ent peer teaching Flashcards
what do audiograms do?
is air or bone better in normal ears?
show how well a person can hear noises at different frequencies
causes of conductive hearing loss?
- ext canal obstruction
- tympanic membrane obstruction (painful + sudden)
- eustachian tube problems - effusion
- acute mastoiditis
- otosclerosis
describe otosclerosis
increased bone turnover -> scleoris = ankylosiis of stapes footplate
stiffening and immobility of stapes foottplate in ovakl window
slowly prog bilat hearing loss
15-35yrs female
sx worsenin pregnancy and menstruation
Ix: audiometry
Mx: hearing aids ?surgery?
Cholesteatoma
what is it?
RFs:
Sx:
Ix:
Rx:
retraction pocket of tympanic membrane shedding layers of old skin
extends and erodes by pressure (commonly into attick)
RFs: reccurent OM infections - perf TM / congentital
Sx:
unilat watery smelly D/C from ear
gradual conductive hearing loss
unilateral ear discomfort
Ix: otoscopy
Rx: surgical removal
conductive hearing loss - pic on audiogram?
bone conduction better than air on audiogram..?
causes of sensorineural hearing loss
- ototoxicity (aminoglycosides eg. gent / azithro / clarithro / salicylates)
- meniere’s
- infections (v zoster / mumps / encephalitis / MENINGITIS)
- presbyacusis
- acoustic neuroma
sensorineural hearing loss - pic on audiogram
nb - learn cutoffs for normal Y axis range..)
both bone and air conduction decreased
presbyacusis
gradually progressive bilateral hearing loss
high frequencies lost first
Dx of exclusion andseen on audiometry
normal TM
Rx:
hearing aids
cochlear implant
Cx:
decreased QOL
worsens dementia
Noise induced hearing loss
graudal bilat hearing loss +/- tinnitus
NOT PROGRESSIVE
Dx: Hx and audiometry
trough at about 4000Hz
Rx:
hearing aids
Acoustic neuroma (inappropriate name…)
benign slow growing tumour of CN VIII
arise from schwann cells of nerve myelin sheath
ANY UNILAT HEARING LOSS = A.N. UNTIL PROVEN OTHERISE (IN ADULTS…)
unilat progressive hearing loss tinnitus vestibular dysf facial pain weakness
Ix:
audiology - sensorineural hearing loss
MRI ** gold standard**
Rx:
If small + mild Sx - can watch and wait
Stereotactic radiosurgery - one large dose of radiation
Microsurgery if big
Vertigo
- causes
- peripheral - BPPV / menieres / labrynthiti / vest neuritis
Central - a.n. / MS / head inhury
drugs - Gent / metronidazole
BPPV 1. what cuases it 2.presentation? Dx Mx
- otoliths deatch into semicircular canals - detached otoliths continue to move once head movement stops - > dizziness and vertigo
2. SHORT EPISODES (20-30S) OF VERTIGO worst in morning rapid resolution provoked by head movements
No hearing loss / tinnitus
3.
Dx:
clinical
o/e - Dix-hallpike test (+=BPPV)
Mgmt: usually self limiting promote - slowly get out of bed / decrease ETOH / slow head movements Epley's manouvere Meds - prochloperazine
Meniere’s
1. what hapens?
- increase in fluid vol in membranous labyrinth
prog distension of membranous labryinth
unknown cause - 40-60yrs
uni/bilat Feeling of increased pressure in ear vertigo and / without N&V Tinnitus hearing loss sensation of aural pressure
Dx: clinical and audiometry
MGMT:
1. acute attack - best rest / reassurance / antihistamine / prochlorperazine buccal
betahistine for proph
inform DVLA
labrythitis
inflamm of membranous labyrinth and vestibular nerve
usually following urti
sudden severe ncapacitating rotational vertigo
hearing loss
NOT TRIGGERED BY MOVEMENT
Dx:
- clnical
- audiometry
- HINTS - head impulse test - turn head to side and pt can’t maintain visual fixation / nystagmus
Mgmt: self-limiting antihistamines prochlorperazine CS topical eg. pred bed rest and oral fluids DONT DRIVE
vestibular neuritis
px
ddxs:
mx:
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus (NB - remember the HINTs exam can be used to differentiater from a posterior circulation stroke - move head sharply back towards the center from turned to the side and will get nystagmus as the eyes return in vestibular neuritis…)
like labyrinthis
BUT INFLAMMATION OF THE VESTIBULAR NERVE ONLY inflammation of the vestibular nerve - ie no labyrinth involvement SO NO hearing loss
hence differentiated from labyrinthitis (which includes both CNVIII and the labryths - hence vertigo AND
often
Otherwise diagnosed and managed pretty much the same. as labrythitis…
ie. acute attack -buccal prochlorperazine
long term prophylaxis- oral antihistamines eg. cyclizine / oral prochlorperazine..
