ENT Flashcards
What is cholesteatoma?
keratinised epithelial cyst in middle ear
What are the two types of cholestoma
Acquired
Congenital
Congenital cholesteatoma: What does this present as ?
Small white pearl behind intact tympanic membrane
What is vertigo?
Sensation of motion (hallucination) either of the body or the environment
Is vertigo typically caused by asymmetric or bilateral dysfunction of the vestibular system
asymmetric
Dizziness: Subjective phonomenon that can be characterised into 3:
- vertigo
- Disequilbirum
- Syncope
What are two types of vertigo?
Central (15%)
Peripheral (85%)
Onset of central vs peripheral vertigo
Central: Gradual Onset
Peripheral: Rapid onset
Beta Histidine Mechanism
Betahistine seems to dilate the blood vessels within the inner ear which can relieve pressure from excess fluid and act on the smooth muscle
4 causes for middle ear fluid
OME with glue ear
Blood
Pus (AOM)
Cerebrospinal Fluid
What are 4 types of chronic middle ear disease?
- OME with glue ear
- perforation
- Atelectasis
- Choleasteatoma
20 40 rule of neck lumps
over 40: malignancy
20-40: salivary gland calclus, infection, tumour, thyroid pathology, chronic infection tb or HIV (cervical lymphanodenopathy)
under 20 : inflammatory (cervical lymphadenopathy) congenital: thyroglossal cyst, brachial cyst, dermaoid cyst haemangioma, lymphoma
MIDLINE thyroglossal duct cyst: who does this occur in
what exerbates it
congenital: But can occur all ages
- -> this is cyst in midline: of tract between tongue and thryoid gland
exacerbated by infeciton
In NZ what is the most common parotid gland malignancy?
metastatic SCC
other midline neck swelling cause paeds
dermaoids
Lateral sided swelling paeds
Branchial cyst
paeds neck lump rule
80% non malignant and located in anterior
20% malignant and located in posterior
adult neck lump rule
80% chance malignant
80% chance it is metastatic SCC
in adult neck lump: if metastatic SCC: where is likely site of origin?
skin
oropharynex (tongue/tonsils)
in head and neck cancer: what is single most important prognostic factor?
state of neck nodes - if +ve comprehensive neck dissection
if -ve selective
NECK LUMPH:
maligant: what is most common
mets from SCC of tongue/skin/aerodigestives
ADULT MIDLINE LUMP DIFF
thyroid disease:
(throygologgsal branchial and dermaoid cyst possible)
Thyroid adenoma
thyroid carcinoma
what % of thyroid cancers are maligant
2-5%
most common maiglangant caricnoma
papillary
4 complications of thyroidectomy
haematoma
recurrent laryngeal nerve inury
hypocalcaemia
hypothyroidism
H and Neck SCC: what do they do early on?
H&N SCC metastasises EARLY to neck nodes
Enlarged neck node may be ONLY symptom
- need to look for primary tumour
investigations neck lump:
ultraound +
examination and biopsy under anasthesia
Fine needle aspiration of neck nodes
CT scan + chest/abdo mets
When is barium swallow done?
see hypophayngex, oseophagus and stomach
lateral sided ncek lump in adult differneitals:
Malignancy mets/lymph nodes Parotid mass lymphoma glandular fever HIv/TB
When is barium swallow done?
DONE FOR DYSPHAGIA
see hypophayngex, oseophagus and stomach
cuases of hoarseness
Reikes oedema.
Polpys
papillomatosis
SCC of vocal cords
Rzeinkes oedema?
odematous vocal cords caus by voice trauma, acid refliux and smoking
masses of salivary glands:
chronic permanent enlargement of salivary gland is ?
neoplastic unless proven otherwise
parotid masses Neoplastic two types
80% beigng pleomorphic adenoma
20% malignant
-metastic SCC
Mucoepidermid carcinoma
parotid masses non neoblastic
stones
sjorgen syndrome
Why must all parotid massses recieve a parotiectoymy?
risk of transofrming into
carcinoma ex pleimoprhic
- mass effect continue to group
Short term risks of parotidectomy?
bleeding
salivary fistula
facial weakness
long term risk factors
long term facial nerve hemiparalysis
Frey syndrome (facial nerve parasympathetic fibres damage where eating triggers sweat production
greater auricular nerve -
treatment frey syndrome
anticholingergic + botox
Investigations parotid mass
FNA /US guided
CT and CXR
During parotidectomy: if malignant what needs to occur?
