ENT Flashcards
1
Q
how does pure tone audiometry work
A
headphones deliver tones at different frequencies and strengths and a mastoid vibrator
2
Q
what is tympanometry
A
measures stiffness of ear drum to evaluate middle ear function
3
Q
what would a flat tympanogram mean
A
mid ear fluid or perforation
4
Q
what would a shifted tympanogram mean
A
change in mid ear pressure
5
Q
how does an evoked response audiometry work and when is it used
A
auditory stimulus to show measurement of elicited brain response by surface electrode, used for neonatal screening if otoacoustic emission testing negative
6
Q
types of hearing tests
A
neonatal = otoacoustic screening, then evoked response audiometry
pure tone audiometry start at 4 years
fabers 512Hz
Rinnes (pinne) and webers (mastoid)
7
Q
in regards to AC and BC, what is normal vs conductive HL vs sensorineural HL
A
normal = AC > BC conductive = BC > AC and localises to affected side sensorineural = BC and AC both decreased and localises to unaffected side
8
Q
definition of conductive hearing loss
A
impaired conduction anywhere between auricle and round window due to inadequate eustachian tube ventilation of middle ear
9
Q
causes of conductive hearing loss
A
OTO COTO obstruction (wax, pus, foreign body) TM perforation (trauma, infection) ossicle defect (otosclerosis, infection, trauma)
10
Q
cause of sensorineural hearing loss
A
defects of cochlea, cochlear nerve or brain
drugs (aminoclycosides, vancomycin, gentamycin, furosemide)
post infective (meningitis, measles, mumps, herpes)
menieres, trauma, MS, CPA lesion (acoustic neuroma), reduced B12, presbycusis, TORCH
11
Q
what is presbyacussis
A
cochlear degeneration and loss of hair on ganglion cells due to age from noise toxicity/arteriosclerosis
12
Q
investigations and treatment in presbyacussis
A
pure tone audiometry and treat with hearing aid
13
Q
symptoms of presbyacussis
A
> 65, bilateral, slow onset, may have tinnitus, hard to follow convo, loss at high frequency
14
Q
treatment of adult hearing loss and how do they work
A
hearing aid - amplify sound
cochlear implant - electrical stimulus to spiral ganglion of auditory nerve
15
Q
what is an acoustic neuroma
A
a vestibular schwannoma - benign slow growing tumour of the superior vestibular nerve
16
Q
symptoms of acoustic neuroma
A
- slow onset, unilateral sensorineural HL, tinnitus and vertigo
- headache due to increased ICP
- CN palsies 5 (absent corneal reflex), 7 (facial palsy), 8 (hearing loss, vertigo, tinnitus)
- cerebellar signs
17
Q
investigations in acoustic neuroma
A
pure tone audiometry
MRI of cerebellopontine angle
18
Q
treatment of acoustic neuroma
A
gamma knife
surgery
high dose dexamethasone
19
Q
what is acoustic neuromas associated with
A
NF type 2 (c.22)
20
Q
what is otosclerosis
A
AD condition, with fixation of stapes at the oval window, and replacement of bone with vascular spongy bone
21
Q
symptoms of otosclerosis
A
- early adult life with bilateral conductive deafness and tinnitus
- HL is improved in noisy places (Willis paracousis) and worsened by pregnancy, menstruation and menopause
- family history
- normal tympanic membrane
22
Q
investigations in otosclerosis
A
pure tone audiometry shows dip (charts notch) at 2kHz
23
Q
treatment of otosclerosis
A
hearing aid
stapes implant
24
Q
risk factors of otitis externa
A
diabetes, immunocompromised, swimming, contact dermatitis, trauma, absence of ear wax, hearing aid
25
main causative organisms in otitis externa
pseudomonas (staph aureus)
26
symptoms of otitis externa
watery discharge, itch, pain and tragal tenderness, mobile tympanic membrane
27
investigations in otitis externa
otoscopy - red, swollen, erythematous
| CT scan if suspect malignant
28
treatment of otitis externa
antibiotics to cover pseudomonas
| betamethosone if non infected but eczematous
29
complications of otitis externa
malignant otitis externa (skull osteomyelitis) which can occur if diabetic or immunocompromised, can lead to CN palsy
30
symptoms of malignant otitis external
