ENT Flashcards
1
Q
Otitis Externa
Definition (1)
A
Discharge, itch, pain and tragal tenderness due to acute inflammation of the skin of the meatus, usually caused by excess canal moisture
2
Q
Otitis Externa
Aetiology (5)
A
Mostly excess canal moisture Trauma eg. fingernails, itching especially in eczema and psoriasis Absence of wax (from self-cleaning) Narrow ear canal Hearing aids Pseudomonas and Staph. aureus
3
Q
Otitis Externa
Mild (3)
A
Scaly skin with some erythema
Normal diameter of external auditory canal
Treatment: clearing with irrigation/syringing, hydrocortisone cream, antibacterial spray
4
Q
Otitis Externa
Moderate (4)
A
Painful ear
Narrowed external auditory canal
Malodorous creamy discharge
Prescribe topical antibiotic +/- steroid drops
5
Q
Otitis Externa
Severe (2)
A
External auditory canal is occluded
Treatment: thin ear wick inserted with aluminium acetate allowing canal to open up enough for microsuction/cleaning
6
Q
Acute Otitis Media
Aetiology (3)
A
Commonly follows a viral URTI
Pneumococcus
Haemophilus
7
Q
Acute Otitis Media Risk factors (4)
A
URTI
Passive smoking
Asthma
GORD
8
Q
Acute Otitis Media
Signs + symptoms (5)
A
Rapid onset of pain due to bulging of the tympanic membrane, which eases if the drum perforates Fever Irritability Vomiting Purulent discharge
9
Q
Acute Otitis Media
Treatment (4)
A
Analgesia
Many resolve spontaneously
Antibiotics if systemically unwell or no improvement over 4 days, amoxicillin
Clean external auditory canal
10
Q
Acute Otitis Media
Complications (4)
A
Mastoiditis
Labyrinthitis
Facial palsy
Meningitis
11
Q
Chronic Otitis Media
Definition (1)
A
Ear with a tympanic membrane perforation in the setting of recurrent/chronic infections
12
Q
Chronic Otitis Media
Signs + symptoms (4)
A
Hearing loss
Otorrhoea
Fullness
Otalgia (painful ear)
13
Q
Chronic Otitis Media
Classification (3)
A
Benign chronic otitis media: dry tympanic membrane perforation without active infection
Chronic serous otitis media: continuous serous drainage (straw coloured)
Chronic suppurative otitis media: persistent purulent drainage through a perforated tympanic membrane
14
Q
Chronic Otitis Media
Treatment (3)
A
Topical/systemic antibiotics
Aural cleaning
Surgery: myringoplasty (repair of the tympanic membrane alone) or mastoidectomy
15
Q
Chronic Otitis Media
Complications (1)
A
Cholesteatoma
16
Q
Cholesteatoma
Definition (1)
A
A cyst/sac of keratinising squamous epithelium that most often occurs in the attic part of the middle ear
17
Q
Cholesteatoma
Pathology (5)
A
Negative pressure in middle ear causes pars flaccida to balloon backwards, forming pocket
Epithelium falls into pocket
Ball of debris enlarges and is infected with Pseudomonas
Grows upwards into attic and backwards into mastoid
Cholesteatoma erodes bone: ossicles- conductive deafness, facial nerve- palsy, labyrinth- vertigo, roof of middle ear- intracranial sepsis
18
Q
Cholesteatoma
Signs + symptoms (5)
A
Foul-smelling discharge
Conductive hearing loss
Attic retraction filled with squamous debris
Discharging attic perforation
Complications: facial palsy, vertigo, intracranial sepsis
19
Q
Cholesteatoma
Treatment (2)
A
Surgical removal
More advanced disease that extends into the mastoid may require mastoidectomy
20
Q
Otitis Media with Effusion (Glue Ear)
Aetiology (3)
A
Dysfunction of Eustachian tubes
URTIs
Oversized adenoids
21
Q
Otitis Media with Effusion (Glue Ear)
Signs + symptoms (5)
A
Chief cause of hearing loss in young children (conductive)
May cause no pain
Variable appearance of tympanic membrane, eg. retracted/bulging drum
May have bubbles or a fluid level
Flat tympanogram (distinguishes from otosclerosis)
22
Q
Otitis Media with Effusion (Glue Ear)
Treatment (3)
A
Usually resolves spontaneously
Surgery: if persistent and bilateral, insert ventilation tubes (grommets or tympanostomy tube)
Hearing aids
23
Q
Mastoiditis
