral symptoms
  • Fluctuating SNHL and can become permanent
122
Q

What investigations should be done for Meniere’s disease?

A
  • Electro-cochleography

- Posterior fossa MRI

123
Q

What is the acute treatment for Meniere’s disease?

A

-Prochlorperazine (short term vestibular sedative)

124
Q

What medication can be used as prophylaxis for Meniere’s disease?

A

-Betahistine

125
Q

What are some surgical approaches that can be used as treatment for persistent symptoms of Meniere’s disease?

A

-Instilation of gentamicin via grommet
-Labyrinthectomy
(causes ipsilateral deafness)
-Vestibular neurectomy

126
Q

What is acute vestibular failure?

A
  • AKA labyrinthitis

- Inflammation of the labyrinth (cochlear and semi-circular canals)

127
Q

What are the symptoms of labyrinthitis/acute we failure?

A
  • Sudden attacks of unilateral vertigo and vomiting in previously well person
  • Often follows a recent URTI
  • Lasts 1-2 days
  • Improves over a week
128
Q

What clinical signs wouold be seen in labyrinthitis?

A

-Nystagmus

>away from the affected side

129
Q

How is labyrinthitis diagnosed?

A
  • Clinical diagnosis

- Audiogram if there is hearing loss

130
Q

How is labyrinthitis treated?

A
  • Usually self resolves within 1-2 weeks

- Vestibular suppressants for symptomatic relief: prochloperazine

131
Q

How is rhinosinusitis defined?

A

-Inflammation of the nose and paransal sinuses with >2 of:
>nasal blockage/obstruction/congestion/nasal discharge
>+/- facial pressure
>Reduction or loss of smell
-Endoscopic or CT signs

132
Q

How can rhinosinusitis be classified?

A
  • Mild, moderate or severe
  • Acute (ARS)
  • Chronic (CRS) > if lasting >12/52
133
Q

What are some risk factors for rhinosinusitis?

A
  • Family history
  • Hay fever
  • More common in children
134
Q

Causes of rhinosinusitis?

A
  • Acute rhinosinusitis (common cold)
  • Acute post-viral sinusitis
  • Chronic rhinosinusitis +/- nasal polyps
  • Allergic rhinosinusitis
135
Q

What are some causes of chonic rhinorrhoea?

A
  • Foreign body
  • CSF leak post head injury
  • Bacteria (TB)
  • HIV
  • Cystic fibrosis
  • Age
  • Pregnancy
  • Decongestant overdose
  • Antibody deficiency
136
Q

What are some causes of nasal congestion in children?

A
  • Large adenoids
  • Choanal atresia (congenital blockage of one or both nasal passages by bone or tissue)
  • Post-nasal space tumour
  • Foreign body
137
Q

What are some causes of nasal congestion in adults?

A
  • Deviated/defected nasal septum
  • Granuloma (TB, syphilis, granulomatosis, leprosy)
  • Topical vasoconstrictors
  • TCAs
138
Q

Which other symptoms are a cause for urgent referral in someone with nasal congestion?

A
  • Numbness
  • Tooth loss
  • Bleeding
  • Unilateral obstructing mass
139
Q

What are the symptoms of rhinosinusitis?

A
  • Watery anterior rhinorrhoea
  • Sneezing
  • Purulent post-nasal drip
  • Nasal obstruction
  • Mouth breathing
  • Snoring
  • Headaches (worse when leaning forwards)
140
Q

What are they symptoms of allergic rhinosinusitis?

A

-May be seasonal (hay fever)
-May be chronic
-Sneezing
-Pruritus
-Nasal discharge
-Bilateral red and itchy eyes
>caused by IgE medicated inflammation from allergen exposure

141
Q

What are some signs of allergic rhinosinusitis on examination?

A
  • Swollen turbinates
  • Pale/mauve mucosa
  • Nasal polyps
142
Q

What investigations should be done for someone with chronic rhinosinusitis with nasal polyps?

