ENT Flashcards
most common causative bacteria in otitis externa
pseudomonas aeruginosa
staphylococcus aureus
causes of otitis externa
trauma (scratching, aggressive cleaning)
chemical irritants
swimming
allergy (neomycin eardrops common)
presentation of otitis externa
ear pain tragal tenderness otorrhea aural fullness itching decreased hearing
clinical findings in otitis externa
normal otoscopy and tympanometry (unless AOM present)
investigations of otitis externa
ear culture of exudate/debris
consider CT of temporal bone if suspecting malignant otitis externa
features of malignant otitis externa
pain disproportionate to findings (often keeps patient awake at night)
granulation tissue along the floor of the external auditory canal
diabetic or immunocompromised
management of otitis externa
topical antibiotics - ciprofloxacin/neomycin ear drops
analgesia - paracetamol
systemic Abx if refractory to topicals - ciprofloxacin
most common causative organisms in AOM
strep. pneumoniae
haemophilus influenzae
presentation of AOM
preceding upper respiratory infection, commonly viral
otalgia
fever
if effusion = decreased hearing
in young children - irritability, increased crying, sleep disturbance
management of AOM
paracetamol/NSAIDs
amoxicillin (erythromycin if resistant)
tympancocentesis
complications of AOM
tympanic membrane rupture
mastoiditis
bullous myringitis
pathophysiology of AOM
viral URTI -> inflammation of nasal passages/eustation tube/middle ear -> impaired mucocillary action and ventilatory function -> build up of nasopharyngeal flora ->effusion which allows growth of bacteria -> inflammatory response -> suppuration and pressure leads to pain and fever ->perforation of TM leading to purulent discharge
define cholesteatoma
presence of keratinising squamous epithelium within the middle ear
this grows and expands causing resorption of underlying bone
the epithelium gets trapped, infected and proliferates into a cholesteatoma
presentation of cholesteatoma
conductive hearing loss with a background of chronic OM
management of cholesteatoma
surgical removal +/- ossicles reconstruction
features of chronic OM
hearing loss chronically discharging (>6weeks) ear in the absence of fever and otalgia
management of chronic OM
topical antibiotics
TM perforations should heal spontaneously but if large = surgery (myringoplasty or tympanoplasty)
causes of facial palsy
Bell’s
lyme disease
gullain-barre
sarcoidosis
define Bell’s palsy
acute unilateral peripheral facial nerve palsy (in those with otherwise normal history and examination)
thought to be a reactivation of HSV type 1 within the geniculate ganglion
management of bells palsy
prednisolone
eye protection - artificial tears, ophthalmic lubricant
antiviral therapy if severe - valaciclovir
define osteosclerosis
abnormal bone growth around the stapes leading to stapes fixation
presentation of osteosclerosis
gradual conductive hearing loss with vertigo and tinnitus
what is carhart’s notch
a dip in bone conduction at 2000Hz on audiogram
associated with osteosclerosis
management of osteosclerosis
hearing aids
stapedectomy
what is Meniere’s disease
an auditory disease caused by over production of/impaired resorption of endolymph
presentation of meniere’s
sudden onset vertigo
low frequency roaring tinnitus
low frequency hearing loss
aural fullness
management of Meniere’s
dietry changes (low Na intake, limit caffeine and alcohol)
diuretics - hydrochlorothiazide
antiemetics, antihistamines, anticholinergics, corticosteroids (for vertigo)
surgery (endolymphatic sac surgery, vestibular nerve section, labyrinthectomy)
risk factors for laryngeal cancer
smoking, alcohol, GORD
presentation of laryngeal cancer
hoarseness is the cardinal symptom
dysphagia, odynophagia, throat pain, supraglottic/glottic mass, lesions on vocal cords, neck mass
investigations for laryngeal cancer
laryngoscopy
FNA of any masses
Neck CT
laryngeal biopsy
management of laryngeal cancer
larynx sparring surgery (laser resection, cordectomy, partial laryngectomy)
total laryngectomy
chemo, radiotherapy
Speech therapy
subglotic tumours require a total + neck dissection (including thyroidectomy)
commonly affected areas in oropharyngeal cancer
base of tongue
soft palate
palatine tonsillar fossa
pharyngeal wall
risk factors of oropharyngeal cancer
alcohol and smoking
HPV
presentation of oropharyngeal cancer
sore throat
oral pain
dysphagia
trismus
neck mass
Wt loss
oral lesions (ulcers, leucoplakia, erythroplakia)
investigations for oropharyngeal cancer