Definition (1)
A
Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation
24
Q
Mastoiditis
Signs + symptoms (3)
A
Erosion of the bone can lead to swelling behind ear and thickening of the postauricular tissues, leading to the pinna becoming pushed out
Fever
Tenderness, swelling and redness behind pinna (mastoid)
25
Mastoiditis
| Investigations (1)
CT
26
Mastoiditis
| Treatment (2)
IV antibiotics
| Myringotomy (incision into eardrum to relieve pressure or drain fluid) +/- mastoidectomy
27
Conductive Hearing Loss
| Definition (1)
Impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes
28
```
Conductive Hearing Loss
Hearing tests (3)
```
Pure tone audiometry: air-bone gap
Rinne's test: negative (bone conduction > hearing loss)
Weber's test: sound localises to the affected ear
29
Conductive Hearing Loss
| Aetiology (4)
External canal obstruction (wax, debris, foreign body)
Drum perforation (trauma, infection)
Problems with the ossicular chain (otosclerosis, infection, trauma)
Inadequate Eustachian tube ventilation of the middle ear (eg. with effusion)
30
Conductive Hearing Loss
| Sudden hearing loss (4)
Infection
Occlusion
Trauma
Fracture
31
Sensorineural Hearing Loss
| Definition (1)
Defects central to the oval window in the cochlea or cochlear nerve leading to hearing loss
32
```
Sensorineural Hearing Loss
Hearing tests (2)
```
Rinne's: positive, AC>BC
| Weber's: localises to unaffected ear
33
Sensorineural Hearing Loss
| Aetiology (7)
Ototoxic drugs (eg. streptomycin, vancomycin, gentamicin)
Post-infective (meningitis, measles, mumps, syphilis)
Meniere's disease
Trauma
Presbyacusis
Acoustic neuroma (consider if unilateral)
Cholesteatoma (consider if unilateral)
34
Sensorineural Hearing Loss
| Sudden Hearing Loss (6)
```
Noise exposure
Gentamicin toxicity
Mumps
Acoustic neuroma
MS
May require steroids as treatment
```
35
Otosclerosis
| Pathology (1)
New bone is formed around the stapes footplate, leading to its fixation and consequent conductive hearing loss
36
Otosclerosis
| Signs + symptoms (4)
Usually appear in early adult life and can be accelerated in pregnancy
Conductive deafness: hearing often better with background noise
Tinnitus
Mild vertigo
37
Otosclerosis
| Investigations (1)
Audiometry with masked bone conduction shows a dip at 2kHz (Cahart's notch)
38
Otosclerosis
| Treatment (3)
Hearing aid
Surgery: stapedectomy or stapedotomy to replace the adherent stapes
Cochlear implant if severe
39
Presbyacusis
| Definition (1)
Age-related, bilateral, high-frequency sensorineural hearing loss
40
Presbyacusis
| Signs + symptoms (2)
```
Gradual deafness (unnoticed until hearing of speech is affected with loss of high frequency sounds)
Hearing most affected when there is background noise
```
41
Presbyacusis
| Treatment (1)
Hearing aids
42
Childhood Deafness
| Epidemiology (2)
1 in 500 newborns
| 50% genetic, 25% non-genetic, 25% idiopathic
43
Childhood Deafness
| Genetic (2)
Conductive: congenital anomalies of pinna, external ear canal, drum or ossicles
Sensorineural: non-syndromic most common, Alport's syndrome, Alport's syndrome, Turner's syndrome
44
Childhood Deafness
| Non-genetic (4)
Intrauterine infection: CMV, HSV, syphilis
Perinatal: prematurity, hypoxia
Infections: meningitis, encephalitis, measles, mumps
Acoustic/cranial tumour
45
Childhood Deafness
| Universal newborn hearing screening (3)
Within weeks of birth
Otoacoustic emissions: microphone placed in external meatus detects tiny cochlear sounds produced by movement of the outer hair cells
Audiological brainstem responses: earphones emit a series of soft clicks, electrodes on the infant's forehead and neck measure brain wave activity in response to the clicks
46
```
Childhood Deafness
Cochlear implants (1)
```
Directly stimulates auditory nerve when electrical signals are applied
47
Tinnitus
| Definition (1)
