ENT pathology - inner ear Flashcards
Meniere’s disease
Disorder affecting the inner ear which is characterised by:
- Vertigo
- Fluctuating hearing loss
- Tinnitus
- Lasts minutes to hours
Associated with a feeling of fullness in the affected ear
Can get positive Romberg test
Caused by abnormal endolymph production
Mx of Meniere’s disease
To confirm diagnosis - refer to ENT
Advise the person not to drive when they are dizzy, or if they might experience an episode of vertigo while driving
1st line - Betahistine
N/V - prochlorperazine
Vestibular neuronitis
Inflammation of the vestibular nerve
Acute, spontaneous and prolonged vertigo
Labyrinthitis
Involves inflammation of the labyrinth
Acute, spontaneous and prolonged vertigo and hearing loss
BPPV
Repeated episodes of positional vertigo due to head movements
Loose calcium carbonate debris
Dix Hallpike manoevre
Epley manoevre
Brandt-Daroff exercises
Vestibular neuronitis presentation and mx
Vertigo
Recent viral infection
Nystagmus - Head impulse test
Mx:
nausea or vomiting - prochlorperazine
Romberg’s test
Close eyes
If unbalanced, problem with ear or brain in terms of balance.
Sinusitis
Inflammation of the paranasal sinuses that completely resolves within 12 weeks
recurrent - 4+ annual episodes
Chronic - more than 12 weeks
Causes of acute sinusitis
Triggered by a viral upper respiratory tract infection
Sinus mucosa oedema, obstruction of the sinus ostia, and reduction in mucociliary action allow secretions to stagnate and give bacteria a suitable environment to grow
Acute sinusitis associations
Asthma Allergic rhinitis Smoking. Anatomical variation - deviated nasal septum, nasal polyps, trauma Seasonal variation CF - impaired ciliary motility
Presentation of acute sinusitis
Presence of nasal blockage or discharge
Tenderness, swelling, or redness over the cheekbone or periorbital areas which gets worse when leaning forward
Cough
Mx of Sinusitis
If a person has had symptoms for 10 days or less: Do not offer an antibiotic prescription as viral
10+ days - high-dose nasal corticosteroid for 14 days or 3 months for chronic
Consider nasal irrigation with saline solution
Avoid allergic triggers
Stop smoking
Good dental hygiene
Allergic rhinitis
IgE-mediated inflammatory disorder of the nose causing a release of histamine and other inflammatory mediators
Triggers for allergic rhinitis
House dust mites Pollen Mould Animal dander Occupational
Mx of allergic rhinitis
Allergen avoidance techniques
Mild:
- an intranasal antihistamine first-line
- non-sedating oral antihistamine - cetirizine
Moderate:
- Intranasal corticosteroid - fluticasone furoate - action after 6–8 hours after the first dose, but the maximal effect may not be seen until after two weeks
Severe: prednisolone for 5 - 10 days
