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ENT - Level 3 Flashcards

1
Q

Definition of cholesteatoma?

A
  • Abnormal accumulation of squamous epithelium and keratinocytes within middle ear
  • Active squamous chronic otitis media
  • Keratinising squamous epithelia (of the skin) within middle ear with foul-smelling otorrhoea
  • Can be locally invasive
  • Bone erosion occurs mainly by pressure and release of osteolytic enzymes
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2
Q

Epidemiology of cholesteatoma?

A
  • Young children
  • 1 in 10000
  • Peak Age: 5-15 years
  • Males
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3
Q

Risk factors of cholesteatoma?

A

o Ear trauma
o Insertion of Grommets
o Otitis media

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4
Q

Classifications of cholesteatoma - congenital?

A

 Squamous epithelium becomes trapped within temporal bone during embryogenesis
 It expands, resulting in conducting hearing loss

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5
Q

Classifications of cholesteatoma - primary acquired?

A

 Most common type
 Chronic negative middle ear pressure
 Dysfunctional Eustachian tube causes erosion of tympanic membrane and defect

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6
Q

Classifications of cholesteatoma - secondary acquired?

A

 Insult to tympanic membrane (perforation or trauma)

 Squamous epithelium implanted by insult

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7
Q

Symptoms of cholesteatoma?

A 
o	Foul-smelling otorrhoea
o	Deafness
o	Headache
o	Ear pain
o	Facial paralysis
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8
Q

Signs of cholesteatoma?

A

o Ear discharge
o Deep retraction pocket in tympanic membrane, with or without granulation tissue
o Crust or keratin in upper tympanic membrane

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9
Q

Assessment of cholesteatoma?

A
  • If ear drum cannot be seen:
    o Treat infection if present
    o Refer to ENT
  • CT imaging
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10
Q

Management of cholesteatoma - all people?

A

arrange semi-urgent referral to ENT specialist

o For audiology and CT scan

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11
Q

Management of cholesteatoma - emergency referral?

A

o Facial paralysis, pain, signs of meningitis

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12
Q

Management of cholesteatoma - medical therapy?

A
  • Medical therapy (only if unfit/refuse for surgery/prior to surgery)
    o Regular ear cleaning with topical antibiotics
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13
Q

Management of cholesteatoma - surgical therapy?

A
  • Mastoid surgery to remove disease
    o Mastoidectomy and tympanoplasty
     Second procedure after 9-12 months
    o Myringoplasty – repair of tympanic membrane
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14
Q

Complications of cholesteatoma?

A 
o	Meningitis
o	Cerebral Abscess
o	Conductive Hearing Loss
o	Mastoiditis
o	Facial Nerve Dysfunction
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15
Q

Definition of acoustic neuroma?

A
  • Indolent, histologically benign slow-growing subarachnoid tumours
  • Causes problems by local pressure and behave as space-occupying lesions
  • Tumour of vestibulocochlear nerve - arise from superior vestibular nerve Schwann cell layer
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16
Q

Location of acoustic neuroma?

A

o Internal auditory canal or cerebellopontine angle

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17
Q

Causes of acoustic neuroma?

A

o 40% a defect in long arm of chromosome 22
o Neurofibromatosis Type-2 – particularly bilateral
o High-dose ionising radiation

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18
Q

Symptoms and signs of acoustic neuroma?

A

Progressive ipsilateral tinnitus +/- sensorineural deafness (cochlear nerve compression)
o Any unilateral sensorineural hearing loss suspicious

Impaired facial sensation

Balance problems

Large tumours – ipsilateral cerebellar or raised ICP symptoms

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19
Q

Management of acoustic neuroma - referral?

A
  • Refer urgently ENT for:
    o Audiological assessment
    o MRI for all those with unilateral tinnitus/deafness
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20
Q

Management of acoustic neuroma - conservative?

A

o Small neuromas and good hearing

o Watch and wait – annual scans to monitor growth

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21
Q

Management of acoustic neuroma - surgical?

A

o Microsurgery

 Risks include – death, CSF leak, meningitis, cerebellar injury, stroke

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22
Q

Management of acoustic neuroma - radiotherapy?

A
  • Stereotactic Radiosurgery

o Single large dose of radiation to control growth of tumour

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23
Q

Definition of nasal polyps?

A
  • Lesions arising from nasal mucosa, occurring at any site in nasal cavity or paranasal sinuses
  • Most commonly in clefts of middle meatus
24
Q

Pathology of nasal polyps?