Perception of sound typically in the absence of auditory stimulation
48
Tinnitus
| Prevalence (1)
15%
49
Tinnitus
| Signs + symptoms (4)
Unilateral or bilateral
Pulsatile or non-pulsatile
Ringing, hissing or buzzing suggests an inner ear or central cause
Popping or clicking suggests problems in the external or middle ear
50
Tinnitus
| Classification (2)
Objective: audible to examiner, rare and due to vascular disorders (pulsatile vibratory sounds from AV malformation/carotid pathology) or high-output cardiac states (anaemia or hyperthyroidism)
Subjective: audible only to patient, most commonly associated with disorders causing SNHL (presbyacusis, Meniere's, noise-induced), ototoxic drugs
51
Tinnitus
| Investigations (3)
Audiometry
Tympanogram
Must do MRI if unilateral to rule out acoustic neuroma
52
Tinnitus
| Treatment (5)
```
Treat any underlying cause
Often improves over time
Hearing aids
Psychological support
CBT
```
53
Noise-Induced Hearing Loss
| Aetiology (3)
One-time exposure to intense sound eg. explosion
Most commonly occupational, continuous exposure to loud sounds that causes hearing loss overtime
Rupture of drum and ossicular fracture may occur
54
Noise-Induced Hearing Loss
| Symptoms (2)
Bilateral symmetrical, sensorineural hearing loss +/- tinnitus
Audiometry typically shows a 'notch' at 3, 4 or 6kHz with recovery at 8kHz
55
Noise-Induced Hearing Loss
| Treatment (4)
Reduce risk of occupational exposure
Provide ear defenders
Screen occupations at risk
In established hearing loss use hearing aids
56
Vertigo
| Classification (2)
Vestibular (peripheral) vertigo: often severe and may be accompanied by loss of balance, nausea, vomiting, reduced hearing, tinnitus, nystagmus
Central vertigo: usually less severe, no hearing loss/tinnitus
57
Vertigo
| Causes of peripheral vertigo (4)
Meniere's disease
Benign paroxysmal positional vertigo
Vestibular failure
Labyrinthitis
58
Vertigo
| Causes of central vertigo (4)
Acoustic neuroma
MS
Head injury
Migraine associated dizziness
59
Vertigo
| Investigations (4)
Assess cranial nerves and ears
Test cerebellar function and reflexes
Romberg's test (+ve if balance worse when eyes are shut)
Dix-Hallpike test
60
Benign Paroxysmal Positional Vertigo
| Pathology (1)
Displacement of otoconia (otoliths) stimulate the semicircular canals
61
Benign Paroxysmal Positional Vertigo
| Signs + symptoms (4)
Attacks of sudden rotational vertigo
Last >30 seconds
Provoked by head turning
+ve Dix-Hallpike
62
Benign Paroxysmal Positional Vertigo
| Treatment (2)
Usually self-limiting
| Epley manoeuvre
63
Meniere's Disease
| Pathology (1)
Dilatation of the endolymphatic spaces of the membranous labyrinth
64
Meniere's Disease
| Signs + symptoms (6)
Sudden attacks of vertigo
Last 2-4h
Nystagmus always present
Increasing fullness of ears +/- tinnitus followed by vertigo
Symptoms often become bilateral
Fluctuating SNHL is common and may become permanent
65
Meniere's Disease
| Treatment (3)
Acute: prochloperazine bucally as short-term vestibular sedative
Prophylaxis: betahistine
Surgery if persistent
66
Acute Vestibular Failure (Labyrinthitis)
| Signs + symptoms (4)
Sudden attacks of unilateral vertigo and vomiting in a previously well person, often following URTI
Lasts 1-2 days, improving over a week
Nystagmus away from affected side
May have haring loss
67
Acute Vestibular Failure (Labyrinthitis)
| Treatment (1)
Vestibular suppressants eg. Buccastem or cyclizine
68
Furunculosis
| Definition (1)
Very painful staphylococcal abscess arising in a hair follicle within the ear canal
69
```
Furunculosis
Risk factors (1)
```
Diabetes
70
Furunculosis
| Treatment (2)
Lancing
| If there is a pinna cellulitis start oral antibiotics (eg. flucloxacillin)
71
Rhinosinusitis
| Definition (1)
Inflammation in the nose and paranasal sinuses with >2 symptoms, one of which must be nasal blockage/obstruction/discharge/congestion +/- facial pain/pressure, reduction/loss of smell, and either endoscopic or CT signs
