ENT Flashcards
What are the causes of conductive hearing loss?
External canal obstruction Tympanic membrane perforation Acute mastoiditis Otosclerosis Cholesteatoma
Which inherited condition causes slowly progressive bilateral hearing loss?
Otosclerosis
When does otosclerosis typically worsen?
Around menstruation and pregnancy
What test is done to assess hearing?
Audiogram
What are the causes of sensorineural hearing loss?
Ototoxicity Menieres disease Infections Presbyacusis Noise-induced Acoustic neuroma
How do you distinguish noise-induced hearing loss from presbyacusis?
Nose induced is not progressive
+ trough on audiogram at 4000Hz
Which drugs are ototoxic?
Aminoglycosides (gentamicin)
Loop diuretics (furosemide)
Platinum based drugs (e.g. cisplatin)
Macolides (clarithromycin)
What frequency sounds are lost first in presbyacusis?
High frequency
How is acoustic neuroma dx?
Audiology and MRI
What are the mx options for acoustic neuroma?
Watch and wait
Radiotherapy
Microsurgery
What are the central causes of vertigo?
Acoustic neuroma
MS
Head injury
What type of crystals cause BPPV?
Otoliths formed from calcium carbonate
What conservative measures can help improve BPPV?
Reduce alcohol
Get out of bed slowly
Head turning
What drug can be used as prophylaxis in menieres?
Betahistine
What drug can be used in an acute menieres attacks to relieve sx?
Antihistamines (e.g. cinnarizine)
Which type of bacteria most commonly cause otitis externa?
Pseudomonas aeruginosa
S.Aureus
Which fungi most commonly cause otitis externa?
ASPERGILLUS NIGER Candida albicans (less commonly)
RFs for otitis externa
Swimming Cotton buds Eczema/psoriasis Immunocompromised/DM Allergies
What is the tx for otitis externa?
Topical abx (gentamicin) + topical steroid (e.g. dexamethasone)
How does Ramsey-Hunt syndrome px?
Bells palsy + very painful vesicular rash in ear and anterior 2/3 of tongue
Ipsilateral HEARING LOSS and vertigo
How is ramsey hunt syndrome tx?
Pred
Aciclovir
Artificial tears
What should you suspect if otitis externa is accompanied with a CN VII palsy?
Necrotising otitis externa
How does necrotising otitis externa px?
Severe pain out of keeping with ear findings
Temporal headaches
CN VII palsy
What organism mainly causes necrotising otitis externa?
Pseudomonas aeruginosa
What is a big risk factor for necrotising otitis externa?
DIABETES
Define necrotising otitis externa?
External otitis media that progresses into osteomyelitis of temporal bone
What might you find on exam in necrotising otitis externa?
Granulations in ear canal
Which organisms most commonly cause AOM?
RSV
Rhinovirus
S.PNEUMONIAE
H.influenzae
How does AOM px?
Otalgia followed by discharge
What are the comps of AOM?
Mastoiditis
Meningitis
What must you exclude if an adult presents with unilateral otitis media with effusion?
Head and neck tumour
What does otitis media with effusion look like on exam?
Yellow retracted tympanic membrane with loss of light reflex
What test can be done to test the mobility of the ear drum?
Tympanogram
What is the tx for cholesteatoma?
Surgery
What forms the vestibular system?
Semicircular canals (rotation)
Utricle (horizontal)
Saccule (vertical)
Before thinking of an ENT causes, what should you rule out in the patient px with dizziness?
Cardiac causes and stroke
What test can be done to determine whether a central cause of vertigo?
Head thrust test
What are the symptoms of menieres?
Tinnitus
Low frequency sensorineural hearing loss
What are the symptoms of labyrinthitis?
Preceding URTI
Sudden, severe vertigo (no triggers)
Sensorineural hearing loss
N & V
What is the main difference between vestibular neuronitis and labyrinthitis?
No hearing loss in vestibular neuronitis (cochlear not affected)
What should you suspect in a patient with unilateral nasal obstruction/rhinorrhoea?
Benign/malignant neoplasm
What does bone conduction louder than air conduction mean on Rinnes test?
Means that there is CHL in that ear
What majority is commonly responsible for bacterial tonsillitis?
Group A beta haemolytic strep (S.pyogenes)
When should you do a monospot test if suspect EBV?
2 weeks after onset of sx
What is it important to advise people post EBV infection?
No contact sports for 8 weeks due to risk of splenic rupture
How does quinsy px?
Severe sore throat Drooling Bad breath Trismus Fever
What are the comps of bacterial tonsillitis?
Rheumatic fever
Glomerulonephritis
Scarlet fever
Quinsy
Which symbol on an audiogram inducates bone conduction?
Triangle
In what condition would you get a flat tympanogram?
Otitis media with effusion
What examination is uselful to distinguish labyrinthitis from stroke?
HINTS test
What does the HINTS test involve?
Head impulse test
Nystagmus type
Skew
Which organisms are the main bacterial causes of acute sinusitis?
S.pneumoniae
H.influenzae
Should you admit a patient with quinsy?
Yes
How can the history suggest salivary duct stone over a tumour?
Stone = pain exacerbated by eating Tumour = pain constant and slowly progressing
Which type of malignancy most commonly affects the naso and oropharynx?
Squamous cell carcinoma
What does unilateral parotid swelling with CN VII palsy suggest?
Neoplasm
What is the most common type of salivary neoplasm?
Pleomorphic adenoma (benign)
What is the name for inflammation of the salivary glands?
Sialoadenitis
What Ix can be used to visualise salivary stones?
Sialography
What virus is responsible for bilateral parotid involvement?
Mumps
When does obstructive sleep apnoea most commonly px and what is the mx?
children (2-6)
Adenotonsillectomy
What is the only way to exclude foreign body in the trachea?
Bronchoscopy
When to refer nasal #?
Deformity at 5-7 days
Septal haematoma
What is Pott’s puffy tumour?
Osteomyelitis of the frontal bone
What are the differentials for salivary gland swelling?
Viral parotitis stone in salivary duct Tumour Sjogren syndrome HIV
Which conditions is sialadenosis (generalized swelling of the salivary glands) associated with?
Sjogrens syndrome
Bulimia
Anorexia
Which viruses can cause congenital hearing loss?
Rubella
CMV
