ENT Flashcards
What name is given to the condition in which there is formation of an oeseophageal web above the aortic arch in associated with concomitant iron deficiency in women?
Plummer-Vinson syndrome
Main symptom=dysphagia
What is concerning with regards to Plummer-Vinson syndrome?
Pre-malignant
associated with development of carcinoma in crico-pharyngeal region
When should tonsillectomy be offered to children?
7 or more documented severe sore throats in a year, 5 or more yearly in 2 successive years, 3 or more yearly in 3 successive years (Paradise criteria)
Difference between pinna cellulitis and pinna perichondritis on examination?
pinna perichondritis typically spares the lobule (as inflammation of the perichondrium surrounding cartilage)
usually result of penetrating trauma e.g. piercing
Most common causative organism in perichondritis and OE?
pseudomonas aeruginosa
whereas staph aureus most common cause of pinna cellulitis-treat with PO Abx +/- topical if underlying OE
Usual tx of perichondritis?
ciprofloxacin
admit for IV Abx if fail to respond to tx
Which dx should be suspected if repeated episodes of atraumatic pinna perichondritis?
relapsing polychondritis=chronic systemic condition, tx with steroids and immunosuppressants
With regards to oral ulcers, when should patients be referred urgently to secondary care? (2ww)
if unexplained oral ulceration persisting for more than 3 weeks
Preferred treatment for patients with persistent sx of vestibular neuronitis lasting more than 1 week?
vestibular rehabilitation exercises
NICE recommend urgent referral to balance specialist for further assessment if sx for more than 1 week
Most common cause of bullous myringitis (<10% of AOM cases)?
Strep pneumoniae
Recommended tx to improve recovery in Bells Palsy if presentation within 72hrs of sx onset?
Prednisolone 50mg OD for 10 days OR
prednisolone 60mg OD for 5 days then dose reduction by 10mg OD for next 5 days
Otitis media with effusion (glue ear) occurs in 90% of children with what condition?
cleft palate
Which intranasal steroid spray is licensed for children from the age of 4?
fluticasone
from the age of 6 can use beclometasone, and from the age of 12 can use budesonide
Who requires a 2ww referral for suspected laryngeal cancer?
if age 45 and over with either:
persistent unexplained hoarseness OR
unexplained lump in neck
also consider 2ww referral for suspected oral cancer at any age with a persistent unexplained neck lump
Loss of hearing at what frequency is characteristic of noise induced deafness?
4 kHz
When to consider 2ww referral for possilbe H+N cancers?
mass/lump in oropharynx
mass/lump in neck
persistent sore throat (espec. if unilateral)
persistent ulceration in oral cavity
>40yrs with unilateral otalgia/dysphagia/odynophagia
erythroplakia/leukoplakia-urgent dental referral within 2 weeks
Management of acute localised OE (furunculosis-S.aureus infection of hair follicle)?
warm compress and analgesia
if severe pain may require incision and drainage
consider PO Abx if systemic involvement suspected
Management of mild diffuse OE?
topical acetic acid 2% spray
can combine with antibacterial and steroids if more severe e.g. otomize
topical Abx recommended-aminoglycoside and quinolone
When to give PO Abx in acute otitis media?
bilateral infection under 2 yrs of age
systemic features
at high risk of complications
otorrhoea
PO amoxcillin, clari if allergic, erythromycin if pregnant
2nd line=co-amoxiclav
Tx of acute otitis externa if cellulitis or disease extends outside ear canal or systemic signs?
PO flucloxacillin
BUT NEED TO REFER TO EXCLUDE MALIGNANT OTITIS EXTERNA
2nd line Abx for sinusitis?
co-amoxiclav
1st line=penicillin V
What specific feature is required to make a diagnosis of otitis media?
a middle ear effusion
can be diagnosed by loss of light reflex on otoscopy or reduced TM movement or bulging TM or otorrhoea
Which adults with hearing loss should be referred for urgent ENT review within 2 weeks?
- sudden onset (over 3 days or less) of unilateral or b/l hearing loss that occurred more than 30 days ago (if less then 30 days require immediate referral) and cannot be explained by external or middle ear causes
- rapidly progressing hearing loss (over 4-90 days), not explained by external or middle ear causes
- features of H+N cancer e.g. hearing loss+middle ear effusion not associated with URTI-NP carcinoma
Monitoring of hearing in patients with dementia or mild cognitive impairement?
should have hearing assessment every 2 years if not previously diagnosed with a hearing problem
Which patients with glue ear (OME) require immediate referral to ENT?
- children with down’s syndrome or cleft palate
- hearing loss of any level assoc with significant impact on child’s educational/social/developmental status
- persistent foul smelling discharge-semi urgent referral
- severe hearing loss (61dB or greater)
- significant hearing loss persists on 2 documented occasions
- TM structurally abnormal
How long should active observation be continued for children with glue ear (OME)?
6-12 weeks
spontaneous resolution is common
Most common fungal pathogen as cause for otitis externa?
aspergillus
When is newborn hearing screening carried out?
ideally within first 4-5 weeks after birth, can be done up to age of 3 months
What test is used in newborn hearing screening?
automated otoacoustic emission test (AOAE)
2nd test may be needed-automated auditory brainstem response test (AABR)
Drugs that may cause tinnitus?
aminoglycosides
loop diuretics
aspirin/NSAIDs
quinine
Which patients with tinnitus should be referred to be seen within 24 hours?
if tinnitus and hearing loss that has developed suddenly (over 72hrs or less) in the last 30 days-ENT or ED
Which patients with tinnitus should be referred to be seen within 2 weeks?
- tinnitus associated with distress which is affecting their mental well being despite having tinnitus support at first POC
- sudden onset hearing loss that developed more than 30 days ago or rapidly progressing hearing loss
- persistent otalgia or otorrhoea that does not resolve with routine tx
Which patients with tinnitus should be referred in line with local pathways?
- tinnitus that bothers them despite support at first POC
- persistent objective tinnitus
- tinnitus associated with unilateral or asymmetric hearing loss
consider referring for tinnitus assessment and management if persistent pulsatile tinnitus-imaging should be offered (*note sudden onset pulsatile tinnitus should be seen immediately), or persistent unilateral tinnitus
What assessment should be offered to all patients presenting with tinnitus?
audiological assessment
In a patient with hx of Bells palsy when should r/f to plastics be made for residual weakness?
after 6 months
R/f to a facial nerve specialist e.g. neurology should be done if:
- any doubt about diagnosis
- no improvement after 3 weeks of treatment
- sx of aberrant reinnvervation e.g. gustatory sweating 5 months or more after onset of bells palsy
- any atypical features
r/f to ophthalmology if any eye sx
When is emergency admission needed in presentation of pt with a cholesteatoma?
- facial nerve palsy
- vertigo
- other neurological sx or signs including pain that could be associated with an intra cranial abscess or meningitis