72
Rhinosinusitis
| Classification (5)
Acute rhinosinusitis (common cold): self limiting but if persist >5 days give intranasal steroids, only use antibiotics if very severe, should easily resolve in 14 days
Chronic rhinosinusitis with nasal polyps
Chronic rhinosinusitis without nasal polyps
Allergic rhinosinusitis
Acute bacterial rhinosinusitis
73
Allergic Rhinosinusitis
| Aetiology (1)
IgE-mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells
74
Allergic Rhinosinusitis
| Signs + symptoms (7)
```
Sneezing
Pruritus
Nasal discharge (bilateral and variable)
Bilateral itchy red eyes
Turbinates may be swollen
Mucosae may be pale or mauve
Nasal polyps
```
75
Allergic Rhinosinusitis
| Treatment (6)
Allergen/irritant avoidance
Nasal saline irrigation
Antihistamines
Intranasal corticosteroid sprays
Oral prednisolone can resolve severe symptoms
Immunotherapy can induce long-term tolerance to allergens
76
Chronic Rhinosinusitis
| With nasal polyps (6)
Typical patient is a male >40
Sites: usually bilateral, most often in middle meatus
Symptoms: watery anterior rhinorrhoea, sneezing, purulent postnasal drip, nasal obstruction, sinusitis, mouth breathing, snoring
Associations: allergic rhinoscopy/nasal endoscopy (polyps are pale, mobile and insensitive to gentle palpation)
Treatment: topical steroid, endoscopic sinus surgery
77
Chronic Rhinosinusitis
| Without nasal polyps (1)
Treatment: intranasal corticosteroids and nasal saline irrigation, consider microbiological cultures and long-term antibiotics, surgery
78
Acute Bacterial Rhinosinusitis
| Signs + symptoms (4)
Discoloured discharge (unilateral predominance) and purulent secretion in the nasal cavity
Severe local pain
Fever
High ESR/CRP
79
Acute Bacterial Rhinosinusitis
| Differentials of sinusitis (4)
Migraine
TMJ dysfunction
Dental pain
Temporal arteritis
80
Acute Bacterial Rhinosinusitis
| Causes (3)
Direct spread
Odd anatomy: septal deviation, polyps
Mechanical ventilation
81
Acute Bacterial Rhinosinusitis
| Investigations (3)
```
Clinical diagnosis (examine nose and look for mucosal inflammation, oedema, discharge)
CT paranasal sinuses
Nasal endoscopy
```
82
Acute Bacterial Rhinosinusitis
| Treatment (4)
98% of sinusitis cases are viral and self-limiting
Simple analgesia, nasal saline irrigation, intranasal decongestants
Antibiotics
Endoscopic sinus surgery
83
Acute Bacterial Rhinosinusitis
| Complications (3)
Orbital cellulitis/abscess
Intracranial involvement: meningitis, encephalitis
Osteomyelitis
84
Nasal Fractures
| Signs + symptoms (4)
Often brief but short-lived epistaxis
New nasal deformity
Associated facial swelling and black eyes
Look for septal haematoma (a boggy swelling of the septum causing near-total nasal obstruction)- if present do urgent incision and drainage
85
Nasal Fractures
| Treatment (4)
Treat epistaxis
Analgesia/ice
Close any skin injury
Reassess 5-7 days post-injury once swelling has resolved, can perform manipulation 10-14 days after injury (before nasal bones set)
86
CSF Rhinorrhoea
| Pathology (2)
Ethmoid fractures disrupting dura and arachnoid can result in CSF leaks
If not associated with trauma it may be a tumour
87
CSF Rhinorrhoea
| Investigations (2)
Nasal CSF discharge tests +ve for glucose
| CSF contains B2 (tau) transferrin
88
CSF Rhinorrhoea
| Treatment (1)
If traumatic, conservative management has high spontaneous resolution: bed rest, head elevation +/- lumbar drain
89
Septal Perforation
| Aetiology (4)
Septal surgery most common
Trauma (nose picking, foreign body, septal haematoma)
Inhalants (nasal steroid/decongestant spray, cocaine)
Infection (TB, syphilis, HIV)
90
Septal Perforation
| Signs + symptoms (3)
Irritation
Whistle breathing
Bleeding
91
Septal Perforation
| Treatment (2)
Saline nasal irrigation
| Surgical closure with septal prosthesis
