ENT SUMMARY Flashcards
What is the most common benign tumor in the cerebellopontine angle?
Vestibular schwannoma (Acoustic neuroma)
First nerve affected in Vestibular schwannoma (Acoustic neuroma)?
Trigeminal nerve
Second nerve affected in Vestibular schwannoma (Acoustic neuroma)?
Sensory facial nerve
What are the results of Rinne’s test, Weber’s test, and Tympanometry in Vestibular schwannoma (Acoustic neuroma)?
Rinne’s test: Positive
Weber’s test: Lateralized to the contralateral side
Tympanometry: Type A (Normal)
What kind of hearing loss is expected in Vestibular schwannoma (Acoustic neuroma)?
SNHL
Investigation for Vestibular schwannoma (Acoustic neuroma)?
Cerebellopontine angle MRI
What are the 2 screening assessments for hearing?
1) Whispered voice test:
Normal hearing can repeat words whispered at 60 cm.
2) Tuning fork tests (Weber’s and Rinne’s test)
Normal Weber’s findings?
No laterization or Centralization
Normal Rinne’s findings?
Air conduction Better than Bone conduction
Cause of false negative Rinne’s test in right ear?
Profound sensorineural hearing loss in the right ear
Rinne’s conductive hearing loss means:
BC > AC
Rinne’s sensorineural hearing loss means:
AC > BC (False positive)
Differential diagnoses for type As tympanogram?
1) Otosclerosis
2) Malleus fixation
3) Scarred tympanic membrane
Differential diagnoses for type Ad tympanogram?
1) Ossicular discontinuity
2) Thin and lax tympanic membrane
3) Post-stapedectomy
Differential diagnoses for Type B (small ear canal volume) tympanogram?
1) Ear canal is occluded with wax/debris
2) The immittance probe is pushed against the side of the ear canal
Differential diagnoses for Type B (normal ear canal volume) tympanogram?
Otitis media with effusion
Differential diagnoses for Type B (large ear canal volume) tympanogram?
Perforation of the tympanic membrane
Differential diagnoses for Type C tympanogram?
1) Developing or resolving otitis media
2) Malfunctioning eustachian tube
3) Tympanic membrane retraction
The most three common causes of peripheral vertigo are:
1) Benign paroxysmal positional vertigo
2) Vestibular neuritis (Labrynthitis)
3) Meniere’s disease
How to test for Benign paroxysmal positional vertigo?
Dix-Hallpike test
How to treat Benign paroxysmal positional vertigo?
1) Epley maneuver
2) Surgery
Etiology of Benign paroxysmal positional vertigo?
1) Idiopathic (50%)
2) Head trauma
3) Chronic otitis media
4) Viral infection
Pathophysiology of Benign paroxysmal positional vertigo?
Dislodge of canalith from utricle to semicircular canal (posterior one most commonly)
Etiology of Vestibular neuritis (Labyrinthitis)?
Viral infection
Treatment for Vestibular neuritis (Labyrinthitis)?
1) IV Fluids
2) Steroids
3) Anti-emetic
Treatment for Meniere’s disease?
1) Lifestyle change: low salt intake
2) Thiazide diuretics
3) Anti-vertigo (Betahistine)
4) Intratympanic injection of aminoglycoside like Gentamycin (Ototoxic drug which damages the dark cells that produce the endolymph) can improve vertigo.
5) Surgery: Labyrinthectomy or Endolymphatic sac decompression.
Causes of Meniere’s syndrome?
1) Chronic otitis media
2) Viral infection
3) Syphilis
Causes of Meniere’s disease?
Idiopathic
Signs of otitis externa?
1) Narrowed external auditory canal
2) Edema and erythema of the external auditory canal
3) Conductive hearing loss may be evident
4) Discharge
5) Positive tragus sign
Otomycosis symptoms?
1) Severe itching
2) Chronic discharge with inflammation of the mucosa of tympanic membrane
Classic triad of otitis media?
1) Otalgia
2) Fever
3) Conductive hearing loss
What are the phases of acute otitis media?