unresolving severe otitis externa, otalgia worse at night, copious otorrhoea and granulation tissue in canal
31
treatment of malignant otitis external
surgical debridement and systemic antibiotics IV
32
what is bullies myringitis
painful haemorrhage blisters on deep mental skin and TM, associated with influenza infection
33
what is chondrodermatitis nodular helicans
benign nodule putting pressure on ear caused by repeated pressure on ear
34
treatment of chondrodermatitis nodular helicans
cryotherapy, steroids and surgery
35
what is temporo-mandibular joint dysfunction and the symptoms
chronic joint tenderness exacerbated by lateral movements of an open jaw
- ear ache referred pain from auriculotemporal nerve, facial pain, joint clicking, teeth grinding, stress
36
management of TMJ dysfunction
MRI
Nsaids
jaw rest
stabilising orthodontic occlusal prostheses
37
main organisms in otitis media
viral (rhinovirus), pneumococcus, haemophillis influenza, moraxella, s. peumoniae
38
risk factors of acute otitis media
smoking, winter, children, post viral URTI, eustachian tube dysfunction, immunocompromised
39
symptoms of acute otitis media
rapid onset ear pain, tugging ear, irritability/anorexia/vomiing in children, purulent discharge if perforation, building red tympanic membrane, fever
40
treatment of acute otitis media
usually resolves spontaneously, give paracetamol
if >4 days, systemic illness of perforation, maybe need amoxicillin (delayed prescription)
if perforation does not heal may need myringoplasty
41
complications of acute otitis media
```
otitis media with effusion
perforation
mastoiditis
facial nerve palsy
meningitis/encephalitis
brain abscess
sub/epidural abscess
bacteraemia
septic arthritis
infective endocarditis
```
42
what is otitis media with effusion
glue ear
| caused by overproduction of secretions and eustachian tube dysfunction
43
symptoms of otitis media with effusion
inattention at school, poor speech development, conductive hearing loss, retracted dull tympanic membrane, bubbles behind ear drum, fluid level, recurrent otitis media
44
investigations in otitis media with effusion
audiometry shows flat tympanogram
| otoscopy
45
treatment of otitis media with effusion
1) usually spontaneous
2) grommets if >3 months
3) bilateral hearing aids
4) adenoidectomy
46
side effects of grommets
infections and tympanosclerosis
47
causes of chronic otitis media
recurrent AOM, smoking, cranial facial abnormality (cleft palate)
48
symptoms of chronic otitis media
painless discharge and hearing loss, perforated tympanic membrane
49
treatment of chronic otitis media
aural toilet clean
antibiotics
topical steroids
50
investigations in chronic otitis media
CT to rule out cholesteatoma
| otoscopy
51
complications of chronic otitis media
cholesteatoma
52
what is mastoiditis
middle ear inflammation leading to destruction of mastoid air cells and abscess formation
53
symptoms of mastoiditis
fever/systemically unwell, mastoid tenderness with boggy mass causing protruding auricle, thick hyperaemic tympanic membrane
54
investigations and treatment of mastoiditis
CT for abscess and treat with IV Abx for 2 weeks and myringotomy +/- mastoidectomy
55
what is cholesteatoma
locally destructive expansion of keratising stratified squamous epithelium in middle ear
56
symptoms of cholesteatoma
- chronic foul smelling white discharge
- headache and pain
- cranial nerve involvement (vertigo, deafness, facial paralysis)
- pearly white attic crust in upper ear drum
57
complications of cholesteatoma
deafness (due to ossicle bone destruction)
meningitis
cerebral abscess
58
treatment of cholesteatoma
surgical removal
59
what is tinnitus
sensation of sound without external sound stimulation
60
causes of tinnitus
```
menieres
acoustic neuroma
otosclerosis
noise induced
head injury
hearing loss
drugs (aspirin, ahminoglycosides, loop diuretics)
```
61
what would unilateral tinnitus suggest
acoustic neuroma
62
what would tinnitus with vertigo suggest
menieres or acoustic neuroma
63
what would tinnitus with deafness suggest
menieres or acoustic neuroma
