ENT: Common problems Flashcards
Anatomy
Outer ear - pinna - tympanic membrane
Middle ear cleft - TM –> oval window
Inner ear - CNVIII
Oval window
Where stapes goes into inner ear
Pinna parts
Lobes Tragus Anti-tragus Helix Anti-Helix
Bones
Stapes
Incus
Malleus - joined to a lateral process
Hearing loss
Conductive
Sensory-neural
If they can hear bone conduction but not air conduction
Air-bone gap
Conductive hearing loss
Inner ear malfunctioning
Air conduction is poorer than expected
Bone conduction also poor
Sensory-neural hearing loss
Otitis externa
presentation?
Treatment
inflammation of outer ear
Painful
Swelling
Ear drops, oral antibiotics only if spreading infection
Wax blockage
Build up of wax –> impaction against tympanic membrane
Pinna haematoma/abscess
Can result in?
Trauma to ear –> haemorrhage between skin and perichondrium
Devascularisation of tissue –> cauliflower ear
Foreign body in the ear canal
Suction, flick out with wax hook
SCC of ear
Common on
Will need
Helix
Urgent resection e.g wedge resection
Pinnaplasty
Correction of protruding ears
Glue ear
Can cause –>
Treatment
Grommets
Middle ear condition
Fluid behind eardrum
Otitis media with effusion
Middle ear fluid
Can cause conductive hearing loss leading to speech development issue
Conservative, grommets, hearing aids
Lets air in behind the eardrum to prevent fluid accumulation
Doesn’t let fluid leave therefore discharge = infection
Acute otitis media
Bacteriology
Infection building up behind eardrum
Will eventually perforate
Resolves after this
Hearing deficit for a few weeks
Strep. Pneumoniae
H. influenza
M. cat
Complications of Acute/Chronic ear infections
Extra cranial/intratemporal
Intracranial
Other
Mastoiditis
Petrositis
Fistula/Labyrinthitis - balance problems
Facial nerve paralysis - runs through middle ear cleft –> Palsy
Hearing loss
Extradural/subdural/brain abscess
Meningitis
Sigmoid sinus thrombophlebitis
Otic hydrocephalus
OTITIS EXTERNA, PINNA CELLULITIS AND PERICHONDRITIS
Traumatic perforation
Excess cleaning
Basal skull fracture
Haemotympanum
Seen in combination with post auricular bruising - can also be non-accidental injury in children
Cholesteatoma
Pathology
Signs
Ball of skin which invades into ear drum into middle ear cleft and destroy nervous tissue, bone –> intracranial abscesses
Recurrent discharge from ear
Facial nerve palsy
Caused by?
Tumour of parotid gland
Check tonsil on specific side
Inner ear
Illusion of movement
Sudden
Vertigo
- illusion of movement
- benign paraoxysmal positional vertigo - displacement of crystals –> spinning
- labyrinthitis
- Meniere’s disease - fluctuating disease
Sudden sensorineural hearing loss - ideally need steroid tx
Vestibular Schwannoma/Acoustic Neuroma - benign tumour mainly on CN VIII - ringing or hearing loss in that ear - collapse, hydrocephalus
Function of nose
Temp regulator Moisture regulation Air filter Smell Immune defence Resonance
History of sinonasal symptoms
Blockages - congestion, time, trigger Sense of smell/taste Sneezing Rhinorrhoea Nasal/ocular or palatal pruritus Facial/sinus pain - acute, recurrent, chronic Snoring Bleeding
Epistaxis First aid Posterior? Fracture Observe for
Most common source is little's area Pinch nose and put head forwards Can occur in older adults Patient usually seen 1/52 post injury Septal haematoma - blood collected between mucoperichondrium and overlying tissue --> devascularisation of cartilage --> septal perforation - can get infected - thrombosis and abscesses
Saddle nose
Result of septal haematoma causing apoptosis of cartilage
Foreign body in nose
Old sponge e.g
Remove
Periorbital cellulitis
Caused by infection of sinuses
Pus has tracked backwards behind orbit
Nasal polyps
Caused by
Growths on mucosa
Allergy
CF
Asthma
Sinonasal tumours e.g
SCC
The pharynx
Tonsillitis and peritonsillar abscess Glandular fever caused by EBV e.g Foreign bodies Ludwig's angina Tumours causing upper airway obstruction
Tonsils are graded
According to emergence from mucosa and obstruction of airway
Tonsillitis
Grade?
Bacterial tonsillitis can result in
IF looks further back
Tonsils covered in exudate and meet in middle - grade IV
Tonsillar abscesses - tonsil pushed outwards and displaces the uvula
Parapharyngeal infection
Tonsil cancer signs
Unilateral enlarged irregular tonsil
Foreign objects in throat
Swallowed fishbone e.g
Extracted
Ludwig’s angina
Risk of? q
Infection tracked into floor of mouth –> swelling
Airway obstruction
Tongue base cancer
Pain on swallowing, sore throat
Easily localised at side of neck
Radiation to ear
Larynx
Epiglottis and supra glottis
Foreign body swallowing
Tumours causing UA obstruction
Epiglottis
Can be caused by H. influenzae type E
Airway obstruction
Inspiratory stridor
Inspiratory and expiratory
Presence of laryngeal cancer
Hoarse voice - progressive Sob Stridor Pain Dysphagia Neck lump Smokers
Neck trauma
Stabbings - breach platysma
Abscesses
Ulceration
Characteristic?
Non-healing
Wait and watch for 2-3 weeks
Proper biopsy