A

-Anterior rhinoscopy
-Nasal endoscopy
>a single unilateral polyp needs biopsy to exclude rare intranasal pathology
-Consider allergy testing

143
Q

What investigations should be done for allergic rhinosinusitis?

A
  • Allergy testing

- Test for eczema

144
Q

How can chronic rhinosinusitis with nasal polyps be treated medically?

A
  • Topical steroid drops to shrink plyps for 2/52 (beclomethasone)
  • Fluticasone for 3/12
  • Long term abx ie doxycyclline
145
Q

How can chronic rhinosinusitis with nasal polyps be treated surgically?

A
  • Endoscopic sinus surgery

- Consider when max medical Rx fails

146
Q

How is chronic rhinosinusitis (without polyps) treated?

A
  • Intranasal corticosteroids
  • Nasal saline irrigation
  • If no improvement after 4 weeks – microbiological cultures, long term (>12 weeks) Abx if IgE is not elevated
  • Perform CT scan if poor response to treatment, consider surgery
147
Q

How is allergic rhinosinusitis treated?

A
  • Allergen/irritant avoidance
  • Nasal saline irrigation
  • Antihistamines ie loratadine
  • Intranasal corticosteroid sprays ie fluticasone
  • Short course prednisolone
  • Immunotherapy
148
Q

What is acute bacterial rhinosinusitis?

A

-Infection of the paranasal sinuses

149
Q

What causes acute bacterial rhinosinusitis?

A

-Obstruction impairs drainage and occurs due to:
>anatomical problems: septal deviation, polyps, mechanical ventilation and Ng tubes
>mucosal problems: viruses causing mucosal oedema and decreased ciliary action

150
Q

What is the main cause of acute bacterial rhinosinusitis?

A

-Viral infection

151
Q

What are the common infecting organisms in acute bacterial sinusitis?

A
  • Strep. pneumonia
  • H. influenzae
  • S. aureus
  • Moraxella catarrhalis
  • Fungi
152
Q

What are the clinical features of acute bacterial sinusitis?

A
  • Discoloured discharge and purulent secretions in nasal cavity
  • Severe local pain
  • Fever >38
  • Elevated ESR/CRP
  • Double sickening (deterioration after initial milder phase of illness)
  • Headaches
  • Pain worse on leaning forwards
153
Q

What are some red flag symptoms which would make you suspect cancer of the paranasal sinuses?

A
  • Onset for the first time later in life
  • Blood stained nasal discharge and nasal obstruction
  • Cheek swelling
154
Q

What are some differential diagnoses for acute bacterial sinusitis?

A
  • Migraine
  • TMJ dysfunction
  • Dental pain
  • Neuropathic pain
  • Temporal arteritis
  • Herpes zoster
155
Q

Investigations for acute bacterial sinusitis?

A
  • Clinical diagnosis

- Recurrent/chronic sinusitis: CT paranasal sinuses and nasal endoscopy

156
Q

What is the treatment for an acute/single episode of sinusitis?

A
  • Mainly viral so self limiting
  • Simple analgesia
  • Nasal saline irrigations
  • Intranasal decongestants (ephidrine)
  • Abx if bacterial infection suspected
157
Q

What are some possible complications of bacterial sinusitis?

A
  • Orbital cellulits/abscess EMERGENCY
  • Intracranial involvement ie meningitis
  • Mucocele infections
  • Osteomyelitis (staph) of frontal bone
  • Pott’s puffy tumour
158
Q

What are some important features to exclude in someone presenting with a nasal fracture?

A
  • Head or c-spine injury

- Septal haematoma

159
Q

What is the most common cause of nasal fracture and how do they normally present?

A

-Direct trauma

>often presents with obvious deformity or epistaxis

160
Q

How is a nasal fracture treated?

A
  • Treat epistaxis
  • Advise on analgesia/using ice
  • Close skin injury
  • Reassess 5-7/7 post injury
  • Ensure no septal heamatoma
  • MUA 10-14/7 after injury before nasal bones set if required
161
Q

What causes CSF rhinorrhoea?