64
investigations in tinnitus
```
otoscopy
tuning forks
pulse and BP
auditometry
tympanogram
MRI if unilateral
```
65
treatment of tinnitus
treat cause
psych support with tinnitus retraining therapy
hypnotics at night
66
what is vertigo
the illusion of movement
67
causes of vertigo
```
menieres
BPPV
labyrinthitis
acoustic neuroma
MS
vertebrobasilar insufficiency
stroke
head injury
inner ear syphilis
drugs (gentamicin, loop diuretics, metronidazole, co-trimoxazole)
```
68
investigations in vertigo
```
hearing test
cranial nerves
cerebellum and gait
rombergs
hallpike
audiometry
calorimetry
LP
MRI
```
69
in vertigo, what does a positive rombergs test suggest
vestibular or proprioception cause
70
pathophysiology of meniere's disease
dilation of endolymph spaces of membranous labyrinth (endolymphatic oedema)
71
symptoms of menieres
- attacks of minutes to hours in clusters, up to 12 hours
- progressive sensiuroneural hearing loss
- vertigo
- tinnitus
- aural fullness
72
investigations of menieres
audiometry shows low frequency SNHL which fluctuates
73
treatment of menieres
```
acute = buccal/IM prochlorperazine
prevention = betahistine
antiemetic = sentinel
lifestyle = furosemide and low salt
surgery (grommets or saccus decompression)
```
74
side effects of prochlorperazine
interferes with central compensatory mechanisms, a D2 antagonist therefore causes EPSE
75
presentation of viral labyrinthitis
post URTI leading to sudden unilateral loss of vestibular function, nausea and vomiting, vertigo, hearing loss
aggravated by head movement
76
difference between viral labyrinthitis and vestibular neuronitis
neuronitis is the same but just CN8 involved, so no hearing loss
77
treatment of viral labrynthitis /vestibular neuronitis
acute = prochlorperazine
avoid triggers
improves in days
78
pathophysiology of BPPV
displacement of otoliths in semicircular canals, common after head injury
79
symptoms of BPPV
sudden rotational vertigo for <30s causing by change in head position
nystagmus
80
causes of BPPV
idiopathic, head injury, otosclerosis, post viral labrynthitis
81
investigations in BPPV
hallpike manoeuvre - causes upbeat torsional nystagmus and vertigo
82
treatment of BPPV
self limiting
epley manoeuvre
betahistine
DVLA
83
differentiating nystagmus causes
```
horizontal = ear
vertical = cerebellum
```
84
what causes vertigo on full neck extension in elderly
vertebrobasilar ischaemia
85
conductive causes of hearing loss in children
congenital cholesteatoma
pierre robin
anomalies of pinna
external auditory canal
86
sensorineural causes of hearing loss in children
TORCH
ototoxic drugs
waardenburgs
alports
87
pinna haematoma
| exostoses
?
88
function of wax
to prevent maceration and exposure to water
89
complications of wax in ear
conductive deafness
90
treatment of accumulation of wax in ear
function under direct vision using microscope and syringing after one week of softening with olive oil
91
pathophysiology of sinusitis
viruses cause mucosal oedema and decreased mucosal ciliary actions, leading to mucus retention and secondary bacterial infection
92
causation organisms in sinusitis
acute = pneumococcus, haemophiliac influenza, moraxella
chronic = s.aureus, anaerobes
93
risk factors of sinusitis
- secondary to viral infection
- secondary to dental root infection
- diving/swimming in infected water
- deviated septum
- polyps
- immunodeficiency
- allergies, asthma, smoker
94
symptoms of sinusitis
- maximally and ethmoidal pain on bending and straining
- discharge from nose and post nasal drip
- nasal obstruction/congestion
- anosmia or cacosmia (bad smell without external source)
- systemic symptoms
95
investigations in sinusitis
nasendoscopy +- CT
96
treatment of sinusitis
acute = bed rest, decongestants, analgesia
>10 days = nasal douching and intranasal corticosteroids, abx (phenoxymethylpenicllin)
chronic = usually a functional cause so stop smoking, fluticasone nasal spray and functional endoscopic sinus surgery if medical failed
97
complications of sinusitis
mucoceles
