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ENT Flashcards

1
Q

Define acute otitis media

A

Inflammation of middle ear mucosa

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2
Q

Epidemiology of acute otitis media

A

Common condition especially in children
High morbidity, low mortality

30% <3yrs visit GP with acute otitis media/year

Peak incidence 3-11 months
By age 3, 50-85% of children have had AOM
Incidence decreases by age 7

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3
Q

Aetiology of acute otitis media

A

Most commonly viral, but can be bacterial or both

Commonly an initial viral infection, complicated by a secondary bacterial infection

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4
Q

Most common bacterial causes of acute otitis media

A

Strep pneumoniae - 40%
Haemophilus influenzae - 30%
Moraxella catarrhalis - 10%

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5
Q

Risk factors for acute otitis media

A 
Male
Daycare
Winter
Genetics (Down's, cleft palate)
Smoking
Not being breast fed
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6
Q

Symptoms of acute otitis media

A 
Otalgia (pain)
Otorrhoea (discharge if TN perforation)
Headache
Fever
Irritability
Loss of appetite
D&V
Reduced hearing in affected ear
Relief on ear tugging
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7
Q

Investigations for acute otitis media

A

Otoscopy (TM bulging, erythematous, may be perforated)

Examine entire head and neck region

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8
Q

Complications of acute otitis media

A 
Otitis media with effusion
Hearing loss (sensorineural, usually temporary)
Acute mastoiditis (inflammation of mastoid air cells)
Perforated ear drum
Facial nerve palsy
Subperiosteal abscess
Labyrinthitis - dead ear
Meningitis
Cerebral abscess
Sigmoid/lateral sinus thrombosis
Recurrent attacks
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9
Q

Treatment of acute otitis media

A

Most cases improve spontaneously - analgesia, antipyretic

Conservative for 3 days, treat if persistent (>4 days):
Otorrhoea
TM perforation
<2yrs and bilateral
Mastoiditis
Systemically unwell
Antibiotics (amoxicillin/clarithromycin)
\+/- myringotomy (surgical incision into eardrum)
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10
Q

Pathophysiology of acute suppurative otitis media

A

Viral induced middle ear effusions secondary to eustacian tube dysfunction

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11
Q

Epidemiology of acute suppurative otitis media

A

Most common in children, rare in adults

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12
Q

Signs and symptoms of acute suppurative otitis media

A

Severe pain
Sometimes fever
+/- discharge (TM rupture)

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13
Q

Management of acute suppurative otitis media

A

Amoxicillin

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14
Q

Define chronic otitis media

A

Recurrent otitis media with effusion
Not infective
Chronic inflammation with accumulation of fluid in the middle ear and no sign of infection due to eustachian tube dysfunction

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15
Q

Signs and symptoms of chronic otitis media

A 
Asymptomatic
Hearing loss (conductive deafness)
Tinnitus
Vertigo
Otalgia
Recurrent infection
Impaired development in speech and language
Fullness in ears (adults)
Commonest cause of acquired hearing loss in children, rare in adults
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16
Q

Investigations for chronic otitis media

A

Conductive hearing loss
Flat tympanogram
Suspect nasopharyngeal cancer if unilateral OM with effusion in adults

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17
Q

Management of chronic otitis media

A

Grommets

Hearing aid

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18
Q

Chronic supparative otitis media

A

Chronic inflammation of middle ear and mastoid cavity

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19
Q

Signs and symptoms of chronic supparative otitis media

A 
Painless otorrhoea (>2 weeks)
Conductive hearing loss of variable severity
Perforated TM (pars flaccida)
Granulation tissue
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20
Q

Management of chronic supparative otitis media

A

Aural toilet
Topical antibiotics
Possible surgery - myringoplasty or tympanoplasty

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21
Q

Define cholesteatoma

A

Expanding destructive growth of keratinising squamous epithelium in middle ear cleft

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22
Q

Causes of cholesteatoma

A

Congenital or acquired
Retraction of TM commonest cause
Ear trauma
Recurrent OM infection

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23
Q

Signs and symptoms of cholesteatoma

A 
Chronic otorrhoea
History of otitis media
Malodorous discharge
Vertigo
Conductive hearing loss
24
Q

Complications of cholesteatoma

A

Facial nerve palsy
Labyrinthitis
Meningitis
Extra/subdural abscess

25
Q

Management of cholesteatoma

A

Surgical: mastoidectomy and tympanoplasty

26
Q

Pathophysiology of cholesteatoma

A 
Eustachian tube dysfunction -> 
Negative middle ear pressure -> 
Retraction of pars flaccida -> 
Infection -> 
Erosion and spread
27
Q

Investigations for cholesteatoma

A

CT

Biopsy

28
Q

Define primary otalgia

A 
Pain that originates within ear:
External otitis
Otitis media
Mastoiditis
Auricular infections
29
Q

Define referred otalgia

A 
Pain originating outside of the ear:
Dental pathology
Sinusitis
Neck problems
Tonsillitis
Pharyngitis
30
Q

Investigations for earache

A

Detailed history and exam

Rule out differentials

31
Q

Management of earache

A

Identification of causative aetiology often necessary to treat successfully

32
Q

Define laryngitis

(acute and chronic)

A

Inflammation of the larynx
Can lead to oedema of the true vocal fold

Acute:
Abrupt onset, usually self-limited

Chronic symptoms:
>3 weeks
Thorough evaluation required as symptoms are similar to laryngeal malignancy

33
Q

Causes of acute laryngitis

A

Infectious:
Most often viral and self-limiting
Rhinovirus, parainfluenza, respiratory syncytial virus, influenza, adenoviruses

