ENT Flashcards
What is the management of acute otitis media without complications?
With perforation - review drum in 6-8 weeks.
If no hearing loss, dry perforation, does not need to be repaired.
What is the management of a traumatic perforation of the ear drum?
Review drum in 6-8 weeks. If not hearing loss, dry perforation, does not need to be repaired.
What are the symptoms of otitis externa?
Inflammation of skin
Itch (cardinal feature)
Minimal hearing loss
Pain
What is otitis externa most commonly caused by?
Pseudomonas
What are the predisposing factors for otitis externa?
Skin conditions (eczema, psoriasis)
Systemic conditions (diabetes)
Cotton bud use
Cosmetics
What is the treatment for otitis externa?
Clean the ear
Topical steroids
Topical antibiotics
Topical antifungals if fungal
What is a sign of necrotising otitis externa?
Granulation tissue
What are the features of necrotising otitis externa?
Pain +++
Discharge
Granulation tissue on floor of ear canal
+/- facial palsy or abducens palsy
What is the management of necrotising otitis externa?
Refer to ENT on call for admission
IV antibiotics with bone penetration for at least 6 weeks
CT temporal bones
Medical management of immunocompromise
Who is most at risk of developing necrotising otitis externa?
Diabetics
People who are immunocompromised.
What is cholesteatoma?
Squamous epithelium in middle ear or mastoid
What are the features of cholesteatoma?
Discharging ear that does not resolve with antibiotics treatment.
What is the management of cholesteatoma?
Surgery: Mastoidectomy Atticotomy Atticoantrostomy Endoscopic approaches
What are the possible methods of pathogenesis for cholesteatoma?
Retraction pocket - pars flaccida, pars tensa
Non-retraction pocket - perforation, traumatic/iatrogenic
Congenital - epithelial rest, intact TM.
What is a discharging perforation?
Perforation with inflammation of middle ear mucosa.
What are the symptoms of a discharging perforation?
Pain initially
Discharging ear
Hearing loss
What is the treatment for a discharging perforation (active chronic otitis media)?
Medical:
Aural toilet (microsuction)
Antibiotics/steroid drops/sprays
Surgical:
Myringoplasty or tympanoplasty
What are the causes of otorrhoea (ear discharge)?
Otitis externa
Acute otitis media with perforation
Active chronic otitis media (COM) - mucosa/squamous
Trauma
What is otalgia?
Ear pain
What can cause otalgia?
Acute otitis media Otitis externa Necrotising otitis externa Furuncle in ear canal Otitis media with effusion Temporomandibular joint
What are the symptoms of acute otitis media?
Otalgia
Pyrexia
Hearing loss
Discharge if drum perforates
What is the management of acute otitis media?
Analgesia
Antibiotics if no improvement
What are the red flags for otitis media with effusion?
Young south-east asian male
Middle aged adults with neck nodes
What are you worried about if you see red flags for otitis media with effusion?
Nasopharyngeal carcinoma
What are the features of tympanic scleorsis?
White flecks on ear drum
Retracted tympanic membrane
Can see head of stapes
What is the function of the eustachian tube?
It equalises pressure across the tympanic membrane.
Allows air into the middle ear.
Opens on swallowing and yawning.
What is the management of otitis meda with effusion?
Decongestant nose drops to nasopharynx. Valsalva maoeuvre/otovent Ventilation tubes Hearing aid Chest postnasal space if unilateral
What are the symptoms of tonisiltis?
Odynophagia
Dysphagia
Systemic upset
What is the management of tonisiltis?
Symptomatic treatment
Penicillin V + analgesia
Which drug should you avoid giving in glandular fever?
Ampicillin - it can cause a rash that lasts for up to 6 months
What are the sign guidelines for tonsillectomy?
Sore throats are due to acute tonsilitis.
Episodes are disabling and prevent normal functioning.
7 or more well documented, clinically significant, adequately treated sore throats in preceding year.
5 or more episodes in each of the preceding two years.
3 or more episodes in each of the preceding three years.
