ENT P3 Flashcards
1
Q
Haemorrhage post-operative tonsillectomy:
A
- all should be assessed by ENT
- primary or reactionary haemorrhage most commonly in first 6-8 hours after
- immediate return to theatre
- secondary between 5-10 days after - associated with wound infection
2
Q
What is presbycusis?
A
- sensorinueral hearing loss
- elderly
- high frequency affected bilaterally
- conversational difficulties
- progresses slowly
- sensory hair cells and neurons in cochlea atrophy over time
3
Q
Causes of presbycusis:
A
- multifactorial
- arteriosclerosis
- diabetes
- accumulated exposure to noise
- drugs (salicylates, chemotherapy)
- stress
- genetic
4
Q
Presenting features of presbycusis:
A
- speech becoming difficult to understand
- need for increased volume on TV or radio
- difficulty using telephone
- loss of directionality of sound
- worsening of symptoms in noisy environments
- hyperacusis: heightened sensitivity to certain frequencies of sound (less common)
- tinnitus (uncommon)
5
Q
Signs and investigations of presbycusis:
A
- possible Weber’s test bone conduction localisation to one side if sensorineural hearing loss not completely bilateral
- otoscopy normal
- tympanometry
- audiometry
- blood tests: inflammatory markers and specific antibodies normal
6
Q
What is Ramsay Hunt Syndrome:
A
- herpes zoster oticus
- caused by reactivation of VZV in geniculate ganglion of seventh cranial nerve
7
Q
Features of Ramsay Hunt syndrome:
A
- auricular pain often first feature
- facial nerve palsy
- vesicular rash around ear
- vertigo and tinnitus
8
Q
Management Ramsay Hunt syndrome:
A
- aciclovir
- corticosteroids
9
Q
Rinne’s test:
A
- tuning fork placed over mastoid until sound no longer heard, reposition over external acoustic meatus
- positive: air conduction normally better than bone conduction
- negative: if bone conduction louder than air, conductive deafness
10
Q
Weber’s test:
A
- tuning fork on middle of forehead
- unilateral sensorineural deafness: sound localised to unaffected side
- unilateral conductive: sound localised to affected side
11
Q
3 pairs of salivary glands:
A
- parotid (serous) - most tumours
- submandibular (mixed) - most stones
- sublingual (mucous)
12
Q
Pleomorphic adenomas:
A
- benign, mixed parotid tumour, 80%
- middle age
- slow growing, painless lump
- superficial parotidectomy; risk = CN VII damage
13
Q
Warthin’s tumour:
A
- benign, denolymphomas, 10%
- males, middle age
- softer, more mobile and fluctuant
14
Q
Salivary gland stones:
A
- recurrent unilateral pain and swelling on eating
- may become infected - ludwig’s angina
- 80% submandibular
- plain x-rays, sialography
- surgical removal
15
Q
Other causes of salivary gland enlargement:
A
- acute viral infection
- acute bacterial infection
- sicca sindrome and Sjogren’s
16
Q
What causes sore throat:
A
- pharyngitis
- tonsillitis
- laryngitis
17
Q
Management sore throat:
A
- paracetamol or ibuprofen
- antibiotics not routinely indicated
18
Q
Antibiotic indications for sore throat:
A
- marked systemic upset secondary to acute sore throat
- unilateral peritonsillitis
- history of rheumatic fever
- increased risk form acute infection
- acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more centor criteria present
- phenoxymethylpenicillin or erythromycin (if patient penicillin allergic)
19
Q
How much saliva do submandibular glands secrete per day?
A
800-1000ml
20
Q
Nervous supply to submandibular glands:
A
- parasympathetic: chordates tympanic nerves and submandibular ganglion
- sensory: lingual branch of mandibular nerve
21
Q
What is sialolithiasis:
A
- 80% salivary gland calculi in submandibular gland
- 70% radio opaque
- calcium phosphate or calcium carbonate
- colicky pain and post prandial swelling of gland
- sialography to show obstruction and associated other stones
- stones impacted in distal aspect of wharton’s duct removed orally, others require gland excision
22
Q
What is sialadenitis:
A
- staph aureus infection
- pus leaking from duct, erythema
- sub mandibular abscess serious complication - can spread to deep fascial spaces and occlude airway
23
Q
Sudden onset sensorineural hearing los:
A
- urgent referral to ENT
- majority idiopathic
- mRI scan to exclude vestibular schwannoma
- high does oral corticosteroids for all cases
24
Q
How do thyroglossal cysts develop?
