ENT Flashcards
Fluid level or bubbles seen at tympanic membrane suggests?
Otitis media with effusion
Where do we place the grommet?
Anterior and inferior quadrant as less important structures
If you see a donut shaped , pushed out tympanic membrane, what would this suggest?
Acute otiis media
What are the 2 parts of the tympanic membrane?
Pars tensa (thick part) Pars flaccida (thin part, supriorly)
What is the umbo?
Most inwardly depressed part of the tympanic membrane
What is a cholesteatoma?
Build up of dead skin cells which can get infected
Hearing:
- Sound waves make tympanic membrane vibrate
- Vibrations transmitted through ossicles
- Footplate of stapes vibrates in oval window
- Vibration of stapes creates pressure waves in perilymph
- Hair cells in the cochlea are moved, AP’s stimulated and conveyed to brain by cochlear nerve
- Pressure waves descend and become vibrations again
- Pressure waves are dampened at the round window
Function of the tympanic cavity?
Conduct sound waves in the air towards the fluid filled cavities of the inner ear
Causes of deafness?
Presbycusis
Otosclerosis
Noise induced
Ototoxicity
What is presbycusus?
Age induced deafness
What is otosclerosis?
Build up of new bone formation of stapes footplate. Genetic condition more common in women in 30’s and 40’s
What is ototoxicity?
Drugs that have been toxic to the ear causing hearing loss
If vertigo lasts seconds it suggests?
BPPV
If vertigo lasts hours it suggests?
Meniere’s
If vertigo lasts days it suggests?
Vestibular neuritis
If vertigo time frame is variable it suggests?
Migraine associated vertigo
Acute otitis media is?
Infection in the middle ear
How does acute otitis media present?
Present with fever, fluid behind eardrum, bulging and possibly hearing loss
How do we treat Acute Otitis Media?
Usually settles alone.
Only give antibiotics if not settling
What is a vestibular schwannoma?
Benign tumour arising in the internal auditory meatus
how does a vestibular schwannoma present?
hearing loss, tinnitus, imbalance
How do we diagnose a vestibular schwannoma?
MRI
Red flag symptoms?
Persistent hoarseness Dysphagia Odynophagia Throat pain Referred otalgia Neck mass Bloody nasal discharge
How likely is a parotid gland mass to be benign?
70%
Which glands are malignant tumours more likely to be found in?
Submandibular and sublingual glands
3 phases of swallowing?
- oral phase
- pharyngeal phase
- oesophogeal phase
Common causes of difficulty swallowing?
Laryngopharyngeal reflux
Pouch
Spasm
Eosinophillic oesophagitis
What is recurrent respiratory pappilomatosis?
small wart like growths on the respiratory tract
The reconstructive ladder:
- Secondary intention
- Primary intention
- Delayed primary closure
- Skin grafts
- Tissue expansion
- Local tissue transfer
- Free tissue transfer
How to diagnose glandular fever?
Atypical lymphocytes in peripheral blood
+ve monospot or Paul Bunnell test
Low CRP (<100)
Management of Glandular fever?
Symptomatic treatment, antibiotics and steroids
Why do we not prescribed ampicillin in glandular fever?
will cause a macular rash
Symptoms of acute sinusitis?
Facial pain
Discharge
Nasal blockage
Most common emergency?
Epistaxis
Management of epistaxis?
- First aid - pinch soft part of nose for 5-10 mins
- Cauterise
- Nasal pack
How to treat sudden sensorineural hearing loss?
Something has happened to cochlear or cochlear nerve so we must treat as EMERGENCY. Do a Weber test. Can give steroids
What is stridor?
Inspiratory high pitched noise, airway obstruction around larynxy
