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Clinical Medicine > ENT > Flashcards

ENT Flashcards

1
Q

Tonsillitis definition

A

Inflammation of pharyngeal tonsils, usually extending to lingual tonsils and adenoids

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2
Q

Causes of tonsillitis

A

Mostly viral: Adenovirus, rhinovirus, RSV, EBV

Also bacterial: Group A strep (beta haemolytic)

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3
Q

Symptoms of tonsillitis

A 
Fever
Sore throat
Halitosis
Dysphagia
Odynophagia
Mild airway obstruction
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4
Q

Signs of tonsillitis

A

Respiratory distress
Tonsillar changes: Erythema, oedema, +/- exudate
Tender cervical lymphadenopathy
Requires flexible nasoendoscopy if severe or presence of respiratory distress

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5
Q

Management of tonsillitis

A

ABCs with resus and airway care of necessary
If bacterial- ABX- GAS- IV penicillin 2mu Q6h for acute inpatients, 10/7 oral for outpatients
Steroids for inpatients- dexamethasone stat or ads
Supportive therapy: Antiemetics, analgesia, antipyretics

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6
Q

Complications of GAS tonsillitis

A

Suppurative: Peritonsillar abscess, deep neck space infections, cervical lymphadenitis
Non-suppurative: Scarlet fever, rheumatic fever, post-streptococcal glomerulonephritis

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7
Q

Describe EBV tonsillitis and the management of this condition

A

EBV is also called mononucleosis
Consider it with tonsillitis + tender lymphadenopathy, splenomegaly, severe lethargy, and a white/grey membrane over tonsils
Confirmed via blood test
Takes longer to resolve, avoid contact sport due to risk of splenic rupture

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8
Q

Define peritonsillar abscess (quinsy)

A

Abscess formation between the tonsil and its capsule

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9
Q

Causes of peritonsillary abscess

A

Secondary to tonsillitis (progresses to cellulitis, then necrosis, then pus formation)
Infection of a minor salivary gland
Often polymicrobial, anaerobic growth. Aerobes likely to be strep, Aureus and H influenzae

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10
Q

Symptoms of peritonsillar abscess

A

Neck pain
Throat pain, worse one side +/- unilateral ear pain
Trismus (lockjaw)
Voice change to hot potato voice- sounds as if a mouthful of hot food

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11
Q

Signs of peritonsillar abscess

A

Resp distress
Tonsillar changes- erythema, uvula deviation to contralateral side, inferior-medial tonsillar displacement, supratonsillar fold/soft palate swelling
Drooling
Trismus
Dehydration
Tender cervical lymphadenopathy
Flexi-nasoendoscopy needed if respiratory distress or to rule out epiglottitis

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12
Q

How do diagnose peritonsillar abscess

A

FBC and U and Es
Monospot to rule out EBV
If deep neck infection suspected, lateral neck X-ray/CT

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13
Q

Management of peritonsillar abscess

A

ABCs
Incision and drainage- mainstay
Supportive therapy- fluids, ABX as for tonsillitis, antipyretics, analgesia

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14
Q

Complications of peritonsillar abscess

A

Deep neck space infection as peritonsillar space is contiguous with parapharyngeal and retropharyngeal spaces

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15
Q

Definition of supraglottitis/epiglottitis

A

Inflammation of structures above the insertion of the glottis in the oropharynx, eg. epiglottis, vallecula, arytenoids and aryepiglottic folds

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16
Q

Causes of supraglottitis/epiglottitis

A

Predominantly strep, staph and gram negatives

H Influenzae used to be the most common cause so ask about vaccination status!

