ENT Flashcards
Examining the ear. What do you do to the pinna / post-auricular?
Pinna: inspect for Deformities / abnormal cartilaginous fragments
Scars/skin changes e.g CA / inflammation
Palpate: Pre/Post auricular lymph nodes. Tragus
On palpation the Tragus is tender. Potential cause?
Otitis Externa
What do you look for when examining the external ear?
Wax/ foreign body, skin changes/ erythema / discharge
Name 2 tuning fork tests for measuring hearing?
Rhinne test
Webber test
Placing a tuning fork against the mastoid process and when ptx. stops hearing it holding it infront of ear is known as…
Rhinne test
Patient is Rhinne Test Positive, what does this mean?
Air conduction heard better than bone conduction (Rh+)= normal/sensorineural HL
Patient is Rhinne Test negative, what does this mean?
Bone conduction heard better than air conduction (Rh-)= conductive HL
Placing a tuning fork on the forehead midline is known as what test?
Weber test
Rhines test indicates that a patient has right-sided conductive hearing loss (bone conduction heard louded than air conducution).
You perform webers test- placing the tuning fork in the middle of their head. Which side does the patient report it is heard loudest?
Heard loudest on right (same side as conductive hearing loss) as the left is subject to ambient sound.
(I think of it as if you have conductive hearing loss your brain has to turn up the sound input on the cochlea)
What is conductive hearing loss?
When there’s a problem transferring sound at some point on the pathway from the outer ear–> tympanic membrane –>middle ear
What is sensorineural hearing loss?
When there’s a problem with the inner ear e.g cochlea or vestiboulocochlear nerve
In Sensorineural loss which side is the sound loudest on in webers test?
Contralateral side
What structures make up the external ear?
Pinna, external auditory canal (meatus), lateral surface tympanic membrane
What makes up earwax
squamous debris, cerumen and sebum
What structures make up the middle ear?
medial surface tympanic membrane, tympanic cavity + eustachian tube, ossicles
Name the 3 ossicles
malleus, stapes, incus
Describe the normal appearance of tympanic membrane
grey, semitransulscent, lower part= pars tensa, upper part= pars flaccida
Which nerve passes through the middle ear? Function?
Chorda tympani
Branch of facial nerve provides taste to anterior 2/3 tongue
Describe the function of the cochlea
Hair cells convert mechanical energy from sound to electrical impulses passed down cochlea branch of CN8
Describe the function of the semi-circular canals
movement of endolymph in semicircular canals converted to electrical impulses carried by vestibular branch of CN8
What allows us to maintain visual fixation on an object despite head movement?
Vestibulo-ocular reflex
Differentials for otalgia (otological causes)
Perichondritis / acute otitis externa/ acute otitis media
Trauma / Tumour
Ramsay Hunt syndrome
RHS is paralysis of facial nerve and rash effecting the ear or mouth
Give 3 infective causes of otoligical otalgia
Perichondritis
Acute otitis externa
Acute otitis media
Herpes Zoster (ramsay hunt syndrome)
Give 3 non-otological causes of otalgia
Tonsil / Pharyngeal inflammation / CA
Temporomandibular joint dysfunction
Dental / Cervical Spine disease
Patient presents with a chronic and offensive ear discharge. Likely diagnosis?
Cholesteatoma
Patients ottorhoea is mucoid, cause?
CSF leak from severe trauma
Itchy ear- likely cause?
Otitis externa
Purulent ottorhoea- likely cause?
Purulent disharge:
ear-drum perforation + infection / otitis externa
What type of patient is tinnitus more common in?
Tinnitis more common in ptx. with hearing loss
What is tinnitus
Buzzing/ringing/whooshing/humming in the absense of stimulus
Give a cause of conductive hearing loss relating to: External ear Tympanic membrane Middle ear space Ossicles
External ear: wax / otitis externa
Tympanic membrane: trauma
Middle ear space: effusion, infection, trauma, tumour
Ossicles: trauma, otosclerosis
Differentials of sensorineural hearing loss?
Genetic / Idiopathic / Presbyacusis
Infection: meningitis, MM(R) (pre-natal)
Acoustic neuroma, Meniere’s disease
Trauma // Occupational / noise-induced
What are the three salivary glands?
Parotid, submandibular, sublingual
Causes of parotid swelling
mumps, stone in salivary duct, benign/malignant tumour,
Sjogren’s, sarcoidosis, HIV
Patient presents with bilateral parotid swelling for 1 week and a low-grade fever, what diagnosis should you work to exclude?
Mumps
What investigations should you undertake for swollen parotids
FBC, ESR/CRP, UE
Blood culture, Viral Seroligy
Salivary antibody testing (mumps IgM)
Imaging: USS / Sialography
CT/MRI ?neoplasm
Give a viral and bacterial cause of parotitis?
viral= mumps bactereial= staph aureus
Symptoms of parotitis
painful, swollen,
fever, dry mouth
Management of mumps
Usually self-limiting
Management of suppurative parotitis?
abx +/- incision and drainage
What structures form the anterior triangle of the neck
Superior- inferior border of mandible
Medial- sagittal line of body
Lateral- medial border sternocleidomastoid
What are the three paired salivary glands?
