ENT Flashcards
Discharge first
pain
eac swelling-> close.
Otitis externa
mx otitis externa
analgesia, warm flannel topical acetic acid antibiotic drops Ciprofloxacin drops -> Pseudomonas. , debridement w microsuction. (neomycin), steroids
popewick dressing.
complications otitis externa
elderly/diabetic -> skull base osteomyelitis, facial cellulitis
acute otitis media
red ejected bulging (w fluid) eardrum,
Pain then Mucinous discharge
palpate neck
Beware: diabetic, I.C, teenage, headache.
complications otitis media
perforation - burst then heal. can become chronic if underlying eustatchian tube issue.
Effusion - glue ear
Mastoiditis - need admission -> CT (can form fistula, citelles abscess (anterior neck), Beszolds abscess (sternocleinomastoid) brain abscess, lateral sinus thrombosis.
Mx otitis media
Analgesia antipyrexials 24-48h.
no d/c -> oral amoxicillin
d/c-> oral + topical
systemic - coamoxiclav.
Loss of light reflex
conductive hearing loss
Pronunciation/language issues.
otitis media w effusion (glue ear)
Mx Effusion
- Watch and wait, 12 wks arrange hearing test. (most resolve by themselves)
- Steroid drops into nose.
- Otovents balloon.
- Grommets.
causes + Mx of perforation
infection
barotrauma
Chronic -> tympanosclerosis
Mx-Myringoplasty
Cheesy gunky appearance above eardrum - dizziness
cholesteatoma
mx: surgical
can erode important structures, chronic infections, facial nerve palsy
unilateral sensoneurinal hearing loss
vestibular schwannoma
Mx: MRI
neurosurgery
Non allergic vs allergic rhinitis
allergic - mucosa swollen blue and pale
itchy, runny nose, seasonal, variable severity. allergic salute/crease.
Non allergic: constant, unvarying, black, thick mucus, pink appearance of nose.
Classification of Allergic rhinitis
Intermittent: <4 days per week <4 weeks Persistent: >/=4days per week >4weeks.
Mild: normal sleep
no impairment daily activities.
Mod severe: abnormal sleep, impairment school, work, sport, leisure.
dx: examination
skin prick testing
serum igE
Mx AR
Mild, intermittent
Saline nasal douche, non sedating antihistamine (cetirizine/loratidine), allergen and irritant avoidance
Mod severe/intermittent
+IN steroid +/- LTRA
Mild persistent
+topical cromone/antihistamine
Mod severe persistent
+Immunotherapy
Blocked nose Facial pressure hyposmia swollen red mucosa runny mucus for 12 weeks endoscopy polyps
Rhinosinusitis
Ix rhinosinusitis
Anterior rhinoscopy
CT -increased density in sinuses.
Mx rhinosinusitis
- Saline douches, long term steroid drops
2. Surgery for polyps
Painful forehead/headache
maxillary pressure
purulent discharge
follow viral URTI
analgesia
saline douche/steroid spray
abx - PenV 500QDS
coamoxiclav if systemically unwell.
why are Nasal decongestants bad
cause rhinitis medica mentosa - blocked nasal cavity
- requires steroids/surgery.
RFs tonsil/oropharynx cancer
Smoking
HPV
Mx:
south east asian , nasopharynx lump
cancer - > refer urgent endoscopy.
HN cancer MDT - radiotherapy
voive change >3w
smoker
Alcohol
SCC larynx cancer Ix: Flexible naso-laryngoscopy. -most often glottic region best prognosis - hoarsenss early. Tx: surgery, radiotherapy, or combo, MDT
bunch of grapes/soap bubble
papillomatosis
-HPV
25yo lump moves on swallowing /tongue protrusion
Thyroiglossal cyst
- dx USS
- mx: sistrunks procedure
22yo smooth fluctuant swelling, 1/3 down anterior SCM
USS
Cholesterol crystals
Branchial cyst
surgery
REd swollen ear , has otitis externa, piercing,
Perichondritis
can -> temporal osteomyeleitis
COamoxiclav
if severe -> IV
foreign body
can leave in for days
if u can see it remove , if pt compliant
button battery emergency
facial palsy .
Ix: otoscopy ,TM + -vesicles EAC - Ramsay hunt
Palpate parotid and neck
Movement of facial muscles.
Steroids + vaciclovir
eye drops/patch
ENT emergency clinic
facial nerve path
skull base -> middle ear cavity, temporal bone -> stylomastoid foramen -> parotid gland
sarcoid parotid enlargment anterior uveitis facial nerve palsy low grade fever
Heerfordt syndrome
RFs Bells palsy
Diabetes
URTI
Pregnancy
mass in parotid
facial nerve paralysis
Mucoepidermoid tumour
Painless well circumscribed swelling tail of parotid bilateral 10% male smoker 65
Warthins tumour
Parotid tumours
80% benign
80% of benigns are pleomorphic adenomas
young children - Haemangioma
most common malignancy - mucoepidermoid carcinmoa - > lymph spread. PAIN, rapid growth, facial nerve palsy.
Facial nerve
motor to stapedius - hyperacusis
superficial petrosal branch -> lacrimation. Geniculate ganglion lesion - shirmers test.
recurrent ulcers, white + erythematous halo
ex smoker
apthous ulcers
failure of ulcers to respond spontanouesly -> biopsy (exclude SCC)
cmv, HSV, EBV, HIV
Apthous ulcers mx
Paracetamol
NSAIDS
topical anaesthetics
persistent Indurated ulcer, lateral tongue, smoking hx,
exophytic, submucosal mass.
squamous cell carcinoma.
examine lNs
Refer - max fax/onc , 2 w wait. -> biopsy
Recurrent laryngeal nerve pasly causes
Thyroid surgery Aortic aneurysm repair oesophageal cancer bronchial carcinoma Polio
trismus , unilateral swelling, sore throat, pyrexia, sepsis
quinsy group A strep Mx: IV benzylpenicllin \+/- metronidazole. Incision and drainage with mosquito artery forceps/needle aspiration
2 seprate episodes -> elective tonsilectomy
infectious mononucleosis mx
IV fluids Get LFTs Analgesia ?steroids Avoid contact sport 6 weks (hepatitis/splenomegaly -> bleed)
Infectious mononucleosis ix
Latex agglutination with paul bunnel antigen -> detect heterphile antibody.
Monospot - most sensitive at 6weeks. better than paul bunnel.
Posterior epistaxis artery
Sphenopalatine artery (branch of internal maxilalry). Ligate with trans nasal endoscopic approach if nasal packing unsuccessful.
Epistaxis
Anterior: visible source. kisselbachs plexus.
Posterior: profuse. sphenopalatine.
Mx: Sit forward. Pinch soft 20mins Cautery. (visible) Packing (non visble) Rapid rhino. Catheter.