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17
Q

Symptoms of supraglottitis/epiglottitis

A 
Sore throat
Odynophagia/dysphagia
Muffled/hot potato voice
Preceding RTI
Fever
Cough
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18
Q

Signs of supraglottitis/epiglottitis

A 
Tripodding
Toxic appearance of patient
Drooling
Irritability
Stridor (late sign indiciating airway obstruction
Cervical lymphadenopathy
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19
Q

How to diagnose supraglottitis/epiglottitis

A

Clinical
Lateral neck Xray shows epiglottitis thumb sign where epiglottis becomes swollen and pointed
Flexible nasoendoscopy if tolerated
Blood cultures

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20
Q

Management of supraglottitis/epiglottitis

A

ABCs and early ENT review- key is managing airway
ABX- ceftriaxone is firstline
Supportive measures- analgesics, antiemetics, IV fluids

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21
Q

Definition of deep neck space infections

A

Infection within a neck space created by planes

Most worrying is involvement of the space anterior to the prevertebral fascia- the danger space

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22
Q

Causes of DNSI

A

Inadequately treated pharyngitis, dental abscess or tonsillitis
Sialadenitis (salivary gland inflammation)
IVDU
Malignancy

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23
Q

Symptoms of DNSI

A 
Sore throat
Dysphagia
Odynophagia
Trismus
Neck and neck movement pain
\+/- painful neck mass
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24
Q

Signs of DNSI

A

Retropharyngeal abscess: posterior pharynx erythema and swelling
Parapharyngeal abscess: Medial displacement of tonsil and lateral pharyngeal wall
General
Torticollis: Holding neck in twisted position
Tender lymphadenopathy
Danger signs
Neurological deficit eg. hoarse voice due to vocal paralysis (carotid sheath and vagal/recurrent laryngeal nerve pressure)
Horner’s syndrome

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25
Q

Diagnosis of DNSI

A

CT neck
FBC, U and Es
Blood cultures

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26
Q

Management of DNSI

A

ABCs and IV fluids
ABX
I and D

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27
Q

Complications of DNSI

A

Internal jugular thrombophlebitis (Lemiere syndrome)- septic emboli and sepsis
Mediastinitis- Chest pain, widened mediastinum on CXR
Rare: Carotid rupture. meningitis, cavernous sinus thrombosis

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28
Q

Surgical sieve causes of neck lumps

A

VITAMIN CD
V: Vascular (AVM, aneurysm)
I: Inflammatory (Submandibular sialadenitis
T: Traumatic (Haematoma, ranula- spit cyst following damaged salivary gland
A: Autoimmune/allergic (thyroiditis)
M: Metabolic (goitre)
I: Infective (lymphadenitis, reactive lymphadenopathy, TB)
N: Neoplastic (carotid body tumour, chemodectoma, thyroid, lymphoma, SCC)
C: Congentita; (Branchial cyst, thyroglossal cyst, dermoid cyst)
Degenerative

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29
Q

History things to know of neck lumps

A

Pain: Chronic oral suggests malignancy, unilateral otalgia can be referred and is assoc with tumours at the tongue base, larynx and oropharynx
Dysphagia: Tumours are gradual, nasal regurg/aspiration suggests neurological
Stridor: Inspiratory sounds caused by blockage at or above vocal cords
Hoarseness: suggests laryngeal disease and requires ENT referral
Constitutional symptoms suggest malignancy
Social factors- smoking and alcohol assoc with cancer, HPV

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30
Q

Exam for neck lumps

A 
Neck lump size, position, contour, texture, mobility and tenderness
Ears
Rhinoscopy
Oral cavity
Cranial nerves
Nasoendoscopy
Head and neck skin (ca)
Thyroid signs
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31
Q

Ix for neck lumps

A

Imaging- USS, CT, MRI
Cytology/histology- FNA/biopsy
Blood tests: FBC, TFTs
ENT referral if necessary

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32
Q

Define Sinusitis

A

Inflammation of the sinuses, always accompanies by inflammation of the nasal cavity

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33
Q

Define acute sinusitis

A

Up to 4/52 of sx

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34
Q

Causes of acute sinusitis

A

Viral- symptoms for <10/7 and do not worsen
Bacterial- sx for 10/7 beyond URTI, worsen after initial improvement (caused by strep. pneumonia, h influence, mortadella)
- Both usually preceded by URTY

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35
Q

Sx of acute sinusitis

A

Purulent nasal discharge
Nasal obstruction
Facial pain/pressure/fullness
This all suggests bacterial more than viral

