ENT/Optho Flashcards
Systemic diseases with nasal symptoms.
Wegners - destructive vascultis, c-ANCA, kidneys and lungs.
Sarcoidosis - nasal obstruction, ACE+ve, hilar lymphadenopathy.
Churg-Strauss - vasculitis/asthma, pANCA
Chronic infective disease - TB, leporsy, syphilis.
CF - chronic sinusitis + polyposis - in children, polyps are indicative of CF.
Important points in otology history.
Hearing loss. Tinnitus - perception of noise in ears. Discharge - otorrhoea. Vertigo - illusion of movement. Previous ear surgery.
Causes of sensorineural hearing loss.
Age related hearing loss (presbycusis). Congenital hearing loss. Infection - meningitis. Trauma/noise exposure. Drugs - aminoglycosides/chemotherapy.
Causes of conductive hearing loss.
Rarely, wax.
Otitis media with effusion (glue ear).
Perforation of tympanic membrane.
Cholesteatoma - retention of squamous debris within middle ear space.
Otosclerosis - fixation of stapes footplate in oval window.
Congenital anomalies of external ear canal/middle ear.
Causes of tinnitus.
Loud noise exposure - bilat, irreversible. Vesibular schwannoma - unilat Drugs - aspirin. Menieres disease. Vascular leasion - pulsatile. Hypertension. Anaemia.
Pysch support in tinnitus - retraining therapy.
Hypnotics at night may help.
Causes of vertigo.
BBPV - 30 second attacks, Hallpike positive
Menieres disease - fluctuating, aural fullness, tinnitus+ vertgo for hours
Vestibular neuronitis - persistant vertigo, days to weeks
Central - migraine, cerebellar disease
Drugs + alcohol
Causes of otalgia.
OE - serous AOM - when complicated by a perforation classically mucoid. COM - Per>3 months Foreign body with secondary infection. Neoplasm.
Acoustic neuroma.
Benign growth of schwann cells along the vestibular nerve.
Unilateral hearing loss +/- tinnitus +/- balance disturbance.
Neurological symptoms as enlarged and obstructs CSF.
MRI of meatus and cerebellopontine angle.
Mx - surgery/radiotherapy.
Otitis externa.
Inflammation of the skin of the EAM.
Itch and pain.
Swimming, trauma, inherited.
Aural toilet, topical steroids with antibiotics.
Diabetic patients need special can - can develop osteomyelitis of temporal bone.
Otosclerosis.
AD with incomplete penetrance.
Fixation of stapes in oval window - prevents sound conduction.
Flat, conductive hearing loss.
Hearing aid or stapedotomy.
Cholesteatoma.
Chronic otitis media.
Squamous tissues in middle ear.
Active - discharging and inflammed.
Inflammation resorbs the underlying bone with subsequent secondary enlargement.
Congenital or acquired.
Complications - hearing loss, tinnitus, vertigo, facial palsy.
Chronic OM.
Perforation >3 months + no squamous debris.
AKA mucosal type.
Active - discharging - topical antibiotics and steroids.
Inactive - no discharge, keep dry.
Repair of TM is recurrent infection or swimmer.
Complications - hearing loss, develop cholesteatoma, intracranial infection.
Acute OM.
Acute inflammation of the middle ear <3 weeks, causing pain, fever and hearing loss.
Viral or strep pneumo, heam influenzae, morexella
Paracetamol
Antibiotics if <2 years or >48-72 hours of fever
Complications - OME, mastoiditis, facial nerve palsy.
Glue ear.
OME - otitis media with effusion.
Common in children due to Eustachian tube function.
TM - dull, retracted, bubble seen.
Mild temporary conductive hearing loss.
Investigations - otoscopy, PTA, tympanometry (measure mobility of TM).
Management - none unless bilateral >3 months = Grommets/hearing aids.
Menieres Disease.
aka Endolymphatic hydrops.
Episodic vertigo with increase in tinnitus, hearing loss and aural fullness.
Cause unknown.
Attacks last 1-24 hours, progressive hearing loss.
Medical management - low salt/caffeine diet, diuretics, betahistine.
Surgery - gent application to middle ear.
Top 5 ototoxic drugs.
Aminoglycosides eg gentamicin. Loop diuretics eg furosemide. Cytotoxics eg cisplastin. Beta-blockers eg atenolol. Salicylates eg aspirin (reversible on withdrawing).
Top 5 findings on otoscopy in children.
Otitis media with effusion (OME) glue ear - fluid level behind retracted ear drum.
Acute otitis media - red bulging ear drum, pyrexia.
Grommet - ventilation tube in ear drum.
Perforation - acute or chronic, with or without discharge from ear.
Paediatric ENT emergencies.
Forgein body - unilateral nasal discharge, ear on otoscopy.
Lymphadenitis - neck lump, secondary to URTI, antibiotics - can form abscesses.
Periorbital cellulitis - swollen eyelids, eye signs, secondary to sinus infection, risk of blindness.
Acute mastoiditis - swelling behind, ear, secondary to otitis media, IVAbx and surgery.
Stridor - acute epiglottis/inhaled forgein body - ENT, anaesthetics, paeds.
