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ENT > ENT surgery > Flashcards

ENT surgery Flashcards

1
Q

Audiometry

A
  • Used to differentiate between conductive and sensorineural hearing loss

Sensorineural - both air and bone conduction will be more than 20db (can be only one or both sides)

Conductive - bone conduction readings will be normal but air conduction will be greater than 20db

Mixed - both air and bone conduction will be greater than 20db but there will be a difference of more than 15db between the two (bone more than air)

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2
Q

Presbycusis

A

*Age related hearing loss - a type of sensorineural hearing loss
* Affects higher pitched sounds
*Occurs gradually and symmetrically

Sx - male voices can be easier to hear, not paying attention or missing conversations, concerns about dementia, tinnitus,

Ix - audiometry - sensorineural (both reduced)

Mx - Hearing aids

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3
Q

Sudden sensorial hearing loss

A
  • Hearing loss over less than 72 hrs, unexplained by other causes
  • ENT emergency

Cx - MS, infection, Menieres, medications, migraines, acoustic neuroma, stroke

Sx - often unilateral

Ix - Tuning fork, audiometry (reduction by 30db in 3 consecutive frequencies)
- CT head

Mx - steroids asap

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4
Q

Eustachian tube dysfunction

A
  • When the tube that drains the inner ear to the throat and equalises pressure becomes blocked

Sx - reduced or altered hearing, popping noises, a fullness sensation in the ear, pain or discomfort, tinnitus
* Worsened when external ear pressure changes and inner ear cannot adjust

Ix - typanometry (CHANGING PRESSURE), audiometry, nasopharyngoscopy, CT head

Mx - nasal sprays, valsalva manoeuvre, anti histamines
- Surgery if persistent

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5
Q

Otosclerosis

A
  • Remodelling of small ear bones (mostly base of stapes), causing stiffening, preventing sound being transmitted
    **Conductive hearing loss
    **Autosomal dominant

Sx - patient under 40 - tinnitus, hearing loss - unilateral hearing loss, lower frequency sounds affected,

Ix - audiometry, tymapometry, CT head

Mx - hearing aids, surgical stapedectomy with replacement
**Surgery generally curative

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6
Q

otitis media

A

*infection in the middle ear (space between tympanic membrane and inner ear) where vestibular apparatus and nerves are found
*Effusion present means glue ear (common in kids)

Cx - Bacteria entering via eustachain tube via back of the throat from upper resp tract infection
**Strep pneumonia most common
- haemophilous influenza

Px - ear pain, reduced hearing, fever, upper resp infection
- vertigo and discharge possible

Ix - otoscope - bulging red, tympanic membrane, discharge if perforation

Mx - Amoxicillin
- allergy give clarithromycin

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7
Q

Otitis externa

A
  • Inflammation of the skin in the external ear canal

Cx - swimmers ear, trauma, removal of ear wax, eczema, fungal infections (lots of antibiotics)
* Staph aureus and pseudomonas aeruginosa
^later can colonise the lung in cystic fibrosis patients - resistant to many antibiotics (mx with gentamicin)

Sx - ear pain, itchiness, discharge, conductive hearing loss

Ix - otoscopy and ear swab

Mx - acetic acid (mild)
- topical antibiotic (neomycin) and topical steroid spray (moderate)
- oral antibiotic (severe)

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8
Q

Tinnitus

A
  • Ears trying to turn up the volume when they cant hear sound

Primary - associated with sensorial hearing loss

Secondary - tinnitus with an identifiable cause (gentamicin and loop diuretics***)

Systemic conditions Axs - anaemia, diabetes, thyroid issues, hyperlipademia

Objective tinnitus - where the patient can hear an extra sound, that can be heard on auscultation with a stethoscope - carotid bruit, aortic murmur, AVM, Eustachian tube dysfunction

Ix - underlying conditions - anaemia, glucose, thyroid, lipids, audiology,

Mx - x

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9
Q

Vertigo

A
  • Imbalance between sensory inputs and the environment of a person

Cx - Proprioception, vision, signals from vestibular system (fluid shifting detection problems in the inner ear)

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10
Q

BPPV

A

Cx - calcium carbonate crystals building up in the inner ear, disrupting flow of endolymph in (posterior) semi circular canals

Px - head movement triggers attacks that last up to a minute
- no hearing loss or tinnitus

Ix - Dix hall pike - triggering rotational nystagmus and vertigo

Mx - eply manœuvre

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11
Q

Vestibular neuronitis

A
  • Inflammation of vestibular nerve - usually due to a viral infection

Sx - acute onset vertigo - initially constant then triggered by head movement, nausea and vomiting, balance problems
*No hearing loss or tinnitus
* History of upper resp viral infections

Ix - Head impulse test - diagnosis for peripheral vertigo (problem with nerve)

Mx - Prochlorperazine (in acute phase only) and antihistamines
- If chronic - vestibular rehab exercises