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36
Q

Management of acute sinusitis

A

1/52 co-amoxiclav

Sinus rinse or surgery may also be indicated

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37
Q

Definition of chronic sinusitis

A

12+ weeks of symptoms post URTI, with 2 or more additional symptoms

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38
Q

Causes of chronic sinusitis

A

Multifactorial

  • Immune mediated (B and T cells)
  • Microbial (Aureus)
  • Anatomical- sinus ostia obstruction
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39
Q

Symptoms of chronic sinusitis

A 
Mucopurulent discharge
Inflammation- mucus, polyps, imaging
Congestion
Facial pain, pressure, fullness
Reduced smell
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40
Q

Management of chronic sinusitis

A

ABX- culture directed, 3-4/52
Anti-inflammatories- intra-nasal, oral and any allergy management
Saline irrigation
Surgery if symptoms are still present following 4-6 weeks of maximal therapy (surgery is called FESS for functional endoscopic sinus surgery)

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41
Q

Sinusitis exam

A
  • Anterior rhinos copy with headlight and thudicum speculum

- Flexible nasendoscopy

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42
Q

Complications of sinusitis (orbital infection)

A 
Periorbital oedema
Orbital celllulitis
Subperiosteal abscess
Orbital abscess
Cavernous sinus thrombosis
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43
Q

Intracranial complications of sinusitis

A

Meningitis
Epidural abscess
Pott’s puffy tumour (osteomyelitis of the frontal bone with subperiosteal abscess)

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44
Q

Definition of allergic rhinitis

A

Inflammation of the nasal mucous membranes caused by IgE reaction to one or more allergens

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45
Q

Symptoms of allergic rhinitis

A

Clear, watery nasal discharge
Itching nose, eyes and throat
Nasal congestion
May be seasonal or trigger based such as pollen or cats

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46
Q

Management of allergic rhinitis

A

Antihistamines
Intranasal corticosteroids
Other options include systemic steroids if consistently failing above or decongestants (but these have rebound effects)

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47
Q

Definition of epistaxis

A

Bleeding from the nose due to mucosal erosion and exposure of underlying vessels

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48
Q

Causes of epistaxis

A

Infection- cold/flu
Trauma- nose picking, foreign body, dry air inhalation
Medications- anticoagulants, topical therapy, drugs
Rare: systemic such as coagulopathy, sarcoidosis, wegeners granulomatosis
Tumour
More than 95% of bleeding comes from Kiesselbach’s plexus (little’s area)

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49
Q

History points to know about epistaxis

A

Unilateral or bilateral start? (ant bleeds are uni, post bi)
General med hx for systemic conditions, anticoagulants and smoking
Bruising/bleeding/nosebleed hx
FHx bleeding disorders
Foreign body insertion

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50
Q

Exam for epistaxis

A

Local anaesthetic required! (may stop the bleed)

Headlight, speculum and suction- identify source

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51
Q

Ix for epistaxis

A

FBC- haemorrhage severity
Coag screen esp if warfarin
BP- this can contribute to bleeds

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52
Q

Management of anterior epistaxis

A
  1. Pinch nose for 10 mins with or without ice sucking
  2. Cotton bowls soaked in lidocaine and adrenaline- multiple times
  3. Cautery with silver nitrate sticks- only when sourced and stopped
  4. Rapid rhino/merocal for 24h
  5. Bilat rapid rhinos
  6. Arterial ligation and embolisation
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53
Q

Management of posterior epistaxis

A
  1. Uni/bilateral rapid rhinos

2. Endoscopic sphenopalatine ligation for persistent bleeds

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54
Q

What is the danger of batteries and the nose?

