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ENT Flashcards

1
Q

Describe the difference between a laryngectomy and a tracheostomy

A

Laryngectomy - surgical removal of larynx and vocal cords, no functional upper airway, trachea separated from oesophagus and brought out opening at front of neck

Tracheostomy - opening in neck made and trachea brought out, voice box in tact, can be permanent/temporary. Tracheostomy tube then placed below level of vocal cords

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2
Q

Describe types of dizziness

A

Can be

  • light headedness
  • vertigo (rotational)
  • unsteadiness
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3
Q

Describe the types of vertigo

A

Subjective - patient is stationary and environment rotates

Objective - patient is in motion and environment is stationary

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4
Q

List the differential causes of vertigo

A

BPPV
Meniere’s disease
Vestibular neuronitis (acute vertigo with no hearing loss)
Labyrinthitis (acute vertigo and hearing loss)
Vestibular migraine
Acoustic neuroma (vestibular schwannoma)

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5
Q

Describe the hallmark features of BPPV:

A
  • comes on with head movements
  • symptoms last seconds
  • repeated episodes
  • no hearing changes
  • Dix-Hallpike manouevre is diagnostic
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6
Q

Describe the hallmark features of Meniere’s disease:

A
  • PRODROME of aural fullness, SN hearing loss and tinnitus, THEN vertigo occurs
  • episodic lasting days/months

Between episodes of the disease the patient is completely fine

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7
Q

Describe the hallmark features of vestibular neuronitis:

A
  • acute onset vertigo, unwell and bed bound, lasts constantly for weeks before resolving, NO HEARING CHANGES
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8
Q

Describe the hallmark features of acute labyrinthitis:

A
  • acute onset vertigo, unwell and bed bound, lasts constantly for weeks before resolving, WITH HEARING LOSS
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9
Q

What special tests are used to

a) diagnose
b) treat

BPPV

A

a) Dix-Hallpike to diagnose

b) Epley to treat

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10
Q

Define tinnitus (subjective and objective)

A

Tinnitus = perception of sound in the absence of acoustic or electrical stimulation of the cochlea lasting >5 minutes

Sub - only heard by the patient, obj - audible to the patient and the examiner

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11
Q

List 7 causes of tinnitus

A 
Idiopathic
Ototoxic drugs
Hearing loss
Meniere's disease
Otosclerosis
Acoustic neuroma
Somatosounds
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12
Q

What are glomus tumours

A

A type of paraganglioma
Can occur in the middle ear, temporal bone, vagus nerve or carotid body
Present with persistent pulsatile tinnitus
Can also secrete catecholamines and present with hypertension
Often a pulsatile red mass can be seen behind the eardrum

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13
Q

When should tinnitus be investigated?

A

If it is pulsatile, unilateral or associated with neurological of vestibular (balance) symptoms

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14
Q

What Q’s would you ask in a tinnitus Hx?

A

constant or intermittent?
Disturbing sleep?
Pulsatile/with heart beat?
Is it in both ears?

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15
Q

How is tinnitus managed

A

Objective - treat the underlying cause -> surgery

Subjective - reassurance, explanation, hearing aids, white noise, councelling, ?TCA’s

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16
Q

Describe red flag symptoms for head and neck cancers

A 
Hoarseness
Weight loss
Dysphagia
New persistent neck lump
Unilateral nasal obstruction
Unilateral otalgia with normal examination
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17
Q

Describe a thyroglossal duct cyst

A

Forms due to failure of the duct to obliterate during embryological development
Midline, firm, trans-illuminatable lump which elevates with tongue protrusion/swallowing
Can malignant transformation later in life
Tx: surgical removal + portion of hyoid bone (sistrunk procedure)

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18
Q

Describe a branchial cyst, its classical presentation and investigation

A

Usually <30yrs (rare >35 therefore need to exclude a cystic met)
A swelling in the middle 1/3 of SCM in the anterior triangle, a developmental abnormality due to failure of closure of branchial cyst

Investigate with USS and FNA

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19
Q

What 2 H&N malignancies present with hoarseness

A 
Laryngeal cancer
Lung cancer (compressing RLN)
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20
Q

What is the most common type of H&N cancer

A

Squamous cell

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21
Q

Describe the centor clinical prediction score

A

Used to predict the risk that a patient has bacterial tonsillitis caused by GABHS and assists the decision to prescribe antibiotics

If >3 are present, then 50% chance the sore throat is caused by GABHS

  • absent cough
  • history of fever
  • presence of tonsillar exudate
  • tender cervical LN
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22
Q

Describe the emergency management of epiglottitis

A

1) O2
2) Get senior help - anaesthetist/ENT
3) Secure airway with ET tube
4) Nebulised adrenaline 1:1000 1mg in 5ml normal saline
5) IV dexamethasone 6.6mg
6) IV antibiotics (ceftriaxone) 2g
7) Heliox if available
8) NBM

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23
Q

Describe the cardinal features of otitis externa

A

ITCH
Discharge and pain which onset at the same time
Sloughy debris seem in the EAM on examination

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24
Q

What is the most common causative bacterial agent of otitis externa?

