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ENT Flashcards

1
Q

What are the 3 bones in the middle ear called?

A

Malleus
Incus
Stapes

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2
Q

What are the 2 muscles in the middle ear called?

A

Stapedius muscle

Tensor tympanic muscle

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3
Q

What are the 2 functions of the inner ear?

A

To convert mechanical signals from the middle ear into electrical signals for conduction via nerve
To maintain balance by detecting position and motion

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4
Q

How can you tell the difference between conductive and sensorineural hearing loss?

A

Weber’s test - Vibrating 256Hz tubing fork. Louder in the abnormal hear in conductive hearing loss and in the normal ear in sensorineural hearing loss.
Rinne’s test - Vibrating 256Hz tubing fork. Normally louder when held at external acoustic meatus than on mastoid bone. Opposite in conductive hearing loss.

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5
Q

What are the most common bacterial causes of acute otitis media?

A

haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
streptococcus pyogenes

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6
Q

How does acute otitis media present?

A

Pain
Fever
Irritability
Discharge from affected ear (if perforated)

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7
Q

TM appearance for acute otitis media?

A

Red, bulging, oedematous

Pus seen behind TM

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8
Q

Treatment for acute otitis media?

A

Analgesia
Watchful waiting
Delayed prescription of amoxicillin 5 days

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9
Q

What are the risk factors for otitis media with effusion (glue ear)?

A 
Age 1-6 years
Older sibling
Male
Breastfeeding
Parental smoking
Day care attendance
Immune deficiency
Allergy
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10
Q

Location in which part of the tympanic membrane is most likely to lead to mastoiditis?

A

Periphery, specifically upper ear drum

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11
Q

How does glue ear present?

A

(Otitis media with effusion)

Ear pain
Hearing loss (mispronouncing words, speech delay)
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12
Q

TM appearance for otitis media with effusion?

A

Opaque ear drum
Loss of light reflex
Indrawn/retracted TM

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13
Q

What is the management of otitis media with effusion?

A

Watch and wait for 3 months as most resolve
Surgery (grommets) is:
- persistant bilateral OME >3 months
- hearing loss >25dB in best ear
- language, educational, social developemental delay
Adenoidectomy if recurrent

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14
Q

What is chronic suppurative otitis media?

A

Chronic inflammation of the middle ear and mastoid cavity due to recurrent infections.
Recurrent infections -> ulceration and oedema -> breakdown of epithelial lining -> TM perforation

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15
Q

Risk factors for chronic suppurative otitis media?

A

Multiple AOM episodes
Living in crowded environment
Day care
Congenital abnormality eg cleft lip/palate, down’s syndrome

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16
Q

How does chronic suppurative otitis media present?

A

> 2 weeks ear discharge
Hearing loss
Ear pain

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17
Q

What is the management of chronic suppurative otitis media?

A

Referral to ENT for diagnosis and exclusion of complications
Aural cleaning
Topical quinolones eg ciprofloxacin ear drops

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18
Q

What are the complications of chronic suppurative otitis media?

A 
Cholesteatoma
Chronic hearing loss
Mastoiditis
Labyrinthitis 
Abscess formation
Facial paralysis
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19
Q

Common causative pathogens of otitis externa?

A 
Pseudomonas
Escherichia coli
Staphylococci
Enterobacter
Candida
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20
Q

Risk factors for otitis externa?

A 
Swimming/Water sports
Humidity
Trauma
Cotton bud use
Diabetes
Immunosuppression
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21
Q

What is the presentation of otitis externa?

A 
Ear pain
Itching
Purulent discharge
Pre-auricular lymphadenopthy
\+/- hearing loss
\+/- fever
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22
Q

Investigation for otitis externa

A

Swab discharge for MC+S

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23
Q

Management of otitis externa

A 
Aural cleaning
Analgesia (paracetamol and NSAIDs)
Topic antibiotics + corticosteroid combination eg sofradex
Ear wick
Oral antibiotics
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24
Q

Complications of otitis externa

A

Chronic otitis externa
Temporary hearing loss
Cellulitis
Necrotising otitis externa

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25
Q

Causes of referred ear pain

A

Tonsillitis
Cervical arthritis
TMJ disorders

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26
Q

What score is used to determine if a patient needs antibiotics for tonsillitis?