MINIMUM dissection of LN 1-3 levels
post op radiotherapy
what random dental thing parotedectomy =
prophylatic dental extraction
while parotid 80% benigng: what is submandibular lumps likely
mailgant
Sjogrens syndrome: waht is this ?
diuagnosis
Autoimmune idisorder that causes lymphoid infiltration into the salivary glands
sublabial biopsy
Serology
test to see if eye produces enough water Diagnosis Schirmer’s test
Parotid gland mass presentaiton if beingng
if malignant
smooth, slow growing non tender
malignant :
pain, radid growth, fixed, facial paralysis
what may look similar to enlarged submandibular gland
tonsillary node enlargement - important to note this is BEHIND the submandibular triagle
head and neck mass what % of all cancers
most common type ?
5-8%
oral cavity
what does oral cavity carcinoma commonly present as
painless superficial ulcer
existing leukoplakia can be present
poorly defined margins
4 major risk factors for head and neck
tobacoo
alcohol
sun exposure
HPV virus
which type is most common of head and neck cancer
squamous cell carcinoma most common from mucosa/skin
Staging head and neck nodes
- single node <3cm
- 3-6cm
N3 > 6cm
Larynx cancer non surgical options
radiation or CO2 laser
larynx: stridor and hoarseness causes
reinkes oedema epiglotitis Polyps Palliomatosis SCC Thyroid (papillary carcinoma most common of malignant: most common is begnign follicular adenoma)
what is most common SKIN cancer of head and neck
BCC
growth and mets of BCC vs SCC
BCC: slow growth rare invasion
SCC: fast growth fast invasion
SCC vs BCC on presentation
BCC = likely on skin , telengectasis, rolled border, pigmentation, ulceration/look like bilsters
SCC: firm flesh coloure scaly/crusted /plaques smooth nodules
diagnosis SCC vs BCC
BCC: diagnosed by biopsy (ecisional) as is SCC
treatment BCC
2-4 mmm margin biopsy or MOhs surgery gold standard
oral SCC floor of mouth imaging
Orthopantomogram X-Ray
ORAL SCC: where does it tend to spread:
tongue, mandible
cervical lymph nodes
SCC of vocal cords: prognosis:
lesions confined to true vocal cord great prognosis:
lesions to anteriro comissure = poor prognosis
SCC of vocal cords glottis region presentation
early: dysphonia:
late - all others
treatment SCC vocal crod
mainly radiotherapy: laryngectomy only indicated for late cancers + neck dissection
papillomatous vocal cord causes
HPV 6 and 11
benign tumour in respiratory tract
Treatment papillomatous vocal cord causes
laser excision
antiviral treatment
papillomatous vocal cord when does this regres?/
teenage years
laryngeal nodules: What are these ?
type of chronic laryngitis
if acute dysphonia does not resolve within ? weeks ?
3 weeks ENT referral
all vocal cord palsues where history and examination is not diagnostic should?
CT to see recurrent laryngeal nerves
laryngeal nodules who is most common in
adult females
child males
where does this occur laryngeal nodule?
at unction of anterior middle thirds of cord
laryngeal nodules: caused by
traumatic opposition of cords= overuse /chronic laryngitis
laryngeal nodules are they usually bilateral or unilateral?
symmetrical or asymmetrical
usuallybilateral symmetrical
most important treatment laryngeal nodules
voice retrating (and then microlaryngoscopic excision)
VOCAL CORD POLYPS
causes
treatment
What is one random thing that can cuase?
smoking
hypothryoidism
prolonged oedema (reinkes)
GERD
treatment: speech retrinaing
excision if large
NASAL POLYPS AND SPECUMULUm:
what colour are they ?
do they present with bleeding?
what do they present with?
are they bilateral or unilater?
What can they cause ?
opalscent colour
do NOT present with bleeding
rhinotorrhoea, nasal obstruction - can cause ansomia (smell blindness)
bilateral - if unilateral ? tumour
chronic sinusitis/bone deformities/
treatment nasal polyps
topical steroids and FESS
Septal deviation presentaion:
which is more symptomatic: anterior or psoterior
what compensated
anterior deviation near nasal valve
large inferior turbinate compensates on opposite side as response
Little’s area
greater ethmoid artery
anterior ethmoidal
superior labial
Sphenopalatine artery
septal deviation treatment + copmlications
submucous resection
+ haemarrhoeage and haematoma
osteosarcoma what is this?
malignant bone in metaphysis area with wide zone transition codmans triangle and periosteal reaciton
more amphorous calcified matrix
Fluffy appearance- bone
Shows cortical destruction
what is codmans triangle?
shows lifting of the periosteum
Ewings sarcoma
wide zone transition
lamellated pertosteal reaciton = long bones
more permative moth eaten
where does osteosarcoma occur in commonly?
distal femur, bones of knee
