ENT Flashcards
Triad of Presbycusis
B/L progressive sensorineural deafness With loss of high frequency pitch initially
Need quiet environment to hear
Observation and education as a t/m
How otosclerosis occurs?
Due to abnormal bone deposition resulting in stiffening of ossicular chains
How otosclerosis presents?
Seen in young adults with conductive hearing loss
Hearing improve in noisy environment (paracusis of willis)
Triad of Aspirin exacerbated Respiratory distress
Asthma
Chronic rhinosinusitis with nasal polyposis
Bronchospasm or nasal congestion with following the ingestion of Aspirin or NASIDS
Important point of Aspirin exacerbated Respiratory distress
Non IgE mediated diseases
Triad of Perforated Nasal septum
Noisy breathing on inspiration
Nasal congestion with crusting and bleeding
Seen in cocaine abuse or nasal surgery
How Vestibular neuritis present?
Self limiting condition occur after viral infection
Vertigo that can last days with abnormal thrust test
Sometimes U/L hearing loss
How to manage Vestibular neuritis?
Vestibular suppressant like meclizine
Steroids
Vestibular rehabilitation
How BPPV presents?
Recurrent vertigo with head movement
Last for less than 1 minute
Dix hallpike maneuver causes nystagmus
Name the complications which leads to Perilymphatic (Labyrinthine) fistula
Head trauma
Barotrauma
Ultimately leads to leakage of fluid from semi circular canal
How Perilymphatic (Labyrinthine) fistula presents?
Vertigo/. Hearing loss / nystagmus and tinnitus whenever sneezing , straining Or loud noises (Tullio phenomenon)
Name the risk factors which causes otitis externa
Water exposure
Trauma like cotton swabs Or Ear candling
Foreign material like headphones or hearing aid
Skin infection like eczema Or contact Dermatitis
Name the organisms causing otitis externa
S.auerus
P.aeruginosa
Triad of Otitis externa
Ear pain with hearing loss and discharge
Pain with auricle manipulation
Without involvement of tympanic membrane
How to manage Otitis externa?
Topical quinolones with or without steroid
Name the risk factors for for leukoplakia
Tobacco and alcohol use
How aphthous ulcer present?
Localized shallow painful ulcer with a gray base
Name the condition causing Referred Otalgia
TMJ joint pathology
Dental caries
Triad of TMJ disorder
Referred Otalgia with normal ear
examination
Sign of bruxism (worn and
Jaw pain and TMJ tenderness)
How to managed TMJ disorder
NSAIDs Dental splint (if bruxism suspected) Avoidance of triggers , use of soft diet
How eustachian tube dysfunction presents?
Ear pain with popping sound
Hearing loss
Tympanic membrane changes
Define Necrotizing (malignant) otitis externa
Life threatening infection of the external auditory canal
Risk factors for Necrotizing (malignant) otitis externa
Age above 60
Diabetes mellitus
Aural irrigation (cerumen removal)
Name the bacteria causing Necrotizing (malignant) otitis externa
P.aeruginosa
Triad of Necrotizing (malignant) otitis externa
Severe unremitting pain more at night and with chewing in elderly patient
Granulation tissue at the bony cartilaginous junction and edematous external canal with Purulent Drainage
S’times cranial nerve 7/10/11 affected
How to t/m Necrotizing (malignant) otitis externa?
IV cipro with or without surgical debridement
Triad of Ramsay hunt syndrome (herpes zoster oticus)
Vesicular rash on the auditory canal or auricle
U/L facial paralysis
Antiviral (valacyclovir) but facial palsy remain
Triad of HSV 1
Bell palsy
Vesicular lesions on oral mucosa
Name the most common suppurative complication of AOM
Acute mastoiditis
Triad of Acute mastoiditis
Fever
Ear pain
Inflamed mastoiditis with displacement of auricle
Examination findings of AOM
Bulging tympanic membrane due to inflammation
Decrease TM mobility on pneumatic insufflation on visible air fluid levels indicate middle ear effusion
How to manage acute mastoiditis?
IV antibiotics
Drainage of Purulent fluid required via tympanostomy (with or withou ear tube placement) OR mastoidectomy
How to manage Epiglottitis?
After securing the airway via ETT, give ABx ceftriaxone and vancomycin
What is the main rain factor for Epiglottitis?
Un vaccination
Triad of Epiglottitis
Fever with dysphagia and drooling
Lean forward and hyperextend neck to maximaze airway
Stridor and muffled hot potato voice
Why stridor doesn’t occur in bronchiolitis?