92
Epistaxis
| Aetiology (5)
```
Local trauma (eg. nosepicking)
Facial trauma
Dry/cold weather
Dyscrasia/haemophilia
Septal perforation
```
93
Epistaxis
| Blood supply to nasal septum (7)
```
Anterior ethmoidal artery
Posterior ethmoidal artery
Sphenopalatine artery
Little's area (anterior ethmoidal, sphenopalatine and facial arteries anastomose to form)
Septal branch
Greater palatine artery
Superior labial artery
```
94
```
Epistaxis
Anterior epistaxis (2)
```
Almost always septal
| Little's area
95
```
Epistaxis
Posterior epistaxis (3)
```
Difficult to see on rhinoscopy so may require invasive procedures
Examination under anaesthesia: if discrete bleeding point it can be treated directly eg. with diathermy
Arterial ligation: of sphenopalatine artery is cornerstone of serious epistaxis
96
Epistaxis
| Management (7)
Apply pressure by pinching lower part of nose for 20 mins
Ice pack to dorsum of nose
Cauterise with silver nitrate and remove clots with gentle suction
Apply cotton ball soaked in adrenaline for 2 mins to cause vasoconstriction or use local lidocaine spray
If can't see bleeding point, refer to ENT
Anterior nasal pack, remove after 24h
If bleeding continues, try postnasal pack
97
Tonsillitis
| Aetiology (2)
Viral: common cold
Bacterial: group A B-haemolytic strep
98
Tonsillitis
| Investigations (2)
Don't routinely take throat swabs for all sore throats (which are either due to tonsillitis or acute pharyngitis)
Antistreptococcal antibody tests have no role but can confirm for group A B-haemolytic Strep.
99
```
Tonsillitis
Centor Criteria (5)
```
Presence of tonsillar exudate
Presence of tender anterior cervical lymphadenopathy
History of fever
Absence of cough
Presence of 3+ of these criteria suggest infection due to Strep and patient may benefit form antibiotics (penicillin V 10 days)
100
Tonsillitis
| Complications (4)
Otitis media
Sinusitis
Peritonsillar abscess (quinsy): sore throat, dysphagia, peritonsillar bulge, uvular deviation, muffled voice
Parapharyngeal abscess
101
```
Tonsillitis
Tonsillectomy criteria (3)
```
>7 well documented, clinically significant adequately treated sore throats in the preceding year
>5 episodes in each of the last 2 years
>3 in the last year
102
```
Stridor
Definitions (2)
```
Stridor: high-pitched noise heard in inspiration from partial obstruction at the larynx/large airways
Stertor: inspiratory snoring noise, coming from obstruction of the pharynx
103
```
Stridor
Aetiology (4)
```
Congenital: laryngomalacia, stenosis, vascular rings
Inflammation: laryngitis, epiglottitis, croup, anaphylaxis
Tumours: haemangiomas or papillomas (usually disappear without treatment)
Trauma: thermal, chemical, intubation
104
```
Stridor
Red flags (4)
```
Swallowing difficulty/drooling
Pallor cyanosis
Use of accessory muscles of respiration
Downward plunging of the trachea with respiration (tracheal tug)
105
Croup
| Aetiology (1)
95% viral (parainfluenza)
106
Croup
| Signs + symptoms (4)
Leading cause of stridor, predominantly inspiratory
Barking cough
May have respiratory distress due to upper airway obstruction
Often worse at night
107
```
Croup
Severity grading (3)
```
Mild: occasional cough, no stridor at rest
Moderate: frequent cough, stridor at rest
Severe: same as moderate + respiratory distress
108
Croup
| Treatment (2)
Give all children with croup of any severity a single dose of dexamethasone
Advise it is usually self-limiting and resolves in 48h
109
Acute Epiglottitis
| Definition (2)
Rapidly progressive inflammation of the epiglottis and adjacent tissues
An emergency because respiratory arrest can occur abruptly due to airway obstruction
110
Acute Epiglottitis
| Signs + symptoms in adults (3)
Severe sore throat
Painful swallowing
Stridor
111
Acute Epiglottitis
| Signs + symptoms in children (5)
```
Short history of fever
Irritability
Sore throat
Drooling
