ENT emergencies Flashcards
Features of peritonsillar abscess (quinsy):
Sever throat pain which lateralises to one side
Deviation of the uvula to the unaffected side
Trismus (difficulty opening mouth)
Reduced neck mobility
Treatment of quinsy?
Needle aspiration with local anaesthesia
Features of retropharyngeal abscess:
Neck pain Trismus Spiking fever Noisy breathing Diagnose with CT
What is the Rinne test?
Tests for conductive hearing loss
Test bone conduction by striking tuning fork and placing on the mastoid process then next to air
Air conduction should be louder than bone conduction
If BC is louder this suggests conductive hearing loss
“Rinne under the Pinne”
What is the Weber test?
Tests for sensorineural hearing loss
Strike tuning fork and place on centre of forehead
If SHL in one ear then it will be heard louder in the unaffected ear and the other ear has SHL
“Tells you Weber it’s right or left”
Management of sudden sensorineural hearing loss?
History: sudden/rapidly progressive hearing loss
Oral prednisone 1 mg/kg
Refer
What causes otitis externa?
Water ingress and local trauma
Pseudomonas and aeruginosa
Treatment for otitis externa?
Ciprofloxacin drops and analgesia
Aural toilet
What causes otitis media?
Same organisms as in URTI
H. influenzae
S. pneumoniae
What does perforation suggest in the context of otitis media?
Resolution
Complications of acute otitis media (rare):
Mastoiditis potentially causing abscess and meningitis
Venous thrombosis
Features of facial nerve palsy:
Muscle weakness
Loss of taste in anterior 2/3 of tongue
Loss of sensation in ear canal
Lack of secretomotor function (no lacrimation can cause corneal damage)
Treatment of Bell’s palsy:
1 mg/kg prednisolone
Cancerous non-Bell’s causes of facial nerve palsy:
Parotid malignancy - adenoid cystic cancer
Facial neuroma
Vestibular schwannoma
Infectious non-Bell’s causes of facial nerve palsy:
Granulomatous disease - WG, Sarcoid, TB
Lyme disease
HIV
Chronic suppurative otitis media (CSOM - inflammation of middle ear post URTI and otitis media)
What is Ramsey Hunt syndrome?
A non-Bell’s cause of facial nerve palsy that causes vesicles on distribution of secretomotor fibres
Causes balance problems and facial weakness
Temporal bone fracture complications:
CSF leaking out of the ear
Facial weakness
Taste CSF down Eustachian tube if ear drum is intact
Osler-Weber-Rendu syndrome (HHT)?
Telangiectasia
Abnormal blood vessels forming in skin and mucous membranes - epistaxis
Can cause anaemia
Cautery agents in epistaxis?
AgNO3
Bipolar
Anterior epistaxis:
More common
Less serious
Younger patients
Posterior epistaxis:
Less common
More serious
Older
Woodruff’s plexus (pharyngeal and post nasal and post ethmoid - ophthalmology)
Which arteries might be ligated in surgical treatment of epistaxis?
Sphenopalatine (endoscopic)
Maxillary (transmaxillary)
Anterior/posterior ethmoid
External carotid
Complications of nasal fracture:
Orbital rim step Diplopia Infraorbital sensory loss Septal haematoma CSF rhinorrhoea
Symptoms of acute rhino-sinusitis:
Pain bending forwards and in teeth with no cheek swelling
Fever
Nasal purulence
Cause of acute rhino-sinusitis:
Double sickening (bacterial infection on top of viral URTI)
Complications of acute rhino-sinuisitis:
Orbital cellulitis Frontal osteomyelitis Meningitis Cerebral abscess Cavernous sinus thrombosis
Treatment of acute rhino-sinusitis:
Decongestants: ephedrine 2 drops QDS; otrivine
Abx
Steroids: flixinaise, becanaise
Risk of orbital cellulitis?
Development of chemises due to venous congestion, abscess development and subsequent rapid (hours) blindness
First to go is colour vision
Treatment of complicated ARS:
Orbital collection drainage (external/endo)
Drainage of intracranial collection
Abx/decongestants/wash out sinuses
Management of airway obstruction:
O2 or heliox (O2 and helium), adrenaline nebuliser
Establish safe airway and intubate
Needle crike and jet ventilation
Cricothyroidotomy
Tracheostomy with local anaesthetic if necessary
Weber test in conductive hearing loss?
Patient will hear the sound louder on the affected side
What is presbycusis?
Age-related sensorineural hearing loss
Loss of hearing high frequency sound
What is otosclerosis?
Autosomal dominant condition affects 20-40 y/o
Abnormal bone growth in ear
Unilateral conductive deafness
What is glue ear?
2 years old - conductive hearing loss
Otitis media with effusion
Secondary speech, balance and behavioural issues
Causes of drug ototoxicity?
Aminoglycosides e.g. gentamicin
Furosemide
Aspirin
Cytotoxics
Noise damage to hearing?
Bilateral
3000-6000 Hz
Acoustic neuroma/vestibular schwannoma?
CN VIII: hearing loss, vertigo, tinnitus
CN V: absent corneal reflex
CN VII: facial palsy
Symptoms of otitis externa?
Severe pains
Headaches
Sign of otitis externa?
Granulation tissue in the external auditory meatus