B/c stridor occurs in upper airway obstruction
Triad of Croup
Seen in children age 6months to 3 years
Fever with stridor
Barky cough
At what age foreign body aspiration is Common?
Age less than 3 years
Triad of Peritonsillar abscess
Seen in older children and adolescent
Gradual onset fever and muffled voice
U/L tonsillar swelling with tonsillar ulceration
Define Otitis media with effusion
Middle ear fluid without inflammation
Triad of Otitis media with Effusion
Seen in children age 6-24 months with episode of AOM or Viral infection
Air fluid levels posterior to the TM and poor TM mobility on pneumatic insufflation
Ear tugging and pulling ear without fever or ear pain
How to manage Otitis media with effusion
Resolve within weeks and doesn’t require t/m
Chronic OME (>3months) need close follow up and warrant t/m like tympanostomy tube placement as it causes speech delayed and long term hearing loss
How to Manage Thyroglossal duct cyst?
Confirm the presence of normal thyroid tissue
Do surgical resection of cyst associated tract and central portion of hyoid bone
How non TB mycobacterial lymphadenitis present?
Slowly enlarging Lateral neck mass
Overlying violaceous skin discoloration
Name the ABx for Neonatal sepsis
Ampicillin and Gentamicin
How laryngomalacia occurs?
Chronic stridor due to laryngeal hypotonia, redundant supraglottic soft tissue and inflammation (due to reflux).Floppy supra glottic structures which collapse during inspiration
Triad of laryngomalacia
chronic inspiratory stridor in infants age 4-8 months
worse in supineposition and improves in prone position
Dx via flexible fiberoptic laryngoscopy which shows ‘‘omega shaped epiglottis and collapse supraglottic structures during inspiration
How to manage laryngomalacia?
In most cases resolves and just need follow upSupra glottoplasty needs in severe cases like feeding difficulties, FTT, cyanosis or tachypnea
How vascular rings present?
Biphasic or expiratory stridor due to tracheal compression and feeding difficulties due to esophageal compression
Imaging of vascular rings shows
bariumswallow can identify indentations of the esophagusdx confirmed via contrast CT Or MR angiography
How choanal atresia presents?
If U/L –> chronic nasal dischargeIf B/L–>noisy breathing with cyclic cyanosis worsen with oral obstruction like feeding and improves when breath via mouth like during crying
How to dx choanal atresia?
Initial test is unable to pass the catheter through nares into oropharynxConfirmed test is Ct scan Or nasal Endoscopy
How to manage choanal atresia?
Oral airwaySurgical airway
What is CHARGE SYNDROME?
C COLOBOMA H HEART DEFECTS A ATRESIA CHOANAE R RETARDATION OF GROWTH G GENITAL ABNORMALITIES E EARABNORMALITIES
Important point
Vertical transmission of HPV causes recurrent respiratory papillomatosis which cause hoarseness due to finger shaped nodules on the vocal cordsRequire surgical debridement as mainstay as medicine has limited efficacy
What are the risk factors for Acute otitis media?
Recent URI
Smoking
Day care center
No breast feeding
How to manage acute otitis media?
first line is Amoxicillin for infant age less than 6 months and for children more than 6 months with high grade fever, severe pain Or B/L disease
2nd line augmentin for recurrent sxs after 2-3 days of ABx therapy Or Recurrent AOM (within 30 days) after ABx therapy.
If penicillin allergic—> give azomax OR clindamycin
Important Point of AOM Tx
if penicillinallergy give clindamycin or Azomax as alternate
When to consider tympanocentesis in AOM?
Tympanocentesis and culture during tympanostomy tube placement when:-Multiple episodes of AOM (>3episodes in 6months)- Or persistent (>3months) middle ear effusion with hearing loss
Name the MCC of non-inherited sensorineural deafness in children
Congenital CMV infection
Important point
sensorineural deafness due to noise exposure is rare at age <5 years
How is otomycosis present?
characteristic appearance of white fungal debri with fruiting bodies or Spores
Triad of Chronic suppurative Otitis media
Otitis media for more than 6 wks
Otorrhea and hearing loss
Tympanic perforation on examination
What are the risk factors for Cholesteatoma?
