ENT Flashcards

1
Q

ENT conditions that can interfere with aviation

A
Barotrauma eg barotitis, barosinusitis
Allergic rhinitis
Sinusitis
Hearing loss
Vertigo
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2
Q

Most common ENT disorders in ADF

A
Nasal obstruction and sinus disorders 
Snoring and sleep apnoea
Tonsillitis, infectious mononucleosis
Otitis external
Other 
- barotitis, hearing loss, throat symptoms, middle ear problems, epistaxis
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3
Q

Presentation and symptoms of Barotitis

A

Presentation: inability to equalise the middle ear with the Atm due to Eustachian tube dysfunction

Cause: URTI, allergy, anatomical defects, tumours

Symptoms and signs

  • pain on descent
  • aural fullness
  • hearing loss
  • bloody discharge
  • tinnitus and vertigo
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4
Q

Aeromedical concerns of barotitis.

  • effect on environment on condition
  • effect of condition on environment
A

The condition

  • incapacitation
  • distraction
  • alternobaric vertigo
  • hearing loss/communications

The environment

  • Altitiude/pressure profile
  • Boyle’s Law
  • use of headsets/earplugs
  • Valsalva with aviator’s mask
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5
Q

Important things to ask and look for when assessing barotitis

A
Hx of URTI or allergy - underlaying cause
Concurrent barotrauma
Likelihood of reverse ear block
Otoscopic
- Erythema of TM
- Punctate haemorrhages
- serous exudate
- Haemotympanum
- perforated TM
- look for Grade of barotrauma
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6
Q

Investigations, treatment and referral for barotitis

A
Audiometry
Tympanometry
Nasal endoscopy
Allergy testing
CT scan sinuses - should have specialist involvement at this stage
Remember adenoids

Tx

  • Tx URTI - decongestants and antibiotics
  • politxerisation
  • myringotomy
  • ventilation tubes eg grommets

Carry decogestants in future

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7
Q

Aeromedical disposition for barotitis

A

Military

  • TMUFF while investigating
  • TMUFF if symptomatic and until cause established
  • Grommets disqualify for flying while they are in.
  • need to be clear to return to flying eg perforation healed

CASA

  • based on function. Applicants should be able to ventilate the middle ear.
  • Perforations of the tympanic membrane are acceptable
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8
Q

Cause of sinus barotrauma

A

Usually history of URTI or chronic sinusitis

Inability to equalise sinuses and atmosphere resulting in shearing of sinus mucosa and submucosal haemorrhage caused by negative pressure

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9
Q

How does Sinus barotrauma present

A
More common than on descent
- persistent pain 
- sometimes tenderness
- epistaxis in 15% of people 
May be acute or chronic 
Affects the frontal sinuses in 80% of cases
Maxillary sinus next most common
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10
Q

Aeromedical concerns for sinus barotrauma

  • condition
  • environment
A

The condition

  • pain is severe
  • incapacitating

The environment

  • altitude/pressure profile
  • Boyle’s Law
  • normally on descent
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11
Q

Treatment and aeromedical disposition for sinus barotrauma

A

Tx - nsala and oral decngestants, analgesia, steroids, saline sprays, flushing, surgery

Military
TMUFF while determining cause
Return to unrestricted flying if correctable cause is fixed
Ground trails as need
Desensitisation therapy can take up to 3 years

CASA
Acute sinusitis temporarily unfit
if underlying chronic sinusitis must be referred to treated

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12
Q

Investigation for allergic rhinitis

A

Total IgE
RAST egress mix, dust/mite mix, mould mix
Skin scratch/prick - allergist
CT sinus

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13
Q

Aeromedical disposition for allergic rhinitis

A

Military
- TMUFF while symptomatic
- good control of symptoms with approval meds compatible with flying
Likely UAMECR

CASA

  • Minimal issue for CASA
  • Managed by GP or DAME
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14
Q

Aeromedical disposition of sinusitis

A

Military

  • acute sinusitis, TMUFF while symptomatic only
  • chronic sinusitis TMUFF, MECR required

CASA
- same as military

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15
Q

Vertigo
Effect of condition on aviation
Effect of aviation on conditions

A

Condition

  • incapacitating
  • many possible diagnosis
  • impairs balance and movement
  • impairs vision

Environment

  • Acceleration forces
  • head movements
  • spatial disorientation
  • loss of aircraft control
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16
Q

Aeromedical disposition for vertigo

A
Military 
TMUFF while symptomatic
period of observation 
return multi crew before solo
IAMECR

CASA
Case by cases based on frequency and severity
must be fully investigated

17
Q

Aeromedical disposition for meniere’s

A

Military
IAMECR/CAMECR
unfit for flying duties A4

CASA
Full investigation, specialist report requried
Case by case but likely unit for flying