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Year 3 GP > ENT > Flashcards

ENT Flashcards

1
Q

Describe the composition of the outer ear

A

Outer 1/3 of ear canal is elastic cartilage (as a continuation of the pinna)
The canal is self cleansing via the epithelial escalator

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2
Q

Describe the composition of Ear Wax and 3 of it’s roles

A

Composed of epithelial cells, lysozymes and oily secretions

Cleaning, Acidic coating prevents microbial growth, Hydrophobic coat prevents water from reaching canal skin

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3
Q

Give 3 risk factors for Otitis Externa

A

Hot & Humid Climates
Swimming
Insufficient/Excess Wax

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4
Q

90% of Otitis Externa infections are bacterial, state two common organisms

A

Staphylococcus Aureus

Pseudomonas Auerginosa

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5
Q

What happens if the infective organism is Herpes Zoster Virus?

A

Ramsay Hunt Syndrome

Reactivates in ganglion causing facial paralysis, loss of taste, vestibulocochlear dysfuncton and ear pain

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6
Q

Give 3 non infective causes of Otitis Externa

A

Acne
Psoriasis
Hearing Aids

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7
Q

Give three classical symptoms of Otitis Externa

A

Pain
Itching
Hearing loss

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8
Q

What is Necrotising/Malignant Otitis Externa

A

Extension of the infection into mastoid and temporal bones, often in the immunocompromised
Headahce of great intensity
Facial nerve paralysis

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9
Q

When do you need to investigate Otitis Externa? And how would you?

A

Only if atypical/treatment failure

Ear swab from medial ear canal

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10
Q

How can you test the integrity of the Tympanic Membrane?

A

Can they taste something put in the ear?

Can they blow air out of their ears when nose is pinched?

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11
Q

How would you manage Otitis Externa?

A

Remove any debris if relevant
Mild - Acetic Acid
Moderate - Antibiotics (not aminoglycosides - OTOTOXIC) +/- steroids
Oral Fluclox if systemically unwell

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12
Q

Give three risk factors for Otitis Media

A

Smoking
Eustacian Tube Dysfunction
URTI

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13
Q

Give two causative organisms for Otitis Media

A

most commonly viral
Haemophilus Influenza
Streptococcus Pneumoniae

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14
Q

Give a classical triad of Otitis Media

A

Otalgia
Hearing Loss
Fever

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15
Q

How would you manage Otitis Media?

A

Paracetamol/NSAIDs
Try to delay abx (unless systemic symptoms of complications - 5 days Amoxicillin)
If recurrent refer to ENT
delayed prescription for strep pneumoniae

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16
Q

What would make you suspect Nasopharyngeal Cancer?

A

Peristent Symptoms
Persistent Cervical Lymphadenopathy
Unilateral Epistaxis

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17
Q

What is Otitis Media with Effusion?

A

A subtype of Otitis Media resulting from either unresolved Otitis Media or non infective obstruction of eustacian tube

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18
Q

Give 3 risk factors for Otitis Media with Effusion

A

Chronic Allergy
Deviated Septum
Enlarged Tonsils

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19
Q

How does Otitis Media with Effusion present

A

Rarely Otalgia
Fullness
Pressure Popping
Imapired hearing

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20
Q

How would the tympanic membrane appear in Otitis Media with Effusion?

A

Retracted and Straw Coloured

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21
Q

How would you temporarily relieve ‘blocked ear’ from Otitis Media with Effusion

A

Valsalva

Normally resolves in 6-12 weeks

22
Q

How would you surgically treat Acute Otitis Media? Give 3 options

A

Adenoidectomy
Grommets
Laser Myringotomy (creating a hole in membrane allows fluid to drain)

23
Q

Describe the pathophysiology of Cholesteotomas

A

Negative pressure pulls the superior part of the tympanic membrane (pars flaccida) backwards allowing epithelial cells to become trapped and proliferate

Normally due to eustacian tube dysfunction

Osteolytic enzyme release can cause bony destruction

24
Q

What is a congenital cholesterotoma?

A

Squamous epithelium is trapped in temporal bone during embryogenesis
Usually presents between 6 months and 5 years
Otoscopy shows pearly white mass behind tympanic membrane

25
Q

Describe Primary and Secondary Acquired Cholesteotomas

A

Primary - 80% of cases

Secondary - Insult to tympanic membrane (as a result of surgery/trauma/otitis media)

26
Q

Give four clinical features of Cholesteatomas

A

Progressive hearing loss
Enzymatic bony destruction (headache, facial nerve palsy)
Foul smelling painless otorrhoea
Pus filled canal with granulation tissue

27
Q

The management of CHolesteotomas is surgical, describe the options

A

General anaesthetic followed by incision behind the ear to remove the Cholesteotoma
Can be open (tymapnomastoidectomy) or closed (tympanoplasty)

28
Q

What is the difference between Vestibular Neuritis and Labyrinthitis?

