ENT Flashcards
What are some indications for antibiotic use in otitis media?
- bulging tympanic membrane
- bilateral OM in a child <2 years
- lasting >4 days
- ottorhoea in a child
Give some post-operative complications of a tonsillectomy
Pain - can increase for up to 6 days
Haemorrhage - usually in first 6-8 hours - urgent return to theatre
Secondary haemorrhage - 5-10 days, wound infection association, treat with admission and antibiotics
What is the presentation of a cholesteatoma?
- Offensive discharge
0 Hearing loss, gradual conductive, unilateral - vertigo and facial paralysis can occur if it erodes into bone
- It is a destructive, expanding keratinised debris collection of squamous cells
- Results in inflammation, discharge, vertigo, hearing loss
What is preauricular sinus?
Foul smelling discharge
Common congenital condition in which an epithelial defect forms around the external ear
Small require no treatment, large may become blocked and develop and infection
How might an acoustic neuroma present?
- Gradual progressive unilateral deafness and tinnitus
- Vertigo (if vestibular nerve involvement)
- vestibular schwanoma
- MRI must be done in unilateral hearing loss to rule this out
- Mx watch and wait if small, stereotactic radiosurgery or microsurgery
What is Ramsay Hunt syndrome?
Herpes zoster oticus
Vesicular lesions on anterior 2/3rd of the tongue and soft palate
Auricular pain
Facial nerve palsy
Vertigo, tinnitus
Treat with oral acyclovir and corticosteroids (PO Pred)
Give some differentials to facial pain.
Sinusitis (cold, facial 'fullness', nasal discharge) Trigeminal neuralgia (sharp, shooting pains, triggered by touch, unilateral) Temporal arteritis (pain over trigeminal distribution) Cluster headache (regular for 4-12 weeks, an 15mins to 2 hr duration, intense eye pain, redness, lacrimation, lid swelling)
Give some differentials for a neck lump
Reactive lymphadenopathy (post-infection, common) Lymphoma (rubebry, painless, night sweats, splenomegaly) Thyroid swelling (moves upwards on swallowing) Thyroglossal cyst (moves upwards on protrusion on the tongue) Pharygeal pouch (posteromedial herniation, dysphagia, regurgitation, gurgling lump) Cystic hygroma (congenital lymphatic neck lump) Cervical rib (extra rib, risk of thoracic outlet syndrome) Carotid aneurysm (pulsatile neck mass)
What features are included in the CENTOR criteria?
Tonsillar exudate
Tender lympadenopathy
History of fever
Absence of cough
3+ give antibiotics
What is your management for a perforated tympanic membrane and would anything change your management?
Reassure and follow-up, self-limiting
Amoxicillin if sign of infection
What is Rinne’s and Weber’s and what does a positive test indicate?
Weber’s - midline, tuning for 512Hx, normal hearing should be in the middle, if sounds louder in one ear then this indicates conductive hearing loss in that ear, or sensorineural hearing loss in other ear
Rinne’s - mastoid tip, should be louder in air next to ear, if not indicates conductive deafness
AIR CONDUCTION SHOULD BE BETTER THAN BONE CONDUCTION
What is the anterior and posterior triangle of the neck?
Anterior - sternocleidomastoid, mandible and midline
Posterior - trapezius, clavicle, sternocleidomastoid
What is the difference between otitis externa and otitis media and what symptoms occur in each?
Externa - inflammatory of external auditory canal, otalgia, otorrhoea, ear discharge
Media - effusion of middle ear, hearing loss, itching, pain => can be acute or chronic or with glue ear
What is the causative organism in ear infections?
Pseudomonas
Staph aureus
What are some complications of acute otitis media?
Abscesses CNS infections Sinus thrombosis Mastoiditis Labyrithitis COM - chronic otitis media
What is Ludwig’s angina?
Cellulitis of the mouth that develops in immunocompromised patients with poor dentition
Swelling of lymph nodes, purexia
What does the monospot test look for?
EBV - mononucleosis
What risk factor exists for malignant otitis externa?
What is the usual causative organism?
Diabetics
Normall caused by pneumococcus
What are some ear-related causes of vertigo?
Viral labyrinthitis (recent viral infection, acute, n+v, hearing, nystagmus)
Meniere’s (tinnitus, aural fullness)
Vestibular neuronitis (recent viral infection, recurrent vertigo, NO hearing loss)
BPPV (nystagmus associated with moving in bed)
Vestibular schwannoma (focal neurology association, unilateral hearing loss)
What medications are given for otitis externa and in what form?
Topical antibiotic - cipro/fluclox
2nd line - PO flucloxacillin
What is a common cause of bacterial otitis media?
H. influenzae
Strep pneumoniae
Morazella catarrhalis
When should antibiotics be prescribes in otitis media?
Symptoms >4 days Systemically unwell Immunocompromise <2 years with bilateral otitis media Performation and/or discharge in canal
Amoxicillin
What is otosclerosis?
- Genetic condition (AD inheritance)
- Fusion of middle ear ossicular chain
- Leads to progressive conductive deafness in middle-age, bilateral
- worsens in pregnancy and menstruation because of oestrogen increase
- ‘Flamingo tinge’ to tympanic membrane
What are some causes of hearing loss?
Presbycusis - age related sensorineual hearing loss, high frequency bilateral loss
Otosclerosis - conductive, low frequency, middle-age, genetic
Glue ear
Meniere’s disease - vertigo, tinnitus
Drug ototoxicity - gentamycin
Noise damage - bilateral, frequencies of 3000-6000
Acoustic neuroma - unilateral
What drugs could cause tinnitus?
Quinine
Loop diuretics
Aminoglycosides
Aspirin
What are complications of malignant necrotising otitis externa?
Meningitis
Cerebral abscess
Dural sinus thrombosis
What is acute mastoiditis and it’s treatment?
Infection of the mastoid bone, occurs as a complication of acute otitis media
Treat with broad spectrum antibiotics
Corticol mastoidectomy if unsuccessful
What is the difference between conductive and sensorinueral hearing loss?
Conductive - affects the middle of outer ear
Sensorinureal - affects cochlear of CNVIII
What are some common causes of deafness in children?
Hereditary - Perre Robin, Alport, Usher’s, Treacer-Collins
Maternal infection - rubella, CMV
Perinatal - anoxia, birth trauma, cerebral palsy
Postnatal - meningitis, lead poisoning