orbital cellulitis
osteomyelitis
intracranial infection
98
pathophysiology of allergic rhinosinusitis
T1HS IgE mediated inflammation from allergen (pollen, dust mites) exposure leads to mediator release from mast cells
99
types of allergic rhinosinusitis
seasonal (hayfever)
perennial
occupational
100
symptoms of allergic rhino sinusitis
```
sneezing
bilateral nasal obstructing
pruritus
rhinorrhoea
post nasal drip
swollen, pale, boddy turbinates
nasal polyps
```
101
investigations in allergic rhino sinusitis
skin prick test
| RAST test
102
management of allergic rhinosinusitis
1) avoid allergy
2) antihistamines (cetirazine) or beclometasone spray
3) intranasal steroids
4) zafirlukast
5) immunotherapy
nasal decongestants for symptoms
103
what is a complication of nasal decongestants
extended use can lead to rebound nasal decongestion, therefore do not use for >7days
104
causes of nasal polyps
```
allergic/non allergic rhinitis
CF
aspirin hypersensitivity
asthma
churg strauss (asthma sinusitis, pANCA +ve, dyspnoea, eosinophilia)
downs
```
105
symptoms of nasal polyps
```
watery anterior rhinorrhoea
purulent post nasal drip
nasal obstruction
sinusitis
headaches
snoring
mobile, pale, insensitive
```
106
what could unilateral nasal polyp mean
red flag for cancer e.g. nasopharyngeal, glioma, lymphoma, neuroblastoma, sarcoma
therefore do CT and get histology and referrer all nasal polyps
107
what is samters triad
asthma
allergic sinusitis
nasal polyps
108
treatment of nasal polyps
```
betamethosone drops for 2 days
short course of oral steroids
flexible endoscopic polypectomy
refer
antihistamines
```
109
questions to ask in nasal fracture
time, LOC, CSF rhinorrhoea, epistaxis, previous nose injury, obstruction, facial fracture symptoms (teeth malocclusion, piplopia)
110
management of nasal fracture
- dont X-ray as cartilaginous injury won't show and also don't alter managemnt
- exclude septal haematoma
- re examine after 1 week when swelling dreased
- reduction under GA with post op splinting within 2 weeks
111
symptoms of septal haematoma
boggy swelling bilaterally, pain, rhinorrhoea, nasal obstruction sensation
112
treatment of septal haematoma
evacuation, drainage and abx under GA for packing and suturing
113
complications of septal haematoma
septal necrosis
nasal collapse
saddle nose deformity
114
causes of epistaxis
nose picking, URTI, pyogenic granuloma, osler weber rendu/HHT, warfarin, saids, haemophilia, reduce platelets, von williebrands, neoplasm, cocaine, trauma
115
initial management of epistaxis
ABCDE
1) sit up, head tilt down, squeeze bottom for 20 mins
2) remove clots by suction if bleeding not controlled
116
anterior epistaxis management
1) gauze soaked with vasoconstrictor and local anaesthetic
2) silver nitrate cauterisation
3) packing
4) ENT referral
117
posterior / major epistaxis management
1) posterior with 18/18G foley catheter through nose into nasopharynx and inflate with water
2) endoscopic visualisation and cautery or ligation
118
advice for after epistaxis
don't pick, sit upright, avoid sun/bending/lifting, sneeze through mouth, no hot food/drink
119
symptoms of HHT
```
AD
telangiectasia in mucosa
recurrent spontaneous epistaxis
GI bleed painless
internal telangiectasia
rarely pulmonary HTN
colon polyps
```
120
what is little's area/kisselbachs plexus
```
LEGS - arteries in anterior nose
labial artery
ethmoid artery
greater palatine artery
sphenoid palatine after
```
121
symptoms of tonsillitis
sore throat, fever, malaise, lymphadenopathy, inflamed tonsils, oropharynx, exudates
122
common organisms of tonsillitis
```
virus = adenovirus, influenza, coxsackie, coronavirus
bacterial = group a beta haemolytic strep (pyogenes), staphs, moraxella
```
123
centor criteria
- history of fever
- tonsillar exudates
- tender anterior cervical adenopathy
- no cough
1 point for each
124
treatment of tonsillitis
analgesia
centor criteria
antibiotics (pen v 250mg PO QDS) (erythromycin in allergic)
surgery
125
when should you do surgery for tonsillitis
- >7 a year
- OSA/airway obstruction/stridor