A

o Sac-like entities with eosinophil rich oedematous wall

o Poor blood supply

25
Epidemiology of nasal polyps?
- Males more than females
26
Causes of nasal polyps?
- Linked with chronic inflammation – chronic rhinosinusitis and vasculitis
27
Symptoms and signs of nasal polyps?
- Recurring acute or chronic sinusitis - Symptoms o Nasal airway obstruction o Nasal discharge – watery, sneezing, postnasal drainage o Dull headaches o Snoring o Decreased smell/taste - Examination with nasal speculum o Visualise polyp – often bilateral
28
Investigations of nasal polyps?
o Rigid or flexible endoscopy (rhinoscopy)
29
Management of nasal polyps - referral to ENT?
o Unilateral polyp | o Children – risk of cystic fibrosis
30
Management of nasal polyps - medical management (1st line)?
``` o Topical corticosteroids – nasal sprays  Betnesol spray o Nasal douche – saline o Antihistamines (if allergic rhinitis present)  Beconase spray ```
31
Management of nasal polyps - surgical management?
Functional endoscopic sinus surgery (FESS) |  Used when medical management fails
32
Complications of nasal polyps?
o Acute bacterial sinusitis o Sleep disruption o Structural abnormalities
33
Prognosis of nasal polyps?
o Recurrence is common
34
Most common form of H&N cancer?
- SCC represent >90% of H&NC | - 6th most common cancer
35
Risk factors for H&N cancer?
``` o Smoking o Alcohol o Poor dentition o Poor diet o GORD o HPV Type 16 (oropharyngeal) ```
36
Types of H&N cancer?
o Oral cavity cancers (buccal mucosa, alveolus, hard palate, anterior 2/3rd of tongue, floor of mouth, lip) o Cancer of pharynx o Cancer of larynx o Salivary gland, nose, sinus, middle ear
37
Symptoms of oral cavity H&N cancer?
o Mass, painless and felt on inner lip/tongue/floor of mouth/hard palate o Bleeding - Erythroleukoplakia
38
Symptoms of pharyngeal H&N cancer?
o Odynophagia, dysphagia, otalgia
39
Symptoms of laryngeal H&N cancer?
o Horse voice, stridor, dysphagia, persistent cough, referred otalgia
40
Referral H&N cancers - laryngeal cancer?
 Aged 45 and over with: • Persistent unexplained hoarseness or • Unexplained lump in the neck
41
Referral H&N cancers - laryngeal cancer?
 Unexplained ulceration in oral cavity for >3 weeks or  Persistent and unexplained lump in neck  Consider to dentist if lump on lip, red/white patch consistent with erythroplakia, erythroleukoplakia
42
Investigations in H&N cancers?
o Clinical examination o Endoscopy o Fine-needle aspiration o CT/MRI for staging
43
Management of H&N cancers - early stage?
o Surgery o Radiotherapy o Neoadjuvant chemotherapy
44
Management of H&N cancers - advanced stage?
o Radiotherapy + Surgery
45
Definition of trigeminal neuralgia?
- Severe, episodic facial pain in distribution of 1 or more branches of 5th cranial nerve - Typically, maxillary or mandibular branches - Frequency from a couple of times a year – hundred of times a day
46
How common is trigeminal neuralgia?
- Rare | - 3% cases bilateral
47
Causes of trigeminal neuralgia?
o 95% caused by vascular compression of trigeminal nerve, leading to demyelination of nerve root entry zone o Other causes – MS, tumours, skull base abnormalities
48
Risk factors of trigeminal neuralgia?
``` o MS o Advancing age o Females o FHx o Hypertension and stroke ```
49
Triggers of trigeminal neuralgia?
``` o Touching face o Talking o Cold wind o Vibration o Cleaning teeth o Shaving ```
50
Symptoms of trigeminal neuralgia?
o Pain in distribution of trigeminal nerve that is:  Severe, unilateral, short-lived, recurrent, episodic  Often described like sharp ‘electric shocks’  Provoked by factors like light touch, eating, talking or exposure to cold air o Preceding symptoms – tingling/numbness
51
Red flag symptoms of trigeminal neuralgia?
``` o Sensory changes o Deafness o Pain in eye socket o Optic neuritis o FHx of MS o Age <40 ```
52
Diagnosis of trigeminal neuralgia?
- Clinical diagnosis - Rule out dental causes of pain - Specialist tests: o MRI to exclude causes
53
Management of trigeminal neuralgia - if red flag symptoms?
- Refer urgently for specialist assessment if red flag symptoms
54
Management of trigeminal neuralgia - if severe pain?
- Refer to neurologist or specialist pain service
55
Management of trigeminal neuralgia - if no red flag symptoms?
o Carbamazepine 100mg BDS and titrate up every 2 weeks in 100-200mg until pain relieved o If contraindicated/ineffective then refer to specialist o Early follow-up to assess progress
56
Management of trigeminal neuralgia - specialist treatments?
o Lamotrigine, phenytoin or gabapentin o Microvascular decompression surgery o Stereotactic radiosurgery (gamma knife)
57
Prognosis of trigeminal neuralgia?
- Attacks can occur daily for time or can be remission o 50% experience remissions of >6 months - 10% will not respond to neuropathic pain drug therapy

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