ENT Flashcards
Signs and symptoms of otitis externa
discharge
itch
pain
tragal tenderness
Causes of otitis externa
due to acute inflammation of the skin of the meatus
usually caused by excess canal moisture
trauma (fingernails - eczema/psoriasis)
absence of wax
narrow ear canal
hearing aids
commonly pseudomonas or staphylococcus aureus
TMJ dysfunction
earache, facial pain, joint clicking/ popping
related to teeth grinding, joint derangement and stress
joint tenderness exacerbated by lateral movement of open jaw or trigger points in the pterygoids
Rx- dental occulsion therapy, physio, CBT, surgery
Acute otitis media
middle ear inflammation
rapid onset of pain, fever ± irritability, anorexia or vomiting
commonly pneumococcus, haemophilus or moraxella
pain relief
amoxicillin if not resolved within 24hrs
grommets if recurrent
mastoiditis
middle ear inflammation leads to destruction of air cells in the mastoid bone ± abscess formation
beware intracranial extension
prevented by Abx for OM
Signs- fever, tenderness, swelling, redness behind the pinna, protruding auricle
IV abx, myringotomy ± definitive mastoidectomy
Genetic hearing loss
Conductive hearing loss
congenital anomalies of the pinna, external ear canal, drum or ossicles
Treacher-Collins, Pierre-Robi, Goldenhar syndrome
Non-genetic hearing loss
Intrauterine TORCH infections - CMV, rubella, toxicoplasmosis, HSV, syphillis
Perinatal - prematurity, hypoxia, IVH, kernictus, infection
Infections - meningitis, encephalitis, measles, mumps
Ototoxic drugs, acoustic or cranial trauma
Conductive hearing loss in adults
external canal obstruction - wax, pus, debris, FB, developmental abnormalities
drum perforation - trauma, barotrauma, infection
inadequate eustachian tube ventilation
Sensorineural hearing loss in adults
defects central to the oval window, cochlea nerve or central pathways
Ototoxic drugs- gentamicin, streptomycin, vancomycin, chloroquine and hydroxychlorquine, vinca alkaloids)
Otosclerosis
new bone formed around the stapes footplate
Autosomal dominant with incomplete penetration
usually appears in early adult life, accelerated by pregnancy
conductive deafness, tinnitus, mild transient vertigo
Rx- hearing aids, stapedectomy/otomy, cochlear implants
Tinnitus character
unilateral, bilateral, pulsatile or non-pulsatile
ringing, hissing, buzzing –> inner ear or central cause
popping or clicking suggests problems in the external or middle ear of the palate
pulsatile tinnitus is often objective
Objective tinnitus
Audible to examiner
rare and occurs due to:
- vascular dioders e.g. AVM, carotid pathology, glous tumours
- high -output cardiac states- paget’s hypoerthyroidism, anaemia,
-myoclonus of palatal or stedius/tensor tympani muscles –> audible click
- patulous Eustachian tube - prolonged opening causes abnormal sound transmission
Subjective tinnitus
associated with SNHL
noise induced hearing loss, Meniere’s
- conductive deafness
- ototoxic drugs
Acoustic neuroma
typically indolent, histologically benign, subarachnoid tumours
causes problems by local pressure then behave as space occupying lesions
arise from superior vestibular nerve Schwann cell laters
progressive ipsilateral tinnitus ± sensorineural deafness
giddiness common, vertigo rare
Benign paroxysmal positional vertigo
commonest cause of peripheral vertigo
attacks of sudden onset rotational vertigo lasting >30 seconds, provoked by head turning
displacement of otoconia stimulate semicircular canals
- no persistent vertigo
- no speech, visual, motor or sensory problems
- no tinnitus, headache, ataxia, facial numbness or dysphagia
- no vertical nystagmus
Hallpike +ve
Meniere’s disease
dilatation of endolymphatic spaces of membranous labyrinth causes sudden attacks of vertigo lasting ~2-4hrs
nystagmus is always present
increasing fullness in ears ± tinnitus
Rx- prochlorperazine, betahistine as prophylaxis
Causes of nosebleeds