1) Exudative inflammation – 1-2 days
2) Resistance & Demarcation – 3-8 days
3) Healing phase – 2-4 weeks
First line antibiotic treatment for otitis media?
Amoxycillin
What should you do if otitis media persists despite antibiotic treatment?
Myringotomy
What is the most common cause of otitis media with effusion?
Adenoid hypertrophy → Eustachian tube dysfunction → negative pressure → retraction pocket → prevents adequate drainage → accumulation of
fluid.
What is the most common symptom of otitis media with effusion?
Mild conductive hearing loss
Rinne’s test on Otitis media with effusion is:
Negative
Indications of grommet insertion?
1) 3 or more episodes of acute otitis media in 6 months
2) 4 or more attacks of acute otitis media in a year with at least one episode in the preceding 6 months
3) Otitis media with effusion with conductive hearing loss persists for 3 months or if there is recurrent pain
Complications of grommet insertion?
Otorrhea
Treatment of dry perforated tympanic membrane?
1) Conservative
2) Myringoplasty (Type one Tympanoplasty) ← Definitive treatment
Treatment of perforated tympanic membrane with discharge?
1) Aural toilet (regular suction)
2) Swab culture
3) Ear drop with antibiotic
4) Myringoplasty (Type one Tympanoplasty) ← Definitive treatment
Causes of recurrent facial palsy?
1) Melkersson-Rosenthal syndrome
2) Sarcoidosis
3) Parotid tumors
Most common cause of Ramsay hunt syndrome?
Varicella zoster virus (VZV)
What is the cause of otalgia in Ramsay hunt syndrome?
Severe pain precedes herpetic eruption
What drains into the superior meatus?
1) Sphenoid sinus
2) Posterior ethmoid
Common causes of chronic cough?
1) Postnasal drip due to adenoid or sinusitis
2) Bronchial asthma / COPD
3) GERD
Vasomotor rhinitis is due to:
Excessive parasympathetic activity
What is rhinitis medicamentosa?
Rebound nasal congestion suspected to be brought on by extended use of topical decongestants (more than 2 weeks)
Findings in allergic rhinitis?
1) Hypertrophied & pale turbinate
2) Edematous mucosa
3) Watery secretion
Best investigation for sinusitis?
CT scan
Best investigation for fungal sinusitis?
MRI
Treatment for chronic sinusitis?
Metronidazole (For anaerobes)
What is Samter’s triad?
1) Nasal polyps
2) Aspirin allergy
3) Asthma
The Nasal polyps are most commonly from the:
Ethmoidal sinuses
Most important artery for embolization in case of epistaxis?
Sphenopalatine
Most important cause of toxic shock syndrome?
Nasal packing
What is Trotters Triad of Nasopharyngeal tumors?
1) Ipsilateral conductive hearing loss
2) Ipsilateral ear pain + facial pain
3) Ipsilateral paralysis of soft palate
Most common site for Adenocarcinoma is:
Ethmoidal
Most common sinus for neoplasms are:
Maxillary sinus
What does Ohngren’s line connect?
Medial canthus of the eye to angle of the mandible
Tumors above Ohngren’s line have __(good/poor) prognosis.
Poor
Most common paranasal sinus malignancy in children < 5 years is?
Rhabdomyosarcoma
Most common neoplasm of nose and sinus?
Non-Hodgkins lymphoma
The most common cause of tonsillitis is:
Viral
Most common pathogen in bacterial tonsillitis?
Streptococcus pyogenes “GAS”
Peritonsillar abscess symptoms?
1) Unilateral bulging with pus and exudate
2) Trismus
3) Drooling of saliva
What is the second step in recurrent laryngeal nerve palsy management after examination?
CT scan from skull base to chest
What is the most common cause of stridor in the neonatal period and early infancy?
Laryngomalacia
What is the most common benign tumor of the larynx?
Papilloma
What is the most common indication for tracheostomy?
Prolonged endotracheal intubation
mall disc batteries cause tissue destruction via:
Low-voltage electrical currents and liquefactive necrosis
