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Scott's Notes > ENT > Flashcards

ENT Flashcards

1
Q

What are the different forms of audiometry, and outline what they assess and how

A

Pure tone audiometry
Assesses bone conduction threshold at different sound frequency and volumes

Tympanometry
Evaluates middle ear function by assessing tympanic membrane stiffness

Evoked response audiometry
Used for neonatal screening by measuring brain response to an auditory stimulus

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2
Q

Outline the presentation of otitis externa

A

Watery discharge
Itch
Pain and tragal tenderness

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3
Q

What are some causes and common infective agents in otitis externa?

A

Moisture
Trauma
Absence of wax
Hearing aid

Most commonly pseudomonas infection but also Staph aureus

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4
Q

What is the management of otitis externa?

A

Ear drops - betamethasone + neomycin or gentamycin

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5
Q

What is malignant otitis media and who gets it?

A

Life threatening infection which may cause skull osteomyelitis presenting in diabetics with severe otalgia esp at night, granulation tissue in the canal and copious otorrhoea

Surgical debridement with IV abx

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6
Q

What is bullous myringitis?

A

Painful haemorrhagic blisters on deep meatal skin and TM associated with influenza infection

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7
Q

What is the clinical presentation of TMJ dysfunction?

A

Ear and facial ache
Joint clicking/popping
Bruxism
Jointline tenderness

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8
Q

What are the Ix and Rx for TMJ dysfunction?

A

MRI
NSAIDs
Stabilising orthodontic occlusional prostheses

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9
Q

What is the classification of otitis media?

A

Acute
Otitis media with effusion - after symptom regression
Chronic - >3 months
Chronic suppurative OM - discharge with hearing loss and evidence of central drum perforation

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10
Q

Which organisms commonly cause otitis media?

A

Pneumococcus
Haemophilus

Viral
Moraxella

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11
Q

What is the typical presentation of otitis media?

A 
Children post viral URTI
Rapid onset ear pain
Irritability, anorexia, vomiting
Purulent discharge if perforation
Fever
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12
Q

What is the treatment of acute otitis media/

A

Paracetamol

Amoxicillin

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13
Q

What are the complications of acute otitis media?

A

Intratemporal - OME, perforation, mastoiditis, facial nerve palsy

Intracranial - menin/encephalitis, brain abscess, sub/epidural abscess

Systemic - bacteraemia, septic arthritis, IE

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14
Q

How does otitis media with effusion typically present?

A

Inattention at school
Poor speech development
Hearing impairment

O/E
Retracted dull TM with fluid level

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15
Q

What is the investigation and management of otitis media with effusion?

A

Typanometry

Usually sel limiting but consider grommets if persistent hearing loss

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16
Q

What is the presentation of chronic suppurative OM?

A

Painless discharge with hearing loss

TM perforation

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17
Q

Management of chronic suppurative OM?

A

Aural toilet

Abx/steroid drops

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18
Q

Qhat is the main complication of chronic suppurative OM?

A

Cholesteatoma

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19
Q

What is the pathology and presentation of mastoiditis?

A

Middle ear inflammation causing destruction of mastoid air cells and abscess formation

Fever
Mastoid tenderness
Protruding auricle

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20
Q

Imaging modality for mastoiditis?

A

CT

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21
Q

Rx for mastoiditis?

A

IV Abx

Myringotomy +- mastoidectomy

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22
Q

What is a cholesteatoma, and what are the two types?

A

A locally destructive expansion of stratified squamous epithelium in the middle ear

Congenital
Acquired (2ary to attic perforation in chronic suppurative OM)

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23
Q

How does a cholesteatoma typically present?

A

Foul smelling white discharge with headache and CN 5, 7 and 8 involvement

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24
Q

Complications for cholesteatoma?

A

Deafness
Meningitis
Abscess

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25
Q

What are the causes of tinnitus?