- quinsy
- malignancy
- recurrent febrile convulsions
- symptoms >1year
126
complications of surgery for tonsillitis
- reactive haemorrhage
| - tonsillar gag may damage teeth, TMJ, posterior pharyngeal wall
127
complications of strep throat
```
PPRRS
peritonsillar abscess (quinsy)
retropharyngeal abscess
lemierre's syndrome
scarlett fever
rheumatic fever
post strep glomerulonephritis
```
128
methods of tonsillectomy
cold steel
| cautery
129
symptoms of peritonisllar abscess
```
trisumus
odonophagia (can't swallow saliva)
halitosis
tonsillitis
unilateral tonsillar enlargement
contralateral uvula displacement
cervical lymphadenopathy
```
130
treatment of peritonsillar abscess
admit
IV Abx
tonsillectomy under GA
131
functions of the larynx
phonation
positive thoracic pressure
respiration
prevention of aspiration
132
symptoms of laryngitis
pain, hoarseness, fever, dysphagia, red and swollen vocal cords
133
causative organisms of laryngitis
```
usually viral (coronavirus)
bacterial = Hib, s.pneumonia
fungal = candidiasis
```
134
investigations in laryngitis
CXR
| sputum
135
treatment of laryngitis
supportive
| pen V
136
what is laryngeal papilloma
pedunculated vocal cord swellings caused by HPV
137
treatment of laryngeal papilloma
laser removal
138
function of the recurrent laryngeal nerve
supplies all intrinsic muscles of the larynx except the cricothyroideus (an extended branch of the superior laryngeal nerve)
139
symptoms of recurrent laryngeal nerve palsy
hoarseness, breathy voice with bovine cough, repeated coughing from aspiration (decreased supraglottic sensation), exertion dyspnoea (due to narrow glottis)
140
cause of recurrent laryngeal nerve palsy
cancers (larynx, thyroid, oesophagus, hypo pharynx, bronchus)
para/thyroidectomy, carotid endarterectomy
aortic aneurysm, bulbar/pseudobulbar palsy
141
risk factors of laryngeal SCC
smoking, alcohol, male
142
symptoms of laryngeal SCC
male smoker with progressive hoarseness leading to stridor, dys/odonophagia, weight loss
143
investigations in laryngeal SCC
laryngoscopy and biopsy including nodes
| MRI staging
144
treatment of laryngeal SCC
based on stage
radiotherapy
laryngectomy
after laryngectomy patients have permanent tracheostomy and need regular follow up for reoccurrence
145
complications of laryngeal SCC
need tracheostomy
| recurrence
146
what is laryngomalacia
immature and floppy aryepiglottic folds and glottis lead to laryngeal collapse on inspiration in children
147
presentation of laryngomalacia
stridor in first weeks of life particularly lying back, feeding, excited/upset
148
treatment of laryngomalacia
no treatment needed but if severe may need surgery
149
symptoms of epiglottitis
sudden onset continuous stridor with drooling and dysphagia
150
organisms in epiglottitis
haemophilus and group a strep (pyogenes)
151
treatment of epiglottitis
- don't examine throat, refer to ENT and anaesthetists
- O2 and nebuliser adrenaline
- IV dexamethasone
- ABX - cefotaxime
- cricothyroidectomy/tracheostomy
152
what is a subglottic stenosis
sublottis in narrowest part of resp tract in children leading to stridor and failure to thrive
153
causes of subglottic stenosis
prolonged intubation
| congenital abnormalities
154
treatment of subglottic stenosis
```
mild = conservative
severe = tracheostomy or partial tracheal resection
```
155
what is ramsay hunt syndrome
reactivation of the varicella zoster virus in the geniculate ganglion of CN7
156
symptoms of ramsay hunt syndrome
- preceding ear pain or stiff neck
- vesicular rash in auditory canal +/- TM/pinna/tongue/hard palate
- ipsilateral facial weakness, ageusia, hyperacuisis
- may affect CN7 palsy - vertigo, tinnitus, deafness
157
treatment of ramsay hunt syndrome
acyclovir
prednisolone
analgesia
eye care
treat within 72hrs to ensure better recovery
158
risk factors of tonsillar SCC
HPV, smoking, alcohol, poor oral hygiene
159
risk factors of vocal cord nodules
teachers and singers - leads to bilateral nodules and a breathy harsh voice
160
treatment of vocal cord nodules