Otits externa
**necrotising otitis externa - red flag?
symptoms:
otalgia
itching
hearing loss
on exam:
ear cananl erythema / oedema / exudate/ fever / preauricular lymphadenopath
ANALGESIA!! - all managements…..
ideally tx with topical abc / compbined abx - may need Oral ABx if spreading / refractory to Tx
Topical ear drops: gent + betamethasone drops
red flag for nec OE = FACIAL NERVE PALSY - Tx with IV ABx
OM
Px: triad: Otalgia fever conductive hearing loss
(+ coryzalSx)
O/E - pyrexial / red or yellow bulging TM / red pinna / discharge
Rx:
analgesia / antipyretics = para and nsaids
PO ABx - amox 5days
recurrent - EM referral
OM with Effusion:
loss of light reflex n
middle ear fluid in adults - suspicious - what do you need to excllude?
head / neck tumour
what does OME look like on a tympanogram
flat / underlying causes excluded
Mastoiditis
fever otalgia swollen tender red mass behind ear protrusion of pinna PAIN BEHIND EAR....
iX: bloods b;ood cultures dicharge culture audiogram skull XR (+/- MRI / LP)
Mx: 3rd gen cephalosporins para nsaids oral abx mastoidectomy...
SInusitis..
RFs for sinusitis
allegric rhinitos
urti
asthma
Acute: <4wks usually viral cause Sx: non-resolving urti Sx>1wk facial tenderness feeling of facial pressure - worse on bending forwards decreased sense of smell
Rx:
antipyretic
intranasal decongestant
warm face packs
chronic - Tx with intranasal decongestants
Bell’s palsy
CN VII controls muscles of face ACUTE, UNILATERAL, IDIOPATHIC FACIAL NERVE PARALYSIS Any age, peak 20-40yrs LMN PALSY = FOREHEAD AFFECTED Sx: vary mild - severe Facial sagging with weak muscles of facial expression Drooping eyelid Drooping corner of mouth Loss of nasolabial fold Hyperacusis Dry mouth, altered taste Decreased tear production Dx = clinical Rx - Prednisolone PO 10 days within 72 hours - Artificial tears Prognosis – commonly spontaneous resolution
why do you get hyperacusis in bell’s palsy?
CNVII innervates the stapedius muscle, which dampens down the stapes vibrations - hence less dampening down with a nerve palsy means hyperacusis
Ramsey Hunt syndrome
essentiallyShingles of the ear -> bell’s palsy Sx + vesicles and erythematous rash on ipsilateral ear / hard palate
Tx with Aciclovir
pharyngitis symptoms
fever
odynophagia - urti sx - hoarse voice
GABS - scarlet fever
laryngitis
inflammation of vocal cords and larynx
tonsillitis
- most common cause?
- signs
- criteria for ABx
- what abx
- GAS - strep pyogenes
nb - children can have abdo pain as well…
- erythematous throat
swollen coated tonsils
swollen regional LNs - modified centor criteria
LEARN - phenoxymethylpenicillin 10 days
glandular fever
- signs
- Ix
3.
signs: tonsillar enlargement palatal petechiae fine macular non-pruritic rash lyphadenopathy later - hepatosplenomegaly
Ix: monospot tests (nb - might be negative early in the illness - do it after 2 weeks ) EBV specific Antibodies Bloods - EBC / ESR / LFTs Throat swab
Mx:
Supportive - para/ bed rest / fluids PO / iB
Avoid:
1, amox - rash
contact sport for 8wks post IM - risk of splenic rupture
what is quinsy?
pus trapped between tonsillar capsule + lateral pharyngeal wall
nb - trismus / hallitosis /
Signs:
uvula dev away from lesion
unilat tonsil bulging
cervical lymphadenopathy
give some DDxs of salivary gland swelling
parotitis - MUMPS
obstruction - stones most common cause. - colicky pain and swelling at meal times - USS to Ix - may pass spontaneously / surgically
sialadenosis - sjogrens / sarcoid / malnutrition / endocrine - biopsy it
