ENT Flashcards
What is the management of a perforated ear drum and after how long should it be attempted?
Myringoplasty after 6-8 weeks if healing has not yet occured
What is the commonest malignant parotid tumour?
Mucoepidermoid carcinoma
How long does septal necrosis take to develop after a septal haematoma?
3-4 days
What are the features of malignant otitis externa?
Diabetes/immunosuppression Severe unrelated deep otalgia Temporal headaches Purulent otorrhoea Possible dysphagia, CN7 palsy, hoaresness
What are the features of acute necrotising ulcerative gingivitis?
Painful bleeding gums with halitosis and punched out gum ulcers
A 26-year-old lady who is currently an intravenous drug user presents with a 2-day history of dysphagia. She describes general malaise and fatigue 2 days prior to this episode. On examination, she is pyrexial with extensive swelling of her submental and submandibular lymph nodes. There is pharyngeal oedema and extensive erythema on the floor of her mouth, however, no exudation can be seen on the tonsils and there are no abscesses near the tonsils . You make a note of her poor dentition. Abdominal examination is unremarkable with no splenomegaly. You decide to admit her. A few hours later, she develops stridor and complains of difficulty breathing. Monospot test came back negative and blood tests show a neutrophilia. What is the most likely diagnosis?
Ludwig’s angina (cellulitis at the floor of the mouth)
Immunocompromised patients with poor dentition can develop airway compromise in this way
What might cause sialadenitis?
Stone
Cancer
What should be done with mouth ulcers persisting for longer than 3 weeks?
2WW to oral surgery
What is the management of acute necrotising ulcerative gingivitis?
Refer to dentist
Oral metronidazole 3 days
Chlorhexidine mouth wash
Paracetamol
What are the otoscopy findings in otitis externa?
The outer ear canal is erythematous, swollen and eczematous. Complaints of pain on manipulation of the tragus during otoscopy.
What is the commonest tumour of the parotid gland, and is it malignant of benign?
Pleomorphic adenomata - benign - slow growing and lobular
Should not invade local structures
What are the presenting features of a nasopharyngeal carcinoma?
Cervical lymphadenopathy Otalgia Otitis media Nasal obstruction/discharge/epistaxis CN3-7 palsies
What is the management of primary haemorrhage after tonsillectomy, and when does this occur?
Primary haemorrhage occurs in the first 6-8 hours post op and is managed by immediate return to theatre
Role of manouvres in BPPV?
Dix Hallpike is diagnostic
Epley is therapeutic
What is the first line oral antibiotic for otitis externa?
Fluclox
What is the management of quinsy?
Urgent ENT referral for needle aspiration or incision and drainage with IV antibiotics.
COnsider tonsillectomy to prevent recurrence
Why might a patient with a chronic sinusitis develop a cough?
Post nasal drip
What is the role of Naseptin in epistaxis management?
Chlorhexidine + neomyin
used to reduce crusting and risk of vestibulitis
What is vestibular neuronitis and how does it present?
An acute self limiting infection of the vestibular nerve presenting with sudden onset vestibular dysfunction but normal hearing and no tinnitus. There may also be a horizontal nystagmus towards the side of the lesion
Webers test in Meniere’s disease?
Localises to contralateral ear
Nasopharyngeal SCC metastasises early or late?
Early
What is black hairy tongue and what are its predisposing factor?
Defective desquamation of filiform papillae
Poor oral hygiene Abx Radiation HIV IVDU
What should be done in the case of otitis externa which does not respond to topical antibiotics?
ENT referral
What is the management of secondary haemorrhage after tonsillectomy, and when does this occur?
Secondary haemorhage occurs 5-10 days post op and is managed with IV antibiotics
Who should be entered in the 2WW pathway for suspected airway cancer?
Persistent unexplained hoarseness OR
Unexplained neck lump
A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.
Sarcoid
What is the conservitave management of epistaxis?
Sit forward with mouth open
Pinch cartilaginous area firmly for 15 minutes and breathe through mouth.
How is sinusitis typically managed?
Analgesia and IN decongestants if acute, IN corticosteroids reduce the rate of recurrence
Antibiotics are only recommended in severe cases
A 3-year-old boy is brought to surgery. His mum reports that he has been complaining of a sore left ear for the past 2-3 weeks. This morning she noticed some ‘green gunge’ on his pillow. On examination his temperature is 37.8ºC. Otoscopy of the right ear is normal. On the left side the tympanic membrane cannot be visualised as the ear canal is full with a yellow-green discharge. What is the most appropriate action?
Amoxicillin and review in 2 weeks
How do cystic hygromas present?
Congenital lymphatic lesion found typically at birth in the posterior triangle which transluminates
An 18-year-old boy presents with pancreatitis. He has bilateral painful parotid enlargement.
Viral parotitis
In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis, suspect mumps
Non-resolving otitis externa with worsening pain should be…?
Urgently referred to ENT as it is indicative of malignant necrotising otitis externa
What causes elderly patients to go dizzy on neck extension?
Vertebrtobasilar ischaemia
what should be done for perforated tympanic membrane due to barotrauma?
Nothing for 6-8 weeks then myringoplasty if not healed
What are some common causes of gingival hypertrophy?
Phenytoin
Ciclosporin
CCBs
AML
How do thyroglossal cysts present?