A
- develops from floor of pharynx and descends into neck during development
- connected to tongue by thryoglossal duct
- forman cecum point of attachment to tongue
- duct normally atrophies but can persist and give rise to cyst
25
Presentation of thyroglossal cyst:
- <20yo
- midline between isthmus of thyroid and hyoid bone
- moves upwards with protrusion of tongue
- painful if infected
26
What nerve can be damaged in thyroid surgery?
recurrent laryngeal nerve
27
Causes of tinnitus:
- Meniere's disease
- otosclerosis
- sudden onset sensorineural hearing los
- hearing los
- drugs
- impacted ear wax
28
What is Meniere's disease associated with?
- hearing loss
- vertigo
- tinnitus
- sensation of fullness or pressure in one or both ears
29
What is otosclerosis?
- 20-40 years
- conductive deafness
- tinnitus
- normal tympanic membrane
- 10% flamingo tinge caused by hyperaemia
- family history
30
What is SSNHL associated with?
neurofibromatosis type 2
31
Drugs causing tinnitus:
- aspirin/NSAIDs
- aminoglycosides
- loop diuretics
- quinine
32
Assessment of tinnitus:
- audiological assessment
- imaging: non pulsatile does not require unless unilateral or other neurological or ontological signs, MRI of internal auditory meatuses first line
- pulsatile tinnitus requires imaging as may be underlying vascular cause - MRA often used
33
Management of tinnitus:
- investigate and treat underlying cause
- amplification devices if associated hearing loss
- psychological therapy e.g. CBT
34
Complications of tonsillitis:
- otitis media
- quinsy - peritonsillar abscess
- rheumatic fever and GN rarely
35
Indications for tonsillectomy:
- sore throats due to tonsillitis (not recurrent upper respiratory tract infections)
- 5 or more episodes of sore throat per year
- symptoms occurring for at least a year
- episodes of sore throat are disabling and prevent normal functioning
- recurrent febrile convulsions secondary to tonsillitis
- OSA, stridor or dysphagia secondary to enlarged tonsils
- peritonsillar abscess if unresponsive to standard treatment
36
Causes of vertigo:
- viral labyrinthitis
- vestibular neuronitis
- benign paroxysmal positional vertigo
- Meniere's disease
- vertebrobasilar ischaemia
- acoustic neuroma
- posterior circulation
- trauma
- multiple sclerosis
- ototoxicity e.g. gentamicin
37
Symptoms of viral labyrinthitis:
- recent viral infection
- sudden onset
- nausea and vomiting
- hearing may be affected
38
Symptoms of vestibular neuritis:
- recent viral infection
- recurrent vertigo attacks lasting hours or days
- no hearing loss
39
Symptoms of benign paroxysmal positional vertigo:
- gradual onset
- triggered by change in head position
- each episode lasts 10-20 years
40
Symptoms of vertebrobasilar ischaemia:
- elderly
| - dizziness on extension of neck
41
How does vestibular neuronitis come about?
often following viral infection
42
Features of vestibular neuronitis:
- recurrent vertigo attacks lasting hours or days
- nausea and vomiting
- horizontal nystagmus
- no hearing loss or tinnitus
43
Differential diagnosis of vestibular neuronitis:
- viral labyrinthitis
| - posterior circulation stroke
44
Management of vestibular neuronitis:
- vestibular rehabilitation exercises preferred treatment
- buccal or IM prochlorperazine for rapid relief
- short oral course of prochlorperazine or antihistamine (cinnarizine, cyclising or promethazine) for severe cases
45
What is labyrinthitis?
- inflammatory disorder of membranous labyrinth
- affects both vestibular and cochlear end organs
- can be viral, bacterial or associated with systemic diseases
- viral most common
46
Difference between viral labyrinthitis and vestibular neuritis:
- vestibular neuritis where only vestibular nerve involved so no hearing impairment
- labyrinthitis when nerve and labyrinth involved so vertigo and hearing impairment
47
Presentation of viral labyrinthitis:
- vertigo - not triggered by movement
- nausea and vomiting
- hearing loss: unilateral or bilateral
- tinnitus
- preceding or concurrent symptoms or URTI
48
Signs of labyrinthitis:
- spontaneous unidirectional horizontal nystagmus towards unaffected side
- sensorineural hearing loss
- abnormal head impulse test: signifies impaired vestibulo-ocular reflex
- abnormal head impulse test: impaired vestibulo-ocular reflex
- gait disturbance: may fall towards affected side
49
Management of viral labyrinthitis:
- usually self limiting
| - prochlorperazine or antihistamines to reduce sensation of dizziness
