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