Recurrent AOM
Chronic middle ear effusion
tympanostomytube placement
Important Point of Cholesteatoma
The dx should be suspected in any patient with continued otorrhea for several weeks despite ABx therapy
Triad of Cholesteatoma
Otorrhea
Conductivehearing loss.
pearly white mass behind the tympanic membrane or visible retraction pocket with draining debri
Triad of Peritonsillar abscess
fever with pharyngeal pain and earache
Uveal deviation away from enlarged tonsil
trismus and muffled hot potato voice
How to managePeritonsillar abscess?
Needle aspiration or incision and drainage
ABx to cover Group A-hemolytic streptococci
Important point
Recurrent URI would cause AOM not OE
What is Landau Kleffner syndrome?
An epileptic condition that presents with regression in language milestones after normal development
Important Point
Frontal sinuses are absent at birth and progressivelypneumatized from age 2 through puberty
Important Point of Nasal discharge
;If U/L—> think of retained foreign body
if B/L—> allergic rhinosinusitis / adenoidal hypertrophy / acute bacterial sinusitis
Name the condition which shows Biphasic stridor
Subglottic stenosis
Name the condition which shows Expiratory stridor
tracheomalacia
Important Point of tracheomalacia
Inspiration decreases the intra thoracic pressure widens the intrathoracic tracheal airwayExpiration increases the intra thoracic pressure narrow the intrathoracic tracheal airway result expiratory stridor
How otomycosis presents and t/m?
whitish fungal debris with fruiting bodies or Spores
Topical clotrimazole
-Important Point
There is perioral numbness in Vertebrobasilar insufficiency(Not Hemifacial)
Name the complication due to Retropharyngeal abscess
acute necrotizing mediastinitis
How does sialadenosis present?
Non tender B/L enlargement of salivar gland
Does not fluctuate and not associated with eating
Name the risk factors for sialadenosis
Alcoholic
Bulimia
malnutrition
How salivary stones (sialolithasis) are presented?
Tender swelling of salivary gland
fluctuating
painful and increased on eating
Why is levothyroxine given in post thyroidectomy due to thyroid cancer?
To replace thyroid gland function
also suppresses TSH as tsh will stimulate thyroid tissue resulting in recurrence of cancer.
What features in U/S which suggest thyroidcancer?
micro-calcifications
irregular margins
increase vascularity
nodule more than 1cm
Important Point
FNAC is considered as safe procedure during pregnancy
U/S is initial modality of choice for workup of thyroid nodules
Name the dx test for CSF Rhinorrhea
CSF specific protein (B2 transferrin / B-trace protein)
Classified the pediatric neck mass on basis of location
if middle–> thyroglossal duct cyst / dermoid cyst
if lateral—> branchial cleft cyst / reactive adenopathy / MAC
If posterior–> cystic hygroma
Triad of laryngocele
outpouching of the laryngeal mucosa
lateral neck mass enlarges with valsalva maneuver due to air inflation
acquired laryngocele seen in glassblowers / trumpet players due to repeated intense oropharyngeal pressure
important point
dermoid cyst in neck doesn’t move with protrusion of tongue
How d/f types of infections are present on larynx(vocal cords)?
fungal –> thick white patches on an erythematous base-
HPV–> irregular exophytic growth in clusters
How to d/f nasal septal hematoma and deviated nasal septum?
Nasal septal hematoma—> soft fluctuant on examination
DNS—> firm
Important Point
nasal septal has no direct blood supply and receives nutrients via diffusion.
Destruction of nasal cartilage leads to septal perforations / saddle nose / nasal obstruction
How to manage nasal septal hematoma?
Incise and drain the nasal septum initially
Do anterior nasal packing with ice packsand NASIDS to reduce edema
What is torus palatinus?
benignbony growth located at the midline suture of hard palate
Name the conditions which would cause Whistling sound (nasal septal perforation)?
Rhinoplasty nose trauma syphilis / tb cocaine nose sarcoidosis/wegner disease
How auricular hematoma present?
There is tender fluctuant blood collection in ANTERIOR pinna
How to manage auricular hematoma?
Immediate incision and drainage
Pressure swelling
What are the complications of auricular hematoma?
Re collection of hematoma
Bacterial superinfection
Cauliflower ear due to fibrocartilage overgrowth
How to treat Barotrauma of the EAR complicated by Rupture of the tympanic membrane?
Only Reassurance and follow up Examination
Important point of Non scrapped hairy cell leukemia
Though occur due to EBV but it is seen in immunodeficient patient such as HIV
So get the test of HIV or underlying cause of immunodeficient before biopsy or any invasive imaging
