ENT Flashcards
Otitis Externa Features
Ear pain
Discharge
Red swollen ear canal
Common causes of otitis externa
Staphylococcus aureus
Pseudomonas aeruginosa
Fungal infection
Management of otitis externa
Ear drop - combined topical abx and steroid drop e.g, gentamicin + prednisolone
When would you avoid using gentamicin in otitis externa and why
If there is tympanic membrane perforation
Due to risk of ototoxicity
What is malignant otitis externa?
Uncommon type of otitis externa where the infection commences in the soft tissues of the external auditory meatus, then progresses to involve the bony ear canal
It can progress to cause temporal bone osteomyelitis
What group of patients is malignant otitis externa most common?
Diabetics and Immunocompromised patients
What organism is the most common cause of malignant otitis externa?
Pseudomonas aeruginosa
Features of malignant otitis externa?
Severe, deep seated otalgia
Temporal headaches
Purulent otorrhea
Possibly facial nerve dysfunction
Management of malignant otitis externa
Urgent referral to ENT
IV abx - ciprofloxacin most common to cover pseudomonas
Features of otitis media
Otalgia Fever Hearing loss Recent viral URTI Ear discharge Bulding tympanic membrane
When would you give antibiotics in otitis media
If symptoms >4 days If pt unwell In Immunocompromised pts <2 years old with bilateral otitis media If there is tympanic membrane perforation If there is discharge
What abx are used for otitis media
5-7 day course of amoxicillin (erythromycin if penicillin allergy)
What is a cholesteatoma?
Complication of otitis media
Non cancerous growth of keratin within pars flaccida (upper tympanic membrane)
Features of cholesteatoma
Foul smelling Non resolving discharge
Hearing loss
Management of cholesteatoma
Referral to ENT for surgical removal
What is the most common cause of conductive hearing loss
Ear wax
Causes of perforated tympanic membrane
Infection e.g, otitis media
Barotrauma
Direct trauma
Management of perforated tympanic membrane
Most cases will usually heal after 6-8 weeks
Avoid water in ear during this time
Amoxicillin - if caused by otitis media
Myringoplasty - if it does not heal by itself
What is otosclerosis?
Replacement of normal bone by vascular spongy bone - this causes fixation of the stapes at the oral window in the ear leading to hearing loss
What type of hearing loss does otosclerosis cause
Conductive
Risk factors for otosclerosis
Family history - as it is autosomal dominant condition
Pregnancy - may precipitate disease in those who are genetically predisposed
Features of otosclerosis
Typically presents at age 20-40 Conductive deafness Tinnitus Normal tympanic membrane Positive family history Symptoms improve with background noise
Management of otosclerosis
Hearing aid
Stapedectomy
Causes of sudden-onset sensorineural hearing loss
Idiopathic
Vestibular schwannoma
Management of sudden-onset sensorineural hearing loss
High dose prednisolone for 7 days
Causes of Vertigo and how to distinguish
Viral labyrinthitis - recent viral infection, hearing affected
Vestibular neuronitis - recent viral infection, hearing okay
BPPV - gradual onset, triggered by change in position
Ménière’s disease - hearing loss, tinnitus, sense of fullness in ears
Vertebrobasilar ischaemia - elderly pt, occurs on neck extension
Acoustic neuroma - hearing loss, tinnitus, absent corneal reflex
What is meinere’s disease
Disorder of inner ear of unknown cause
Excessive pressure and progressive dilation of the endolymphatic system
Features of meneires disease
Unilateral Episodes lasting minutes to hours of: Vertigo Tinnitus Sensorineural hearing loss Feeling of fullness in ear
Pts will have:
- Nystagmus
- positive romberg’s test
Management of Ménière’s disease
Prevention of attacks - beta histone
During attacks - buccal or IM prochlorperazine
Must inform DVLA of diagnosis
Features of vestibular schwannoma
Unilateral: Vertigo Sensorineural hearing loss Tinnitus Absent corneal reflex Possible Facial palsy
Diagnosis of acoustic neuroma
MRI of the cerebellopontine angle
What is Ramsey hunt syndrome?