A

-Ethmoidal fracture
>usually follows head trauma: frontobasal skull fracture or intracranial surgery
-If not associated with trauma: look for tumour

162
Q

How should CSF rhinorrhoea be investigated?

A
  • X ray skull(fractures)

- Nasal CSF testing: +ve for glucose

163
Q

How should CSF rhinorrhoea be managed?

A

-Traumatic: conservative management
>7-10/7 bed rest and head elevation
>avoid coughing/nose blowing
-Cover with abx and pneumococcal vaccine

164
Q

How should a foreign body in the nose be treated?

A
  • Ask child to blow nose if possible
  • Be wary of using forceps to pull things out
  • refer to ENT if failed attempt/ uncoopertive pt
165
Q

What are the causes of nasal septal perforation

A
  • Most common: septal surgery
  • Trauma: nose picking, foreign body, laceration
  • Inhalants: nasal steroids/decongestant sprays, cocaine abuse
  • Infection: TB. syphilis, HIV
  • Inflammation/malignancies: SSC, churg strauss, vasculitis
166
Q

What are the symptoms of nasal septal perforation?

A
  • Irritation
  • Whistling
  • Crusting
  • Bleeding
167
Q

How is nasal septal perforation treated?

A

-Symptom relief:
>nasal saline irrigation
>petroleum jelly at the edge of perforation
-Surgical closure

168
Q

What is the most common ENT emergency?

A

-Epistaxis
>anterior easily seen with rhinoscopy, easier to treat/less severe
>posterior

169
Q

What causes epistaxis?

A
  • Local trauma ie nose picking
  • Facial trauma
  • Dry/cold weather
  • Haemophillia and other bleeding disorders
  • Septal perforation
170
Q

How should epistaxis be managed?

A
  • Nasal packing
  • Balloons
  • Catheterise and compression
171
Q

How is a septal haematoma managed?

A

-Draining in theatre
>can become infected and damage the nasal cartilage
>pus can drain backwards to the brain due to venous drainage into the cavernous sinus

172
Q

What is tonsilitis?

A

-Inflammation of the tonsils
>viral or bacterial
>causes an acute sore throat

173
Q

What are the most common viral causes of tonisillitis?

A
  • Common cold: rhinovirus, parainfluenza, coronavirus
  • Influenza A&B
  • Adenovirus
  • HSV
  • EBV (glandular fever)
174
Q

What are some bacterial causes of tonisilitis?

A
  • Group A beta haemolytic strep (pyogenes)

- Rarer: H,influenza B

175
Q

Which criteria should be used for tonsilitis and it’s treatment?

A
  • Feverpain score

- Used to be centor criteria

176
Q

What are the centor criteria?

A
  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy
  • History of fever
  • Absence of cough
  • 3/4 suggest staph infection
177
Q

What are the feverpain criteria?

A
  • Fever in past 24hrs
  • Absence of cough/coryza
  • Symptom onset <3 days
  • Purulent tonsils
  • Severe tonsil inflammation
178
Q

How should tonsilitis be managed?

A
  • Symptomatic relief
  • Abx if score suggests it
  • If immunosuppressed: seek urgent specialist advice
  • If on DMARDS or carbimazole: check FBC urgently
179
Q

Why should FBC be checked urgently in someone that is on DMARDS/carbimazole with a sore throat?

A

-Causes agranulocytosis

180
Q

Which abx should be used for tonsilitis ?

A

-Penicillin V for 10/7

181
Q

What abx should be used if allergic to penicillin for tonsilitis?

A

-Clarithromycin or erythromycin for 5/7

182
Q

What abx is important to avoid in tonsilitis?

A

-Amoxicillin

>if tonsilitis is due to EBV, amox will cause widespread maculopapular rash

183
Q

Indications for tonsilectomy?

A

-Certainty that recurrent sore throat is due to tonsillitis
-Episodes of sore throat must be disabling
>7 documented cases in 1 year
-OSA
-Quinsy
-Suspicion of malignancy

184
Q

Complications of tonsillectomy?