HiNTS exam - distinguishes between posterior circulation stroke

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12
Q

Labyrinthitis

A
  • Inflammation of the bony labyrinth in the inner ear (cochlea affected)
    **Often post upper viral resp infection
  • Can be bacterial via otitis media or meningitis

Px - acute onset vertigo, can have associated tinnitus and hearing loss, horizontal nystagmus

Ix - head impulse test - to detected movement problems

Mx - prochlorperazine and antihistamines
- antibiotics

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13
Q

Menieres disease

A
  • Long term inner ear disorder that causes recurrent attacks of vertigo, hearing loss and tinnitus
  • Full feeling in ear

Cx - excessive build up of endolymph in the labyrinth, increasing pressure

Px - 40-50 yo with unilateral vertigo, tinnitus and hearing loss, episodic lasting for 20mins to hours (can be clustered over weeks and months)
- unexplained drop attacks
- spontaneous nystagmus during attacks (horizontal)

Ix - clinical diagnosis

Mx - conservative
- acute attacks - prochlorperazine and anti histamines
*Beta histine to prevent attacks

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14
Q

Vestibular schwannomas

A
  • Benign tumours of Schwann cells surrounding the auditory/vestibular nerve
  • Occur at cerebellopontine angle
  • Unilateral but if bilateral - neurofibromatosis II

Sx - Unilateral sensory hearing loss, unilateral tinnitus, dizziness, fullness in the ear
*Patient typically 40-60

Ix - Audiometry - sensorineural hearing loss
- CT or MRI to detect presence

Mx - Surgery to remove (scar behind ear)
- radiotherapy to shrink

  • Associated with facial nerve palsy
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15
Q

Cholesteatoma

A
  • Abnormal collection of squamous epithelial cells in the middle ear - non cancerous
  • can erode middle ear boned and invade tissues

Px - foul discharge, unilateral conductive hearing loss
- infection, pain, vertigo, facial nerve palsy (if expanding)

Ix - otoscopy - build up of white debris or crust in upper tympanic membrane - locate the attic to exclude cholesteatoma
- CT head for surgery

Mx - surgical removal

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16
Q

Nosebleeds

A

*epistaxis
**Bleeding from Kiesselbach’s plexus in little’s area - nasal mucosa at the front of nasal cavity that is very vascular

Mx - Anterior nasal packing - where bleeding site hard to locate
- nasal cautery (silver nitrate)

17
Q

Sinusitis

A

*Inflammation of paranasal sinuses - produce mucus and drain into nasal cavities via Ostia holes - blockage leads to sinusitis

  • usually accompanied by inflammation of the nasal cavity - rhino sinusitis

Cx - Infection, allergies, obstruction (polyps), smoking

Px - facial pain, congestion, discharge, loss of smell..

Ix - nasal endoscopy
- CT head

Mx - high dose steroid spray if severe or last longer than 10 days
- irrigation if chronic rhino sinusitis
- Functional endoscopic sinus surgery - obstructions

18
Q

Nasal polyps

A
  • Growth of the nasal mucosa that occur in the nasal cavity or sinuses
  • Usually bilateral - unilateral raise suspicions of a tumour

Px - chronic rhinosinusitis
- Difficulty breathing through the nose, snoring, nasal discharge, loss of sense of smell

Ix - nasal endoscopy, otoscopy
- polyps appear round pale grey/yellow

Mx - steroid spray
- intra cranial or endoscopic polypectomy - if they are close to the nostrils or further in respectively

19
Q

Obstructive sleep apnoea

A
  • Collapse of the pharyngeal airway causing episodes of apnoea - patient unaware

Px - episodes of apnoea, snoring, morning headache, poor sleep, concentration problems, daytime sleepiness

Ix - sleep studies by specialist

Mx - correct reversible risk factors - smoking, obesity…
- CPAP to maintain open airway
- surgical (UPPP)

20
Q

Tonsillitis

A
  • Most commonly viral but can be viral:
    strep pyogenes most common (group A)

Px - sore throat, fever, pain on swallowing
Criteria for bacterial: fever, tonsillar pus, absence of cough, tender c lymph

Ix - red, inflamed, enlarged tonsils with or without exudates
- cervical lymphadenopathy (only anterior)

Mx - Penicillin 5
- clarithromycin in allergy

21
Q

Quinsy

A
  • Peritonsilar abscess
  • complication of tonsillitis

Cx - group A strep (pyogenes)
- staph aureus and haem influenza

Px - tonsillitis sx
plus - trismus, change in voice, swelling and redness
- uvula deviated to opposite side

Mx - Fine needle aspiration or surgical drainage

22
Q

Tonsillectomy

A
  • Preventing recurrent tonsillitis

*7 or more in 1 year, 5 per year for 2 years, 3 per year for 3 years

`*Any bleeding within 24hrs straight back to surgery
* Bleeding 5-10 days post op - infection - refer to ENT and give co-amoxiclav