A

Centor score

FeverPAIN

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27
Q

What factors are taken into consideration on the centor score?

A 
Age (3-14= +1, >45=-1)
Exudate
Tender lympadenopathy 
Fever (>38)
Cough (absent)
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28
Q

What is the 1st choice antibiotic for tonsillitis?

A

Pen V (phenoxymethylpenicillin)

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29
Q

What is the first 1st line antibiotic for tonsillitis in a penicillin allergic patient?

A

Erythrocmycin

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30
Q

How might you treat a patient systematically unwell with tonsillitis?

A

IV Benzylpenicillin stat
Steroids
IV Fluids

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31
Q

What is Ramsay Hunt Syndrome?

A

Herpes zoster oticus
Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal.
Infection of the facial nerve (CNVII)

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32
Q

What pathogen causes Ramsay Hunt Syndrome?

A

Varicella Zoster Virus

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33
Q

Symptoms of Ramsay Hunt Syndrome?

A

PURPLE acronym
P - Pain in face, head, ear or mouth
U - Unsteady (vertigo/dizziness)
R - Red rash, vesicles in mouth, ear, throat, hairline
P - Palsy (LMN facial palsy, forehead not spared)
L - Loss of hearing, tinnitus
E - Exception, there is not always a rash)

34
Q

Treatment of Ramsay Hunt Syndrome?

A

Acyclovir
Steroids
Analgesia

35
Q

Complications of Ramsay Hunt Syndrome?

A

Lasting neurological damage in approx 30%.

36
Q

Investigations for Ramsay Hunt Syndrome?

A

Bloods: Antibodies for VZV
Saliva: PCR for VZV
MRI: Inflammation of facial nerve

37
Q

What is mastoiditis?

A

Inflammation of the mastoid lining of the mastoid antrum and mastoid air system inside the mastoid process of the temporal bone.

38
Q

What organisms are the most common cause of mastoiditis?

A 
haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
streptococcus pyogenes
staphylococcus aureus
39
Q

What is the clinical presentation of mastoiditis?

A

Red, painful, swollen mastoid process
Fever
Ear pain
Headache

40
Q

Investigation for mastoiditis

A

Blood cultures
MRI - to confirm diagnosis and look for extra cranial complications
Fluid from middle ear due to perforated drums or by intervention (tympanocentesis) for MC+S
LP - if intracranial spread is suspected

41
Q

Management of mastoiditis

A

IV broad spec antibiotics eg ceftriaxone
Analgesia
Surgery (myringotomy +/- tympanostomy) to drain pus from middle ear

42
Q

Complications of mastoiditis

A 
Labyrinthitis (hearing loss)
Facial nerve palsy
Abscess formation
Meningitis
Epidural 
Brain abscess
43
Q

Through what 2 anatomical connections can bacteria gain access to the membranous labyrinth?

A

Between CNS and subarachnoid space via internal auditory canal and cochlear aqueduct
Through congenital or acquired defects of the bony labyrinth

44
Q

How does labyrinthitis present?

A

Sudden, spontaneous, severe and incapacitating vertigo. Not triggered by movement but can be exacerbated by movement.
N+V
Hearing loss
Tinnitus

45
Q

What investigations would you do for labyrinthitis?

A

MC+S if ear discharge

CT of temporal bone

46
Q

Management of labyrinthitis

A

Antiemetics eg prochlorperazine (buccal or deep intramuscular injection if severe)
Surgery: Myringotomy

47
Q

Complications of labyrinthitis

A

Falls
Unilateral hearing loss
BPPV

48
Q

What condition is associated with acoustic neuromas?

A

Neurofibromatosis type 2

49
Q

What is the inheritance of neurofibromatosis type 2?

A

Autosomal dominance

50
Q

What cell type to acoustic neuromas arise from?

A

Schwaan cells

51
Q

Symptoms of acoustic neuroma other than hearing loss?

A

Subtle balance disturbance
Facial pain/numbness
Earache

52
Q

Investigations for acoustic neuroma?

A

Audiogram

MRI

53
Q

What types of drugs can cause hearing loss?