A 
Specific
Menieres
Acoustic neuroma
Otosclerosis
Noise induced
Injury
Presbyacusis

General - HTN, anaemia

Drugs - 
Aspirin
Aminoglycosides
Loop diuretics
EtOH
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26
Q

How might the history of tinnitus point you to the cause?

A

Character; constant, pulsatile
Unilateral - ac neuroma
FHx - otosclerosis
Vertigo/deafness - ac neuroma, Meniere’s

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27
Q

Aside from audiometry, what Ix should be done for patients with unilateral vertigo and why?

A

MRI for CPA malignancy

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28
Q

Rx of tinnitus?

A

Treat the cause
Psych support
Hypnotics

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29
Q

What are the causes of vertigo?

A

Vestibular
Menieres, BPPV, labyrinthitis

Central
Neuroma, MS, vertebrobasilar insufficiency, injury, inner ear syphillis

Drugs -
Gentamicin, loops, metronidazole, co-trimoxazole

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30
Q

What investigations would you do in a vertigo patient?

A 
Hearing
CN exam
Cerebellum and gait
Romberg (+ve indicates vestibular or proprioception)
Hallpike manouvre
Audiometry, calorimetry, LP, MRI
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31
Q

What is the underlying pathology in Meniere’s disease?

A

Dilatation of endolymph spaces of membranous labyrinth

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32
Q

What is the presentation of Meniere’s disesae?

A 
Attacks of vertigo occuring in clusters lasting up to 12 hours
Progressive SNHL
Vertigo and N/V
Tinnitus
Aural fullness
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33
Q

What is the key investigation finding seen in Meniere’s disease?

A

Audiometry showing low frequency SNHL which fluctuates

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34
Q

Management of Meniere’s disesae?

A

Medical
Cyclizine, betahistine for vertigo

Surgical
Gentamicin instillation via grommets
Saccus decompression

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35
Q

How does viral labyrinthitis present and how is it managed?

A

Following febrile URTi with sudden vomiting and severe vertigo exacerbated by head movement

Cyclizine

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36
Q

Whgat is the pathology and presentation of BPPV?

A

Displaced otoliths in the semicircular canals commonly after head injury.

Presents with sudden rotational vertigo for <30 seconds provoked by head turning, with nystagmus

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37
Q

What is the positive investigation finding in BPPV?

A

Positive Hallpike manouvre with upbeat torsional nystagmus

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38
Q

How is BPPV treated?

A

Self limiting
Epley manouvre
Betahistine

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39
Q

What is the site of conductive hearing loss?

A

Anywhere between the auricle and round window

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40
Q

What are some causes of conductive hearing loss in adults?

A

Obstruction - wax, pus, FB
TM perf - trauma, infection
Ossicles - otosclerosis, infection, trauma
Inadequate Eustacian tube ventilation of the middle ear

41
Q

What is the site of SNHL?

A

Dochlea
Cochlear nerve
Brain

42
Q

What are some causes of SNHL in adults?

A

Drugs - Aminoglycosides, vancomycin
Post infective - meningitis, measles, mumps, herpes
Misc - Menieres, trauma, MS, CPA lesion, low b12

43
Q

With which syndrome is ac neuroma associated/

A

NF2

44
Q

How would an acoustic neuroma present?

A

Slow onset unilateral SNHL with tinnitus and or vertigo
Headache (due to raised ICP)
5,7,8 palsies
Cerebellar signs

45
Q

What differentials might you have for an ac neuroma?

A

Meningioma
Cerebellar astrocytoma
Mets

46
Q

What is the inheritance pattern of otosclerosis?

A

AD with fixation of the stapes at the oval window

47
Q

How does otosclerosis present and when?

A

Begins in early adult life with bilateral conductive deafness and tinnitus
HL improved in noisy places (Willis’ paracousis)
Worsened by pregnancy, menopause and menstruation

48
Q

What are the congenital causes of conductive hearing loss in children?

A

Structural anomalies
Congenital cholesteatoma
Pierre-Robin

49
Q

What are the congenital causes of SNHL in children?

