ENT presentations Flashcards
Epistaxis local causes
Idiopathic
Traumatic
Iatrogenic
Foreign body
Inflammatory - rhinitis, polyps
Neoplastic
Epistaxis systemic causes
Hypertension
Coagulopathies
Vasculopathies
Hereditary haemorrhagic telangiectasia
Epistaxis mx
ABC
First aid
- pinch soft part of nose
- head forward
- spit out any blood in mouth
Examination - locate source of bleed
Conservative
- cautery - silver nitrate/bipolar diathermy
- anterior bleed with anterior rhinoscopy
- posterior bleed (rigid endoscope) & topical adrenaline may help control bleeding before cautery
- nasal packing if cautery fails to control bleeding
- surgical/radiological - vessels can be ligated surgical surgically/embolised radiologically
Causes of sensorineural hearing loss
Sudden sensorineural hearing loss (< 72 hours)
Presbycusis
Noise exposure
Meniere’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions → stroke, MS, brain tumours
Infections - meningitis
Medications - loop diuretics (furosemide), aminoglycoside abx (gentamicin), chemotherapy drugs (cisplatin)
Causes of conductive hearing loss
Ear wax
Infection - otitis media or otitis externa
Fluid in the middle ear
ET dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours
Weber’s test results
Normal result = patient hears the sound equally in both ears
Sensorineural hearing loss = sound will be louder in the normal ear
Conductive hearing loss = sound will be louder in the affected ear
Rinne’s test
Normal result = AC > BC
- referred to as Rinne’s positive
Abnormal result = BC > AC
- conductive cause for the hearing loss
Neck lump causes
Reactive lymphadenopathy
Lymphoma
Thyroid swelling
Thyroglossal cyst
Pharyngeal pouch
Cystic hygroma
Branchial cyst
Cervical rib
Carotid aneurysm
Thyroglossal cyst
More common in patients < 20 years old
Usually midline
Moves upwards with protrusion of the tongue
May be painful if infected
Pharyngeal pouch
More common in older men
Represents a posteromedial herniation between the thyropharyngeus and cricopharyngeus muscles
Usually not seen, but if large → midline lump in the neck that gurgles on palpation
Sx - dysphagia, regurgitation, aspiration & chronic cough
Cystic hygroma
Congenital lymphatic lesion, typically found in the neck, classically on the left side
Most are evident at birth, 90% < 2 years of age
Branchial cyst
Oval, mobile cystic mass that develops between SCM muscle & pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Facial pain differentials
Trigeminal neuralgia
Sinusitis
Dental problems
Tension-type headache
Migraine
GCA
Hoarseness causes
Voice overuse
Smoking
Viral illness
Hypothyroidism
GORD
Laryngeal cancer
Lung cancer
Referral for suspected laryngeal cancer
Referral to ENT for people > 45 with:
- persistent unexplained hoarseness OR
- unexplained lump in the neck