What are the symptoms of allergic rhinitis?
Nasal congestion Runny nose Itchy nose Sneezing \+/- red and watery eyes
What is the appearance of the nose in allergic rhinitis?
Pale, oedematous turbinates
Nasal congestion
Clear discharge
What is the treatment for non-allergic rhinitis?
Saline douching/spray
Trigger avoidance/reduction
+/- nasal steroid
What is rhinitis medicamentosa?
Rhinitis or nasal blockage caused by medication.
Which medications tend to cause rhinitis medicamentosa?
Xylometazoline HCl
Oxylometazoline HCl/phenylephrine sprays
Sudafed
Can occur after 7 days of use
What do nasal polyps looks like?
Pale
Insensate
What are the symptoms of nasal polyps?
Rhinorrhoea
Blockage
Smell disturbance
(Subset of chronic rhinosinusitis)
What are the two main symptoms of sinusitis?
Nasal blockage
Nasal discharge
\+/-: facial pain poor sense of smell endoscopic features CT changes
How long does acute rhinosinusitis last?
Less than 12 weeks
How long does chronic rhinosinusitis last?
> 12 weeks
How do you make a diagnosis of acute bacterial rhinosinusitis?
At least 3 of: Discoloured discharge Severe, localised facial pain Pyrexia Raised ESR/CRP Deterioration after initial milder symptoms
What is the management for acute bacterial rhinosinusitis?
Consider topical steroids
Consider oral antibiotics
What is the treatment of a deviated septum?
Exclude or treat concurrent pathology i.e. allergic rhinitis
Trial of medical therapy
Septoplasty if symptoms match the deformity
What are the red flags for sinonasal malignancy?
Unilateral anything.
Blood stained discharge.
Dental/orbital signs: loose teeth, proptosed eye, unilateral decreased eye movements.
What is a symptom of septal perforation?
Nasal obstruction
What can septal perforation be a symptom of?
Underlying systemic condition
What are the causes of septal perforation?
Idiopathic Rhinotillexomania Cocaine use Iatrogenic Autoimmune conditions
What is the treatment for septal perforation?
Saline douching
Vaseline
Stop causative agents
Surgery:
Septal button, flaps
What can GPs prescribe for epistaxis?
Naseptin (but not if the patient has a peanut or soy allergy)
What causes globus sensation?
Increased tension in the muscles of the neck/pharynx.
Stress and anxiety; particularly when trying to hold back strong emotions
Acid reflux
Which types of HPV are most carcinogenic?
16 and 18
What are the red flags of head and neck cancer?
Hoarseness for >6 weeks
Ulceration or swellings of the oral mucosa >3 weeks
Red and white patches of the oral mucosa
Dysphagia
Persistent unilateral nasal obstruction, especially if accompanied with purulent discharge.
Neck masses >3 weeks duration.
Cranial nerve involvement
Persistent unilateral otalgia with normal otoscopy.
What are the causes of a hoarse voice?
Laryngitis Laryngeal cancer Vocal cord palsy Vocal cord polyp Vocal cord granuloma Respiratory papillomatosis Reinke's oedema Vocal nodules Muscle tension dysphonia
What does dysphagia mean?
Difficulty swallowing
What does odynophagia mean?
Painful swallowing
What is the management for sudden onset hearing loss?
Steroids (1ml/kg, max 60mg) within 72 hours of symptom onset if normal ear canal, tympanic membrane, no infection and reduced hearing with clinical testing.
What are the features of a malignant neck lump?
Firm to touch, but can be cystic.
Overlying skin changes
What are the investigations of a lateral neck mass?
Full examination
Ultrasound and fine needle aspirate/core biopsy
CT/PET-CT
What could a malignant lateral mass on the neck arise from?
Squamous cell carcinoma - likely to arise from head and neck
Adenocarcinoma - pathology more likely to lie below clavicles
Lymphoma
What are the types of benign parotid lump?
Pleomorphic adenoma (malignant potential) Warthin's (can be bilateral)
What are the features of a parotid lump that would suggest malignancy?