A 
AD - Waardenburgs
AD - Alports (+haematuria), Jewel Lange Nielson (+long QT)
Xlinked - Alports
INfections - CMV, rubella, HSV, toxo
Ototoxic drugs
50
Q

What is the management of a cauliflower ear?

A

Aspiration + firm packing

51
Q

What is Exostoses?

A

Smooth symmetrical bony narrowing of the internal ear canals due to cold exposure, resulting in conductive hearing loss

52
Q

What is the pathology of allergic rhinosinusitis?

A

T1HS IgE mediated inflammation from allergen exposure leading to mediator release from mast cells

53
Q

How would you investigate rhinosinusitis?

A

Skin prick testing

RAST tests

54
Q

What is the management of allergic rhinosinusitis?

A

Allergy avoidance

  1. Antihistamine or beclometasone nasal spray
  2. IN steroids + antihistamines
  3. Zafirlukast
  4. Immunotherapy
55
Q

What are the causative agents of acute and chronic sinusitis?

A

Acute - Pneumococcus, Haemophilus, Moraxella

Chronic - Staph, anaerobes

56
Q

What are the causes of sinusitis?

A 
Mostly following viral illness
Some 2ary to dental root infections
Swimming in infected water
Anatomical susceptability
Systemic disease e.g. Kartageners
57
Q

What are the clinical features of sinusitis?

A 
Pain
Discharge (-> post nasal drip)
Nasal obstruction
Anosmia
?fever
58
Q

What is the management of acute sinusitis?

A 
Bed rests
decongestants
analgesia
nasal douching
topical steroids
Abx generlaly not used
59
Q

What is the mnagement of chronic/recurrent sinusitis?

A

Stop smoking
Fluticasone spray
Functional endoscopic sinus surgery

60
Q

What are the complications of sinusitis?

A

Mucoceles
Orbital cellulitis
Osteomyelitis
CNS infection

61
Q

What are the featuers of a nasal polyp?

A 
Watery rhinorrhoea
Purulent post nasal drip
Nasal obstruction
Sinusitis
Headaches
Snoring
62
Q

What are some of the associations of nasal polyps?

A

Rhinitis
CF
Aspirin hypersensitivity
Asthma

63
Q

What might a single unilateral polyp indicate?

A

Malignancy

64
Q

What is the management of nasal polyps?

A

Betametasone drops

Endoscopic polypectomy

65
Q

What important checks must be done in a nasal #?

A

Teeth malocclusion and diplopia

66
Q

WHat is the management of a fractured nose?

A

Exclude septal haematoma
Rexamine after 1 week
Reduce under GI with post op splinting within 2 weeks

67
Q

What is the danger and management of a septal haematoma?

A

Septal necrosis and nasal collapse if untreated
Boggy swelling and nasal obstruction
Needs evacuation under GA with packing and suturing

68
Q

What are the common causes of epistaxis?

A 
Unknown
Trauma
Local infection
Pyogenic granuloma (overgrowth of tissue on littles area)
Osler Weber Rendu
Coagulopathy 
Neoplasm
69
Q

What is little’s area/Kiesselbach’s pleuxs?

A

An area on the anterior nasal septum where ethmoid and other arteries anastamose

70
Q

Initial management of epistaxis?

A

Assess for shock
Sit up head tilted down, compress nasal cartilage for 15 minutes
If bleeding not controlled remove clots by suction or blowing to try to visualise the bleed

71
Q

Management of anterior epistaxis?

A

Usually at Little’s area
Insert gauze soaked in vasoconstrictor and local anaesthetic for 5 mins
Can use silver nitrate sticks for cautery
Merocel pack for persistent bleeds

72
Q

Advice for after the bleed

A 
Dont pick nose
sit upright and out of sun
Avoid bending or lifting
Sneeze through mouth
No hot food or dtrink
Avoid drink and tobacco
73
Q

What are the features and inheritance pattern of HHT?

A

AD inheritance

Mucosal telangiectasia
Internal telangiectasiae and AVMs (lungs, liver, brain)
Rarely pulmonary HTN and colon polyps which may progress to cancer.