A

-Primary and secondary haemorrhage

185
Q

Complications of tonsillitis?

A
  • Ottiis media
  • Sinusitis
  • Peritonsillar abscess (quinsy)
  • Pharyngeal abscess
  • Lemierre syndrome (acute septicaemia and jugular vein thrombosis)
186
Q

What is a peritonsillar abscess or quinsy?

A
  • Sore throat
  • dysphagia
  • peritonsillar bulge
  • trismus
  • muffled voice
  • Needs abx and aspiration
187
Q

Define stridor

A

-High pitched inspiratory noise from partial obstruction of the larynx or large airways

188
Q

Define stertor

A
  • Inspiratory snoring noise: obstruction of the pharynx

- Heard in post-ictal phase of Tonic clonic seizure

189
Q

Why is stridor more obvious in children than in adults?

A

-Children’s airways are narrower than adults so obstruction happens faster and more dramatically

190
Q

Name the most common congenital cause of stridor?

A

-Laryngomalacia (soft immature cartilage of the upper larynx collapses inwards during inhalation)

191
Q

Name some inflammatory causes of stridor?

A
  • Laryngitis
  • Epiglottitis
  • Croup
  • Anaphylaxis
192
Q

Name some tumours that can cause stridor?

A
  • Haemangiomas
  • Papillomas
  • Oesophagela cancer
  • Any cancer of the throat
193
Q

Name some traumatic causes of stridor

A
  • Thermal/chemical burns

- Intubation

194
Q

Name some infetive causes of stridor

A
  • Laryngotrachobronchitis (croup)

- Acute epiglottitis

195
Q

What are the clinical features of stridor/impending obstruction?

A
  • Audible inspiratory sounds
  • Swalloing difficulty/drooling
  • Pallor/cyanosis
  • Use of accessory muscles of respiration
  • Downward plunging of the trachea with respiration (tracheal tug)
196
Q

What are the clinical features of laryngomalacia?

A
  • Excessive collapse and indrawing of the supraglottic airways during inspiration = stridor
  • Commonly seen in new borns
  • Breathing and feeding difficulties
  • Usually resolves by 2 years and no treatment is needed
197
Q

How should acute airway obstruction be managed in adults?

A
  • Help
  • ABCDE
  • O2
  • Nebulised adrenaline
  • Call oncall ENT/anaesthetist
  • ET intubation
  • Emergency needle criothyroidotomy
  • Surgical cricothyroidotomy
198
Q

Deifine dysphonia?

A

-Hoarseness of voice

199
Q

Causes of dysphonia?

A
  • Viral URTI
  • Laryngeal carcinoma
  • VOice overuse
  • Vocal cord palsy
  • Reflux laryngitis
  • Reinke’s oedema
  • Vocal cord nodules
  • Muscle tension/spasm
  • Children with functional speech disorders
200
Q

What is Reinke’s oedema?

A

-Chronic cord irritation from smoking +/- chronic voice abuse causing gelatinous fusiform enlargement of the cords = deep gruff voice

201
Q

What are the clinical features of dystonia?

A
  • Vocal cord palsy: weak, breathy voice
  • Laryngitis: pain on speaing, fever
  • Reflux laryngitis: GORD symptoms
  • Vocal cord nodules: variable, husky voice
202
Q

Why is it important to investigate hoarseness of voice?

A
  • dysphonia is the main and often only presenting compliant of laryngeal carcinoma
  • Especially important to check in smokers
  • > any hoarseness that lasts >3 weeks
203
Q

How should someone with a hoarse voice be assessed?

A
  • SALT assessment
  • Head and neck examination
  • Neurological examination
  • Respiratory examination
  • Voice handicap index
  • Reflux symptoms index
  • Laryngoscopy
  • CT/MRI head neck larynx chest
  • Biopsy
204
Q

How should hoarseness caused by laryngitis be treated?