Muffled voice/cry
```
112
Acute Epiglottitis
| Treatment (5)
Don't examine throat and get senior help
Diagnosis made by laryngoscopy
Intubate
Dexamethasone
Antibiotics (usually caused by H. influenzae type B)- cefotaxime
113
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Vocal Cord Palsy
Unilateral presentation (3)
```
May manifest in first few weeks of life
Hoarse, breathy cry that is aggravated by agitation
Feeding difficulties +/- aspiration
114
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Vocal Cord Palsy
Bilateral presentation (2)
```
Inspiratory stridor at rest
| Worsens upon agitation +/- significant respiratory distress
115
Vocal Cord Palsy
| Treatment (2)
Unilateral: supportive, most recover by 2-3 years
Bilateral: urgent airway intervention may be needed (tracheostomy, intubation)
116
```
Hoarseness
Differential diagnoses (6)
```
Laryngitis: usually viral and self-limiting or may be secondary to GORD, present with pain, hoarseness and fever
Vocal cord palsy: weak 'breathy' voice, cancer
Laryngeal cancer: progressive, persistent gruff voice
Reflux laryngitis: chronic laryngeal symptoms associated with GORD
Vocal cord nodules: due to vocal abuse, variable husky voice
Reinke's oedema: chronic cord irritation from smoking +/- chronic voice abuse causes cord enlargement- hypothyroid old lady smokers
117
Hoarseness
| Investigations (2)
Always investigate hoarseness (especially in smokers) lasting > 3 weeks as it is the chief presentation of laryngeal carcinoma
Laryngoscopy to assess cord mobility, inspect mucosa and exclude local causes
118
Laryngeal Nerve Palsy
| Anatomy of recurrent laryngeal nerve (3)
Supplies the intrinsic muscles of the larynx
Responsible for abduction and adduction of the vocal fold
Originates from vagus nerve and has a complex course making it susceptible to damage
119
Laryngeal Nerve Palsy
| Aetiology (3)
30% due to cancers (larynx, thyroid, oesophagus, hypopharynx, bronchus)
25% iatrogenic (after parathyroidectomy, oesophageal or pharyngeal pouch surgery)
15% idiopathic
120
Laryngeal Nerve Palsy
| Signs + symptoms (3)
A weak 'breathy' voice with a weak cough
Repeated coughing/aspiration
Exertional dyspnoea (narrow glottis reduces air flow)
121
Laryngeal Nerve Palsy
| Investigations (2)
CXR
| CT +/- US thyroid if CXR normal
122
Laryngeal Nerve Palsy
| Treating non-malignant causes (2)
Unilateral palsies can be compensated for by movement of the contralateral cord
Reinnervation nerve surgery
123
Dysphagia
| Differentials (9)
```
Oesophageal cancer
Pharyngeal cancer
Gastric cancer
Extrinsic pressure, eg. from lung cancer or node enlargement
Bulbar palsy
Myasthenia gravis
Benign strictures
Pharyngeal pouch
Achalasia
```
124
Dysphagia
| Investigations (5)
```
Endoscopy with biopsy
Oesophageal motility studies
FBC, ESR
CXR
Barium swallow
```
125
Head and Neck Cancer
| Pathology (2)
90% squamous cell carcinoma
| Invades adjacent structures and spreads via lymphatics
126
Head and Neck Cancer
| Associations (5)
```
Smoking increases risk by 10x
Alcohol consumption
Vitamin A + K deficiency
HPV
GORD
```
127
Head and Neck Cancer
| Signs + symptoms (10)
```
Neck pain/lump
Hoarse voice >6 weeks
Sore throat >6 weeks
Mouth bleeding.numbness
Sore tongue
Painless ulcers
Patches in the mouth
Earache/effusion
Speech change
Dysphagia
```
128
Head and Neck Cancer
| Investigations (3)
Fibre-optic endoscopy
Fine needle aspiration or biopsy of any masses
CT/MRI primary tumour
129
Head and Neck Cancer
| Staging (3)
T: extent of primary tumour, T1= <2cm, T4= extension to bone, muscle, skin, neck
N: involvement of regional lymph nodes, N3= any node >6cm
M
130
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Oropharyngeal Carcinoma
Risk factors (5)
```
```
Age
Smoking (especially pipes)
Chewing tobacco
HPV
Male
```
131
Oropharyngeal Carcinoma
| Signs + symptoms (4)
Often advances at presentation