74
Q

Where is the jugulodigastric node?

A

Midway down the anterior border of sternocleidomastoid

75
Q

What organism must be considered in tonsillitis?

A

EBV

76
Q

What are the Centor criteria and how is it interpreted?

A 
1 point each for
Absence of cough
Fever
Tonsillar exudates
Tender anterior cervical adenopathy

0-1 no Abx
2 consider rapid Ag test
3 or more - Abx indicated

77
Q

Why should amoxicillin not be used for tonsilitis?

A

It causes a severe mac Pap rash in EBV

78
Q

What are the indications for tonsillectomy?

A

Recurrent cases
Airway obstruction
Quinsy (peritonsillar abscess)
Ca suspicion

79
Q

What are the potential complications of a tonsillectomy?

A

Reactive haemorrhage

Tonsillar gag may damage teeth or TMJ

80
Q

What are the complications of strep throat?

A 
Quinsy
Retropharyngeal abscess
Lemierre's syndrome
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
81
Q

What are the features of quinsy?

A 
Trismus - lock jaw
Odonophagia - unable to swallow saliva
Halitosis
Tonsillitis - unilateral
Contralateral uvula displacement
Cervical lymphadenopathy
82
Q

What is the management of quinsy?

A

ADMIT

IV Abx

83
Q

What is Samter’s triad?

A

Nasal polyps
Asthma
Aspirin hypersensitivity

84
Q

What is Lemierre’s syndrome?

A

IJV thrombophlebitis with septic embolization most commonly affecting the lung

Caused by Fusiform necrophorum

85
Q

What are the functions of the larynx?

A

Phonation
Positive thoracic pressure
Respiration
Prevention of aspiration

86
Q

What are the features of laryngitis?

A

Pain, hoarseness, fever with redness and swelling of the vocal cords

87
Q

Laryngeal papilloma is secondary to which viral infection, and how does it present?

A

HPV

Kids with scratchy voices

88
Q

What are the symptoms of a recurrent laryngeal nerve palsy?

A

Hoarseness
Breathy voice with bovine cough
Repeated coughing from aspiration
Exertional dyspnoea due to narrowed glottis

89
Q

What are the causes of laryngeal nerve palsy?

A

30% local cancers
25% iatrogenic (para-/thyroidectomy, carotid endarterectomy
Aortic aneurysm
Bulbar palsy

90
Q

What is the classic presntation of laryngeal SCC?

A

Male smoker and drinker presents with dys/odynophagia and hoarsenss progresisng to stridor with weight loss

91
Q

What are patients who have had laryngeal SCC left with?

A

Trachy with speech valve

92
Q

What is the presentation of laryngomalacia in children?

A

Floppy aryepiglottic folds and glottis causing laryngeal collapse on inspiration

Stridor early + positional

93
Q

What agents cause epiglotitis in children and how does it presnet?

A

GAS

Sudden onset
Continuous stridor
Drooling
Toxic

94
Q

Treatment of epiglottitis?

A 
Do not examine throat
Consult anaesthetics and ENT surgeons
02 + adrenaline nebs
IV dex
Cefotaxime
Intubate IN THEATRE
95
Q

What are the possible complications following Bell’s palsy?

A

Synkinesis - blinking causes oral upturning

Crocodile tears - eating stimulates unilateral lacrimation rather than salivation

96
Q

What is the typical presentation of Ramsay Hunt syndrome?

A

Preceding ear pain/stiff neck
Vesicular rash in auditory canal
Ipsilateral facial weakness, ageusia, hyperacusis
May affect CN7 as well

97
Q

Rx of Ramasy Hunt?

A

Valaciclovir and prednisolone within 72 hours

98
Q

What are the differentials for a facial nerve palsy?

A 
Bells - non forehead sparing
Ramsay Hunt - rash
Cholesteatoma - discharge
Otitis media
Parotid tumour
Trauma
Peripheral neuropathy

Scott's Notes (21 decks)

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