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ENT > ENT > Flashcards

ENT Flashcards

1
Q

In whom is acute otitis media common?

A
  • young children

- 1/2 have 3 or more episodes by 3yo

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2
Q

Pathophysiology of acute otitis media:

A
  • viral URTIs typically precede
  • most secondary to bacteria esp. streptococcus pneumonia, haemophilus influenza and moraxella catarrhalis
  • disturb normal nasopharyngeal microbiome, allowing bacteria to infect middle ear via Eustachian tube
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3
Q

Features of acute otitis media:

A
  • otalgia
  • fever 50%
  • hearing loss
  • recent viral URTI symptoms
  • ear discharge if tympanic membrane perforated
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4
Q

Otoscopy findings acute otitis media:

A
  • bulging tympanic membrane - loss of light reflex
  • opacification or erythema of tympanic membrane
  • perforation with purulent otorrhoea
  • decreased mobility if using pneumatic otoscope
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5
Q

Criteria to diagnose otitis media:

A
  • acute onset
  • presence of middle ear effusion (bulging membrane, otorrhoea or decreased mobility of pneumatic otoscope)
  • inflammation of tympanic membrane
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6
Q

Management otitis media:

A
  • generally self-limiting
  • analgesia to relieve otalgia
  • antibiotics: 5-7 days amoxicillin (erythromycin/clarithromycin)
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7
Q

When should antibiotics be prescribed for otitis media?

A
  • symptoms more than 4 days or not improving
  • systemically unwell not requiring admission
  • immunocompromised or high risk complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
  • younger than 2 years with bilateral otitis media
  • otitis media with perforation and/or discharge in canal
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8
Q

Common sequelae acute otitis media:

A
  • perforation of tympanic membrane - otorrhoea
  • unresolved with perforation may develop into chronic suppurative otitis media (CSOM)
  • CSOM - perforation with otorrhoea > 6 weeks
  • hearing loss
  • labyrinthitis
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9
Q

Complications otitis media:

A
  • mastoiditis
  • meningitis
  • brain abscess
  • facial nerve paralysis
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10
Q

What is acute sinusitis?

A
  • inflammation of mucous membrane of paranasal sinuses

- most common: streptococcus pneumonia, haemophilus influenzae and rhinoviruses

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11
Q

Predisposing factors acute sinusitis:

A
  • nasal obstruction e.g. septal deviation or nasal polyps
  • recent local infection e.g. rhinitis or dental extraction
  • swimming/diving
  • smoking
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12
Q

Features acute sinusitis:

A
  • facial pain
  • typically frontal pressure pain which is worse on bending forward
  • nasal discharge: thick and purulent
  • nasal obstruction
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13
Q

Management acute sinusitis:

A
  • analgesia
  • intranasal decongestants or nasal saline
  • intranasal corticosteroids if symptoms more than 10 days
  • oral antibiotics not normally required
  • only phenoxymehylpenicillin or co-amoxiclav if systemically unwell and serious
  • double sicking - viral sinusitis worsening due to secondary bacterial infection
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14
Q

Features of acute tonsillitis:

A
  • pharyngitis, fever, malaise and lymphadenopathy
  • over half are bacterial: streptococcus pyogenes
  • tonsils oedematous and yellow or white pustules
  • infectious mononucleosis mimics
  • may cause local abscess formation (quinsy)
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15
Q

Treatment acute tonsillitis:

A

penicillins

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16
Q

What is allergic rhinitis?

A
  • inflammatory disorder of nose
  • sensitised to allergens e.g. house dust mites, grass, tree, pollens
  • seasonal, perennial or occupational
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17
Q

Features of acute rhinitis:

A
  • sneezing
  • bilateral nasal obstruction
  • clear nasal discharge
  • post-nasal drip
  • nasal pruritus
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18
Q

Management acute rhinitis:

A
  • allergen avoidance
  • mild-to-moderate, intermittent or mild symptoms: oral or intranasal antihistamines
  • moderate-to-severe, persistent or initial drug ineffective: intranasal corticosteroids
  • short courses of topical nasal decongestants e.g. oxymetazoline - not prolonged as tachyphylaxis and rebound hypertrophy of nasal mucosa (rhinitis medicamentosa) upon withdrawal
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19
Q

Above what dB on audiogram is normal?

A

20dB

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20
Q

What conduction is impaired in sensorineural hearing loss?

A

air and bone

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21
Q

What conduction is impaired in conductive hearing loss?

A

air only

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22
Q

What conduction is lost in mixed hearing loss?

A

both with air being worse than bone

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23
Q

What is an auricular haematoma?

A
  • common in rugby players and wrestlers

- cauliflower ear formation

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24
Q

management of auricular haematomas?