A

Pseudomonas aeroguinosa

25
How is otitis externa treated?
CLEAN - cut nails, no cotton buds Topical steroids Topical Abx drop (May need Pope Wick insertion by ENT in some cases)
26
Describe necrotising otitis externa
A form of skull base osteomyelitis Seen in immunocompromised/DM Caused by pseudomonas Ear pain which KEEPS AWAKE AT NIGHT and discharge Granulation tissue seen on examination Needs Tx with IV Abx with bony penetration for 6/52
27
Describe otitis media
Infection of middle ear with fluid present Can be sterile fluid (glue ear) or pussy (acute OM) Commonly caused by strep pneumoniae Ear pain, discharge then occurs later if TM perfs Buldging red TM seen on examination Tx: paracetamol +/- amoxicillin
28
Differentiate PTA testing from tympanometry
PTA = pure tone audiogram, this is subjective and needs soundproof conditions Tympanometry = objective, tests middle ear compliance, more time consuming
29
List conductive causes of hearing loss
- pinna malformation - ear wax - otitis externa - TM performation - otitis media - cholesteatoma - otosclerosis
30
Describe a cholesteatoma and how it may present
= active squamous otitis media - a sac of keratinising squamous epithelium occurs in the middle ear and presents with a DISCHARGING EAR THAT DOES NOT RESPOND TO ABX
31
What is the most common cause of sensorineural hearing loss?
Presbyacusis (age related SNHL)
32
List causes of SNHL
``` Presbyacusis Cochlear nerve damage Menieres disease Labyrinthitis Ototoxic medication Infection e.g. meningitis CPA lesions e.g. acoustic neuroma ```
33
Describe otosclerosis
Abnormal bone growth around the stapes leading to stapes fixation
34
What is the characteristic feature of otosclerosis on PTA
Carhart's notch
35
How is otosclerosis treated
Hearing aid | Stapedectomy
36
When are air conduction and bone conduction hearing aids used?
Air conduction hearing aids -> for CHL | Bone conduction hearing aids -> for CHL when ^ does not work, or for some types of SNHL
37
Describe the newborn hearing tests which exist
AOAE (automated oto-acoustic emission test): from birth to 3 months, plays noise into ear and looks for rebound response. May need repeated if noisy surroundings or fluid in ear canal AABR (automated auditory brainstem response): used if failed result from ^, sensors placed on baby's head and noise played through headphones, looks for brainstem stimulation
38
Wha are the impacts of hearing loss in childhood?
Slowed development Poor speech and language Peer acceptance/social isolation Access to work/higher education opportunities reduced
39
Define allergic rhinitis vs non-allergic rhinitis
Allergic rhinitis = inflammation of the nasal mucosa caused by an allergen, and non-allergic rhinitis = inflammation of the nasal mucosa not formed caused an allergen but by an irritant e.g. smoke, air pollution (allergy tests are -ve)
40
What are the features of allergic rhinitis
nasal congestion, runny nose (discharge), itch, sneezing, red watery eyes, associated with other atopic disease e.g. house dust, pollen
41
What are the findings on examination of allergic rhinitis
Oedematous, swollen nasal turbinates, nasal congestion and clear discharge
42
What should you ask in a history for allergic rhinitis?
When did symptoms start? Do they occur every year or always at the same time? Do they have pets/feather bedding? When are their symptoms worst - e.g. when visiting a relative with pets? What treatments are they on/have tried?
43
What are the treatments for allergic rhinitis
self care nasal saline / steroid sprays / antihistamine nasal sprays barrier creams (vaseline) to catch allergen Oral antihistamine for seasonal allergic rhinitis only
44
Is itchiness mainly a feature of allergic or non-allergic rhinitis?
Allergic
45
Define acute and chronic sinusitis/rhinosinusitis
``` Sinusitis = inflammation of the paranasal sinuses Rhinosinusitis = inflammation of the paranasal sinuses + nasal mucosa ``` Acute <12/52, chronic >12/52
46
Describe the EPOS criteria for diagnosing rhinosinusitis
2+ of the following symptoms: - nasal obstruction - nasal blockage - nasal congestion - nasal discharge
47
What investigations may be carried out for sinusitis?
- CT paranasal sinuses | - endoscopy
48
What complication can arise from nasal fracture which must be ruled out
Septal haematoma -> can lead to ischaemia, necrosis and perforation
49
List 5 causes of voice hoarseness
``` Laryngeal cancer (SCC) Functional dysphonia Vocal cord nodules Reinke's oedema (smokers) Presbyphonia ```
50
What are the branches of the facial nerve?
``` temporal zygomatic buccal marginal mandibular cervical ```
51
Describe the common parotid tumours
80% benign (pleomorphic adenomas and warthlin's tumour) 20% malignant (mucoepidermoid carcinomas, adenocarcinomas and squamous cell carcinomas) parotid tumours make up 80% of all salivary gland tumours
52
What virus causes ramsay hunt syndrome
HZV (herpes zoster virus)
53
What are the red flag symptoms that warrant a 2 week urgent referral for suspicion of H&N cancer?
Hoarseness > 6 weeks Oral mucosa (ulcerations or swellings) > 3 weeks Red/white patches on oral mucosa New persistent neck lump >3 weeks Dysphasia Persistent unilateral nasal obstruction (esp. accompanied with purulent discharge) Persistent unilateral otalgia with normal otoscopy Cranial nerve involvement
54
List 6 differentials of hoarse voice
``` Laryngeal cancer Vocal cord palsy (from RLN damage 2o to lung ca) Presbyphonia Laryngitis (from reflux) Reinke's oedema Vocal cord cyst/polyp ```
55
What is the most common type of H&N cancer
Squamous cell carcinoma
56
Contrast the infective agents which cause OM vs OE
``` OE = pseudomonas aerginosa OM = strep pneumoniae, haem influenza ```
57
What is the visible difference between costochondritis and pinna cellulitis
Lobe is spared in costochondritis
58
What 4 blood vessels converge to form Little's area in the nose?
GASS - greater palatine - anterior ethmoidal - sphenopalatine - superior labial (all branches of the internal and external carotid branches)

Year 4 (28 decks)

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