23
Q

Neck lumps

A
  • Arises in anterior and posterior triangle plus midline of neck

Examples
- Goitre, gland: stones, swelling or tumour, lipoma

Carotid body tumours - at bifurcation, slow growing in ant triangle, pulsatile, painless, side to side but not up and down - associated nerve palsy

Branchial cysts - Congenital - 2nd branchial cleft fails to form space with epithelial tissue in lateral aspect of the neck

Px - soft, round, swelling between jaw angle and sternocleidomastoid in ant triangle

24
Q

Throglossal cysts

A
  • During fetal developement, thyroid begins at base of tongue and moves to front of trachea leaving a tract (thyroglossal duct) which should disappear
  • if left it can give rise to a fluid filled cyst

Px - midline, mobile, non tender, soft, moves with tongue

Mx - conservative
- surgical excision

25
Q

Head and neck cancer

A

*Usually SCC

locations - nasal cavity, paranasal sinuses, mouth, salivary glands, pharynx, larynx
** Spread to lymph nodes first

Red flags - mouth or lip lumps, unexplained ulceration, persistent neck lump, unexplained hoarseness, thyroid lump

Mx - radio, chemo, surgery
*Cetuximab - targets epidermal growth factor, blocking growth and mets (for head and neck)

26
Q

Tongue conditions

A

Glossitis - smooth, red, swollen tongue
cx - anaemia

Angioedema - fluid accumulating - swollen tongue Cx - allergies, ACE inhibitors, hereditary

Oral candidiasis (thrush) - white spots and patches Cx - ICS, antibiotics, HIV…
Mx - miconazole (anti fungal), nystatin (antibiotic)

Geographic tongue - patches that lose epithelial surface

Strawberry tongue - swollen, red and papillae (tb) become enlarged and white
**Scarlet fever and Kawasaki disease

Black hairy tongue - decreased shedding of keratin, papillae elongate and take on appearance of hairs - bacteria and food cause dark pigmentation *metalic taste

27
Q

Mouth and gum conditions

A

Leukoplakia - white patches in mouth - precancerous SCC (cant be scraped off)

Erythroplakia - similar^ but lesions are red and white - pre cancerous SCC

Lichen planus - auto immune chronic inflammation of skin - skin shiny, purple, with white lines (web)

Apthous ulcer - small painful ulcers in mucosa, punched out appearance
Axs - IBD, coeliac, HIV and vit deficiency

  • Givingial hyperplasia - drugs - phenytoin, CCBs, cyclosporin
28
Q

Glue ear

A

*Otitis media with an effusion
* Peaks at 2 years old
*If adults, need to rule put posterior nasal space tumour - 2 week ENT referral

Sx - conductive hearing loss, speech and language delay, behavioural and balance problems

Mx - Active observation 3 months
- grommet insertion
- adenoidectomy
* If perf noted, keep dry and see in 4 weeks
* If adult - 2 week referral to ENT

  • If acute give amoxicillin for 2 weeks
  • If downs syndrome - refers to ENT
  • Can cause mastoiditis - displaced external ear, tender mastoid bone, septic picture
  • just give IV antibiotics
29
Q

Branchial cyst

A

Px - painless swelling, lateral aspect, smooth, fluctuant

30
Q

Thyroglossal cyst

A

Px - midline neck lump, cystic, painless, upwards on protrusion of the tongue

31
Q

Auricular haematomas

A
  • Trauma to ear

Mx - same day ENT referral for incision and drainage

  • if left untreated can cause cauliflower ear
32
Q

Nasal septal haematomas

A

Cx - trauma

Sx - bilateral nasap swelling

Mx - urgently referred to ENT for drainage

*If left untreated can cause saddle shaped deformity via septic necrosis where blood supply os cut off

33
Q

Sore throat criteria

A

CENTOR CRITERIA

  • Tonsillar exudate
  • Tender anterior lymphadenopathy or lymphadenitis
  • History of fever
  • Absence of cough
  • 3-4 of these present - 60% chance of strep infection
    Mx - Penicillin 5
  • 1-2 of these present - 80% chance viral
    Mx - pain relief
34
Q

Infectious mononucleosis

A

Cx - EBV virus

Sx - combination of pharingitis and tonsillitis
- Tonsils can meet in the midline, evidence of mild bleeding (oropharynx), splenomegaly,
**Triad of - sore throat, pyrexia, and lymphadenopathy (ant and post neck)

Ix - heterophil antibody test (monospot test)
* 99% of patients that take amoxicillin when they have mono will have a rash

Mx - Rest and pain relief

35
Q

Givingial hyperplasia

A

Cx drugs - phenytoin, CCBs, cyclosporin

Cx - acute myeloid leukaemia

ENT (3 decks)

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