Pain
Facial nerve palsy
Skin changes
Associated lymphadenopathy
What are the investigations of a parotid lump?
Full examination including inside mouth
Ultrasound and fine needle aspirate
Parotidectomy if malignant/PSA
What is a second cleft branchial cyst?
Lateral mass
Squamous-lined cyst - hypothesised to be epithelial inclusions with lymph nodes that occur during development of neck from pharyngeal arches
Who is most likely to to present with a 2nd cleft branchial cyst?
Young adults
What are the investigations of 2nd cleft branchial cysts?
Ultrasound and fine needle aspirate
Extreme care in over 35s - can be similar to cystic metastases
What is the management of 2nd cleft branchial cysts?
Can be treated by surgical excision
What causes a thyroglossal duct cyst?
Failure of thyroglossal duct to obliterate during development
Who is most likely to present with a thyroglossal duct cyst?
Usually present in children, but can be young adults.
What is the key feature of a thyroglossal duct cyst?
Midline neck lump that moves on swallowing and tongue protrusion
What is the risk of a thyroglossal duct cyst becoming infected?
Can form fistula
What is the treatment of a thyroglossal duct cyst?
Surgical excision along with central portion of body of hyoid bone (sistrunk’s procedure)
What are the features of thyroid nodules?
Midline neck lump that only moves on swallowing (not tongue protrusion)
What are the red flags for thyroid nodules?
Family history of thyroid cancer Radiation history Child Hoarseness/stridor Rapid enlargement Cervical lymphadenopathy Associated pain
What are the causes of a thyroid goitre?
Iodine deficiency
Hashimoto’s thyroiditis
Grave’s disease
How would a thyroid goitre be investigated?
TFTs
TPO antibodies
TSH receptor antibodies
What is stertor?
A kind of snoring
What causes stertor?
Partial obstruction above larynx
What causes stridor?
Partial obstruction at level/below larynx
What forms the borders of the anterior triangle of the neck?
Sternocleidomastoid muscle
Midline
Border of mandible
What forms the borders of the posterior triangle of the neck?
Trapezius
Clavicle
Midline
What are the causes of vocal cord pathology?
Mucosal lesion
Paralysis
Age related
What are the risk factors for vocal cord pathology?
Smoking
Alcohol excess
What happens to the vocal cords in age-related voice change (presbyphonia)?
Bowing of vocal cords due to atrophy
Incomplete glottic closure
What is laryngitis?
Common, short lasting acute inflammation affecting the laryngeal mucosa.
What are the aetiologies of laryngitis?
Upper respiratory tract infection
Chemical injury
Physical injury
What can cause chronic or recurrent laryngitis?
Laryngeal reflux Smoking Alcohol Snoring Systemic disease (rare) e.g. RA, sarcoidosis
What are the symptoms of a vocal cord palsy?
Breathy voice
Cough/choking after swallowing
What is the aetiology of a vocal cord palsy?
Iatrogenic - neck surgery (particularly thyroid)/cardiothoracic surgery
Tumours - head and neck - direct invasion of larynx or recurrent laryngeal nerve
Lung cancer
Stroke
Neck or chest injury
Neurological
Viral infections
What is the treatment for vocal cord palsy?
Usually conservative - especially if lung tumour, poor prognosis
Speech and language therapy
Cord medialisation procedures to improve voice
Cordotomy procedures to improve airway
What are the types of vocal cord polyps?
Pedunculated or sessile
What is the aetiology of vocal cord polyps?
Voice abuse Chronic cough Chemical - laryngeal pharyngela reflux, smoking, alcohol Infection Allergy/inflammation
What can cause a vocal cord granuloma?
Continous damage and the subsequent healing process.
e.g. intubation trauma, arytenoid granuloma
What can infection with HPV types 6 and 11 cause?
Recurrent respiratory papillomatosis
What is the treatment for recurrent respiratory papillomatosis?
Endoscopic removal with microdebrider
LASER
Mitomycin/interferon
Preventative - HPV vaccination
What is Reinke’s oedema?
