ENT Flashcards
What are the causes of sinusitis?
Infection (usually viral)
Allergic
Air pollution
Structural problems
Treatment of sinusitis?
1) Watchful waiting
2) © Acute = Intranasal decongestants, nasal douching + warm face packs
3) © Chronic = Intranasal steroids (beclametasone) if symptoms >10 days + prevention
4) No improvement in 7-10 days + systemically unwell – amoxicillin/co-amoxiclav
5) Symptomatic relief – painkillers e.g. naproxen, nasal steroids
What is BPPV?
See notes
What are the 4 cardinal symptoms of Meniere’s?
- Vertigo (lasts mins-hours, the patient is normal between attacks)
- Hearing loss (uni/bilateral, but level fluctuates)
- Tinnitus (usually precedes an attack of vertigo)
- Aural fullness (described as a pressure, fullness or warm feeling in the ear)
- Can also get nystagmus
What are the average number of Menieres attacks/yr?
6-11
Mx of Menieres?
- Tx: medical management – beta-histamine, gentamicin injections (saw the lady in GP), low salt diet and diuretics (to prevent fluid build-up)
- Surgical management – decompressing the inner ear (draining the endolymphatic sac), disconnecting the labyrinth (vestibular neurectomy) or labyrinthectomy (destruction of the labyrinth)
Difference between labyrinthitis and vestibular neuritis?
Lab - semi-circular canals AND vestibular nerve, hearing IS affected, get NYSTAGMUS
VN - ONLY vestibular nerve, UNaffected hearing, Tx with prochlorperazine (antiemetic) in acute phase
What are the S+S of acoustic neuroma?
- Unilateral sensorineural hearing loss (must exclude in all presenting patients)
- Unilateral tinnitus
- Impaired facial sensation (CN5)
- Balance problems
- Otalgia
- Ataxia
- Signs of increased ICP
- Absent corneal reflex
How to Tx acoustic neuroma?
1) Watchful waiting – weigh up the risks of surgery vs rapid tumour growth
2) Surgery
3) Stereotactic radiosurgery
What are the RFs for oral Ca?
RFs: men, increasing age, smoking, heavy drinking
What is the treatment for oral Ca?
Photodynamic therapy
Excision
What are the S+S of oral Ca?
- An ulcer that won’t heal
- Red/white plaques on the inside of the mouth
- A painful lump that won’t resolve
S+S of cholesteatoma?
Foul-smelling, unresolving watery discharge, unilateral conductive hearing loss
Other – vertigo, facial nerve palsy
What do you see on otoscope for cholesteatoma?
Attic crust
What are nasopharyngeal tumours and how to Ix?
See notes
What is otosclerosis?
See notes
Cause of sudden onset sensorineural hearing loss?
Causes – infection, trauma, immunological, toxins, ototoxic drugs, MS
Mx of sudden onset sensorineural hearing loss?
many spontaneously recover c/in 3 days, oral corticosteroid therapy immediately
+ refer to ENT, hyperbaric oxygen, antivirals, vasodilators etc
What are you concerned about with a unilateral serous effusion?
Nasopharyngeal tumour
How to Tx acute OM?
See notes
What can you see in OME?
Intact, retracted tympanic membrane
Loss of light reflex
What can cause OME?
Obstruction or damage to the eustachian tube
How to Tx OME?
o 95% resolve spontaneously within 1 year
o Only consider treatment for persistent bilateral OME and hearing loss after 3 months – Tx with decongestants and antibiotics
o Grommets in some cases
What pathogens © cause OM?
H. influenza, S. pneumonia, Moraxella catarrhalis
What are the causes and RF for OE?
Narrow, tortuous ear canal Moisture Foreign body Trauma Chronic skin condition
Ix for OE?
Test urine for sugar if >50
Swabs
Tx for OE?
abx + steroids = Gentisone-HC
Flucloxacillin
Clotrimazole
Aural toileting
What is malignant OE?
OE that has spread to cause osteomyelitis of the skull base, due to pseudomonas aeruginosa + anaerobes causing a mound of tissue in the external canal
Tx of malignant OE?
emergency
IV ciprofloxacin
What are the S+S of mastoiditis?
Earache + discharge
Pyrexia, ill-looking
Tenderness over mastoid antrum
Pinna may be pushed down and forward due to a swelling in the post-auricular region
Tympanic membrane = red, bulging or perforated
Signs of conductive deafness
How to Mx mastoiditis?
IV 3rd gen cephalosporin
May req drainage
What is masked mastoiditis?
abx fail to resolve acute presentation so low-grade granular osteitis develops in the mastoid bone
What is a pre-auricular sinus and how to Tx?
Form by incomplete fusion of the pinna
Can be foul-smelling pus if infected
Need surgical removal
What are the worrying signs for nasal polyps?
Unilateral
Bleeding
Triggers thoughts of nasal Ca
What is Samter’s triad?
Aspirin sensitivity, asthma and nasal polyposis
Management of nasal polyps?
- Test for allergy
- Check for CF in children
- Biopsy for neoplasia if unilateral
Medical Mx – topical steroids
Surgical Mx – nasal polypectomy
What is the presentation of nasal septal haematoma?
- © the sensation of nasal obstruction
- Pain + rhinorrhoea
- Classically pt has a bilateral, ‘boggy’, red swelling arising from the septum
Why do you need to treat nasal septal haematomas as an emergency and how to Tx?
Because the septum could become necrotic within 3-4 days and cause a saddle-nose deformity
Tx with drainage and IV abx
What is the management for allergic rhinitis?
Mild-mod: oral/intranasal antihistamines
Mod-sev: intranasal corticosteroids
For topical decongestants role, see notes
S+S of ramsay hunt syndrome?
PAIN, hearing loss + earache, FN palsy, vesicular rash around the ear or on tongue, vertigo, tinnitus
What is the pathophysiology of ramsay hunt syndrome?
Shingles that is affecting the facial nerve
What is the management of Ramsay-hunt syndrome?
PO acyclovir and corticosteroids
Mx of Bell’s palsy?
prednisolone PO 10 days within 72 hours + artificial tears
Causes of Bell’s?
Herpes predominently
Which drugs are ototoxic?
Gentamicin, quinine, furosemide, aspirin + some chemo
What is the presentation of quinsy?
- Severe throat pain, lateralises to one side
- Deviation of the uvula to the unaffected side
- Reduced neck mobility
- ‘lockjaw’ may occur d/t trismus (motor disturbance of the trigeminal nerve)
Tx of quinsy?
Need urgent ENT review
Tx with needle aspiration under local anaesthasesia
Systemic penicillin
Consider tonsillectomy in 6wks time