A 
Loop diuretics
Aspirin
Quinines
Cisplatin
Gentamicin
Carboplatin
54
Q

What is the most common bacterial cause of pharyngitis?

A

Group A streptococcus

55
Q

What investigations can be done for patients with suspected pharyngitis?

A

Rapid antigen test for GAS

Throat swab for MMC+S

56
Q

What is the antibiotic of choice for confirmed group a strep pharyngitis?

A

Phenoxymethylpenicillin

57
Q

Presentation of quinsy

A 
Sore throat
Fever
Drooling of saliva
Foul smelling breath
Trismus
Painful swallowing
Ear ache
Headache
General malaise
58
Q

What symptom indicates pharyngitis over tonsillitis?

A

Trismus

59
Q

What is the management of quinsy?

A 
Same day referral to ENT
IV fluids
Analgesia
IV antibiotics
Needle aspiration, incision and drainage
60
Q

What condition is characterised by the triad of vertigo, tinnitus and hearing loss?

A

Meniere’s disease.

Symptoms occur for about 2-3 hours approx 6-11 times a year, remitting for months at a time.

61
Q

What is the most common salivary gland tumour?

A

Pleomorphic adenoma

Benign, slow-growing, rubbery

62
Q

2 most common locations for epistaxis to occur

A

Anterior bleed from Kiesselbach’s plexus - secondary to trauma. It predominantly involves the anterior and posterior ethmoid arteries as well as the superior labial artery and greater palatine artery.
Posterior bleed from the sphenopalatine artery - this occurs as a result of underlying pathologies such as hypertension of due to old age

63
Q

What are the 5 parts of the temporal bone?

A 
Mastoid
Styloid process
Tympanic bone
Squamous part
Petrous part
64
Q

Differentials for parotid swelling

A 
Pleomorphic ademoma
Parotid abscess
Lymphoma
Adenocarcinoma of the parotid
Parotid adenitis
65
Q

What nerves innervate the larynx? What muscles do they innervate?

A

Recurrent laryngeal nerve - All except cricothyroid (+sensory innervation of to trachea and larynx below vocal cords)
Superior laryngeal nerve - divides into external which supplies cricothyroid muscle and internal which is responsible for sensation

66
Q

What is Meniere’s disease?

A

Increase in volume of the fluid within the vestibular apparatus causing progressive distension of membranous labyrinth. Cause is unknown.

67
Q

Differentials for vertigo

A

Otological: BPPV, meniere’s, vestibular neuritis
Central: Migraine, stroke, SOL, multiple sclerosis

68
Q

Management of Meniere’s disease?

A

Anti-emetics eg prochlorperazine
Regular betahistine
Lifestyle factors - avoid caffeine and chocolate
Surgery

69
Q

What test on examination is diagnostic of BPPV?

A

Dix-Hallpike manoevure

70
Q

What manoeuvre can be done for the management of BPPV?

A

Epley’s manoeuvre

71
Q

What is the main different between BPPV, Meniere’s and vestibular neuritis?

A

The duration of symptoms.
BPPV: seconds
Meniere’s: minutes-hours
Vestibular neuritis: days

72
Q

What cause of vertigo is likely to be preceded with a viral URTI?

A

Vestibular neuritis

73
Q

How do you treat vestibular neuritis?

A

Usually self limiting

Antihistamiens/antiemetics (vestibular sedatives)

74
Q

What is a complication of vestibular neuritis?

A

Long term vestibular deficit

Cawthorne-Cookey exercises

75
Q

Causes of epistaxis

A

Trauma
Coagulopathies
Medications
Cocaine

76
Q

What is the treatment of epistaxis?

A 
Nasal cautery (silver nitrate or electrically charged wire)
Vaseline
77
Q

What is a cholesteatoma?

A

Keratinising squamous cell epithelium and connective tissue collection within the middle ear which is locally invasive and destructive due to the production of osteolytic enzymes.

78
Q

Presentation of cholesteatoma?

A 
Progressive unilateral conductive hearing loss
Vertigo
Otorrhoea
Headache
Facial nerve palsy
79
Q

How is cholestatoma diagnosed?

A

CT

80
Q

How do you treat a cholesteatoma?

A

Surgically

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