A

Batteries causes alkali burns and tissue necrosis

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55
Q

Define stridor

A

A mainly inspiratory noise indicating a partial upper airway obstruction
A MEDICAL EMERGENCY in children

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56
Q

Causes of stridor in children

A

Traumatic: Foreign body
Autoimmune/allergic: Anaphylaxis
Infective: Croup, tracheitis, supra/epiglottitis, DSNI
Neoplastic: Respiratory papillomatosis, vocal cord papilloma, cysts, nodules
Congenital: Laryngomalacia, laryngeal web, vocal cord paralysis, subglottic stenosis

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57
Q

Pathogenesis of laryngomalacia

A

Stridor develops due to the prolapse of supraglottic structures into the laryngeal inlet during inspiration
Most common cause of infantile stridor and most common laryngeal anomaly

58
Q

Management of laryngomalacia

A

Conservative- 10% need surgery

Often resolves by 18-20 months of age

59
Q

Pathogenesis of laryngeal web

A

Congenital condition presenting with abnormal cry and stridor
Due to embryonic failure of laryngeal recanalisation

60
Q

Management of laryngeal web

A

Thin webs- incision

Thick webs - stenting

61
Q

Definition and causes of subglottic stenosis

A

Partial or complete subglottic narrowing
May be congenital or acquired
Congenital- birth stridor (intermittent if mild)
Acquired- secondary to previous ET intubation

62
Q

Management of subglottic stenosis

A

Varies based on age, grade and type of stenosis

Anything from observation if mild to reconstruction if severe

63
Q

Definition of dysphonia (hoarseness)

A

Change in voice

64
Q

Causes of dysphonia

A

Trauma: Voice abuse and misuse leading to inflammation, nodules and polyps
Neoplasm: Benign- nodule, polyp, papilloma, cyst. Malignant- laryngeal SCC
Other: Vocal cord paralysis, recurrent laryngeal nerve paralysis

65
Q

Symptoms of dysphonia to ask about

A

Onset, duration and progression
Preceding URTI, trauma, ET intubation
Smoking and alcohol use
Employment- professional voice users have increased trauma rates
Thyroid and reflux history
Age- assoc. with increased malignancy, whereas children likely have benign nodules or papillomatosis
Assoc symptoms such as dysphagia/odynophagia

66
Q

Dysphonia exam components

A

Head and neck exam
Flexible nasoendoscopy
Video stroboscopy- slow motion recording of vocal cords

67
Q

Management of dysphonia

A

Malignancy- depends on histology, grade and stage
Multidisciplinary. Surgery may require partial or total laryngectomy +/- flap reconstruction, radiotherapy may be primary or adjuvant. Chemotherapy is rarely used
Vocal fold papilloma- requires collation (surgery)

68
Q

Chronic cough definition

A

Cough lasting >8 weeks

69
Q

Causes of chronic cough

A

Post-nasal drip as secretions increase cough
Asthma
GORD either through acid exposure or micro aspiration if no heartburn sx
These 3 make up 95% of causes!
Others include ACE inhibitors, smoking, CHF etc

70
Q

How to differentiate between causes of chronic cough

A

Post-nasal drip is diagnosed often due to long term response to chronic rhino sinusitis treatments. Underlying allergies should also be managed
Non-asthmatic eosinophilic bronchitis Is diagnosed on sputum showing eosinophilia (very good response to corticosteroids)
GORD is based on PPI treatment

71
Q

Stepwise management of chronic cough

A
  1. Smoking cessation and other factors (eg allergies) for 1 month
  2. CXR to rule out pulmonary lesions
  3. Trial PPI
  4. CT sinuese
  5. Induced sputum
  6. TB culture sputum, high res CT, bronchoscopy
72
Q

Globus definition

A

Persistent or intermittent painless sensation of a lump or foreign body in the throat

73
Q

Causes of globus

A 
GORD accounts for up to 50%
Nonspecific oesophageal motility disorder
Malignancy
Psychosomatic or stress dincued
Retroverted epiglottis
Thyroid disease
TMJ dysfunction
74
Q

Investigations and management for globus

A

Evaluate for reflux, malignancy and psych factors
3 month PPI trial
ENT exam to exclude sinister causes
If PPI not helping, 24h monitoring of gastric pH, as well as endoscopy and barium swallow
If no cause or response found- psych input

75
Q

Define Zenker diverticulum

A

Herniation of the posterior pharyngeal/oesophageal mucosa and submucosa secondary to increased intraluminal pressure