biopsy
FNA of nodes
PET/CT head and neck
risk factors for nasopharyngeal cancer
EBV infection smoking alcohol poor oral hygiene salted fish
presentation of nasopharyngeal cancer
chronically blocked nose recurrent epitaxis, rhinorrhoea hearing impairment, tinnitus, ear pain neck pain cranial nerve palsies
red flags for cancers of the head
hoarseness > 6weeks
ulceration or swelling in mucosa > 3 weeks
red or white patches in oral mucosa
dysphagia
persistent unilateral nasal blockage (especially if purulent discharge)
neck lump > 3 weeks
types of oesophageal cancer
80% adenocarcinoma(GORD and barret’s)
squamous cell carcinoma (smoking, alcohol)
causes of tonsilitis
70% viral (HSV, influenza, parainfluenza)
30% bacterial (grp A haemolytic strep pneumoniae, haemophilus influenzae, s aureus)
EBV can cause a severe tonsillitis called glandular fever
signs of tonsillitis
pain redness pus white plaques hepatosplenomegaly in glandular fever
investigations for tonsillitis
CRP, WCC
LFTs - may be deranged in glandular fever
monospot - chesks for EBV infection
if pyrexic - throat swab and blood cultures
what is the centor score
evaluates risk of tonsillitis form GAHSP
tonislar exudates, tender cervical nodes, history of fever, no cough
management of tonsillitis
paracetamol/NSAIDs
penicillin
admit if can’t eat or drink (IV fluids and IV benzylpenicillin)
tonsillectomy
if glandular fever avoid alcohol and contact sports (liver injury)
what is a glomus tumour
paragangliomas in the middle ear, temporal bone, vagus nerve or the carotid body
presentation of a glomus tumour
persistent pulsatile tinnitus
can also secrete catecholamines, presenting with hypertension
a pulsatile red mass behind the eardrum
management of epiglottitis/supraglottitis
secure airway
oxygen
IV antibiotics (ceftriaxone)
dexamethasone
what airway problem appears as a ‘cherry red swelling’
epiglottitis
presentation of epiglottitis/supraglottitis
rapid onset fever
sore throat (out of proportion, tonsils appear normal)
classic tripod positioning
breathing difficulty
causative organisms of epiglottitis/suprsglottitis
haemophilus influenzae B
strep pneumoniae
staph aureus
which vessels make up kisslbach’s plexus
greater palatine
anterior ethmoid
sphenopalatine
superior labial
types of bleeds in epistaxis
anterior (90%) - littles area - younger patients
posterior (10%) - sphenopalatine artery - older patients
management of Epistaxis
A-E Trotter's method (15min) nasal packing AgNO3 cautery surgical ligation
clinical findings in allergic rhinitis
pale, oedematous and enlarged turbinates
nasal congestion and clear discharge
management of allergic rhinitis
saline rinse/irrigation
petroleum based ointments (barrier method)
intranasal steroids
oral antihistamines
leukotriene receptor antagonists may help if asthmatic
management of non-allergic rhinitis
saline douching/spray
nasal steroids - beclomethasone
intranasal antihistamine - azelastine
anticholinergic nasal spray
describe the innervation of the larynx
innervated by the vagus nerve
branches into superior laryngeal nerve and recurrent laryngeal nerve
causes for vocal fold paralysis
post viral neuropathy damage from surgery (thyroid, parathyroid, skull base, carotid) malignancy (H&N, intrathoracic) trauma MS
causes of hoarsness
age related (prebyphonia) laryngitis laryngeal cancer vocal cord polyp vocal cord nodules reinke's oedema
management of vestibular neuritis
reassure that it is self limiting (several weeks)
anti-emetic: cyclizine or buccal prochlorperazine
presentation of vestibular neuritis
vertigo
N&V
nystagmus
absence of tinnitus, hearing loss or focal neurological signs
indications for tonsilectomy
high risk of malignancy OSA recurrent tonsillectomy (7 or more a year, more than 5 a year for 2 years, more than 3 a year for 3 years) 2 quinsy abscess in year
complications of tonsillitis
quinsy (peritonsillar) abscess
parapharyngeal abscess
submental abscess
hamorrhage after tonsilectomy
management of a quinsy
incision and drainage IV antibiotics dexamethasone analgesia tonsillectomy if >2 a year
what is a brachial cyst
a benign developmental defect of the brachial arches
a cyst filled with acellular fluid with cholesterol crystals
presentation of a brachial cyst
typically presents in young adults/teens as asymptomatic neck lumps anterior to the SCM muscle
describe a brachial cyst
unilateral - more common on the left side
non tender, slowly enlarging, smooth
no movement on swallowing or transillumination
