ENT Flashcards
Who do ENT work with?
ITU Oncology Respiratory and allergy SALT Anaesthetics Neuro Opthalmology Thoracic surgery
What do you need to clinically diagnose chronic rhinosinusitis?
- Nasal obstruction or congestion bilaterally for at least 3 months
PLUS either:
- Rhinorrhoea
- Post nasal drip
AND either:
- Loss of sense of smell (or cough if child)
- Facial pain
oedema/ polyps/ CT findings
What do you look for in the Hx of Chronic rhinosinusitis?
- Nosebleeds
- Allergies
- Surgeries
- Nasal steroids (not as bad as orals)
What is the treatment for CRS?
- Many polyps = surgery
- Intranasal steroids
- Sea salt
What are the serious complications of nasal surgery?
- Brain damage
- Eye damage
What is a septal haematoma?
Blood supply damage causes revascularisation of the septal cartilage and causes it to seperate
Causes perforation and atrophy of septal cartilage and saddle nose
What is allergic rhinitis?
- Positive allergy test
- Symptoms
What are the symptoms of allergic rhinitis?
- Blocked congested nose
- Watery/ red/ itchy eyes
- Sneezing/ cough
- Sore throat
How do you treat allergic rhinitis?
- Nasal antihistamines
- Intranasal corticosteroids (but not in glaucoma)
- Avoid allergen
What is rhinoplasty?
Operation of the nose ‘nosejob’
What is otology?
The study of hearing of balance
What is the part of the outer ear?
Pinna/ auricle
What is the in the middle ear?
Contains the ossicles (malleus, incus, stapes) attached to the tympanic membrane
What is in the inner ear?
Semicircular canals and cochlea
What is the pars tensa?
Taut part of the eardrum under the ossicles
What is the pars flaccida?
Floppy part of the eardrum above the ossicles
What is the central part of the tympanic membrane called?
Umbo
Where are vulnerable points in the ear?
Pars flaccida
Facial nerve over the stapes
Eustachian tube
What can cause otitis externa?
Staphylococcus
Klebsiella
E. Coli
Pseudomonas
Who is more likely to get otitis externa?
People who have:
- Eczema
- Psoriasis
- Sebhorrhoeic Dermatitis
use of:
- Shampoo
- Detergent
- aerosols
What does otitis media look like?
- Bulging
- Dilated blood vessels
- Pus
What can otitis media cause?
- Mastoiditis with abscess which requires surgery 9can result in mastoid fistula if not treated
- Brain abscess which causes death
What does a tympanic membrane perforation look like?
- Blood
- Hole
What causes tympanic membrane perforation?
- Pressure changes
- Cottone buds
What happens if a tympanic perforation heals badly?
- Can be fine if kept clean and dry
- May cause pouching and dead cell aggregation resulting in a tumour like appearance and can grow into bone, sinuses, brain (cholesteatoma) needs surgery
What are the routes of ear surgery?
- Through the ear canal
- Through the Mastoid bone
- Both
How do you treat otitis media with effusion (glue ear)?
- Put in a grommet (to air out the middle ear when the eustachian tube can’t)
What does unilateral glue ear suggest?
Compression of eustachian tube not from a cold (cancer more likely)
Why is an active middle ear implant better?
Drives stapes directly not through ear canal and membrane
What is a BAHA?
Bone Anchored Hearing Aid
Vibrate the cochlea throug the skull bone to hear
How do you treat a damaged cochlea?
Cochlea implant
Stimulates 8th nerve directly via electical impulse
What happens if you don’t have an 8th nerve?
Brainstem implant
electrodes onto auditory nucleus on brainstem
What are the parts of the vestibular system?
- Vestibular apparatus (semicircular canals, utricle and saccule)
- 8th nerve (vestibular branch)
- Vestibular nuclei (medulla)
- Cerebellum, RETICULAR FORMATION, somatic motor neurone controlling eyes
- Thalamus
- Cerebral cortex
What are the semicircular canals oriented like?
Superior
Posterior
Lateral
Why are the SCC oriented like that?
To allow detection of movement of your head in any rotational direction
Allows focus on a fixed point (vestibular ocular reflex)
Which canals detect which movements?
Superior- Forward/ Back
Posterior- Sidewards (ear to shoulder)
Lateral- Sidewards (Look around)
How do SCC work?
Endolymph (filled with cations) moves around the SCC in movement which opens ion channels on hair cells causing nerve firing as cations rush in
How do the utricle and saccule work?
(Linear movements and gravity)
Have their own stereocilia
Endolymph moves up and down causing ion channel opening in hair cells
Gravity causes constant downward pushing so we know which way is down
Utricle = lying down Saccule = gravity
What can the word dizzy mean?
Light headed (presyncope)
Unsteadiness (Dysequilibrium)
Spaced out (Dissociation)
Vertigo (Abnormal sensation of motion)
What is associated with vertigo?
Room spinning
on a boat
N/V
Nystagmus
What are peripheral causes of vertigo?
