ENT Flashcards
26-M urgent appointment in your duty clinic. 2/52 left sided facial pain and malaise. Symptoms initially were improving after 7/7 however they then worsened again and he is now feeling worse than he did initially. He is normally fit and well.
Low grade pyrexia of 37.9 degrees but other obs N. Anterior rhinoscopy shows a purulent discharge coming from the left middle meatus. dx?
bacterial sinositis
‘double sickness’ - secondary bacterial infection
unilateral swelling of one of the salivary glands =
sialadenitis
common bacterial causes sinositis adults?
Streptococcus pneumoniae, Haemophilus influenzae
facial pain - worse on bending forwards?
sinusitis (acute)
mx sinusitis?
analgesia
IN corticosteroids if sx> 10 days
PO abx if severe presentation (Pen V)
44M. perforated left eardrum. mx?
watch and wait
ENT referral if not healed after 6/52
BPPV ix, mx?
Dix-Hallpike manoeuvre is diagnostic
Epley manoeuvre is for treatment
sudden onset of dizziness and vertigo triggered by changes in head position. dx?
bppv
sudden-onset sensorineural hearing loss causes?
idiopathic commonest 85%
acoustic neuroma or other brain mass
trauma, blasts and loud noise, barotrauma, meningitis, herpes zoster, syphilis, immunological disease, AIDS, MS, Meniere’s disease, Lyme disease and stroke.
which ix would exclude a vestibular schwannoma.?
MRI
mx suden onset sensorineural hearing loss?
urgent ENT referral
corticosteroids PO high doses
what in high doses can cause tinnitus?
nsaids or aspirin
also loop diuretics and aminoglycosides.
Associated with hearing loss, vertigo, tinnitus and sensation of fullness or pressure in one or both ears
dx?
meniere’s disease
also have nystagmus sometimes
audiogram rules:
> 20 = normal
in sensorineural hearing loss both air and bone conduction are impaired
in conductive hearing loss only air conduction is impaired
mixed - both but air worse than bone
what symptom distinguishes vestibular neuronitis from labyrinthitis?
normal hearing in vestibular neuronitis
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2
dx?
acoustic neuroma
unilateral sensorineural hearing loss
3-M. 2/52 left-sided otalgia associated with a purulent discharge. You prescribed amoxicillin and arranged to see him today. Much better and says she has managed to keep the ear dry. Left side a perforation of the tympanic membrane is noted. What is the most appropriate action?
keep ear dry
review again in 4/52
-no indication to continue abx if ear dry
what may be used to decide whether to give antibiotics in the context of sore throat ?
centor or feverpain
centor criteria and what score indicates abx?
Tonsillar exudate Tender anterior lymphadenopathy or lymphadenitis History of fever Absence of cough 3+ = pen V
non-ent related causes of vertigo?
posterior circulation stroke
trauma
multiple sclerosis
ototoxicity e.g. gentamicin, quinine
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo
acute viral labyrinthitis
42M 2 week history of a worsening sore throat, is complaining of painful swallowing. On examination you notice that he has difficulty opening his jaw, purulent tonsils and his uvula is deviated to the right. Given the likely diagnosis, how should this condition be managed?
quinsy (peritonsilar abscess)
iv abx and surgical drainage
consider tonsillectomy in 6/52
Rinne’s test negative means?
bone conduction > air conduction and thus there is a conductive hearing loss in that ear ABNORMAL finding (even tho says negative)
Weber’s test can lateralise to the right….?
right ear has a conductive hearing loss, or the left ear has a sensorineural hearing loss
17-F One week previously she had an elective tonsillectomy for recurrent tonsillitis. She initially made a good recovery however last night had a sudden bleed from her left tonsillectomy site. Spontaneously resolved after five minutes. Well, normal obs. She has normal post-operative appearances of her oropharynx with a small blood clot visible adhered to her left tonsillar bed. mx?
same day ENT assessment
all post-tonsillectomy haemorrhages need referral
62-M 2 days after receiving a punch to his head on the right side. Since the injury, hearing muffled on the right side. No bruising. Both his ears are obscured by a thin translucent layer of wax. On the right, Rinne’s test demonstrates the tuning fork is easier to hear when pressed on the mastoid bone. On Weber’s test the sound is heard best on the right hand side.dx?
perforated eardrum
leading to sensorineural hearing loss on right
37-M otalgia. Seen in ED 2/7 previously but was discharged with advice only. He has now had otalgia for 5 days. Temp 38.5ºC, and red bulging ear drum on the right. How should you manage this gentleman?
otitis media amoxicillin treatment after a delay of 2-3 days if there is no improvement in symptoms. erythro if pen allergic coamox 2nd line
acute otitis media commonly viral (50%), which bacteria can cause?