A
  • Supportive

- Phenoxymethylpenicillin if necessary

205
Q

How should hoarseness caused by reflux laryngitis be treated?

A
  • PPI
  • Diet/lifestyle alterations
  • Weight loss
  • Surgical fundoplication
206
Q

How should hoarseness caused by Reinke’s oedema be treated?

A
  • Smoking cessation
  • SALT
  • Laser therapy
207
Q

How should hoarseness caused by vocal cord nodules be treated?

A

-Speech therapy and surgical excision

208
Q

How should hoarseness caused by spasmodic dysphonia be treated?

A

-Botox injections into laryngeal muscles

209
Q

How should hoarseness caused by muscle tension dysphoniabe treated?

A
  • Reassure and explanation

- Speech therapy

210
Q

How should hoarseness caused by cancer be treated?

A
  • Surgery
  • Radio
  • Chemo
211
Q

What ‘vocal hygiene’ advice would you give to someone with dysphonia?

A
  • Drink plenty
  • Sleep well
  • Take adequate breaths whilst speaking
  • Steam inhalations to hydrate the coval cords
  • Avoid shouting or whispering
  • Rest voice if feel tired
  • Avoid excess throat clearing
  • Avoid irritants ie spicy food, tobacco, smoke, dust, alcohol
  • Avoid late night eating
  • Avoid throar lozenges
212
Q

What is laryngeal nerve palsy?

A

-Paralysis or the recurrent laryngeal nerve
>supplies the intrinsic muscles of the larynx (apart from the cricothyroid)
>abduction and adduction of the vocal fold
>originates from the vagus nerve

213
Q

What causes laryngeal nerve palsy?

A 
-Cancer of the:
> larynx, thyroid, oesophagus, hypopharynx, bronchus
-Iatrogenic (surgery)
-CNS disease
>polio, syringomyelia
-TB
-Aortic aneurysm
-Idiopathic (post viral neuropathy)
214
Q

What are the clinical features of laryngeal nerve palsy?

A
  • Weak ‘breathy’ voice
  • Weak cough
  • Repeated coughing/aspiration
  • Exertional dyspnoea
215
Q

What investigations should be done for someone with larygneal nerve palsy?

A
  • CXR

- if CXR normal: CT +/- USS thyroid +/- OGD

216
Q

How should larygneal nerve palsy be managed?

A

-Malignant: treat underlying cancer
-Non-malignant:
>unilateral palsies: compensation by contralateral cord: injections and thyroplasty
>Reinnervation techniques

217
Q

Describe the course of the facial nerve?

A
  • Arises in the medulla oblongata
  • Emerges between the pons and the medulla
  • Passes through the posterior fossa
  • Runs through the middle ears
  • Emerges from the stylomastoid foramen into the parotid
218
Q

What are the intracranial branches of the facial nerve?

A
  • Greater superficial petrosal nerve: lacrimation
  • Branch to strapedius: (lesions above causes hyperacusis)
  • Chorda tympani: supples taste to the anterior 2/3 of tongue
219
Q

What is hyperacusis?

A

-Increased sensitivity to certain volumes/frequencies of sounds

220
Q

What are the extracranial branches of the facial nerve?

A
  • Temporal
  • Zygomatic
  • Buccal
  • Marginal mandibular
  • Cervical
  • Posterior auricular nerve
221
Q

Where do the extracranial brnaches of the facial nerve emerge from? What type of nerves are they?

A
  • Stylomastoid foramen

- Motor fibres

222
Q

Where does the facial nerve branch into the 5 major branches to control facial expression?

A

-Parotid

223
Q

What is the name for idiopathic facial palsy?

A

-Bell’s palsy

224
Q

What are some intracranial causes for facial nerve palsy?

A
  • Brainstem tumours
  • Stroke
  • Polio
  • MS
  • Cerebellopontine angle lesions ie acoustic neuroma, meningitis
225
Q

What are some intratemporal causes of facial nerve palsy?