Parotid, Sublingual, Submandibular
What important structure passes through the parotid gland?
Facial nerve
Most parotid gland tumours are…
benign (80%)
Risk factors for parotid gland tumour
Radiation exposure, EBV, smoking, genetics
S&S of parotid gland tumour
painless enlarging mass, facial nerve palsy, redness, ulceration
Which key symptom of a parotid gland tumour indicates that it is malignant?
Facial nerve palsy
Investigations of parotid gland tumour
Bloods- ?infective cause
FNA cytology- ?malignant
CT neck + thorax- staging
What is the management for a parotid gland tumour?
Partial/Total parotidectomy +/- adjuvant radiotherapy
What is sialadenosis?
Chronic, bilateral swelling of parotids
Non-inflammatory, non-neoplastic
Associated with sjogren’s
Name a medication given to patients with hyposalivation?
Pilocarpine
What are the 4 tonsils surrounding the superior pharynx (waldeyer’s ring)?
Pharyngeal, Tubal, Palatine, Lingual
What is xerostomia?
Dry mouth
What is sialectasis?
Cystic dilation of salivary gland ducts
Tonsilitis is most commonly viral or bacterial?
Give examples of each
*Viral- Rhino/corono/parainfluenza virus
Bacterial- group A beta haemolytic strep
What are the centor criteria for tonsilitis?
Tonsilar exudate, fever, tender lymphadenopathy, absence of cough
Score 3/4= likely strep, give Abx
Commonest bacterial cause of tonsilitis?
Group A B-haemolytic strep
Management of viral / bacterial tonsilitis
Viral: sx relief (ibruprofen / paracetamol)
Bacterial: sx relief and penicillin 10 days
What is quinsy?
3 S&S?
Mx?
Asymmetrical peritonsilar abscess which pushes uvula to one side
Dysphagia, hot potato voice, trismus, uvula deviation
Drainage, tonsilitis mx
Trismus= locked jaw
Cause of Glandular Fever?
EBV
Patient presents with sore throat, fever, malaise, lethargy, cervical lymphadenopathy, white film on tonsils and hepatosplenomegaly. Likely diagnosis? Mx?
Glandular fever
Analgesia, steroids, no contact sports +/-abx
Commonest form of laryngeal CA?
Squamous cell carcinoma
Risk factors for laryngeal CA?
smoking, alcohol, HPV, M>F
What are the risk factors for epistaxis
trauma, nose pickers, cold/hayfever, pregnancy, chemotherapy, anticoagulants, infection
Mx of epistaxis
ABCDE
Topical: vasoconstrictors (e.g adrenaline), lidocaine, tranexamic acid, cautery
Nose packing / gauze
Anterior nasal blood supply:
Name of area
Name of arteries
Kiesselbach’s (little’s) area.
LEGS: labial, ethmoidal (anterior), greater palpatine, sphenopalpatine
Differentials for anosmia
nasal obstruction, parkinsons, DM, alzheimer’s, COVID-19
What is trismus?
lock jaw / reduced jaw movement
How many episodes of bacterial tonsilitis per year to have tonsilectomy?
7
Does the presence or absence of cough score a point on centor criteria and why?
Absence of cough scores
Cough is more indicative of URTI than tonsilitis
What is tympanosclerosis?
Calcification of tymapanic membrane and middle ear
What is a potential treatment for fungal otitis externa?
Canestan
Co trimazole
What happens to the light reflex in AOM?
Lost because the tympanic membrane bulges towards you
O/E of ear you see black dots, what is the likely diagnosis?
Fungal infection aspergillis niger
What is a furuncle?
AKA boil
painful infection which forms around a hair follicle, contains pus
OE there is eczematous inflammation with otitis externa. Give 2 examples of drugs which could be used to treat this?
Gentisone (gentamicin + hydrocortisone) Otomize soray (neomycin, dexamethasone, acetic acid)
Give 3 drugs which are involved in the treatment of balance disorders?
Prochlorperazine (stematil)- labrynthitis
Cinnarizine (sturgeron) / Betahistine dihydrochloride (serc)- vertigo, tinnitus and menierre’s
Give an example of a drug prescribed for acute otitis media?
Augmentin (amoxicillin and clavulanate potassium)
Give several differentials for a patient that presents with otorrhoea?
Serous- otitis externa
Mucoid/purulent- otitis media
Clear/blood stained- CSF (if head injury)
Foul smelling- cholesteatoma
Give several differentials of otalgia:
External?
Middle ear?
Referred?
External- trauma, otitis externa, furunculosis
Middle ear- acute otitis media, acute mastoiditis
Referred- teethh, larynx, pharynx, neck
Patient on webers test reports the sound is heard equally in both ears. What does this indicate?
Normal hearing
Rhinnes test reveals
Left ear: air conduction heard louder than bone conduction
Right ear: bone conduction heard louder than air conduction
What does this indicate?
Right sided conductive hearing loss