Common in <20 year olds, usually midline between thyroid isthmus and hyoid.
Moves up on tongue protrusion
What are the common bacterial causes of otitis media?
H influenzae
S pneumoniae
M catarrhalis
WHat is the role of intranasal epinephrine in epixtaxis?
prevents rebleeding once initially stopped
What drugs can cause tinnitus?
Aspirin
Aminoglycosides
Loop diuretics
Quinine
What is the typical presentation of otosclerosis?
AD inheritance onset at 20-40 years with conductive deafness, tinnitus and family Hx
What ECG features might arise after thyroid surgery?
QT prolongation due to hypocalcaemia
What is the management of vestibular neuronitis and for what duration?
Prochlorperazine in the acute phase only ( as it delayes recovery by interfering with central compensatory mechnanisms)
A 19-year-old presents to his general practitioner (GP) with an asymptomatic right sided neck lump that he noticed 4 weeks previously. On examination the lump is soft and mobile, is within the dermal layer of the skin and on transillumination the area is equal to the surrounding tissue. There is no central punctum. What is the most likely diagnosis?
Lipoma
In what instances might you use oral Abx for otitis externa/
Cellulitis extending beyond external canal
If earwick cannot be inserted due to swelling/debris
Immunodeficiency
High risk of severe infection
What is the management of sudden idiopathic SNHL?
High dose steroids for 7 days and urgent pure tone audiometry and MRI to exclude vestibular schwannoma
What is the management of allergic rhinitis?
Avoidance
Oral/IN antihistamines
IN corticosteroids
Oral corticosteroids for short term cover
How would you investigate and manage a parotid mass?
Plain x-ray to exclude calculi
Sialography for anatomy
FNAC
If malignant - wide local excision
What is the management of a unilateral nasal polyp?
ENT referral
What is the first line management for otitis media?
Amoxicillin 500mg TDS for 7 days
What is the first line management of otitis externa?
Topical gentamicin and hydrocortisone drops
What are the common causes of sinusitis?
s. pneumoniae
h. influenzae
rhinoviruses
When should cautery or packig be considered in epistaxis, and when would you use one over the other?
After continuous bleeding with pressure for 10-15 minutes.
Use cautery (preceded by anaesthetic spray) if source of bleeding is visible, whereas packing is used when there is no visualised bleeding source
You see a 40-year-old man with reduced hearing on the right side. You examine his ears and note the right ear canal is blocked with wax but the left ear is clear. What would be the expected findings on testing Rinne and Weber?
Weber localises to right
Rinne BC>AC (neg) on right and AC>BC on left
Where are Whartons’ and Stensen’s ducts?
Whartons is in the submandibular gland
Stensens is in the parotid
What life event might precipitate the presentation of otosclerosis?
Pregnancy
What is rhinitis medicamentosa?
Rebound nasal congestion brought on by the extended use of topical decongestants
Management is stopping use of decongestants
On the right, Rinne’s test demonstrates the tuning fork is easier to hear when pressed on the mastoid bone. On Weber’s test the sound is heard best on the right hand side.
Right sided conductive hearing loss
What are the complications of thyroid surgery?
Anatomical e.g. laryngeal nerve damage
Bleeding -> airway compromise
Parathyroid damage -> Low Ca
What might unilateral epistaxes indicate which would prompt urgent investigation?
Nasal cancer
How do branchial cysts present?
Oval mobile cystic mass between sternocleidomastoid and pharynx
What do these results imply?
Rinnes
Left bone>air
Right Air>bone
Webers lateralises to the left
Left conductive deafness
A 49-year-old Caucasian male presents with a 12 week history of pus-like discharge from his ear. You decide to perform otoscopy. What is the most important part of the tympanic membrane to visualise?
The attic/pars flaccida - as this is where cholesteatomata arise from
WHat are the classical features of sinusitis?
Facial pain worse on leaning forwards
Nasal discharge
Tickling cough
Why should IN decongestants such as oxymetazoline only be used for short periods of time?
Tachyphylaxis (tolerance)
What is Warthin’s tumour?
Most common bilateral benign neoplasm of the parotid
Occurs in old people
What is the causative agent and first line treatment of otitis externa in diabetics?
Pesudomonas
Ciprofloxacin IV
WHat are the features of Quinsy?
Severe lateralising throat pain
Uvular deviation to unaffected side
Trismus (difficulty opening mouth)
Reduced neck movility
What does a negative Rinne’s test mean?
BC>AC
WHat is the choice of antibiotics for tonsillitis?
Phenoxymethylpenicillin for 10 days
Audiogram interpretation
Audiograms are usually the first-line investigation that is performed when a patient complains of hearing difficulties. They are relatively easy to interpret as long as some simple rules are followed:
anything above the 20dB line is essentially normal (marked in red on the blank audiogram below)
in sensorineural hearing loss both air and bone conduction are impaired
in conductive hearing loss only air conduction is impaired
in mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone
Which medication is useful for preventing attacks of Meniere’s disease?
Betahistine
How does Meniere’s disease present?
In middle aged adults with recurrent episodes of vertigo and tinnitus with sensorineural hearing loss.
Other features include nystagmus and positive Romberg test.
What is the typical presentation of sialolithiasis?
Pain
Foul taste in the mouth
Purulent discharge
Pyrexia
