ENT - miscellaneous Flashcards
Allergic rhinitis
- The commonest allergens are pollens (which produce seasonal symptoms) and house dust/animal dander
- Rhinorrhoea, Nasal Blockage, and Itching/Sneezing
- Ix: Skin Prick allergy tests or Radioallergosorbent Test (RAST) Serology
- Tx: avoidance, PO Antihistamines (Certirazine, Fexofenadine)
Rhinosinusitis (bacterial)
- bacterial infection usually follows URTI
- pain over affected sinus and worse on leaning forward
- treatment: analgesia, nasal decongestants (xylomethazoline); if does not settle, start antibiotics
- acute sinusitis can spread to orbit and cause periorbital cellulitis and abscess–> needs urgent drainage
Peritonsillar abscess (quinsy)
- acute tonsillitis with cellulitis and abscess
- high fever, marked trismus (difficult and limited mouth opening), sore throat, dysphagia
- O/E, displaced swollen tonsils to the midline
- treat - drainage by aspiration or by incision under local anaesthetic
- consider tonsillectomy
Head and neck cancer - definition
Head and neck cancer is an umbrella term. It typically includes:
- Oral cavity cancers
- Cancers of the pharynx (including the oropharynx, hypopharynx and nasopharynx)
- Cancers of the larynx
Most are SCC (90%) (HNSCC), rest are adenocarcinomas
Head and neck cancer - features
- risk factors: smoking, alcohol, UV light exposure, occupational chemicals/asbestos, oncogenic viruses (HPV 16 and 18, HIV - kaposi sarcoma), age (60s and 70s), previous EBV infection, GORD, HSCT
- neck lump, neck pain
- hoarseness
- persistent sore throat
- persistent mouth ulcer
- dysphagia
- earache (referred pain)
- Red, White or Dark patches in the mouth that do not resolve
Laryngeal Cancer - NICE 2WW red flags
NICE suspected cancer pathway referral criteria (for an appointment within 2 weeks)- Laryngeal cancer
Consider a suspected cancer pathway for laryngeal cancer in people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck
Oral Cancer - NICE 2WW red flags
Consider a suspected cancer pathway referral for oral cancer in people with either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
Thyroid Cancer - NICE 2WW red flags
Thyroid cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump
Head and Neck Cancer - diagnosis
Fine Needle Aspiration with cytology and histology will be taken from the suspected source and the cancer will then be staged with further CT/PET imaging
Nasopharyngeal Carcinoma
- rare, but more common in Chinese
- older and smokers
- may present with nasal obstruction or polyp, unilateral glue ear or with 2ary neck lump. Otalgia
- Ix flexible nasendoscopy of postnasal space, biopsy and MRI for staging
- Mx: grommet insertion if glue ear
MDT discussion and usually chemo + radio or in only selected refractory cases surgical resection
Why can head and neck cancer present with ear pain?
- tonsil area is supplied by glossopharyngeal nerve –> irriation lead to ear pain referred via Jacobson’s nerve
- other causes of referred otalgia: irritation from nerves V, VII, IX, X, and cervical C2 and C3 - dental pathology, pharyngitis, TMJ pathology, sinusitis, cervical spine pathology, mumps, retro and parapharyngeal abscess
Laryngeal cancer - features
- commonly presents with hoarseness due to malignancy in larynx, or in chest (pancoast tumour pressing on recurrent laryngeal nerve) - for this reason CXR must be considered for a smoker with persistent hoarseness
- sometimes can also get sho
- tend to be SCC and associated with smoking/drinking
- treatment is surgical excision with radio or chemo
Idiopathic sensorineural hearing loss
- sudden onset HL +/- tinnitus, no other abnormalities, otherwise fit and well
- get bloods and MRI scan of internal auditory meatus (rule out serious causes e.g. acoustic schwannoma)
- start PO steroids (intra-tympanic if poorly controlled diabetic or PUD)
- treatment: hearing aids, +/- tinnitus rehabilitation therapy
Otosclerosis
Replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults. Increased risk of developing it during pregnancy
Onset is usually at 20-40 years - features include:
- conductive deafness
- tinnitus
- normal tympanic membrane
- positive family history
Management
- hearing aid
- stapedectomy
Adenotonsillar hypertrophy and OSA in children
= large adenoids (tonsils)
Enlarged adenoids can become nearly the size of a ping pong ball and completely block airflow
- risk of developing OSA = child presents with hx of snoring, enuresis, wakes up tired and irritable
- how to approach this: OSA could be monitored with a pulse oximetry test. If this showed normal or mild symptoms monitoring would be appropriate. If the child is struggling to even eat and breathe at the same time due to nasal obstruction then adeno-tonsillectomy would be an appropriate consideration.