A
  • Otitis media
  • Ramsay hunt syndrome (shingles of the facial nerve)
  • Cholesteatoma
226
Q

What are some infratemporal causes of facial nerve palsy?

A
  • Parotid tumours

- Trauma leading to complete palsy

227
Q

What are some other causes of facial nerve palsy?

A
  • Lyme’s disease
  • Sarcoidosis
  • Diabetes
  • Bell’s palsy
  • MS
228
Q

Name some risk factors for Bell’s palsy?

A
  • Pregnancy

- Diabetes

229
Q

What is the difference between an UMN and LMN facial nerve palsy on clinical examination?

A
  • LMN lesions: paralysed all of one side of the face

- UMN lesions: forehead muscles spared due to bilateral innervation

230
Q

What are the symptoms of Bell’s palsy?

A
  • Abrupt onset
  • Complete weakness at 24-72hrs
  • Mouth sagging/drooping
  • Dribbling
  • Watering or dry eyes
  • Impaired brow wrinkling
  • Impaired whistling
  • Impaired eye-lid closure
  • Impaired cheek pouting
  • Impaired speech/taste
231
Q

What investigations should be done for a facial nerve palsy?

A
  • ESR
  • Glucose
  • Lyme disease serology
  • Parotid gland examination
  • Examine ears: cholesteatoma, Ramsy Hunt
  • History: head trauma
  • CT/MRI brain if suspicious of CVA, MS, fracture
232
Q

How is facial nerve palsy treated?

A

-Prednisolone
-Protection of the eye (lubricating drops)
-Referral for:
>recurrent, bilateral palsy, no sign of improvement after 1m)

233
Q

What referral pathway should be followed for any ? malignant neck lumps?

A
  • 2WW

- Urgent ENT referral

234
Q

What are some causes of midline neck lumps?

A
  • Dermoid cyst
  • Thyroglossal cyst (moves up on protruding the tongue)
  • Thyroid mass
  • Chondroma (bony and hard on paplation - benign cartilaginous tumour)
235
Q

What are the causes for neck lumps in the submandibular triangle?

A
  • Reactive lymphadenopathy
  • Malignant lymphadenopathy ie ass. w/ B symptoms
  • TB
  • Submandibular salivary stone
  • Tumour
  • Sialadenitis (inflammation of the salivary glands)
236
Q

What are the causes of neck lumps found in the anterior triangle?

A
  • Lymphadenopathy
  • Branchial cysts
  • Partoid tumour
  • Laryngoceles
  • Carotid artery aneurysm
  • Tortuous carotid artery
  • Carotid body tumour
237
Q

What are some causes of neck lumps in the posterior triangle?

A
  • Cervical rib
  • Pharyngeal pouches
  • Cystic hygromas
  • Lymphoma (if lymphadenopathy and B symptoms are present)
238
Q

Investigations for neck lumps?

A
  • Uss (shows lump architecture and vascularity)
  • CT (defines mass in relation to anatomical structures)
  • Virology ie EBV
  • Mantoux test
  • CXR (malignancy or BHL in sarcoidosis)
239
Q

How should neck lumps be managed ?

A
  • Treat underlying cause

- Urgent ENT referral if ?malignancy

240
Q

What are the names of the 3 major pairs of salivary glands?

A
  • Parotid
  • Submandibular
  • Sublingual
241
Q

How should the salivary glands be examined?

A
  • Look for external swellings
  • Paplate for stones
  • Test faical nerve function
  • Assess mass: size, mobility, fixed
  • Assess surrounding skin
242
Q

Define sialadenitis?

A

-Actue infection of the submandibular or parotid glands
-Usually in elderly or debilitated pts
>dehydrated, poor oral hygiene

243
Q

What are the symptoms of sialedenitis?

A
  • Painful diffuse swelling of the gland
  • Fever
  • Pressure applied over the gland = pus leakage
  • Pain and swelling on eating
  • Chronic infections can be caused by strictures from previous infection or salivary gland stones
244
Q

How is sialadenitis treated?