Bilateral oedema of the vocal cords caused by smoking (and sometimes severe laryngeal reflux)
What are the consequences of reinke’s oedema?
Deepening of the voice
What is the treatment for reinke’s oedema?
Stop smoking Lateral cordotomy (remove fluid) if required
What is the main cause of vocal cord nodules?
Voice misuse: singers, teachers, sports coaches, children
What is the treatment for vocal cord nodules?
Speech and language therapy
What is the progression of vocal cord nodules?
Early: soft inflammatory swelling over microhaemorrhage
Later: fibroblasts and collagen fibres
What causes muscle tension dysphonia?
Increased and sustains tension in laryngeal muscles resulting in abnormal movement of cords.
What is the most common type of laryngeal cancer?
Squamous cell carcinoma
What are the risk factors for laryngeal cancer?
Smoking
Alcohol
Lower socio-economic group
HPV related
What is the cardinal symptom of laryngeal cancer?
Hoarseness
What are the other symptoms of laryngeal cancer?
Dysphagia Weight loss Haemoptysis Neck lump Pain Aspiration Airway compromise
What are the investigations for laryngeal cancer?
Cytology (fine needle aspirate of cervical lymphadenopathy or biopsy of vocal cords)
Imaging - CT/USS/PET
What is the management of laryngeal cancer?
Depends on staging - MDT decision.
Surgery - laser resection for early stage.
Laryngectomy
Radio/chemotherapy
What are the possible causes of airway compromise?
Facial trauma: maxiall/mandibular fracture, base of skull fracture
Oral cavity: foreign body, tongue enlargement, angioedema, floor of mouth swelling
Bleeding: tonsil bleed, trauma
Neck: masses, goitre, scars
Larynx: mass, infection
What is the presentation of supraglottitis?
Septic with sore throat
Why is swallowing button batteries bad?
It causes local erosion
What are the signs of glandular fever?
White exudate
Lymphadenopathy
Hepatosplenomegaly
What causes glandular fever?
EBV infection
What is the management of glandular fever?
Avoid alcohol
Avoid anything that could lead to abdominal trauma e.g. contact sports, gigs, sex
Avoid sharing of saliva (to prevent passing it on)
What is the management for quinsy?
Drain abscess Aspirate or incise and drain Admit IV antibiotics +/- dexamethasone Consider tonsillectomy if more than 1 episode
How do you manage a patient with post tonsillectomy bleed?
Treat as any haemorrhaging patient
What is ludwig’s angina?
Severe cellulitis involving the floor of the mouth
What are the symptoms of a parapharyngeal abscess?
Neck mass
Unwell
Febrile
Decreased rotational neck movements
What are the features of a retropharyngeal abscess?
Swinging pyrexia (picket fence) Decreased neck movements Maybe relatively well Usually children May cause airway compromise
What is the possible emergency management for retropharyngeal abscess?
May need tracheostomy
Likely difficult intubation
May rupture abscess on intubation
In what age group do you immediately give antibiotics for otitis media?
<2 years
What are the possible complications of acute otitis media?
Intracranial abscess
Facial palsy
Mastoiditis
Meningitis
What is the management of mastoiditis?
24 hours of IV antibiotics
Nil by mouth until ENT review
May need CT head/temporal bones and drainage if unwell
What does peri-orbital cellulitis often follow?
URTI
What are the features of peri-orbital cellulitis?
Eye proptosis
Reduced visual acuity
Unwell
Red vision reduced
What is the management of peri-orbital cellulitis?
ENT/ophthalmology/paeds assessment
NBM
Stat IV antibiotics
What does a Pott’s puffy tumour often follow?
URTI
What is the management of a suspected Pott’s puffy tumour?
CT with contrast
NBM
IV antibiotics
What is the treatment ladder for epistaxis?
Adequate 1st aid:
- head forward over bowl/sink
- pinch soft part of nose
- ice over bridge/back of neck/in mouth
Secondary care intervention:
- protection (gloves, goggles, apron, mask)
- headlight and thudichums
- suction clot from nose/nasopharynx/oropharynx
- spray LA
- Identify bleeding points
Monitor for shock.