A
  • same day assessment ENT

- incision and drainage superior to needle aspiration

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25
Q

Average age of onset benign paroxysmal position vertigo:

A

55yo

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26
Q

Features of benign paroxysmal position vertigo:

A
  • triggered by change in head position
  • nausea
  • 10-20 seconds
  • positive Dix-Hallpike manoeuvre
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27
Q

Symptomatic relief benign paroxysmal position vertigo:

A
  • Epley manoeuvre (80%)
  • vestibular rehabilitation e.g. Brandt-Daroff exercises
  • medication e.g. betahistine limited value
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28
Q

What is black hairy tongue?

A
  • defective desquamation of filiform papillae

- tongue brown, green, pink or another colour

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29
Q

Predisposing factors black hairy tongue:

A
  • poor oral hygiene
  • antibiotics
  • head and neck radiation
  • HI
  • IV drug use
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30
Q

Investigations and management black hairy tongue:

A
  • swab to exclude candida
  • tongue scraping
  • topical antifungals if candida
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31
Q

What is a branchial cyst?

A
  • benign developmental defect of branchial arches
  • filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium
  • may have fistula so prone to infection
  • may enlarge following a respiratory tract infection
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32
Q

When do branchial cysts present?

A
  • late childhood/early adulthood
  • asymptomatic neck lateral lumps
  • usually anterior to sternocleidomastoid muscles
  • slight male predisposition
33
Q

Typical features branchial cyst:

A
  • unilateral typically left
  • lateral, anterior to SCM
  • slowly enlarging
  • smooth, soft, fluctuant
  • non-tender
  • fistula may be seen
  • no movement on swallowing
  • no transillumination
34
Q

Differential diagnosis of congenital neck lump in children:

A
  • branchial cyst
  • thyroglossal cyst
  • dermoid cyst
  • vascular malformation
35
Q

Differential diagnosis of inflammatory neck lump in children:

A
  • reactive lymphadenopathy

- lymphadenitis

36
Q

Differential diagnosis of neoplastic neck lump in children:

A
  • lymphoma
  • thyroid tumour
  • salivary gland tumour
37
Q

Diagnosis, investigations and treatment of branchial cysts:

A
  • consider and exclude other malignancy
  • US
  • referral to ENT
  • fine-needle aspiration
  • treat conservatively or excise surgically
  • antibiotics acute infections
38
Q

What is a cholesteatoma?

A
  • non-cancerous growth of squamous epithelium
  • trapped in skull base causing local destruction
  • most common 10-20yo
39
Q

What increases risk of cholesteateoma?

A

cleft palate x100

40
Q

Features cholesteatoma:

A
  • main: foul smelling, non-resolving discharge and hearing loss
  • vertigo
  • facial nerve palsy
  • cerebelopontine angle syndrome
41
Q

Otoscopic findings cholesteatoma:

A

attic crust (uppermost ear drum)

42
Q

Management cholesteatoma:

A

refer to ENT for surgical removal

43
Q

What is chronic rhinosinusitis?

A
  • 1 in 10 people
  • inflammatory disorder of paranasal sinuses
  • 12 weeks of longer
44
Q

Predisposing factors chronic rhinosinusitis?

A
  • atopy: hay fever, asthma
  • nasal obsturciton e.g. septal deviation or nasal polyps
  • recent local infection e.g. rhinitis or dental extraction
  • swimming/diving
  • smoking
45
Q

Features chronic rhinosinusitis:

A
  • facial pain: frontal pressure pain worse with bending forwards
  • nasal discharge: clear if allergic or vasomotor, thick/purulent suggests secondary infection
  • nasal obstruction
  • post-nasa drip
  • may have chronic cough
46
Q

Management of chronic rhinosinusitis:

A
  • avoid allergen
  • intranasal corticosteroids
  • nasal irrigation with saline solution
47
Q

Red flag symptoms chronic rhinosinusitis:

A
  • unilateral symptoms
  • persistent symptoms despite compliance with 2 months treatment
  • epistaxis
48
Q

How is cochlear implant suitability determined?

A
  • children: audiological assessment and/or difficulty developing basic auditory skills
  • adults: complete trial of appropriate hearing aids for at least 3 months (no benefit or limited)
49
Q

Causes of severe-to-profound hearing loss in children:

A
  • genetic (50%)
  • congenital e.g. maternal CMV, rubella or varicella
  • idiopathic (30% childhood deafness)
  • infectious e.g. post meningitis
50
Q

Causes of severe-to-profound hearing loss in adults:

A
  • viral induced hearing loss
  • ototoxicity e.g. following administration of aminoglycoside antibiotics or loop diuretics
  • otosclerosis
  • meniere disease
  • truma
51
Q

What is required for ensuring the success of the cochlear implant?

A

surviving spiral ganglion neurons

assess anatomy by otolaryngologist/skull base surgeon

52
Q

What can complicate cochlear surgical implantation?

