ENT Diagnostics and Procedures Flashcards
X-RAY
- purpose
- indications
- types of sinus radiographs
Purpose:
- detect sinusitis
- detect fluid in sinuses
- Detect polyps
Indications:
- pain and pressure in the face, especially when lowering head
- when clinical sx need supportive evidence to make the dx
Type:
- waters view/water projection: PA view of skull
- maxillary sinus: frontal view of maxillary sinus, orbits, nasal structures, and zygomas.
Pathopneumonic signs found on XRAY
- thumb print sign in Epiglottitis
- steeple sign in Croup
- retropharyngeal abscess can be seen on XRAY but the imaging test of choice is CT.
CT:
-useful for dx what?
- sensitive to bone destruction and infection
- retropharyngeal abscess
- Ludwigs Angina
- scanning larynx for neck nodes, tumor volume, cartilage sclerosis
- provide info about sinus and nasal obstruction
- detects fluid in sinuses
- detects thickened membranes
- assist with dx of sinusitis
What is Ludwigs angina?
-infection/pus that has gone past the muscle attachment causing swelling under the tongue that may lead to throat closure.
MRI
-useful in dx of what?
- distinguishing tumors, malignancy (acoustic neuroma)
- evaluates mucous membranes
What test would you use for each of the following?
- Epiglottitis
- Retropharyngeal abscess
- sinusitis
- trauma
- ludwigs angina
- peritonsillar abscess
- tumors
- most radiation of the three
- XRAY
- CT
- XRAY (Watersview) or CT
- CT
- CT
- CT
- CT
- MRI
- CT
Throat and Nasal Swab
-indications
Throat: sore throat, fever of unknown origin, chronic carriers with recurrent infection
Nose: nasal or sinus infections, carriers of pathogenic bacteria (MRSA)
Throat Cultures
- when are these done?
- what are the common bacteria identified
when: must be performed before abx therapy is initiated
Identify:
- bordetella pertussis
- streptococci (Beta hemolytic strep)
- meningococci, corynebacterum diptheriae
Nasal swab & nasopharyngeal swab detect which bugs most commonly?
Nasal:
- staph aureus
- MRSA
Nasopharyngeal swab:
- hflu
- RSV
- Influenza
- Pertussis
- Think atypical and virus
Rapid Strep Test
- what type of swab is this?
- how long does it take?
- what if its negative? positive?
- detects which organism?
Posterior Pharyngeal Swab
Takes 5 minutes to perform
Negative & sx of strep you need to get a culture.
If culture negative no strep infection.
Positive = treat w/ abx
Detects group A strep
Throat Culture:
-what are the types of media?
chocolate
strep-specific
other agar
Cerumen Disimpaction
-how is this done?
- ) safest method = remove cerumen using a curette or otoloop.
* less sensitive along the top*
2.) ear irrigation
Treatment of Epistaxis
- topical vasoconstrictors/analgesics:
- inhaled afrin
- cotton ball soaked in epi and lidocaine - Direct pressure: Nose clip
- Silver nitrate cautery:
after 20minutes of direct pressure remove cotton balls, inspect nare with nasal speculum, if ongoing bleeding apply silver nitrate to site for 10 seconds and roll around surrounding area. apply abx over cauterized area.
- *MUST BE ABLE TO VISUALIZE THE BLEEDING SITE**
- DO NOT cauterize both sides of nasal septum (risk for septal perforation)
- Nasal Packing; follow up within 24hrs, leave in place for 48hrs
- anterior (90%): gauze soaked in petrolatum or commercial nasal tampon (Rhino rocket, Mercel)
-posterior (done by ENT doc)
SE of nasal packing
may cause necrosis if packing is too tight
may develop sinusitis, otitis media, Toxic Shock Syndrome
Pneumatic Otoscopy
- what is this?
- interpretation of mobility
-blow air in ear/valsalva to assess the movement of the TM at the level of the pars flacida.
Interpretation:
-increased mobility could be d/t atrophy, tympanostomy tube, or perforation
-decreased/absent mobility could be d/t AOM or scarring
Audiometry
- what is this?
- hearing is measured from high to low pitches, what is this range of frequencies?
- higher numbers of dB indicates worse/better hearing?
- what is a normal score?
what: formal measurement of hearing, involves the presentation of tones or speech to each ear.
- low 250Hz to high 8000Hz
- higher numbers(dB) indicate worse hearing at any given frequency.
- normal score is 0, less than 0 indicates better than average hearing.
Weber/Rinne
- purpose
- which comes first, the chicken or the egg?
- explain each test and its results
purpose: to determine whether the hearing loss is caused by sensory problem (sensorineural hearing loss) or a mechanical problem (conductive hearing loss)
- Rinne is always performed first and must all be done in conjunction with the Weber.
Rinne: testing air vs bone conduction, mainly for conductive hearing loss
-Normal = positive = AC greater than BC
-abnormal - negative
Results:
–BC greater than AC there is something blocking the air conduction = conductive hearing loss
–if sensorineural hearing loss the AC and BC will be equally diminished and the AC will still be greater than BC.
Weber: checking for lateralization
- Rinne normal then there is SNHL in the ear opposite of where weber was heard best.
- Rinne abnormal in the same ear that the Weber lateralizes to then thee is CHL in that ear.
Tympanometry
- what is this?
- results
What; soft probe placed into ear canal and small amount of pressure applied. Measures movement of tympanic membrance in responses to pressure changes.
Results: tympanogram
-if tympanogram was flat there was not appropriate vibration and there is probable fluid in the middle ear or perforation.
-if air in the middle ear(normal) is higher or lower pressure than atmospheric pressure the line on the tympanogram will be shifted
Tympanometry
-useful in identifying?
Identify:
- middle ear effusions in children
- facial nerve paralysis
- differentaite sensory from neural hearing losses
- disruption of the ossicles and otosclerosis
- stiff ear drums, floppy eardrums
Vestibular Caloric Testing
- used for what?
- how does this work?
Used to test disorders of the ear or brainstem
e.g. positional vertigo, perilymph fistula, vestibular neuritis, gentamycin ototoxicity
How:
-Cold water enters the ear and the inner ear changes temp, it should cause fast nystagmus. (eyes should move away from the cold water and slowly back)
- warm water placed into the ear, eye should move toward the warm water and then slowly away
- ICE water caloric: used to help confirm absence of brainstem functionin the comatose patient. if eyes do not move with cold water there is lack of brainstem function.
