ENT Flashcards
Otitis media
Antibiotics should be prescribed immediately if:
Symptoms lasting more than – days or not improving
Systemically unwell but not requiring admission
— or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than –years with – otitis media
Otitis media with perforation and/or — in the canal
If an antibiotic is given, a 5-day course of— is first-line.
In patients with penicillin allergy, – or – should be given.
Otitis media
Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
If an antibiotic is given, a 5-day course of amoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given.
Unilateral – are a red flag symptom
Unilateral polyps are a red flag symptom
Nasal polyps
Associations a-- a-- infective sinusitis c-- --syndrome -- syndrome
The association of asthma, aspirin sensitivity and nasal polyposis is known as — triad.
Features
nasal –
rhino–, sneezing
poor sense of —–
Unusual features which always require further investigation include unilateral symptoms or bleeding.
Management
all patients with suspected nasal polyps should be referred to ENT for a full examination
topical — shrink polyp size in around 80% of patients
Nasal polyps
Around in 1% of adults in the UK have nasal polyps. They are around 2-4 times more common in men and are not commonly seen in children or the elderly.
Associations asthma (particularly late-onset asthma) aspirin sensitivity infective sinusitis cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome
The association of asthma, aspirin sensitivity and nasal polyposis is known as Samter’s triad.
Features
nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell
Unusual features which always require further investigation include unilateral symptoms or bleeding.
Management
all patients with suspected nasal polyps should be referred to ENT for a full examination
topical corticosteroids shrink polyp size in around 80% of patients
Gingival hyperplasia:
Gingival hyperplasia:
phenytoin, ciclosporin, calcium channel blockers and AML
CAML PC
Tonsillitis and tonsillectomy
Complications of tonsillitis include:
otitis–
quinsy - — abscess
– fever and –nephritis very rarely
Tonsillitis and tonsillectomy
Complications of tonsillitis include:
otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely
Neck lumps
The table below gives characteristic exam question features for conditions causing neck lumps:
Reactive lymphadenopathy
There may be a history of local – or a generalised –illness
Lymphoma Rubbery, painless lymphadenopathy
The phenomenon of pain whilst — is very uncommon
There may be associated – and —
Thyroid swelling May be hypo-, eu- or hyperthyroid symptomatically
— on swallowing
Thyroglossal cyst More common in patients < 20 years old
Usually –, between the isthmus of the thyroid and the hyoid bone
Moves upwards with –
May be painful if infected
Pharyngeal pouch More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are –, –, – and–
Cystic hygroma A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the – side
Most are evident at —, around 90% present before 2 years of age
Branchial cyst An oval, mobile cystic mass that develops between the —muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Cervical rib More common in adult –
Around 10% develop thoracic outlet syndrome
Carotid aneurysm Pulsatile lateral neck mass which —swallowing
Neck lumps
The table below gives characteristic exam question features for conditions causing neck lumps:
Condition Notes
Reactive lymphadenopathy By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness
Lymphoma Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly
Thyroid swelling May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing
Thyroglossal cyst More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
Pharyngeal pouch More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
Cystic hygroma A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
Branchial cyst An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Cervical rib More common in adult females
Around 10% develop thoracic outlet syndrome
Carotid aneurysm Pulsatile lateral neck mass which doesn’t move on swallowing
Otosclerosis Autosomal –, replacement of normal bone by vascular spongy bone.
Onset is usually at– years - features include:
– deafness
tinnitus
tympanic membrane - 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
positive family history
Otosclerosis Autosomal dominant, replacement of normal bone by vascular spongy bone. Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
tympanic membrane - 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
positive family history
Glue ear
Also known as otitis media with effusion
peaks at 2 years of age
– is usually the presenting feature (glue ear is the commonest cause of – hearing loss and elective surgery in childhood)
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
Glue ear Also known as otitis media with effusion
peaks at 2 years of age
hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
Meniere’s disease
More common in — adults
recurrent episodes of x3
– is usually the prominent symptom
a sensation of aural – or pressure is now recognised as being common
other features include nystagmus and a positive — test
episodes last minutes to hours
Meniere’s disease More common in middle-aged adults
recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
Drug ototoxicity
Examples include – (e.g. G–), f–, a– and a number of cytotoxic agents
Drug ototoxicity Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
Noise damage Workers in heavy industry are particularly at risk
Hearing loss is bilateral and typically is worse at frequencies of — Hz
Noise damage Workers in heavy industry are particularly at risk
Hearing loss is bilateral and typically is worse at frequencies of 3000-6000 Hz
Acoustic neuroma (more correctly called vestibular schwannomas)
Features can be predicted by the affected cranial nerves
cranial nerve VIII:
cranial nerve V:
cranial nerve VII:
Bilateral acoustic neuromas are seen in – type 2
Acoustic neuroma (more correctly called vestibular schwannomas) Features can be predicted by the affected cranial nerves
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
Bilateral acoustic neuromas are seen in neurofibromatosis type 2
Auricular haematomas need:
Auricular haematomas need same day assessment by ENT
Facial pain
Sinusitis
Facial ‘–’ and –
Nasal –, pyrexia or post-nasal drip leading to –
Trigeminal neuralgia
-lateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination
May be triggered by –, emotion
Cluster headache Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
Clusters typically last 4-12 weeks
Intense pain around –
Accompanied by —, lacrimation, lid swelling, nasal stuffiness
Temporal arteritis Tender around–
Raised –
acial pain
The table below gives characteristic exam question features for conditions causing facial pain
Condition Characteristic exam feature
Sinusitis Facial ‘fullness’ and tenderness
Nasal discharge, pyrexia or post-nasal drip leading to cough
Trigeminal neuralgia Unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination
May be triggered by light touch, emotion
Cluster headache Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
Clusters typically last 4-12 weeks
Intense pain around one eye
Accompanied by redness, lacrimation, lid swelling, nasal stuffiness
Temporal arteritis Tender around temples
Raised ESR
Rinne’s test
tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus
‘positive test’: — is normally better than – conduction
‘negative test’: if – > – then – deafness
Weber’s test
tuning fork is placed in the middle of the forehead equidistant from the patient’s ears
the patient is then asked which side is loudest
in unilateral sensorineural deafness, sound is localised to the – side
in unilateral conductive deafness, sound is localised to the - side
Rinne’s test
tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus
‘positive test’: air conduction (AC) is normally better than bone conduction (BC)
‘negative test’: if BC > AC then conductive deafness
Weber’s test
tuning fork is placed in the middle of the forehead equidistant from the patient’s ears
the patient is then asked which side is loudest
in unilateral sensorineural deafness, sound is localised to the unaffected side
in unilateral conductive deafness, sound is localised to the affected side