A
  • infection
  • facial paralysis due to nerve injury intra-operatively
  • CSF leakage
  • meningitis
53
Q

What vaccinations should one have before cochlear implant surgery?

A

streptococcus and haemophilus

54
Q

How long after surgery should patients return for a post-op device stimulation?

A

3-5 weeks

55
Q

Contraindications to cochlear implant:

A
  • lesions of cranial nerve VIII or in brain stem causing deafness
  • chronic infective otitis media, mastoid vacuity or tympanic membrane perforation
  • cochlear aplasia
56
Q

Relative contraindications cochlear implant:

A
  • chronic infective otitis media or mastoid cavity infections
  • tympanic membrane perforation
57
Q

Most common causes of hearing loss:

A
  • ear wax
  • otitis media
  • otitis externa
58
Q

Features of presbycusis:

A
  • age related
  • sensorineural
  • difficulty following conversations
  • audiometry: bilateral high frequency hearing loss
59
Q

Features of otosclerosis:

A
  • autosomal dominant
  • replacement of bone with vascular spongy bone
  • onset 20-40 years
  • conductive deafness
  • tinnitus
  • tympanic membrane - 10% flamingo tinge caused by hyperaemia
  • positive family history
60
Q

What is glue ear?

A
  • otitis media with effusion
  • peaks at 2yo
  • hearing loss presenting features
  • secondary: speech delay, behaviour or balance problems
61
Q

What is Meniere’s disease?

A
  • middle aged adults
  • recurrent episodes vertigo, tinnitus and hearing loss
  • sensorineural
  • vertigo most prominent
  • sensation of aural fullness
  • nystagmus and positive Romberg test
  • episodes minutes to hours
62
Q

What causes drug ototoxicity?

A

e.g. aminoglycosides (gentamicin), furosemide, aspirin, cytotoxics

63
Q

What frequencies are lost with noise damage?

A

3000-6000Hz

64
Q

What are acoustic neuromas?

A

-vestibular schwannomas
-CN VIII: hearing loss, vertigo, tinnitus
-CN V: absent corneal reflex
-CN VII: facial palsy
bilateral in neurofibromatosis type 2

65
Q

Impacted ear wax symptoms:

A
  • pain
  • conductive hearing loss
  • tinnitus
  • veritgo
66
Q

Treatment ear wax:

A
  • olive oil
  • sodium bicarbonate
  • almond oil
67
Q

Whom should not be given ear drops to treat ear wax?

A
  • perforation

- grommets

68
Q

Where does anterior epistaxis originate?

A

Kiesselbach’s plexus

69
Q

In whom do posterior nosebleeds typically occur?

A

older patients - higher risk aspiration and airway compromise

70
Q

What can nosebleeds indicate apart from trauma?

A
  • platelet function disorders: thrombocytopenia, splenomegaly, leukaemia, Waldenstrom’s macroglobulinaemia and ITP
  • juvenile angiofibroma
  • drug use - abrasion and atrophy
  • elderly: haemorrhage telangiectasia
  • Wegener’s, pyogenic granuloma
71
Q

Management epistaxis:

A
  • pinching, leaning forwards etc.
  • topical antiseptic e.g. naseptin (chlorhexdine and neomycin) to reduce crusting and risk of vetibulitis
  • mupicorin
  • if not after 10-15 minutes: cautery or packing
72
Q

How is cautery carried out for epistaxis?

A
  • topical local anaesthetic spray e.g. co-phenylcaine and wait 3-4 minutes
  • silver nitrate stick to bleeding point 3-10 min
  • dab area with cotton bud and apply naseptin or mupicorin
73
Q

How is packing carried out for epistaxis?

A
  • anaesthetise with topical LA spray e.g. co-phenylcaine and wait 3-4 minutes
  • pack nose
74
Q

Characteristic exam features of sinusitis:

A
  • facial fullness and tenderness
  • nasal discharge
  • pyrexia or post-nasal drip leading to cough
75
Q

Characteristic exam features of trigeminal neuralgia:

A
  • unilateral facial pain
  • brief electric shocks
  • abrupt onset and temrination
  • triggered by light touch and emotion
76
Q

Drug causes of gingival hyperplasia:

A
  • phenytoin
  • ciclosporin
  • calcium channel blockers
77
Q

Other cause of gingival hyperplasia:

A

acute myeloid leukaemia

78
Q

What is gingivitis usually secondary to and presentation?

A
  • poor dental hygiene

- simple gingivitis or necrotising ulcerative gingivitis

79
Q

Management gingivitis:

A
  • simple gingivitis: dentist

- refer to dentist and oral metronidazole 3 days, chlorhexidine or hydrogen peroxide mouth wash, analgesia

ENT (3 decks)

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