A
  • ABX and good oral hygiene
  • Sialogogues to stimulate salivation ie pineapple
  • Surgical drainage
245
Q

Define sialotithiasis

A

-Salivary gland stones

>usually affects the submandibular gland

246
Q

What are the clinical features of salivary gland stones?

A
  • Pain
  • Tense swelling of the gland during/after meals
  • Stone may be palpable in floor of mouth
247
Q

What management should be done for suspected salivary gland stones?

A
  • Small stones may pass spontabneously
  • Sialogogues
  • Larger stones may need surgical removal
248
Q

Name some inflammatory conditions which affect the salivary glands?

A
  • Sjorgren’s syndrome
  • Viral infections
  • Granulomatous disease ie TB sarcoidosis
249
Q

Which salivary gland is most commonly affected by tumours?

A

-Parotid

250
Q

What are the risk factors for salivary gland malignancy?

A
  • Radiation to the neck

- Smoking

251
Q

What are they symptoms of salivary gland malignancy?

A
  • Hard fixed mass +/- pain
  • Overlying skin ulceration
  • Local LN enlargement
  • Doesn’t vary in size when eating (like in inflammation or stones)
  • Ass. facial nerve palsy
252
Q

How should salivary gland malignancy be managed?

A
  • Urgent ENT referral
  • USS/MRI
  • CT guided biopsy
  • Surgery, radiotherapy
253
Q

Define xerostomia

A

-Dry mouth

254
Q

What are the causes of dry mouth?

A

-Hypnotics and tricyclics
-Antipsychotics
-Beta blockers
-Mouth breathing
-Diuretics
-Dehydration
-ENT radiotherapy
-Sjogren’s syndrome
-SLE and scleroderma
-Sarcoidosis
HIV/AIDs
-Parotid stones

255
Q

What are the clinical signs of dry mouth?

A
  • Dry atrophic fissured oral mucosa
  • Discomfort (difficulty eating, speaking etc)
  • No saliva pooling in the floor of mouth
  • Difficulty in expressing saliva from major ducts
256
Q

What are the complications of a chronic dry mouth?

A
  • Dental caries
  • Candida infection
  • Ulceration/sores
257
Q

How is dry mouth treated?

A
  • Increased oral fluid intake
  • Good dental hygiene
  • No acidic drinks or foods
  • Saliva substitutes ie biotene
258
Q

When should an oral ulcer be referred for secialist assessmeent?

A
  • When it has not healed for 3 weeks

- Needs biopsy to exclude malignancy

259
Q

What are the main causes of facial pain?

A
  • Tooth pathology
  • Sinusitis
  • TMJ dysfunction
  • Salivary gland pathology
  • Migraine
  • Trigeminal neuralgia
  • Atypical facial pain
  • Trauma
  • Angina
  • Cluster headache
  • Frontal bone osteomyelitis (post sinusitis)
  • ENT tumours
260
Q

What is the main histological type of cancer found in the head and neck?

A

-Squamous cell carcinoma

261
Q

Where can oropharyngeal neoplasms occur?

A
  • Oral cavity
  • Oropharynx
  • Hypopharynx
  • Larynx
  • Trachea
262
Q

Risk factors for oropharyngeal neoplams?

A
  • Smoking
  • Alcohol
  • Vitamin A&C deficiency
  • HPV
  • GORD
  • Socioeconomic deprivation
263
Q

Clinical features of oropharyngeal cancers?

A
  • Neck pain/lump
  • Hoarse voice/sore throat >6 weeks
  • Mouth bleeding/numbness
  • Sore tongue
  • Painless ulcers
  • Patches in the mouth
  • Earache/effusion
  • Lumps
  • Speech change
  • Dysphagia
264
Q

What ar ethe clinical features of oral cavity and tongue cancer?

A
  • Uncommon in the UK
  • Painful persistent ulcers
  • White or red patches on tongue, gums, mucosa
  • Otalgia
  • Odonophagia (pain with swallowing)
  • Lymphadenopathy
265
Q

Clinical features of oropharyngeal carcinoma?

