ENT Flashcards
What is cerumen impaction and it’s RF?
Cerumen - substance that helps to protect, lubricate and cleans external auditory canal.
Ear wax - made up of cerumen, sebum, dead flattened cells.
RF impaction –> >50, male, hair in ears, using cotton buds, recurrent acute otitis media, downs syndrome.
How does cerumen impaction typically present?
What is a more common symptom in children rather than adults?
- Hearing loss over days-months - conductive
- Possible feeling of fullness/blocked ears
- Possible otorrhoea - much more common in children - yellow waxy discharge
- Itchiness
What are the important things to exclude in cerumen impaction?
-Otitis externa and foreign body
What are the investigations for cerumen impaction?
- Otoscopy –> can visualise.
- Possible rinnes and weber
- Diagnosis –> visual cerumen impaction w symptoms e.g hearing loss or unable to visualised tympanic membrane
What is initial Tx for cerumen impaction?
Ceruminoltyic agents –> olive oil/saline/acetic acid for 3-5 days –> should help to soften wax and loosen.
Not worked –> aural irrigation. CI –> prev perforated TM, ear surgery, ear canal stenosis.
- Neither of above successful and/or CI –> REFER TO ENT for manual removal e.g suction
- Possible after unsuccessful irrigation –> try ceruminolytic agents again for 3-5 days then reassess w possible irrigation again.
What is acute pharyngitis and its causes?
- Inflammation at part of throat behind soft palate - oropharynx
- Viral causes –> common cold (rhinovirus), influenza
- Bacterial causes –> group A beta haemolytic strep
- Others –> candida, STIs
What are the symptoms of acute pharyngitis?
- Sore throat, headache
- In children - nausea and vomiting
- CENTOR criteria for group A beta strep –> tonsillar exudate, fever, abscence of cough, anterior cervical lymphadenopathy
- FEVER PAIN –> fever in last 24 hours, absence cough, purulence, severely inflamed tonsils, attending rapidly w/i 3 days or less
How is acute pharyngitis diagnosed?
- Clinical diagnosis
- Swabs and culture play little role
What is the management of acute pharyngitis?
What is the alternative Ab in children?
What are the indications for Ab? (5)
- Analgesia –> paracetomal and ibuprofen
- Rest, fluid intake, salt water gargle, lozenges
- Can return to school when feel well or >24 hours after starting Ab
Ab
- 1st line –> phenoxymethlpencillin - Pen V - 500mg QDS 7-10 days.
- PA –> clari. PA and pregnant –> erhythromycin
- Children –> potential take oral amoxi as more palatable.
- Can’t intake orally for 10 days –> consider IM benzylpenicillin
Indications for Ab
-CENTOR criteria w 3 or more, symptoms not resolving w fever >38.3 after 3 days conservative Tx, unilateral peritonsillitis, Hx rheumatic fever or increase risk e.g diabetes, immunocompromised/suppressed v young or old.
Candida cause –> Nystatin 100,000 units QDS 7 days
- Gonorrhoea –> ciprofloxacin 500mg single dose
- Chlamydia –> doxycycline 100mg BD 7 days
Hospital admission
- Severely dehydrated, sepsis, breathing difficulties
- Complications –> peritonsillar abscess e.g quinsy or pharyngeal abscess
What is acute otitis media?
What are the typical causative organisms?
- Infection involving the middle ear space.
- Typically preceded by an URTI –> changes normal nasopharyngeal microbiome and allows bacteria to enter middle ear from ET
- Whilst typically follows URTI, most cases occur secondary to bacterial infection
- Strep pneumo (40%), haemophillis influ, moxaella catarrhalis.
- 75% cases in those <10 years. Peak 12-18 months
-RF –> male, younger, bottle feeding, increase risk URTI e.g at schol
What is the typical presentation of acute otitis media?
- Otalgia (ear pain)
- Fever (50%)
- Hearing loss
- Can be irritability, disturbed sleep,
- Otorrhoea (ear discharge) –> when TM perforation
- Possible viral URTI symptoms e.g corzya
What are the investigations for acute otitis media?
What would you expect to find?
- Clinical diagnosis
- Otoscopy
- Bulging TM –> loss of light reflex. Bagel doughnut appearance.
- TM erythema w inflamm. Or opacification.
- Decreased TM mobility
What is the management for acute otitis media?
What are the indications for Ab? (5)
- Most cases begin to improve w/i 3 days
- Analgesia for otalgia
- When Ab indicated –> amoxicillin 5-7 days 1st line. When PA –> clari, PA and preg then erythromycin.
- Advise to return if symptoms don’t improve or worsen w/i 3 days
-Admit any <3 months w fever
Indications for Ab
- Bilateral in those <2
- Symptoms >4 days not improving or worsen
- TM perforation or otorrhoea
- Immuncompromised or increase risk complications –> e.g heart, kidney disease
- Systemically unwell but don’t need admission
What is otitis externa?
What are the common precipitating/risk factors?
- Diffuse inflammation of the external ear canal, and possible pinna or TM.
- A form of cellulitis that involves the skin and subdermis of the external auditory canal, with acute inflammation and variable oedema.
- ‘Swimmers ear’ –> water that enters warm canal provides moist enviro for bacteria.
- Most commonly caused by bacterial infection –> pseudomona aeruginosa and staphylococcus.
- Can be acute <3 weeks or chronic >3 weeks.
- Major precipitating factors –> ear trauma (syringing, cotton bud), excessive moisture (warm weather holiday), dermatitis.
- RF –> external auditory canal obstruction, high environmental humidity, warmer environmental temperatures, swimming, allergy, skin disease, diabetes, immunocompromised state, and prolonged used of topical antibacterial agents.
- Affects all ages, peaks 7-12
What is the presentation of otitis externa?
- Ear pain, itch, discharge. Otoscopy, red, swollen, or eczematous canal
- Acute –> rapid onset (48 hours) of symptoms within past 3 weeks w signs ear canal inflamm
- Rapid onset of severe ear pain, tenderness, itchy, possible discharge (seruous or purulent)
- Ear canal/external ear –> red, swollen, eczematous w shedding scaly skin
- Tragal tenderness –> tenderness w manipulation of tragus/pinna e.g inserting otoscope
- Tenderness on moving jaw
- Possible tender regional lymphadenitis
- Hearing loss when sufficient swelling to occlude ear canal (rare)
- Swelling in ear canal –> early presentation of localised, later swelling has white/yellow centre w pus can progress and swell causing occlusion