Bacterial:
Can be life-threatening
H influenzae, Moraxella, Strep pneum, Staph aureus, klebsiella, diptheria, TB

Fungal
Non-infectious agents
Vocal misuse 
Reflux laryngitis - caused by GORD
Chronic irritant laryngitis
Allergic
Autoimmune (RA, relapsing polychondritis, Wegener granulomatosis, sarcoidosis)
34
Q

Signs and symptoms of laryngitis

A

Hoarseness of voice (gradually over <7d, preceded by viral URTI)
Dysphagia, sore throat
May present with airway distress and high fever
Infective signs - odynophagia, cough, fever, respiratory distress

35
Q

Investigations for laryngitis

A

Culture
Laryngoscopy (inflammation seen, biopsy)
Analysis of vocal fold movement (asymmetry)
FBC
PCR for diphtheria rapid antigen detection test (group A strep)

36
Q

Management of laryngitis

A

Secure airway
Vocal hygiene
Supportive care (cough suppressant, mucolytic)
Analgesia

Viral:
Voice rest
Hydration (humidified air)

Bacterial:
Antibiotics and supportive measures
Vocal strain - voice therapy and vocal hygiene

37
Q

Define epiglottitis

A

Acute inflammation in supraglottic region of oropharynx

With inflammation of the epiglottitis, vallecula, arytenoids, aryepiglottic folds

Airway emergency - especially in children (may be more indolent in adults)

Classically occurs in children 2-6 yrs

38
Q

Causes of epiglottitis

A 
Infectious
Most common organisms:
H. influenzae (25%)
H. parainfluenzae
Strep pneumoniae
Group A strep

Can be any other of bacteria/viruses

Candida and aspergillus are important causes in immunocompromised patients
Non-infectious
Thermal (drug smoking, bottle-feeding)
Causitic insults
Foreign body ingestion
Head and neck chemo
39
Q

Signs and symptoms of epiglottitis

A 
Rapid onset and progression
High fever
Sore throat
Inability to control secretions
Tripod positioning
Difficulty breathing/swallowing
Muffled voice
Preceding URTI symptoms
40
Q

Complications of epiglottitis

A 
Meningitis
Adenitis
Vocal granuloma
Pneumonia and other lung pathology
Pericarditis
Septic arthritis
Cellulitis
Sepsis
Death (asphyxia)
41
Q

Investigations for epiglottitis

A

Clinical diagnosis (don’t delay securing airway)
Nasopharyngoscopy/laryngoscopy
Radiology (soft tissue lateral neck radiography, USS)
Cultures of systemically unwell

42
Q

Management of epiglottitis

A

ABCDE
Airway management, intubate if necessary
(respiratory distress, airway compromise, stridor, dysphagia, drooling, deterioration)

43
Q

Define acute pharyngitis

A

Rapid onset sore throat and pharyngeal inflammation

With or without exudate

Pathophysiology includes infection and inflammation of the pharynx

44
Q

Signs and symptoms of pharyngitis

A

Acute onset sore throat
Pharyngeal exudates
Cervical adenopathy
Fever

Absence of cough, nasal congestion and discharge suggests bacterial aetiology

Generally self-limited with resolution within 2 wks

45
Q

Causes of pharyngitis

A

Group A strep

Viral:
EBV, adenoviruses, enteroviruses, influenza, parainfluenza

Candidal pharyngitis
Diphtheria
Measles
Tularaemia

Sexually transmitted:
Acute HIV, gonorrhoea, chlamydia

46
Q

Differentials of pharyngitis

A 
Epiglottitis
Abscess
Infectious mononucleosis (EBV)
Diphtheria
Lemierre's (thrombophlebitis of the jugular vein)
Measles
Oropharyngeal cancer
47
Q

Investigations for pharyngitis

A

Throat swab
Blood agar
RATD

48
Q

Management of pharyngitis

A

Analgesia, LA
Salt water
Antibiotics if proven strep A

49
Q

Complications of group A strep pharyngitis

A 
Suppurative (pus)
Peri-tonsillar abscess
Lymphadenitis
Sinusitis
Otitis media
Mastoiditis
Invasive infections e.g. toxic shock syndrome, necrotising fasciitis
Non-suppurative
Acute rheumatic fever
Acute glomerulonephritis
50
Q

Define tonsillitis

A

Acute infection of the parenchyma of the palatine tonsils

May occur in isolation or as part of generalised pharyngitis

Clinical distinction between tonsilitis and pharyngitis in the literature is unclear, often referred to as “acute sore throat”

51
Q

Pathophysiology of tonsillitis

A

Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema and pain

Rarely swelling may progress to soft palate and uvula (uvulitis) or inferiorly to the region of the supraglottis

52
Q

Causes of tonsillitis

A

Mostly viral:
Commonly rhinovirus
Then coronavirus & adenovirus, influenza, parainfluenza, enteroviruses, herpes, EBV

Bacterial causes:
10-30% 
Group A strep (Beta haemolytic)
Strep pyogenes
Staph aureus
H-influenza
53
Q

Symptoms of tonsillitis

A 
Acute onset fever
Throat pain exacerbated by swallowing
Headache
Malaise
Halitosis
Odynophagia
Tonsils enlarged, red, purulent exudate
Cervical lymphadenopathy
54
Q

Investigations for tonsillitis

A 
Throat culture
Rapid strep antigen testing
FBC
Antibody testing for mononucleosis (EBV)
Throat swab/ASO titre +/- MONOSPOT
55
Q

Management of tonsillitis

A

Conservative for 7d if pyrexic
Analgesia/anaesthesia
Salt water gurgling

If microbiologically confirmed group A strep: penicillin or macrolide

Tonsillectomy if recurrent

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