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
33-M-> GP 4/12 hx persistent nasal discharge on his left hand side and facial pressure which is worse on bending forward. He often finds he has to breath through his mouth due to his nose being blocked. PMH asthma and is a smoker with a 5 pack-year history.
What is the most appropriate management?
ent referral
unilateral chronic sinusitis is a red flag
(along with persistence >3/12 and epistaxis)
An unexplained persistent sore throat with hoarseness. mx?
2ww referral for oral ca
laryngeal nerve - either laryngeal ca or lung ca
56-M reduced hearing and mild discomfort in his left ear for two weeks which he attributes to an ear infection, and he is asking for antibiotics. hearing a bit muffled, and he hears clicking and popping at times, especially when swallowing. He says he hasn’t had a cold recently. He is a current smoker. Right tympanic membrane appears normal, left tympanic membrane looks dull and retracted. The oral cavity looks normal and there are no enlarged cervical lymph nodes. mx:
2ww ent for ca
unilateral middle ear effusion could be nasopharngeal cancer
5-m -> GP 5/7 hx right-sided otalgia and reduced hearing. temp 38.5ºC hr 120 bpm. There is swelling around his right ear and the ear appears to be displaced anteriorly. The canal appears normal however the tympanic membrane is red and bulging. mx?
referral to ENT - sx of mastoiditis
25F slowly enlarging mass on the side of the face. Clinical examination demonstrates that the mass is located in the tail of the parotid gland. There is no evidence of facial nerve involvement. What is the most likely cause?
pleomorphic adenoma
benign
typically found in elderly males and are composed of multiple cysts and solid components consisting of lymphoid tissue. ???
warthins tumours
- most often found in the tail of the parotid gland
If a perforated tympanic membrane does not heal by itself after 6/12 - mx?
myringoplasty
42M->GP 6/52 after developing a cold. Whilst all of his other symptoms have now resolved, the patient is experiencing persistent blockage of his left nostril associated with rhinorrhoea and sneezing. Large polyp is seen in the left nostril. Examination of the right nostril is unremarkable. Next step in management?
urgent ENT referral -
unilateral polyp is red flag sx
bilateral polyp mx?
routine ENT referral
topical corticosteroids
asthma, aspirin sensitivity and nasal polyps triad =
samter’s triad
2M parents are concerned after he develops a lump in his neck. On examination there is a swelling in the subcutaneous tissue of the posterior triangle which transilluminates. dx?
cystic hygroma
congenital lymphatic lesion
40F presents with a painless neck lump. There is a mass noted beneath the sternocleidomastoid muscle. There is a long history and somewhat unkindly her husband remarked on her rather noticeable halitosis. dx?
pharyngeal pouch
32F referred to the clinic with recurrent infections and abscesses in the neck. Midline defect with an overlying scab, which moves upwards on tongue protrusion. dx?
thyroglossal cyst
Tonsilar SCC is associated with >
HPV 16
oral sex
25-M->ED: injury in a rugby game, went to ground, another player’s boot impacted his left ear. No LOC and only had some ear pain immediately after. In the ensuing minutes the pain worsened and he noticed a persistent ringing. When he felt his ear it was tender and swollen, with other players telling him it looked very red and puffy. No neurological deficit or pain other than in his left ear. The ear is ecchymotic and swollen with loss of normal anatomy to the anterosuperior pinna. Next step?
urgent ENT referral
same day assessment needed with auricular haematoma
A 42-year-old man with a 3 month history of chronic cough presents with a persistent headache dx?
sinusitis
- chronic - cough 2nd to post nasal drip
64F 7/7 hx pain above and lateral to her left eye. Tender over that area. dx?
temporal arteritis