Downs Syndrome.
Trisomy 21. OME. Sleep apnoea. Subglottic narrowing. Hearing loss.
Pierre Robins.
Microganthia.
Macroglossia.
Cleft palate.
Airway obstruction.
Goldenhar Syndrome.
Hemifacial microsomia.
External canal atresia.
SNHL.
Waardenburg Syndrome.
Pigmentory abnormalities.
White forelock.
SNHL.
Tretcher Collins Syndrome.
Manidibulofacial dysostosis.
Microtitia.
Micrganthia.
Macrostoma.
Name the salivary glands.
Parotid.
Submandibular.
Sublingual.
Phases of swallowing.
Voluntary phase.
Pharyngeal phase.
What are the 2 types of tinnitus?
Objective - can be perceived by others which is due to sounds created in the body.
Subjective - only perceived by the affected individual, can be due to a wide range of causes.
What are some causes of loss of balance?
Common - vestibular neuritis/labyrinthitis, menieres, thiamine deficiency, ototoxic drugs.
Uncommon - acoustic neuroma, vestibular hypofunction
Conductive hearing loss.
Impaired conduction anywhere between the auricle and the round window.
External obstruction - wax/pus/foreign body.
TM perf - trauma/infection.
Ossicle defects - otosclerosis/infection/trauma.
Sensorineural hearing loss.
Defects of the cochlea, cochlear nerve or brain.
Drugs - vanc/gent.
Post-infective - meningitis/measles/mumps.
Menieres/trauma/MS.
Otosclerosis.
AD - incomplete penetrance.
Fixation of stapes to the oval window.
Improved in noisy places - Wills paracoussis.
Mx - Hearing aid or stapes implant.
Presbyacussis.
Age related hearing loss. SN loss. Progressive damage of the organ of corti. Loss of higher frequencies initially. Mx - hearing aids or cochlear implants.
Noise induced hearing loss.
> 85dB
Sudden loud sound results in damage to the cilia hair cells.
Repeated noises - SNHL.
Loud noise - perf - conductive.
Hearing adjuvants.
Hearing aid - conductive and sensorineural HL. Mild to moderate.
Cochlear implants - SNHL. Moderate to severe.
Indications for a Tracheostomy.
Long term ventilation - >3 weeks.
Acute upper airway obstruction.
Between cricoid cartilage and sternal notch.
Indications for a Cricothyrotomy.
Emergency procedure. Through cricothyroid membrane to obtain airway access, If ETT has failed. Obstruction - tumour, angioedema. Laryngospasm.
Common pathogens in acute tonsillitis.
Viral, <5 and young adults.
Bacterial 5-15.
Viral - adenovirus, EBV.
Complications of acute tonsillitis.
Peritonsillar abscess - quinsy.
Retropharyngeal abscess.
Post-strep GN.
Epiglottitis.
Hib. Group A strep. RISK FACTOR NOT BEING IMMUNISED. Sudden onset, high fever, drooling. Dysphagia/drooling/distress.
Mx - dont examine through, o2 and ned adrenaline, IV dex and IV cefotaxime.
Laryngitis.
Usually viral and self-limiting.
Rhino, adno and influenza virus.
Secondary bacterial infection may occur.
Laryngoscopy - red and inflammed vocal cords.
Mx - vocal rest, steam inhalation.
Penicillin V if necessary in bacterial superinfection.
Pharyngitis.
Acute - usually viral or IM.
Chronic - may be related to chronic sinusitis, bronchitis or reflux.
Infectious Mononucleosis. .
Glandular fever. 95% are seropositive. EBV virus - spread via saliva. Infects B lymphocytes via the CD21. 4-8 weeks incubation. Symptoms 2-4 weeks. Splenomegaly, fever, fatigue, malaise. Pharyngitis/tonsilitis/bilat cervical lymphadenopathy. Macpap rash.
Ix - Monospot Test, elevated LDH and liver transaminases, >10% atypical lymphocytes/lymphocytosis.
Mx - avoid . contact sports for 3 weeks, fluids, analgesics and antipyretics.
Complications of Mono.
NS - GBS/meningoencephalitis/CN palsies
Haem -TTP/HUS/DIC.
Splenic rupture, acute renal failure, AOM.
Pathology of OSAS.
Obstruction of upper airways. Apnoea. Low PaO2. Increased pCo2.
Investigation of OSAS.
Polysomnography.
Bloods - polycythaemia.
Management of OSAS.
Lose weight. Stop smoking. Sleep hygiene. Lateral sleeping position. CPAP @ night via a nasal mask. Surgery - tonsillectomy.
What is the definition of an orbital blow out fracture?
Orbital contents are typically forced through a fractured orbital floor.
What is the presentation of an orbital blow out fracture?
Unilateral periorbital pain, oedema +/- ecchymosis.
En or exopthalmos.
Orbital rim step off.
Epistaxis.
What is the management of an orbital blow out fracture?
Opthalmic consultation.
Anitbiotics.
Steroids to reduce swelling.
Topical vasoconstrictor for epistaxis.
What are the signs of a basal skull fracture?