Silver nitrate cautery of bleeding vessels
Nasal packing - nasal packs, foley catheter and BIPP
What are the causes of epistaxis?
Trauma Nasal septal deviation/spur/perforation Iatrogenic Inflammation Foreign body Environmental Malignancy Systemic disorders
Which area of the nose is most commonly involved in a nose bleed?
Kiesselbach’s plexus in Little’s area
What is a fractured nose assessed for?
Other injuries/fractures
Compound fracture
Septal haematoma
What are the causes of a septal haematoma?
Nasal trauma
Post operative complication
What is the management of a septal haematoma?
Incision and drainage
Antibiotics
Take to theatre same day.
What are the risks associated with septal haematoma?
Septal perforation
Abscess
Cavernous sinus thrombosis
What are the features of a septal haematoma?
Boggy cherry red swelling
When should a fractured nose be treated?
Assessment 5-7 days after injury to allow swelling to settle.
Manipulation before 14 days.
How should a fractured nose be treated?
Septoplasty +/- rhinoplasty later
What is bell’s palsy?
Facial palsy with no identified underlying cause.
What is the treatment for facial nerve palsy?
Treat underlying cause
Steroids within 72 hours.
Eye protection
What is the name of the scale given to document a facial palsy?
House Brackmann scale
I-VI
Where on a House Brackmann scale can a patient still close their eye?
I-III
What is the aetiology of facial palsy?
Idiopathic (68%)
Trauma
Tumour
Infection
What is Ramsay Hunt syndrome?
Bells palsy + vesicles
Herpes zoster infection
What are the symptoms of Ramsay Hunt syndrome?
Bells palsy Vesicles in mouth and around ear Hearing loss Vertigo Pain
What is the management of Ramsay Hunt syndrome?
Analgesia
Steroids
Acyclovir
What happens if you don’t drain a pinna haematoma?
You get a cauliflower ear
How do you remove a foreign body from an ear?
Syringing
Suctioning
Fine hook
If it’s an insect drown it first.
What are the symptoms of a traumatic tympanic membrane perforation?
Hearing loss
Bleeding ear
Discharge
What are the signs of a base of skull fracture?
Panda eyes Battle's sign Facial palsy Haemotympanim (blood behind eardrum) Halo sign
How do you know if a facial palsy if lower motor neurone or upper motor neurone?
If it involves the forehead it is lower motor neurone.
How do you test visual stimulus in a patient with vertigo?
Halmaygi head thrust test
How do you test proprioception in a patient with vertigo?
Romberg’s test
How do you test vestibular function in a patient with vertigo?
Unterberger’s test
What is the most likely cause if a patient get dizzy on head movements or looking up/
BPPV
What is the most likely cause if the patient gets vertigo with a feeling of a blocked ear or tinnitus?
Meniere’s
What is the most likely cause if the patient gets sudden onset vertigo and feels dreadful for weeks with no hearing loss?
Vestibular neuronitis
What is the diagnosis if a patient gets sudden onset vertigo and feels dreadful for weeks with hearing loss?
Labyrinthitis
What is a positive finding in the halmaygi head thrust test?
Eyes do not stay fixed on target, deviate to the side of the lesion.
Indicates pathology in vestibular system.
What is a positive finding in a test of skew?
Quick vertical gaze corrections suggests a central cause
Where is the location of pathology if the patient has dysdiadokinesis or past pointing?
Cerebellum
What happens in a Romberg’s test?
If patient closes eyes they can’t stay upright
What happens in unterberger’s test?
If patient closes eyes they rotate
What happens in a positive Dix-Hallpike test?
Rotatoinal nystagmus related to head movement. Fatiguable. Latency period.
What are the phases of nystagmus?
Slow and fast phase
Which phase of nystagmus defines the direction?
Fast phase`
What are the causes of nystagmus?