local trauma - picking facial trauma dry/cold weather dyscrasia/ haemophilia septal perforation
Peritonsillar abscess
Quinsy
presents with sore throat dysphagia, peritonsillar bulge
uvular deviation, trismus (lock jaw) and muffled voice
Abx and aspiration are needed
Parapharyngeal abscess
serious but rare
diffuse swelling in the neck
Rx- US to identify site, incise and drain under GA
Lemierre syndrome
acute septicaemia and jugular vein thrombosis secondary to infection with fusobacterium species + septic emboli
rare
Scarlet fever
caused by endotoxins released from strep pyogenese
- rash on chest, axillae or behind ears 12-48hrs after initial sore throat and fever
red pinprick blanching rash
facial flushing with circumoral pallor
Rx - penicillin v for 10/7
CENTOR criteria
- presence of tonsillar exudate
- presence of tender anterior cervical lymphadenopathy
- history of fever
- absence of cough
Stridor
high pitched noise on inspiration
partial obstruction of the larynx or large airways
Stertor
inspiratory snoring noise
obstruction of the pharynx
Causes of stridor
Congenital - laryngomalacia, web/stenosis, vascular rings
Inflammation - laryngitis, epiglottitis, croup, anaphylaxis
Tumours- haemangiomas or papillomas (usually disappear without treatment
Trauma- thermal/chemical or from intubation
Laryngotracheobronchitis
CROUP
leading cause of stridor
barking cough ± respiratory distress due to upper airway upper airway obstruction
Rx 0/15mg/kg dexamethasone
Acute epiglottitis
rapidly progressive inflammation of the epiglottis and adjacent tissues
respiratory arrest can occur
presents with fever, irritability, sore throat, pooling and drooling of saliva, muffled voice or cry
lean forward and breath tentatively
Laryngomalacia
main congenital abnormality of the larynx
noticeable within hours of birth
excessive collapse and in-drawing of the supraglottic airways during inspiration –> stridor
self resolving or may need surgery if not resolved by 2.
Differential diagnoses for hoarse voice (dysphonia)
laryngeal cancer - progressive and persistent gruff voice
vocal cord palsy - weak breathy voice
laryngitis/reflux laryngitis
reinke’s oedema - chronic cord irritation from smoking ± chronic voice abuse
vocal cord nodules
Disorders of speech articulation causing a hoarse voice
spasmodic dysphonia
muscle tension dysphonia
children with functional speech disorders
Laryngeal nerve palsy
recurrent laryngeal nerve supplies intrinsic muscles of the larynx
abduction and adduction of the vocal vold
arrises from the vagus
weak breathy voice
repeated coughing/ aspiration
exertional dyspnoea
- causes - cancer, iatrogenic, CNS disease, TB, aortic aneurysm, idiopathic
Causes of dysphagia
oesophageal carcinoma
benign oesophageal stricture, Barrett’s oesophagus, Achalasia
pharyngeal pouch
globus pharyngeus (globus hystericus)- sensation of lump in the throat
Bell’s Palsy
unilateral LMN facial palsy
diagnosis of exclusion
Features of Bell’s palsy
inflammatory oedema from entrapment of the facial nerve in the facial canal
abrupt onset- over night/ after a nap
complete weakness at 24-72hrs
mouth sags
dribbling and watering/ dry eyes + impaired brow-wrinkling, blowing, whistling, lid- closure, cheek-pouting taste and speech ± hyperacusis from stapedius palsy
Treatment of Bell’s Palsy
Prednisolone within 72hrs of onset
eye drops to maintain eye lubrication
Ramsay Hunt herpes zoster oticus
herpes zoster of the facial nerve often in the elderly severe otalgia precedes VII nerve palsy zoster vesicles around the ear, in the deep meatus ± soft palate and tongue may be vertigo, tinnitus or deafness
Rx- prednisolone and aciclovir
Vestibular neuronitis/ labyrinthitis, acute vestibular failure
sudden attacks of unilateral vertigo and vomiting in a previously well person
often following a recent URTI
lasts 1-2 days and improves over a week
Nystagmus away from the affected side
Rx- prochlorperazine or cyclizine
