ENT Flashcards
Pharyngeal pouch management
AVOID ENDOSCOPY due to perf risk
Smaller pouches: no intervention necessary
Larger pouches: surgery
African lady with chronic nose swelling. Dx + responsible organism + Rx?
Rhinoscleroma - chronic granulomatous bacterial disease of URT
Klebsiella
Tropical disease ~South America/Africa
Rx: Tetracycline or Cipro
Indication for ABx in tonsillitis
at least 3 out of 4 centor criteria:
- tonsillar exudate
- tender anterior lymphadenopathy
- lack of cough
- fever
OSA diagnostic test
Polysomnography (sleep studies) - monitors number of desaturations
Hoarse voice, chest pain, chronic cough - worse after eating spicy food
GORD ie. can cause hoarse voice
Management of facial injury causing swollen nose and deviated nasal bones + asymmetrical and boggy septum
Septal haematoma evacuation (as can lead to septal necrosis)
Then review in 7 days to determine if not manipulation required
Most USEFUL investigation for neck lump
FNA
Elderly lady with progressive dysphagia to solids, pain on swallowing, weight loss
Hypopharyngeal ca
Dysphagia occurs when larynx invaded
Most common head and neck cancer
Squamous cell laryngeal cancer
Presentation of squamous cell laryngeal cancer
Persistent hoarse voice in male alcoholic/smoker ie. refer all hoarse voice >6/52 urgently to ENT
What is Frey’s syndrome?
Injury to auriculotemporal nerve, which reforms inappropriately- complication of parotid surgery
Parasympathetic impulses inappropriately trigger sympathetic nerves:
- gustatory sweating
- facial swelling
A few days old newborn shows poor otoacoustic testing performance; mother had fever and rash during pregnancy
Congenital rubella syndrome, features:
- eye, ears, brain, cardiac
- related to contact in 1st trimester
ENT complication and treatment for severe hyperbilirubinaemia in newborn
Cx: Hearing loss or damage
Rx: Exchange transfusion (plot graph of bilirubin levels + blue UV light conservatively first)
Repeated and prolonged exposure to what level of noise can cause hearing loss?
> 85db
Young boy with ear pain and fever
o/e: tender ear, tender boggy swelling posterior to pinna
?Dx + Rx
Mastoiditis - swelling of mastoid process (usually due to untreated OE)
Rx: admission for IV ABx
Part of the ear most commonly affected in otosclerosis
Stapes
Which narrow structure connects nasopharynx to middle ear? Clinical relevance?
Eustachian tube
Small in kids ie. easily blocked -> glue ear
Most appropriate hearing test in newborn
Otoacoustic emissions
OR
Auditory brainstem responses
Most appropriate hearing test in >5yo
Pure tone audiometry
60yo male with hoarse voice >2months.
PMH GORD
Chronic laryngitis (where Sx last >3/52)
Singer with 3 week history of hoarse voice. No other Sx
Vocal cord nodule
Singer with 3 week history of hoarse voice. Also has pain
vocal cord granuloma
Drugs that cause hearing loss
Aspirin
Gent
Frusemide
Quinine
Features of TMJ dysfunction
Covers anything from muscles of mastication to temporamandibular joint
Px: ear/jaw pain -> restricted mandibular movement, multiple manifestations eg.
- teeth grinding at night
- ear ache
- tender tragus
Complications of ingestion of bleach
laryngeal structural/vocal cord damage ie. hoarse voice
oesophagitis
pneumonitis
Poorly controlled asthmatic boy with voice hoarseness
Drug induced dysphonia ~inh steroids
- causes myopathy of vocal cords
- reverses when steroids withdrawn
Nigerian woman with purulent discharge of swollen parotid gland, fever, anterior uveitis, facial palsy
Heerfordt’s syndrome (form of sarcoidosis)
Other features of sarcoid can also be present
Treatment of branchial cyst
Excision (may recur)
Cause of OSA in children with normal BMI
Chronic tonsillitis
Child with sore throat, dysphagia, halitosis, fever, trismus, headache, neck pain, ear ache, displacement of tonsil inferomedially
Dx+Rx
Quinsy (peritonsillar abscess)
Rx: analgesia, DRAINAGE, ABx
Facial/peripheral swelling + weight gain following sore throat
Post-streptococcal glomerulonephritis
Genetic conditions with SN hearing loss
Pendred syndrome
Usher’s syndrome
Alport’s syndrome
Waardenburg syndrome
Red flags for investigation if have nasal congestion
numbness bleeding tooth loss unilateral obstructing mass suspicion of tumour
Commonest cause of orbital cellulitis in children
Ix + Rx
Ethmoidal sinus infection (medial wall of orbit is thin)
Ix: Contrast CT
Rx: IV Abx
Viral labyrinthitis features
SUDDEN
N+V, horizontal nystagmus, hearing disturbance, vertigo
Glue ear Rx
Conservative UNLESS
affecting education or have Downs/Cleft palate
(then refer for hearing test)
What is polychondritis?
Common causative organisms?
Rx?
Infection of ear, often follows bites/trauma/surgery
Pseudomonas or S aureus
Rx: IV ABx + Steroids
(NB. if recurrent, consider Wegener’s)
When to consider malignant OE?
Rx?
Persistent OE in DM/immunosuppressed/elderly, as may have extended to bony ear canal
Rx: admit for IV ABx
Samter’s triad
Asthma + aspirin sensitivity + nasal polyps
Nasal polyps Rx?
Topical steroids
ENT referral for ALL
Initial treatment of epistaxis
Pinch soft part of nose and lean FORWARD
Vestibular neuronitis features
Recurrent vertigo and nausea for hours, post viral
NB. NO tinnitus/hearing loss
Otosclerosis vs presbycusis
Otosclerosis = conductive Presbycusis = SN
Age of presentation of glue ear/OME
Associations of OME
~2 years old
speech/language/balance/behavioural delay
“Aural fullness” + SN h/l
Meniere’s
Acoustic neuromas can be manifestation of which genetic condition?
NF2
Treatment for candidial OM
Topical antifungal for 14/7
+/- ENT referral for aural toilet