Physiological Spontaneous nystagmus (pathological vestibular) Gaze evoked nystagmus Positional nystagmus Central positional nystagmus
What happens in spontaneous pathological nystagmus?
Constant drift of eyes to side of lesion, interrupted by fast component in contralateral direction.
How is spontaneous nystagmus graded?
Alexander’s law
1st degree: only present if eye deviated towards fast phase.
2nd degree: present when eye in primary position.
3rd degree: present when eye deviated towards slow phase.
What happens in gaze evoked nystagmus?
Cannot sustain gaze away from primary position i.e. cannot sustain lateral gaze.
What causes gaze evoked nystagmus?
Central dysfunction (i.e. areas controlling reflexes) Maybe iatrogenic (anticonvulsants, psychotrpic) or due to alcohol.
What are the common causes of vertigo?
Benign paroxysmal positional vertigo
Vestibular neuronitis
Migraine
What are causes of imbalance?
Common: Postural hypotension Hypertension Vestibular migraine BPPV
Uncommon:
Meniere’s disease
Cerebellopontine angle tumour
What is the patholphysiology of benign paroxysmal positional vertigo?
Otolith dislodgement in posterior semicircular canal causing irritation of the cupula.
Or
Cupulolithiasis - otoliths adherent to cupula
What is the treatment for vestibular neuronitis?
Prochlorperazine (short course)
What is the treatment for Meniere’s disease?
Conservative:
lifestyle - low salt, reduce caffeine
Medical:
Preventitive medication - betahistine (limited evidence)
Symptomatic medication - buccal prochlorperazine.
Surgical - vestibular destructive:
Disabling vertigo and patient not coping
Intratympanic gentamicin.
Effective in 90%. Hearing loss in 15-20%.
What are the indications for a tracheostomy?
Mechanical obstruction Protection of trachebronchial tree Respiratory failure Retention of bronchial secretions Elective (part of major surgery)
What are the advantages of a tracheostomy?
Bypasses obstruction when ET tube cannot be passed.
Decreases dead space by 150ml (50%)
Better tolerated than ET tube.
Eventual swallowing and speaking.
What are the disadvantages of a tracheostomy?
Lost of humidifcation and warming - increased mucous, increased mucous plugging.
Neck wound/scar
Tracheocutaneous fistula
Possible discharge from hospital delay
Where is the tracheal window?
2nd/3rd ring
What are the elements of tracheostomy care?
Humidification
Suctioning
Cleaning
Changing
Which virus causes epiglottitis?
Haemophilis influenza B
What is the decibel threshold for normal hearing?
up to 20 decibels
Which patients get a pharyngeal pouch?
Patients over 70
What are the symptoms of a pharyngeal pouch?
Dysphagia Regurgitation of unaltered food (food enters pouch preferentially) Chronic cough Recurrent chest infections Weight loss
What is the management of a pharyngeal pouch?
Conservative:
Alter diet
Manage risk factors
Medical:
Reflux control
Surgery:
Endoscopic division/stapling (most common)
Open resection
What is globus sensation?
Feeling of something stuck in the throat/tightness in the throat.
What are the symptoms of silent reflux?
Sore throat - mild, daily, in the morning. Lump in throat sensation Post nasal drip sensation Nocturnal cough Hoarse voice Excessive throat clearing Throat closing over (laryngospasm) Water brash (liquid suddenly appearing in the throat)
What are the risk factors for GORD?
Adult: Smoking Alcohol/coffee High BMI Pregnancy Hiatus hernia Trigger foods (typically salted or fatty) Late night eating Some connective tissue disorders.
Infant: Neuromuscular disorders Cow's milk intolerance 13q14 mutation Neuro-developmental conditions
What is the treatment for GORD?
Weight loss
Alginate
PPI
H2-receptor antagonist
What are the complications of GORD?
Oesophagitis including erosion and ulcers.
Barrett’s oesophagus
Adenocarcinoma of oesophagus
Laryngeal granulomas
Laryngospasm
Stenosis
Association with laryngeal carcinoma in non-smokers
What is sialolithiasis?
Salivary gland stones.