76
Q

Causes of zenker

A

Lack of muscle coordination

Hypertensive upper oesophagus

77
Q

Symptoms of Zenker diverticulum

A

Dysphagia
Regurgitation (+/- aspiration) of undigested food
Halitosis

78
Q

Zenker diverticulum investigations

A

Barium swallow

Fiberoptic endoscopic swallow evaluation +/- GORD pH evaluation

79
Q

Management of zenker diverticulum

A

Endoscopic CO2 laser/electrocautery

Open repair

80
Q

Definition of otitis externa

A

An inflammatory and infectious process of the external auditory canal +/- auricle

81
Q

Causes of otitis externa

A

Bacterial- pseudomonas, S aureus, S epidermidis, proteus, E coli, diphteroids

82
Q

Risk factors for otitis externa

A

Heat
Humidity
Trauma
Water exposure- results in cerumin removal from EAC- swimmers especially prone

83
Q

Symptoms of otitis externa

A 
ear pain
Ear discharge
Aural fullness
Pruritis
Tenderness
Hearing loss
IF ADVANCED
Oedema
Erythema of auricle/pinna
84
Q

Signs of otitis externa

A

EAC oedema, erythema and otorrhea
Pain on distraction of the pinna
Periauricular/cervical lymphadenopathy

85
Q

Management of otitis externa

A
  1. ABX- sofradex firstling, cipro and steroid for pseudomonas or second line
  2. Earwick for 48h to stent EAC if occluded- allows ABX to reach infection site
  3. Suction and microscope guidance if experienced
  4. Analgesia
  5. If exostoses present- surgical management to prevent recurrence
    Steroids help reduce ear canal swelling
86
Q

Complications of otitis externa

A

Malignant otitis externa- skullbase osteomyelitis

EAC -> temporal bone –> beyond, especially in elderly diabetics

87
Q

Define acute otitis media

A

Inflammation and infection of the middl ear

88
Q

Causes of acute otitis media

A

Pathogenesis is Eustachian tube dysfunction leading to pathogens from the nasopharynx moving to the middle ear
Usually preceded by a viral URTY, causing tube inflammation and dysfunction
Common agents include S pneumonia, H influenza and moraxella

89
Q

Symptoms of otitis media

A 
Otalgia
Fever
Hearing loss
Otorrhea if perforated drum
reduced appetite
Concurrent URTI
Children- fussiness and irritability
90
Q

Signs of otitis media

A

Bulging erythematous tympanic membrane

91
Q

Management of acute otitis media

A

Analgesia and watchful waiting for low risk children
ABX in severe illness, those less than 6mo old and those not improving within 48h
Amox is first line and erythromycin/cotrimoxazole are second line
In paeds always give max dose for weight range
Analgesia- paracetamol firstline, ibuprofen if not contraindicated

92
Q

List the complications of acute otitis media

A 
TM perforation
Mastoiditis
Facial nerve paresis in children
Labyrinthitis
Intracranial complications
93
Q

Describe TM perforation as complication of AOM

A

Most heal in 3 weeks, if not within 3 months then ORL referral
Can cause long term hearing loss and choleastoma

94
Q

Describe mastoiditis as complication of AOM

A

Fevers, post-auricular erythema, tenderness, ear proptosis and other AOM findings- emergency due to infection spread

95
Q

Facial nerve paresis as complication of AOM

A

Children secondary to bacterial toxins or cytokines on CNVII in the mastoid cavity
NB other causes can be herpes zoster oticus (Ramsay Hunt Syndrome), skull base fracture, parotid tmoursm cholesteatoma and meningioma

96
Q

Describe labyrinthitis as complication of AOM

A

Sudden sensorineural hearing loss, vertigo and nystagmus with nausea and vomiting
In AOM this is secondary to bacteria invading the round window and can cause meningitis

97
Q

What intracranial complications can occur as complication of AOM

A

Meningitis
Abscess- epi/subdural, cerebral
Sigmoid sinus thrombophlebitis

98
Q

Define AOM plus effusion (glue ear)

A

Inflammation of the middle ear with presence of effusion

99
Q

Causes of glue ear

A

Eustachian tube dysfunction either secondary to pressure dysfunction (causing ‘ve pressure in the middle ear, transudative secretion and chronic inflammation) OR AOM reflux induced mucin transudate
Dysfunction is worsened by parental smoking, lack of breast feeding, adenoid hypertrophy and daycare attendance