Leakage of CSF from SAS through an external opening.
Due to a dural tear - may show halo sign (rapidly expanding ring of clear fluid surrounding blood)
Subcut haematoma.
What are the signs of an anterior basal skull fracture?
CSF rhinorrhoea
Raccoon eyes
Cranial nerve 1,5,6,7,8 palsies
What are the signs of a posterior basal skull fracture?
CSF otorrohea
Haemotypanum
Battles sign
Cranial nerve 6,7,8 palsies
What is the most common deep neck infection?
Peri-tonsillar abscess/quinsy.
Quinsy.
Develop from tonsillitis.
Strep pyogenes.
Hot potato voice.
Trismus.
Uvula shifted to opposite side, with inferior and medial displacement.
Unilateral fluctuant, swollen red tonsil.
Same sided cervical lymphadenopathy.
What is the management of a Quinsy?
IVAbx.
Incision and drainage or needle aspiration.
When would a tonsillectomy be indicated in a quinsy?
Unresponsive to drainage and abx.
Quinsy before.
Airway obstruction.
Parapharyngeal abscess.
Children <5. Caused by dental infections. Medial displacement of the lateral pharyngeal wall. CT. IV ABx and drainage.
Retropharyngeal abscess.
Children <5.
Spread from URTI.
Unilateral swelling of the posterior pharyngeal wall (possible fluctuance)
Neck asymmetry, anterior cervical lymphadenopathy (inability to extend neck)
Dx - lateral x-ray - widened prevertebral space on CT
What is the 2 mechanisms of angioedema?
Bradykinin - hereditary/ACEi induced
Histamine - NSAIDs.
What is the presentation of angioedema?
Facial oedema - mouth, eyelids, tongue
Laryngeal involvement - SOB, stridor, potentially life threatening.
Possible swelling of extremities and urogenital area.
What are some common causes of angioedema?
ACE inhibitors - common
Hereditary - rare
What is the management of angioedema?
Secure airway Adrenaline. Steroids. Antihistamines. Discontinue ACE-inhibitors.
How can you rule out a facial fracture in those with a fractured nose?
Teeth mal-alignment
Diplopia. .
What are the investigations for fractured nose?
None - cartilaginous injury wont show on x-ray and radiographs wont alter management.
What is the management for a fractured nose?
EXCLUDE SEPTAL HAEMATOMA Re-examine after 1 week - reduced swelling. Reduction (anaesthetic) and splinting Early ENT referral - reduction. Late - septorhinoplasty.
What are the complications of a fractured nose?
Septal haematoma.
Nasal obstruction.
What is a nasal septal haematoma?
Rare complication of nasal bone fracture.
What is the presentation of a nasal septal haematoma?
Nasal obstruction. Blue-red bulge from nasal septum. May be uni or bilateral. Overlying oedema. Occlusion of nare.
What is the management of nasal septal haematoma?
Incision and drainage.
Packing.
What is the prognosis of a nasal septal haematoma?
Prompt intervention is required to prevent cartilaginous necrosis of the septum/saddle deformity.
Can perforate the septum.
What are some causes of epistaxis?
80% unknown Trauma - nose picking/fracture Foreign body Local infection - URTI HHT Coagulopathy
Osler-Weber-Rendu/HHT.
AD
Telangectasia in mucosa.
Internal ones and AVM.
Pinna haematoma.
Result from blunt force trauma, usually from sports.
Blood accumulates in the subperichondral space and can result in decreased blood flow, necrosis and infection.
What are some differentials for pinna haematoma?
Perichondritis.
Abscess.
Relapsing polychondritis.
What is the management of pinna haematoma?
Evacuation - needle decompression/I+D/ .
Compression dressing - dental rolls, casting agent.
Antibiotics.
Malignant otitis externa.
Life threatening infection which can lead to skull osteomyelitis.
90% are immunocompromised.
Severe otalgia, worse at night.
Copious ottorohoea.
Granulation tissue in the canal.
What is the management of malignant otitis externa?
Surgical debridement.
Systemic ABx.
Bells Palsy.
Inflammation and oedema from entrapment of cranial nerve 7 in narrow facial canal.
HSV1.
What is the presentation of Bells Palsy?
Sudden onset Complete, unilateral weakness Numbness of pain around the ear. Decreased taste. Hyperacussis - stapedius palsy.
What is the management of Bells Palsy?
Protect the eye,
Prednisolone.
Variciclovir if HZV suspected.
Complete lesions - 80% full recover, 20% delayed or permanent.
Ramsey Hunt Syndrome.
Reactivation of VZV in the geniculate ganglion of CN7.
What is the presentation of RHS?
Preceding ear pain.
Vesicular rash in the EAC
Ipsilately facial weakness, ageusia and hyperacusis.
What is the management of RHS?
Varicylovir and prednisolone
What are some causes of facial nerve palsy?
Unilateral - Bells palsy, RHS Bilateral - Lyme disease, GBS, Leukaemia Intracranial lesions - MS, SOL Intratemporal lesions - OM, cholesteatoma, RHS Infratemporal - parotid tumours Systemic - DM, IV, botulism.
