ENT Flashcards
What is epistaxis?
Bleeding from the nose
Types of epistaxis?
Anterior bleeds 90% - in Little’s area where there is an anastomosis of 5 arteries (so is highly vascularised)
Posterior bleeds 10% - deeper structures of the nose, occurs in older individuals, have a greater risk of obstructing the airway
Important things for epistaxis history?
Recent trauma (picking, foreign body) Co-morbidities Drugs (clotting) Facial pain (nasopharyngeal tumour) FHx/PHx of clotting disorders Otalgia Systemic symptoms
Management of epistaxis
Sat up, sat forward (to protect airway)
Resus if necessary
Nose peg applied for 20 minutes
Ice to back of neck/bridge of nose to promote vasoconstriction
Investigating epistaxis
Adrenaline soaked gauze can cause vasoconstriction and help to visualise the septum
Examine the oropharynx if no bleeding point identified
What is nasal packing used for?
Pack the nose with a nasal tampon to attempt to control the bleeding if no bleeding point found
Posterior packing with a Foley catheter can be used if bleeding into oropharynx
When do we consider surgery in epistaxis?
When nasal packing has been unsuccessful we can ligate surgically or embolise radiologically.
Arteries in Little’s area
Ant./post. ethmoidal
Sphenopalatine artery
Greater palatine artery
Superior labial artery
If we can visualise the point of bleeding in epistaxis, what can we do?
Cauterise using silver nitrate
What is a nasal septal haematoma?
An important complication of nasal trauma in which there is a haematoma between septal cartilage and perichondrium
Symptoms of nasal septal haematoma?
Sensation of nasal obstruction Pain Rhinorrhoea (runny nose) Bilateral red swelling from nasal septum Boggy to palpate (as opposed to deviated septums which are firm)
Management of nasal septal haematoma
Surgical drainage
IV abx
Features of nasal polyps?
Nasal obstruction
Poor sense of smell
Rhinorrhoea/sneezing
Management of nasal polyps?
Corticosteroids shrink 80%
ENT referral
What is the most common cause of tonsillitis?
Viral infections
Bact. infection (1/3) - s. pyogenes/S. aureus
Features of tonsillitis
Difficult/painful swallowing
Pyrexia
Halitosis
Erythematous/swollen tonsils
What is the centor criteria?
Used to assess likelihood of bacterial tonsillitis. Abx if >2
Hx of pyrexia
Tonsillar exudate
No cough
Tender anterior cervical lymphadenopathy
Important differentials of tonsillitis?
EBV (infectious mononucleosis) Head and neck malignancy Leukaemia Scarlett fever Abscess formation
Management of tonsillitis
Symptomatic
Hydration
Abx - penicillin 5 or benzylpenicillin
Why don’t we give amoxicillin in tonsillitis?
If it’s caused by EBV it’ll result in a maculopapular rash
Indication for tonsillectomy?
>7 episodes in the last year >5 episodes in each of the last 2 years >3 episodes in each of the last 3 years Suspected malignancy Sleep apnoea Peritonsillar abscess formation
What is quinsy?
Quinsy is a peritonsillar abscess, a common complication of bacterial tonsillitis
What are the symptoms of quinsy?
Sore throat Difficulty swallowing Trismus (reduced ROM of jaw - lockjaw) Pyrexia Peri-tonsillar swelling and a deviated uvula
How do we treat quinsy?
Needle aspiration with topical anaesthetic
Incision and drainage
Following drainage, abx cover - typically metronidazole and penicillin regime