BPPV
Menieres
Vestibular neuritis/ labrynthitis
What is BPPV?
Otolith organ has dislodged otoconia causing abnormal sensation on movement
Seconds
Horizontal nystagmus
What tests are used to diagnose and cure BPPV?
Diagnose: Dix-Hallpike Lie them down very quickly- causes horizontal nystagmus Cure: Epley manouvre Sit up Lie down Turn head Sit up (30 s between each)
What is menieres?
Abnormal sensation of motion (minutes)
Too much endolymph
Vertigo, hearing loss, tinnitus, ear fullness
What is the treatment of Menieres?
Betahistine
Intr tympanic steroid injection
What is vestibular neuritis/ labrynthitis?
Vestibular neuritis- Inflamed nerve
Labrynthitis- inflamed labrynth
What are central causes of Vertigo ?
Vestibular migraine
Brainstem, cerebellar, thalamic or cortical pathology
What is a vestibular migraine?
Dizziness and migraine
Treat like a migraine
What may indicate a central cause of vertigo?
Non horizontal nystagmus
What are the common conditions in paediatric ENT?
Tonsils Adenoids Glue Ear and grommets Paediatric airways Foreign bodies
What is tonsilitis?
Glandular rings at the back of the throat which become inflamed due to infection
Where is the adenoid?
Behind uvula
What are the tonsil diseases?
Acute tonsilitis
Recurrent tonsilitis
Obstructive hyperplasia
Malignancy
What are the symptoms of tonsilitis?
Prodrome (1-2 days) - fever and malaise Sore throat, odynophagia, dysphagia Otalgia Cervical LN (>2cm) or tender LN Off school/ work
What are the common tonsil infections?
- Virus (Adenovirus, EBV, RSV, CMV)
- Bacteria (Strep pyogenes, Haemophilus influenza, Staph aureus, Strep pneumoniae)
What is the treatment of tonsilits?
- Analgesia
- Antibioitic (penicillin, erythromycin)
What are the differentials for tonsilitis?
Infectious mononucleosis Malignancy (lymphoma, leukaemia, carcinoma) Diptheria Scarlet fever Agranulocytosis
What is obstructive hyperplasia?
Sleep disordered breathing - snoring - upper airway resistance - obstructive sleep apnoea (mild/ moderate/ severe)
What can obstructive hyperplasia cause?
Snoring
Restless sleep
Daytime symptoms (chronic mouth breathing, poor mentation, decreased attention, poor scholastic performance, dysphagia)
What conditions predispose to obstructive hyperplasia?
Downs
Craniofacial abnormalities (Pierre Robin, Treacher Colins)
NM disorders
What are the tonsil grades?
0- in fossae 1- <25% obstruction 2- 25-50% 3- 50-75% 4- >75%
What investigations might you do for obstructive hyperplasia?
Sleep study polysonography
+ Interpretation
perioperative issues (HDU post- op)
What are the complications of obstructive sleep apnoea?
- Pulmonary HTN
- Cor pulmonale
- Dysrhythmias
- Failure
- Intracranial HTN
What are the causes of unilateral tonsillar enlargement?
Apparent vs true
- Displacement by parapharyngeal mass
Non-neoplastic
- Hypertrophy
- Acute/ chronic infection
- Congenital
Neoplastic
- Benign papillomas
- Lymphoma
- SCC
What are some adenoid diseases?
Obstructive hyperplasia
Acute adenoiditis
Recurrent adenoiditis
Malignancy
What are some Adenoidal symptoms?
Obstruction
- Smoring
- Mouth breathing
- Hyponasality
Discharge
- Rhinorrhoea
- Post nasal drip
- Nocturnal cough
Adenoide facies
- Overbite
- long face
- crowded incisors
What are the investigations for adenoids?
Nasendoscopy
Posterior rhinoscopy
Lateral Neck soft tissue X ray
When is a lateral neck X ray useful?
When Hx/ Ex not in agreement
Accuracy dependent on proper positioning and patient co-operation
What are the indications for a tonsilectomy?
- Recurrent or chronic tonsilitis > Children: 7 episodes for 1 yr, 5/y or more for 2 years , 3/y or more in 3 years - Peritonsilar abscess - Hypertrophy causing SDB - Unilateral tonsillar enlargement - Halitosis, tonsiloliths
What are the indications for an adenoidectomy?
Obstruction
- chronic or obligate mouth breathing
- SDB/ OSA
- Speech problems
Infection
- Recurrent/ chronic adenoiditis
- Recurrent/ chronic glue ear
What are the contraindications for an adenoidectomy?
- Overt or submucous cleft palate
- Neuromuscular abnormalities with impaired palatal function
- anaemia or disorders of haemostasis
You need to evaluate a palate before an adenoidectomy- how?
- Cleft palate
- Bifide uvula
- midline muscle diastasis
- Velopharyngeal insufficiency
- Neuromuscular disease
- evaluate speech
