ENT Flashcards
What is the treatment for bacterial otitis externa?
Gentamicin drops
Steroid drops
Why does having a hearing aid increase the risk of otitis externa?
Keeps air in auditory canal continuously moist
What can overuse of gentamicin ear drops lead to?
Secondary fungal infection
A 57 year old mechanic presents with unilateral left sided tinnitus and hearing loss. On examination you notice he is unable to abduct his left eye. What is the likely cause?
Acoustic neuroma
What is a cholesteatoma?
Keratinising squamous epithelium that grow and invade structures in the middle ear so patient can present with facial nerve problems, sensorineural hearing loss, purulent discharge
Why might a patient with obstructive sleep apnoea complain of a sore throat?
Mouth breathing: air is not moistened by normal mechanisms in the nose so dries and damages the pharyngeal mucosa
What are causes of vertigo?
Benign paroxysmal vertigo
Labyrinthitis
Ménière’s disease
What causes benign paroxysmal vertigo?
An otolith in the semicircular canals which disturbs the fluid and causes a sensation of vertigo especially when turning head to side
What is treatment for benign paroxysmal vertigo?
Epley manoeuvre
What is Ménière’s disease?
Due to over production of fluid within semi circular canals and causes vertigo and tinnitus, hearing loss and aural fullness
What is presbyacusis?
Deterioration of hearing related to age
Hearing loss in group situations and when there is background noise
Comes on gradually and is difficult to pinpoint the starting point
Audiogram will show sensorineural deafness in higher frequency ranges
What is otosclerosis?
Autoimmune disease where there is bony fusion occurring between ossicles, specifically between foot plate of stapes and oval window
Presents as gradual conductive hearing loss
What would expect nasal polyps to look like on examination?
Mucosa appears pale and gelatinous
Polyps found under middle turbinate
They can fill maxillary sinus and extend out from middle meatus
What are symptoms of nasal polyps?
Rhinorrhoea
Obstructed nasal airways
What is the treatment for chronic otitis media?
Grommet insertion
What might a tympanic membrane of an adult look like who had a history of recurrent otitis media with effusion as a child?
Ear drum look retracted and scarred
Tympanosclerosis
What is the treatment for chronic otitis media?
Grommet insertion
What might a tympanic membrane of an adult look like who had a history of recurrent otitis media with effusion as a child?
Ear drum look retracted and scarred
Tympanosclerosis
A 47 year old male has a lump in the back of his neck. It’s 2cm round lesion which is non tender and freely moveable beneath dermis. It’s hard with a smooth surface. The overlying skin is a normal colour and a sinus is visible. What is the likely diagnosis?
Sebaceous cyst
A 67 year old female presents to her GP with a soft fluctuant non tender 5cm round mass at the side of her neck. It has been present for many years and caused her no problems. What is the likely diagnosis?
Lipoma
What is a laryngocoele?
Rare cause of neck lump in wind instrument players. High pressure in larynx causes outpouching of laryngeal mucosa
Where would you find a branchial cyst?
Anterior triangle a third of the way along SCM
What is the embryological origin of malleus?
Mesoderm of first pharyngeal arch
What are risk factors otitis media?
Younger age Male sex Smoking in the household Nursery attendance Formula feeding Craniofacial abnormalities GORD Dummy use Winter Supine feeding
What are symptoms of otitis media?
Pain (pulling at ear) Malaise Irritability, crying, poor feeding, restless Fever Coryza/rhinorrhoea Vomiting
What are signs of otitis media?
High temperature
Red, yellow or cloudy tympanic membrane
Bulging tympanic membrane
Air fluid level behind tympanic membrane
Discharge in auditory canal secondary to perforation
Red pinna
Which cases of acute otitis media should be admitted?
Children under 3 months with a temp 38 or more
Children with suspected complications - meningitis, mastoiditis or facial nerve paralysis
What are the most common bacterial pathogens that cause acute otitis media?
Haemophilus influenzae
Strep pneumoniae
Moraxella catarrhalis
Strep pyogenes
What are the boundaries of the posterior triangle of the neck?
Sternocleidomastoid
Trapezius
Middle 3rd clavicle
What are the arteries in the anterior triangle of the neck?
Third part of subclavian
Transverse cervical
Suprascapular
Occipital
What are the nerves in the posterior triangle?
Supraclavicular part of brachial plexus Accessory nerve Cervical plexus Lesser occipital nerve Great auricular nerve Transverse cervical nerve Phrenic nerve Supraclavicular nerve
What would a perforated eardrum from otitis media look like?
Central perforation
Can see drum margin clearly around hole
What is the fistula sign?
Putting pressure on external ear canal by forcibly occluding external auditory meatus with a finger causes vertigo - sign of serious otitis media
What is the hallpike manoeuvre?
Patient sits on couch
Head turned towards one ear and supported by examiner while patient lies down until head below horizontal
Nystagmus noted when head turned to affected ear
Diagnose BPPV
What is the Epley manoeuvre?
Treat BPPV
Uses gravity to relocate otoliths back into utricle where they can no longer stimulate the cupula
Patient begins in upright sitting position with legs rotated and head rotated 45 degrees towards side that gave a positive hallpike test
Patient quickly and passively forced down backwards into supine position with head in 30 degree neck extension
Look for nystagmus
Remain in this position 1-2 mins
Roll onto shoulder and rotate head another 90 degrees in direction they are facing
Look for nystagmus
Remain for 1-2 mins
Bring up to sitting position while maintaining 45 degree rotation of head
What is the management for otitis media?
Treat pain
Usually no or delayed prescription (4 days)
Antibiotics if: under 2, lasts over 4 days, perforation and discharge, systemically unwell or Immunocompromised
What are management options for glue ear?
90% will resolve in a year, so don’t need to do anything
Auto inflators
Grommets if affecting their speech
A patient has otitis externa, what advice would you give them?
Antibiotic resistance can be a problem
What can lead to Eustachian tube dysfunction?
Upper respiratory tract infection
Hayfever
What region do cholesteatomas grow in?
Attic area
A 63 year old man presents with unilateral tinnitus, what is the appropriate next step?
Arrange hearing test - rule out acoustic neuroma (deafness)
What triad is present in Menieres?
Deafness
Tinnitus
Vertigo