Sore throat
Sensation of lump
Referred otalgia
132
Oropharyngeal Carcinoma
| Investigations (1)
MRI
133
Oropharyngeal Carcinoma
| Treatment (2)
Surgery
| Radiotherapy
134
Oropharyngeal Carcinoma
| Prognosis (1)
5-year survival 50% for stage 1 (better for tonsillar cancer)
135
Hypopharyngeal Tumours
| Signs + symptoms (5)
```
Lump in throat
Dysphagia
Odynophagia (painful to swallow)
Pain referred to ear
Hoarse voice
```
136
Hypopharyngeal Tumours
| Prognosis (1)
Poor (it is rare cancer or may be premalignant)- 60% at 1 year
137
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Laryngeal Cancer
Risk factors (4)
```
Age
Male
Smoking
HPV
138
Laryngeal Cancer
| Signs + symptoms (2)
Progressive hoarseness leading to stridor
| Difficulty or pain on swallowing +/- haemoptysis +/- ear pain
139
Laryngeal Cancer
| Investigations (3)
Laryngoscopy + biopsy
HPV status
MRI staging
140
Laryngeal Cancer
| Treatment (2)
Radical radiotherapy for small tumours
| Larger tumours treated with partial/total laryngectomy
141
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Neck Lumps
Differentiating signs (2)
```
If lump present <3 weeks, reactive lymphadenopathy from a self-limiting infection
If intradermal, may be sebaceous cyst (with central punctum) or lipoma
142
Neck Lumps
| Investigations (5)
US to show lump architecture and vascularity and allows FNAC
CT to define masses
Virology + Mantoux test
CXR may show malignancy or lymphadenopathy
FNAC
143
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Neck Lumps
Midline lumps (4)
```
If <20 likely to be dermoid cyst
If it moves up on protruding tongue and is below the hyoid, it is likely a thyroglossal cyst
If >20 could be thyroid mass
If bony hard may be a chondroma
144
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Neck Lumps
Submandibular triangle (3)
```
If <20, self-limiting reactive lymphadenopathy is likely
If >20 exclude malignant lymphadenopathy
If not a node think of submandibular salivary stone/tumour
145
```
Neck Lumps
Anterior triangle (6)
```
```
Lymphadenopathy common
Branchial cysts: emerge under sternomastoid
Parotid tumour
Laryngocele
Carotid aneurysm
Carotid body tumour
```
146
```
Neck Lumps
Posterior triangle (4)
```
May be due to intruding cervical ribs
Pharyngeal pouches
Cystic hygromas (transilluminate)
Lymphadenopathy
147
Salivary Gland Infection (Sialadenitis)
| Definition (1)
Acute infection of the submandibular or parotid glands
148
Salivary Gland Infection (Sialadenitis)
| Signs + symptoms (2)
Painful diffuse swelling of gland + fever
| Pressure applied over gland may lead to pus leaking out of the duct
149
Salivary Gland Infection (Sialadenitis)
| Treatment (2)
Antibiotics + good oral hygiene
| Surgical drainage
150
```
Salivary Stones (Sialothiasis)
Pathology (1)
```
Usually effect submandibular gland where secretions are richer in calcium and thicker
151
```
Salivary Stones (Sialothiasis)
Signs + symptoms (3)
```
Pain
Tense swelling of the gland during/after meals
Stone may be palpable in the floor of the mouth
152
```
Salivary Stones (Sialothiasis)
Investigations (1)
```
Plain X-ray or sialogram if diagnostic doubt
153
```
Salivary Stones (Sialothiasis)
Treatment (2)
```
Small stones may pass spontaneously (sialogogues may help- they stimulate salivation)
Large stones may need surgical removal
154
Salivary Gland Tumours
| Pathology (2)
Parotid gland mostly (superficial lobe)
| Most are benign pleomorphic adenomas
155
```
Salivary Gland Tumours
Risk factors (2)
```
Radiation to neck
| Smoking
156
Salivary Gland Tumours
| Signs + symptoms suggestive of malignancy (5)
```
Hard, fixed mass +/- pain
Overlying skin ulceration
Local lymph node enlargement
Tumours don't vary in size at all as seen in inflammation or salivary stones
Facial nerve palsy
```
157
Salivary Gland Tumours
| Investigations (2)
US/MRI
| FNAC/CT-guided biopsy
