ENT Flashcards
What are the red flags for a local neck lump? (7)
Dysphagia or odynophagia Persistent sore throat Loose or misaligned teeth Cough Haemoptysis Ipsilateral otalgia, nasal obstruction or epistaxis Sensation of lump in throat
What are the red flags for a haematological malignancy and neck lump? (5 groups)
B symptoms: night sweats, fever, weight loss, fatigue
Unexplained bleeding, bruising or petechiae
Unexplained recurrent infections
Alcohol induced pain
Bone pain
What are some causes of neck lumps? (7)
Congenital Neoplasm - benign e.g. lipoma Neoplasm - malignant e.g. lymphoma, salivary gland Vascular - aneurysm, tumour Infection Inflammatory e.g. sarcoidosis Thyroid
Over what age would you be more concerned about a neck lump?
40 years
Where do most nose bleeds arise from?
Little’s Area
After how long would you consider admitting for a nosebleed?
20 mins - admit to ENT ward
What are the initial management options for a nose bleed?
What should you do next if you successfully controlled bleeding?
Pressure, ice packs, cautery if can visualise bleeding
If not, can use an anterior pack. If still bleeding, use a posterior pack
Advice - do not blow nose for a week, no hot drinks or baths/showers, no strenuous exercise
Naspetin ointment BD for 2 weeks to keep crust-free
What do you need to consider if using a posterior pack for nosebleeds?
If in place for >48h, need antibiotics
What are some causes of nasal blockage? (6)
Infection
Allergy +/- polyps
Septal deviation
Drugs - chronic decongestants, cocaine abuse
Neoplasm
Inflammatory - sarcoidosis, vasculitis, Kartagener’s
What are the management options for allergic rhinitis?
Nasal douching
Avoid allergen
Steroid sprays
Antihistamines
What is the diagnostic criteria for acute sinusitis?
Symptoms present for <12 weeks
Have one of nasal blockage or discharge PLUS either facial pressure/pain or reduction in smell
What is the mangement for acute sinusitis? (4)
What are the certain requirements for the medication used?
Analgesia
Nasal saline irrigation
Nasal decongestant (<5 days)
Intranasal steroids (if symptoms lasting >10 days or worsen after 5 days)
What are the complications of acute sinusitis?
- Intracranial (3)
- Extracranial (3)
- meningitis, cavernous sinus thrombosis, intracranial abscess
- osteomyelitis, orbital cellulitis or abscess
What is the diagnostic criteria for chronic sinusitis? (3 components)
Symptoms present for >12 weeks
Must have one of nasal obstruction OR nasal discharge PLUS one of either facial pain/pressure or reduction in smell
PLUS endoscopic polyps, oedema or discharge OR CT shows mucosal changes
What diagnostic tests are there for chronic sinusitis? (2)
CT sinuses
Endoscopy
What is the management for chronic sinusitis? (4)
What is the option if medical management fails?
Nasal saline irrigation Short term nasal decongestants If no polyps, intranasal steroids If polyps, oral steroids followed by intranasal steroids Antibiotics if infection
Surgery - functional endoscopic sinus surgery
What is the management for otitis externa? (3)
What is the management for malignant otitis externa? (3)
Keep ear dry, Topical antibiotics and steroids for <1 week, Analgesia
MRI skull base, surgical debridgement, IV antibiotics for 6w
What is the management for otitis media?
How long dose it take to resolve?
When should you consider antibiotics?
What is the criteria for recurrent otitis media?
Analgesia - most resolve within 3-7 days
Consider antibiotics after 4 days or immunocompromised
More than 4 episodes in 6 months
What are the causes of otitis media with effusion? (2)
How would you investigate OME? (3)
What is the management of OME in children? (4)
Eustachian tube dysfunction, nasopharyngeal tumour
Audiometry, tympanometry, nasoendoscopy (adults)
Watch and wait, hearing aid, grommets, adenoidectomy
What is the management of chronic otitis media? (4)
Topical antibiotics and steroids if perforation
Aural cleaning (microscope)
Strict water precautions
Myringoplasty if not resolving or socially embarassing
What are the complications of otitis?
- Internal (4)
- External (3)
- Vertigo, hearing loss, otitis externa, facial weakness
2. Meningitis, abscess, sigmoid sinus thrombosis
What is the initial management of cholesteatoma? (3)
What is the definitive management of cholesteatoma?
Audiogram, aural cleaning, antibiotics and steroids if infection
Mastoidectomy
