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ent peer teaching Flashcards

1
Q

what do audiograms do?

is air or bone better in normal ears?

A

show how well a person can hear noises at different frequencies

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2
Q

causes of conductive hearing loss?

A
  1. ext canal obstruction
  2. tympanic membrane obstruction (painful + sudden)
  3. eustachian tube problems - effusion
  4. acute mastoiditis
  5. otosclerosis
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3
Q

describe otosclerosis

A

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?

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4
Q

Cholesteatoma

what is it?

RFs:

Sx:

Ix:

Rx:

A

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

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5
Q

conductive hearing loss - pic on audiogram?

A

bone conduction better than air on audiogram..?

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6
Q

causes of sensorineural hearing loss

A
  1. ototoxicity (aminoglycosides eg. gent / azithro / clarithro / salicylates)
  2. meniere’s
  3. infections (v zoster / mumps / encephalitis / MENINGITIS)
  4. presbyacusis
  5. acoustic neuroma
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7
Q

sensorineural hearing loss - pic on audiogram

nb - learn cutoffs for normal Y axis range..)

A

both bone and air conduction decreased

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8
Q

presbyacusis

A

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

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9
Q

Noise induced hearing loss

A

graudal bilat hearing loss +/- tinnitus
NOT PROGRESSIVE

Dx: Hx and audiometry
trough at about 4000Hz

Rx:
hearing aids

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10
Q

Acoustic neuroma (inappropriate name…)

A

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

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11
Q

Vertigo

  1. causes
A
  1. peripheral - BPPV / menieres / labrynthiti / vest neuritis
    Central - a.n. / MS / head inhury
    drugs - Gent / metronidazole
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12
Q 
BPPV 
1. what cuases it
2.presentation?
Dx
Mx
A
  1. 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
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13
Q

Meniere’s

1. what hapens?

A
  1. 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

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14
Q

labrythitis

A

inflamm of membranous labyrinth and vestibular nerve
usually following urti
sudden severe ncapacitating rotational vertigo

hearing loss
NOT TRIGGERED BY MOVEMENT

Dx:

  1. clnical
  2. audiometry
  3. 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
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15
Q

vestibular neuritis

px

ddxs:

mx:

A

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..

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16
Q

Otits externa

**necrotising otitis externa - red flag?

A

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

17
Q

OM

A 
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

18
Q

middle ear fluid in adults - suspicious - what do you need to excllude?

A

head / neck tumour

19
Q

what does OME look like on a tympanogram

A

flat / underlying causes excluded

20
Q

Mastoiditis

A 
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...
21
Q

SInusitis..

A

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

22
Q

Bell’s palsy

A 
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
23
Q

why do you get hyperacusis in bell’s palsy?

A

CNVII innervates the stapedius muscle, which dampens down the stapes vibrations - hence less dampening down with a nerve palsy means hyperacusis

24
Q

Ramsey Hunt syndrome

A

essentiallyShingles of the ear -> bell’s palsy Sx + vesicles and erythematous rash on ipsilateral ear / hard palate

Tx with Aciclovir

25
Q

pharyngitis symptoms

A

fever
odynophagia - urti sx - hoarse voice

GABS - scarlet fever

26
Q

laryngitis

A

inflammation of vocal cords and larynx

27
Q

tonsillitis

  1. most common cause?
  2. signs
  3. criteria for ABx
  4. what abx
A
  1. GAS - strep pyogenes

nb - children can have abdo pain as well…

  1. erythematous throat
    swollen coated tonsils
    swollen regional LNs
  2. modified centor criteria
    LEARN
  3. phenoxymethylpenicillin 10 days
28
Q

glandular fever

  1. signs
  2. Ix

3.

A 
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

29
Q

what is quinsy?

A

pus trapped between tonsillar capsule + lateral pharyngeal wall

nb - trismus / hallitosis /

Signs:
uvula dev away from lesion
unilat tonsil bulging
cervical lymphadenopathy

30
Q

give some DDxs of salivary gland swelling

A

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

ENT (2 decks)

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