100
Q

Symptoms of glue ear

A

Often asymptomatic
Hearing loss
Trouble sleeping secondary to pressure

101
Q

Signs of glue ear

A 
Dull grey/yellow immobile TM on otoscopy
Abnormal tympanometry (TM motility test)
Conductive hearing loss on audiometry
NB flexible nasoendoscopy should be performed in adults to rule out nasopharyngeal tumour
102
Q

Management of glue ear

A

Varies depending on pt risk
High risk of speech language or learning deficiency in children- ENT referral, ?grommets or adenoidectomy
Low risk- watchful waiting

103
Q

Complications of glue ear

A

Conductive hearing loss and developmental impact
Speech delay
Atelectasis/retractive TM secondary to negative pressure in middle ear, potentially leading to ossicular erosion, hearing loss and cholesteatoma
Cholesteatoma- retracted tympanic membrane leading to disruption of squamous epithelial movement

104
Q

Cholesteatoma definition

A

Destructive lesion of the skull base and middle ear formed by trapped squamous epithelium

105
Q

Causes of cholesteatoma

A

Secondary to TM retraction
Squamous epithelium migration during surgery such as grommets
Congenital

106
Q

Pathogenesis of cholesteatoma

A

Trapped epithelium forms a sac with keratin debris, which grows and migrates
This causes osteoclast activation, eustachian tube dysfunction and oedema, leading to a bacterial medium

107
Q

Symptoms of cholesteatoma

A 
Persistent/recurrent purulent discharge
Painless discharge is the hallmark
Hearing loss
tinitus
Vertigo
Ataxia
Facial nerve paresis
108
Q

Signs of cholesteatoma + ix

A

No response to otitis externa treatment
Retraction on otoscopy
Copious discharge on otoscopy
Investigate with audiometry, CT and MRI if other structures involved such as factial nerve, cranium, labyrinth

109
Q

Management of cholesteatoma

A

Mastoidectomy, extent depending on location
Microscopic debris removal from external canal
Keep ears dry
Topical ABX

110
Q

Complications of cholesteatoma

A

Bone and ossicular chain erosion
Sensorineural hearing loss and dizziness
Facial nerve injury
Infection- mastoiditis, meningitis, intracranial abscess, sigmoid sinus thrombosis

111
Q

Conductive causes of hearing loss

A 
Cerumen impaction
Middle ear effusion and glue ear
TM perforation
Chronic suppurative otitis media
Cholesteatoma
Otosclerosis
112
Q

Sensorineural causes of hearing loss

A 
Syndromic or non syndromic conditions
LBW/sepsis
Infections pre or post natal
Trauma
Ototoxic drugs like aminoglycosides
Presbycusis/age related
Neoplasms- accoustic neuroma/cerebellopontine angle tumours
113
Q

History to know about hearing loss

A

Duration, nature, progression and side(s) of hearing loss
Presence or absence of tinnitus, vertigo, imbalance, otorrhea, headache, facial nerve dysfunction
Previous head trauma, ototoxic drugs, noise exposure and family history

114
Q

Exam for hearing loss

A

Otoscopy
Nose, nasopharynx and oral exam with nasoendoscopy if needed
CN exam- V, VII and VIII plus weber and rinne tests

115
Q

Ix for hearing loss

A

Audiometry

Imaging- CT if cholesteatoma, MRI if asymmetric SNHL

116
Q

Management of hearing loss

A

Environmental: Reduce background noise and ensure good lighting on speakers face
Amplification- hearing aids, bone anchored hearing aids
Cochlear implant

117
Q

Define presbycusis

A

Otherwise unexplained SNHL in the elderly

118
Q

Causes of presbycusis

A

Multifactorial

  • Genetic
  • Noise trauma
  • Diet and ototoxic drugs
  • Age related changes- decreased auditory cells, increased processing time, reduced hair/supporting cells, CNVIII fibre loss
119
Q

Sx of presbycusis

A 
Progressive hearing loss
Worse with ambient noise
Often high noise jobs or FHx involved
Exam to exclude other DDx
Audiometry is diagnostic but consider other tests if unsure
120
Q