speech therapy
| surgery
161
risk factors of obstructive sleep apnoea
obese, male, middle age, smoking, sedatives, alcohol, family history
162
symptoms of OSA
snoring, daytime sleepiness, macroglossia, apnoea
163
treatment of OSA
Epworth sleepiness score
1) behavioural
2) CPAP
3) modafinil for daytime sleepiness
4) surgery
164
what is bells palsy
inflammatory oedema from entrapment of CN7 in narrow facial canal, usually of viral origin (HSV1), causes 75% of facial palsy
165
symptoms of bells palsy
- sudden onset complete unilateral facial feature
- bells sign (failure of eye closure) leading to dryness and conjunctivitis
- numbness or pain around ear
- reduced taste (ageusia)
- hyperacuisis (stapedius palsy)
166
investigations of bells palsy
serology - borrelia or VZV antibodies
MRI - SOL, stroke, MS
LP
167
treatment of bells palsy
- protect eye = dark glasses/artificial tears/tape closed at night
- prednisone in 72 hours
- acyclovir if zoster suspected
- plastic surgery
168
prognosis of bells palsy
- incomplete paralysis usually recovers completely within weeks
- complete lesions may have delayed recovery or neurological/cosmetic abnormalities
169
complications of bells palsy
aberrant neural connections
- synkinesis = blinking causes up turning of mouth
- crocodile tears = eating stimulates unilateral lacrimation, not salivation
170
treatment of croup
O2 and neb adrenaline and dexamethasone
171
causes of stridor
croup, epiglottitis, cancer in adults, inhaled foreign body, post op
172
what is gingerval hyperplasia
overgrowth of gums caused by phenytoin, ciclosporin and AML
173
what is necrotising ulcerative gingivitis symptoms and causes
caused by poor dental hygiene, leading to bleeding gums, ulcers, halitosis
174
treatment of necrotising ulcerative gingivitis
metronidazole, chlorhexide mouthwash, analgesia
175
risk factors of mouth ulcer
>40 years, smokers, heavy drinkers, chewing tobacco
176
when to refer mouth ulcers
>3 weeks, red/white patches, one sided pain in head/neck, unexplained neck lump, persistent sore throat
177
symptoms of mumps
parotitis, pancreatitis, orchitis, reduced hearing, meningoencephalitis
178
what is a black hairy tongue, its causes and treatment
destructive desquamation of the filiform papillae
caused by poor oral hygiene, antibiotics, head and neck radiation, HIV, IVDU
tongue scrapings and antifungals if candida
179
the 3 ossicles
malleus, incus, stapes
180
function of the ossicles
transmit sound from tympanic membrane to the cochlear, then amplify sound waves and hair cells in the basilar membrane detect vibrations
181
3 salivary glands
parotid
mandibular
sublingual
182
3 unpaired cartilage in larynx
cricoid, thyroid, epiglottis
183
nerves innervating the larynx
superior and recurrent laryngeal nerves
184
blood supply of the thyroid gland
superior and inferior thyroid arteries
185
function of the semicircular canals
for balance
186
blood supply and nerves innervating the pharynx
external carotid artery
| innervated by the vagus and glossopharyngeal nerve
187
investigations for lump in neck
non contrast CT
US and cytology
TFTs
FBC
188
what is sialandetis
blocked/ inflamed salivary gland caused by stone/tumour
189
symptoms of sialandetis
pain in neck on eating and lump in neck
190
differentiating between thryoglossal cyst and thyroid swelling
cyst - moves on swallow and tongue out as connected to foramen caecum
swelling - moves on swallow only
191
types of thyroid cancer
parathyroid
papillary
medullary - calcitonin
follicular
192
red flags of neck lump
```
change in voice
swallowing with referred pain
haemoptysis
dyspnoea
weight loss
night sweats
```
193
symptoms of dermoid cyst
teratoma with hair and teeth in <20years usually
194
symptoms of virchows node
trosiers sign - enlarged left sided supraclavicular lymph node - appears in gastric cancer
195
symptoms of cynic hygroma
congenital, transilluminates, recurrence, fluctuate on L side
196
symptoms of brachial cyst
benign unilateral in young adults, contains acellular fluid ad cholesterol crystals