Reactivation of varicella zoster virus in the geniculate ganglion of the facial nerve
Features of Ramsey hunt syndrome
Ear pain Facial nerve palsy Vesicular rash around ear Vesicular lesions may be seen on anterior 2/3rds of the tongue and soft palate Vertigo Tinnitus
Management of Ramsey hunt syndrome
Oral aciclovir
Corticosteroids
Management of allergic rhinitis
Allergen avoidance
Mild disease - Oral or intra nasal antihistamines
Moderate disease - intra nasal corticosteroids
Severe disease - oral corticosteroids
What are the common causative agents of rhinosinusitis
Streptococcus pneumoniae
Haemophilis influenzae
Rhino viruses
Definition of chronic Rhinosinusitis
Inflammation of paranasal sinuses and linings of nasal passages lasting >12 weeks
Risk factors for Rhinosinusitis
Hayfever or rhinitis Asthma Nasal obstruction e.g, septal deviation, nasal polyps Swimming Smoking
Features of Rhinosinusitis
Facial pain - typically a frontal pressure worse on bending forward
Nasal discharge
Nasal obstruction - e.g, mouth breathing
Post nasal drip - may be producing a cough
Management of Rhinosinusitis
Intra nasal corticosteroids
Oral phenoxymethylpenicillin - for severe presentations
What population group are nasal polyps more common in?
Males
What is samter’s triad
Asthma
Aspirin sensitivity
Nasal polyposis
Clinical features of nasal polyps
Nasal obstruction
Rhinorrhoea (runny nose)
Poor sense of taste/smell
Bilateral symptoms (unilateral nasal polyps is red flag sign for nasal pharyngeal cancer)
Management of nasal polyps
Bilateral - routine referral to ENT
Unilateral - urgent referral to ENT
Topical steroids are usually given to shrink polyps
CENTOR Criteria for tonsillitis
Tender cervical lymphadenopathy
Tonsillar exudate
Absence of cough
Fever >38
Antibiotics given for tonsillitis
Phenoxymethylpenicillin - 7-10 day course
Erythromycin if penicillin allergy
Indications for tonsillectomy
All of the following:
>5 episodes of sore throat in a year due to tonsillitis
Symptoms present for >1 year
Episodes are disabling and preventing normal functioning
OR one of the following:
Recurrent febrile convulsions due to tonsillitis
Obstructive sleep apnea, stridor or dysphagia secondary to large tonsils
Peritonsillar abscess
Complications of tonsillitis
Otitis media
Quinsy/peritonsilar abscess
Rheumatic fever and glomerulonephritis
Features of peritonsillar abscess
Severe unilateral throat pain
Deviation of uvula to unaffected side
Difficulty opening mouth
Management of quinsy
Urgent ENT referral
Needle aspiration or incision and drainage
IV abx
What are sialolithiasis
Calculi in the salivary glands or ducts
Features of sialolithiasis
Unilateral colicky pain and swelling on eating
Swelling of submandibular gland
What is sialadenitis
Inflammation of salivary gland secondary to obstruction by stone in the duct
Caused by staph aureus infection
Can cause foul taste in mouth as purulent discharge from duct drains into floor of mouth
Most common cause of parotid tumour
Pleomorphic adenoma
Which medications can cause ototoxicity
Gentamicin Quinine Furosemide Aspirin Some chemotherapy agents
What is glue ear?
Otitis media with effusion
Where the Eustachian tube becomes blocked, which causes fluid to build up in the middle ear
When the middle ear becomes full of fluid it can cause loss of hearing in that ear
Management of glue ear
Referral to audiometer - to help establish diagnosis and extent of hearing loss
Usually resolves without treatment in 3 months
Grommets can be inserted into tympanic membrane by ENT surgeons which allows fluid to drain out through the tympanic membrane into the ear canal (grommet usually fall out within a year)
Common site of epistaxis
Kiesselabachs plexus (littles area) - area that contains lots of blood vessels in the nose
Management of epistaxis
Sit up and head tilt forwards squeezing soft part of nose
Nasal packing if it doesn’t stop
Nasal cautery if it doesn’t stop