A
  • Older pt

- smoker with sore throat or sensation of lump and complaining of otalgia

266
Q

Describe the typical pt for larygneal cancer

A
  • Older
  • Male smoker with progressive hoarseness > stridor.
  • Difficulty/pain on swallowing
  • Haemoptysis
  • Ear pain
  • IF younger, usually HPV +VE
267
Q

How should suspected oropharyngeal cancer be investigated?

A
  • Pts with suspicious symptoms
  • Endoscopy
  • Fine Needle Aspiration or biopsy of masses
  • CT/MRI of primary tumour site
  • TNM staging
268
Q

How is oropharyngeal cancer managed?

A
  • MDT
  • Radiotherapy
  • Surgery
269
Q

What is TMJ syndrome?

A
  • Temporomandibular joint dysfunction

- Biopsychosocial disorder = can become a chronic pain syndrome

270
Q

Symtpoms of TMJ syndrome?

A
  • Earache
  • Facial pain
  • Joint clicking/popping related to teeth grinding or joint derangement
  • Stress
271
Q

Signs of TMJ dysfunction?

A
  • Joint tenderness exacerbated by lateral movement of the open jaw
  • trigger points in the pterygoids (chewing muscle)
272
Q

How it TMJ syndrome treated?

A
  • Usually self limiting
  • Simple analgesia
  • Soecialist treatment: oral splinting, physiotherapy
  • CBT
273
Q

What are the clinical signs of basal skull fracture?

A
  • Peri-orbital haematoma (panda eyes)
  • Battle sign (significant bruise behind the ear)
  • Cranial nerve palsies
274
Q

What investigations should be uone for a suspected basal skull fracture?

A
  • X ray skull

- Examination of the cranial nerves

275
Q

Management of a basal skull fracture?

A

-Admit under head injury team for neuro obs
-Non-urgent ENT referral
-CNVII - ENT emergency
>drill into ear to relieve pressure

276
Q

What investigations should be done for someone with a nasal fracture and how should it be treated?

A
  • Exclude other max-fax fractures
  • Exclude CSF rhinorrhoea
  • Routine referral if there is a deformity
  • Urgent referral if obvious deformity
  • Analgesia
  • Repair
277
Q

What is orbital cellulitis and how is it managed?

A
  • Cellulitis of the orbit
  • Children: systemic abx ie cefuroxime, met, fluclox
  • Otrivine (reduces nasal congestion symptoms)
  • analgesia
278
Q

What are clincial features of cavernous sinus thrombosis

A
  • Chemosis

- Ophthalmoplegia

279
Q

What is the difference between primary and secondary haemorrhage post-tonsillectomy

A
  • Primary: reactive (occurs within 24 hours after tonsillectomy)
  • Secondary: occurs >24hrs after tonisllectomy
280
Q

How should a primary haemorrhage post tonsillectomy be managed?

A

-Requires immediate return to theatre due to risk of further extensive bleeding

281
Q

How should a secondary haemorrhage post tonsillectomy be managed?

A

-More likely to be due to infection so treat with abx

282
Q

Where is the most likely area for bleeding to occur from in the nose?

A

-Anterior nasal septum (little’s area)

>an area of 4 confluencing arteries

283
Q

What is a branchial cyst?

A
  • A mobile cystic mass
  • Develops between the sternocleidomastoid and the pharynx
  • Develops due to failure of obliteration of the second branchial cleft in embryonic development
284
Q

Which drugs can cause gingical hyperplasia (overgrowth of gums)?

A
  • Phenyotin
  • Ciclosporin
  • Calcium channel blockers
285
Q

How is quinsy managed?

A
  • Iv abx

- Surgical drainage

286
Q

What is the main side effect of using topical decongestants fro prolonged periods?

A

-Tachyphylaxis

>increasing the doses is needed to proivde the same effect

Phase 3B (14 decks)

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