A

Labyrinthitis - affects labyrinth and vestibular nerve, causes hearing loss
Vestibular Neuritis - affects vestibular nerve only, does not cause hearing loss

29
Q

What is a common cause of Vestibular Neuritis?

A

Reactivation of laent HSV1 infection in vestibular ganglion

Commonly preceded by URTI

30
Q

What is the cause of Labyrinthitis?

A

Inflammation f membranous labryinth

Usually viral in origin (bacterial is more dangerous)

31
Q

What are the common clincial features of Labyrinthitis and VN?

A

Sudden spontaneous veritgo (not necessaeily triggered by movement)
Nausea and Vomiting

32
Q

What extra features does Labyrinthitis have?

A

Hearing Loss

Tinnitus

33
Q

What would Nystagmus look like Labyrinthitis and VN?

A

Consistent and Unidirectional

34
Q

How would you manage Labyrinthitis/VN?

A

If sudden unilateral hearing loss - A&E

Reassurance and mobile as soon as possible

Medication - Prochlorperazine or Antihistamines

35
Q

What is Meniere’s Disease?

A

Distension of membranous labyrinth due to excess endolymph

36
Q

Give 3 risk factors for Meniere’s Disease

A

Allergy
Autoimmunity
Genetic Succeptibility

37
Q

Give 4 clinical features of Meniere’s

A

Vetigo (2 x 20mins is diagnostic)
Tinnitus
Aural Pressure
Fluctuating hearing loss

38
Q

There is no cure for Meniere’s (and requires DVLA notification), what would you give in an acute attack?

A

Prochlorperazine
Cyclizine
IM Steroid Injection (and tapered oral)

39
Q

Give two conservative and two pharmacological prophylactic managements of Meniere’s

A

Conservative - Low Salt, Low Caffiene

Pharmacological - Trial of Betahistine, Diuretics

40
Q

Give two surgical managements of Meniere’s

A

Endolymphatic Sac Decompression

Labyrinthectomy (causes hearing loss)

41
Q

BPPV is the most common cause of vertigo, describe the pathophysiology

A

Hair cells are embedded in otoliths and stimulated by movement of endolymph
If Otoliths become detached there will still be movement
Causes are generally idiopathic

42
Q

Give three presenting features of BPPV

A

Vertigo promoted by head movement (lasting 20-30 seconds)
Nausea
Usually worse in mornings

43
Q

The Dix-Hallpike examination can be used in BPPV. Describe it.

A

Sit patient up on the bed, hold there head at a 45 degree angle and then suddenly drop the patient so their head is off the bed

Observe for Nystagmus (vertical and rotary suggests posterior canal, horizontal suggests horizontal canal)

44
Q

BPPV is self limiting, describe three conservative managements

A

Get out of bed slowly
Reduced head movements
Epley’s manouvre

45
Q

Describe the Epley’s manouvre

A

Aims to reposition the otoliths
Do the Dix-Hallpike movement, wait for nystagmus to cease before turning the patient’s head 90 degrees, then asking patient to slowly roll over and sit up

46
Q

What is an Acoustic Neuroma? Name two risk factors

A

Tumour (often benign and slow growing) arising from the schwann cells of the vestibulocochlear nerve

Risk Factors - Neurofibromatoses, High Dose Ionising Radiation in H&N

47
Q

Describe three presenting features of Acoustic Neuroma

A

Unilateral hearing loss/tinnitus
Impaired Facial Sensation
Balance Problems

48
Q

After investigating with MRI, how could you surgically treat an Acoustic Neuroma?

A

Sterotactic Radiosurgery

Microsurgery

49
Q

What is Otosclerosis?

A

Slowly progressing conductive hearing loss due to increased bone turnover (and subsequent ossicle fusion

Genetic element (Autosomal Dominant) and environmental element (such as lack of Fluoride)

50
Q

Describe three managements of Otosclerosis (post audiological assessment)

A

Bilateral Hearing Aids
Bisphosphonates/NaF
Stapedectomy/Stapedotomy

51
Q

Describe the two types of Tinnitus

A

Objective (Pulsatile - Carotid Stenosis, Muscular - Tympanic Muscle Spasm)

Subjective (Drug related - salicyclates, aminoglycosides, NSAIDs)

52
Q

What should you NOT give if you suspect Glandular Fever?

A

Amoxicillin (can cause secondary rash)

Year 3 GP (6 decks)

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