Management of presbycusis

A

Hearing aids
Assisting devices- amplifiers, TV headsets
Cochlear implants only for profound loss

121
Q

Definition of vertigo

A

Perception of movement in the absence of movement

122
Q

Overall cause of vertigo

A

Asymmetry in baseline vestibular centre input, causing vertigo, nystagmus and vomiting

123
Q

Central causes of vertigo

A

Ischaemic- TIA, stroke, vertebrobasilar insufficiency, migraine
Neoplastic- accoustic neuroma assoc with unilateral progressive hearing loss
MS

124
Q

Peripheral causes of vertigo

A 
BPPV
Meniere disease
Vestibular neuronitis
Labyrinthitis
Others including otitis media and sinusitis
125
Q

History things to know for vertigo

A

How long episodes last
Sudden or gradual onset
Assoc with movements or postures
Tinnitus, hearing loss, otalgia, aural fullness, otorrhea
Preceding URTI
Smoking, medication, herbal remidies
Systems review for gait, head trauma, pmhx and other ENT issues

126
Q

Exam for vertigo

A

Vital signs- lying standing BP
full ENT exam- esp for infection and hearing loss
Dix hallpike manoeuvre, romberg’s head thrust and caloric testic

127
Q

Ix for vertigo

A

MRI with asymmetric hearing loss (suspect accoustic neuroma)

Baseline bloods- FBC, u and es, glucose

128
Q

Definition of BPPV

A

Vertigo elicited by certain head positions, which trigger nystagmus

129
Q

Causes of BPPV

A

Canalithiasis- otoliths become detached from saccule/utricle and float freely, exerting force on the cupula mechanism (think pebbles in a tyre)
Cupulolithiasis- otolith deposits on the cupulae themselves, causing them to be more sensitive to gravity in certain positions (think top heavy pole hard to hold straight)

130
Q

Sx of BPPV

A

sudden, severe 30s vertigo
Assoc with head movement and position changes
Assoc with nausea and vomiting

131
Q

Exam for BPPV

A

Dix hallpike is diagnosis- shows nystagmus

Otherwise normal exam

132
Q

Management of BPPV

A

Canalith repositioning with modified epley manoeuver
Vestibulosuppressants if symptomatic relief needed- promethazine, benzos, scopolamine
Surgery if intractable

133
Q

Definition of meniere disease

A

An inner ear disorder causing syndromic features including vertigo
Causes of meniere disease- overall unknown, but thought to be due to infections/immune responses/allergies

134
Q

Sx of meniere disease

A 
Occurs as attacks lasting hours
Unilateral fluctuating SNHL
Vertigo for minutes to hours
Constant or intermittent tinnitus
Aural fullness
Assoc with nausea and vomiting
Lethargy a few days post
135
Q

Ix for meniere disease

A

Clinical diagnosis
Audiometry confirms SNH
Rule out syphilis and do MRI for neoplasm

136
Q

Management of meniere disease- acute

A

Vestibular suppressants- promethazine, benzos, scopolamine

Betahistine

137
Q

Management of meniere disease- long term

A 
Salt restriction
Thiazide diuretic
Betahistine
Aminoglycoside injection to middle ear
Surgery if severe and intractable
138
Q

Definition of vestibular neuronitis

A

A sustained, acute dysfunction of the peripheral vestibular system

139
Q

Causes of vestibular neuronitis

A

Reactivation of HSV in vestibular ganglion/nerve (most likely)
Other viruses

140
Q

Sx of vestibular neuronitis

A

Vertigo, N and V
No hearing loss
Lasts days and is debilitating
- If SNHL is present, suggests labyrinthitis- ABX and admit

141
Q

Signs of vestibular neuronitis

A

Normal hearing and neuro exam

Nystagmus with slow phase towards affected ear

142
Q

Management of vestibular neuronitis

A

Vestibular suppressants- promethazinem benzos and scopolamine
3 weeks of corticosteroids (reduces risk of long term vestibular functional loss)

Clinical Medicine (5 decks)

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