What is the most common location of a salivary gland stone?
Submandibular gland
What is the presentation of sialolithiasis?
Intermittent pain and swelling associated with meals +/- palpable hard lump in duct.
Who is most commonly affected by sialolithiasis?
Men aged between 30-60 years.
What are the complications of salivary gland stones?
Infection - associated erythema, pus discharging from duct.
What is the management for sialolithiasis?
Hydration
Sialogogues
Analgesia +/- antibiotics
Surgery: incision over duct to remove stone. Gland removal (associated risks)
What is sialadenitis?
Infection/inflammation of salivary glands.
Viral or bacterial.
What is the presentation of sialadenitis?
Swelling of gland
Pain
Systemic upset
What is the management of sialadenitis?
Supportive: rehydration, sialogogues, antibiotics.
Name two hearing tests.
Pure tone audiogram.
Tympanogram.
On a hearing test which ear does red represent?
Right.
What does a tympanogram test?
Middle ear function
What are the causes of conductive hearing loss?
Pinna - microtia/atresia
External auditory canal - wax, foreign body etc.
Tympanic membrane - large perforations, large tympanosclerotic plaques.
Middle ear - otitis media with effusion, haemotympanum, cholesteatoma, ossicular disruption, otosclerosis.
What are the causes of sensorineural hearing loss?
Inner ear - cochlear aplasia/hypoplasia Perilymph fistula Otoxic medication Meningitis Menieres cochlear otosclerosis Labyrinthitis Noise induced hearing loss Presbyacusis
Retrocochlear - cochlear nerve damage
IAM/CPA lesions
Intracranial lesions/disease
Processing dysfunction
What happens in age related hearing loss (presbycusis)?
Peripheral degeneration
Reduction in number of inner and outer hair cells.
Leads to secondary neural (central degeneration)
Central component (arteriosclerosis)
Hearing impaired in background noise
What is otosclerosis?
Abnormal bone growth around stapes, leading to stapes fixation.
What is the age of onset of otosclerosis?
Young adult/adult
Can become worse in pregnancy
What is the inheritance pattern of otosclerosis?
Autosomal dominant inheritance.
Often sporadic mutation
What is the management of otosclerosis?
Hearing aid
Stapedectomy if does not tolerate hearing aid and sensorineural component negligible.
What is the management of otitis media with effusion?
Decongestant nasal drops to nasopharynx
Valsalva manoeuvre/otovent
Ventilation tubes (grommets)
Hearing aid
What are the causes of tinnitus?
Drugs: Salicylate Quinine Ototoxic Noise induced Menieres Otosclerosis Vestibular schwannoma
What is the management of tinnitus?
Habituation - explanation and information - reasurrance - masking - white noise, hearing aids, tinnitus maskers Formal tinnitus counselling (severe cases) Medication (rarely): TCA, benzos, high dose lignocaine. Surgery (rarely): anatomical causes (glomus tumour)
When do we investigate tinnitus?
Pulsatile
Unilateral
Associated vestibular symptoms or signs
How is an acoustic neuroma investigated?
MRI
How is acoustic neuroma managed?
Watchful waiting (serial MRI) Stereotactic radiotherapy (small but rapidly growing) Surgery
Which rheumatological conditions can have nasal symptoms?
Granulomatosis with polyangitis Sarcoidosis Eosinophillic granulomatosis with polyangiitis Relapsing polychondritis Systemic lupus erythematosis
What is the management of chronic rhinosinusitis?
Nasal steroids
Increase potency and/or frequency of nasal steroids
Saline douching 2-3x per day
Oral steroids
Antibiotics
CT scan if no improvement despite compliance.
Function endoscopic sinus surgery
Which arteries make up Kiesselbach’s plexus?
Anterior ethmoidal
Superior labial
Sphenopalatine
Greater palatine
Give some causes of hoarse voice.
Laryngitis Vocal cord palsy Laryngeal cancer Vocal cord polyp VC granuloma Papillomas Reinke's oedema Vocal nodules Muscle tension dysphonia
