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ENT Textbook Flashcards

1
Q

How much of the external auditory meatus cartilage and how much is bone?

A

Outer 1/3rd is cartilage

Inner 2/3rd is bone

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2
Q

What nerve supplies the anterior part of the auricle?

A

Auricotemporal branch of trigeminal

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3
Q

What nerves supply the posterior part of the auricle?

A

Greater auricular nerve and branches of the lesser optical nerve

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4
Q

What is anotia?

A

Absence of the ear

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5
Q

What symptoms can wax blocking the EAC cause?

A

Hearing loss

Attempts at cleaning ear may –> trauma/otitis externa

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6
Q

How can you treat a wax blocked EAC?

A

Softening drops, e.g. sodium bicarbonate
2nd line: syringing
3rd line: microsuction

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7
Q

What is ear syringing?

A

Flushing ear with water to wash out wax/debris

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8
Q

What things may predispose to OE?

A

Trauma

Eczema, psoriasis

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9
Q

What organisms are usually implicated in OE?

A

Pseudomonas, staphylococcus

Sometimes viral or fungal (e.g. aspergillus/candida)

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10
Q

Mucinous discharge in the ear must originate from where?

A

Middle ear (EAC doesn’t have any mucous glands)

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11
Q

What are the features of OE?

A 
Auricle is tender, esp. tragus
Discharge from ear
Reduced hearing 
Itch, pain 
Ear may be full of debris, skin cracked etc.
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12
Q

How is OE treated?

A

Microsuction to remove debris

Antibiotic and steroid ear drops

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13
Q

Who is malignant OE usually seen in?

A

Elderly patients with diabetes or immunocompromised patients

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14
Q

What is the most common causative organism of malignant OE?

A

Pseudomonas

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15
Q

What happens in malignant OE?

A

Infection from OE spreads to bone causing osteitis or OM in the skull base

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16
Q

What are the clinical features of malignant OE?

A

Pain
Cranial nerve palsies (7, 9, 10, 11)
Granulations in the meatus

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17
Q

How is malignant OE treated?

A

IV antibiotics and debridement

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18
Q

What are the most common tumours of the auricle?

A

BCC and SCC

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19
Q

What part of the ossicles is attached to the tympanic membrane?

A

Handle of malleus

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20
Q

Superiorly there is a small area of the tympanic membrane where the middle fibrous layer is missing - what is this layer called?

A

Pars flaccida

The rest of the ear drum is the pars tensa

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21
Q

In which quadrant does the cone of light sit?

A

Anterior inferior

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22
Q

Where does dead skin from the tympanic membrane go?

A

Moves laterally out the tympanic membrane and then is swept along the EAC

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23
Q

What is the path of the facial nerve in the middle ear?

A

Crosses medial wall of middle ear, goes posterior to oval window, turns 90 degrees and descends to exit via the stylomastoid foramen

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24
Q

What is the function of the eustachian tube?

A

Allows air to pass freely between middle ear and nasal cavity
(keep intranasal and middle ear pressure the same and allows O2 to get to middle ear mucosa)

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25
Q

Where is the opening of the eustachian tube into the middle ear?

A

Anterior wall

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26
Q

How does the eustachian tube open?

A

Muscles of the pharynx are attached to it and when they contract during swallowing they open it

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27
Q

What are the three ossicles called?

A

Malleus, incus, stapes

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28
Q

What joint connects the three ossicles?

A

Synovial joints

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29
Q

What part of the one of the ossicles is attached to the oval window?

A

Footplate of stapes

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30
Q

What is the role of the ossicles in hearing?

A

Transmit sound from tympanic membrane to oval window and allow for amplification

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31
Q

How can infection of the middle ear spread?

A

Superiorly –> temporal lobe of brain, dura (meningitis)
Laterally –> mastoid, cerebellum
Inferiorly –> jugular bulb
Medially –> inner ear, facial nerve

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32
Q

What kind of hearing loss do you get in middle ear pathology?

A

Conductive (Rinne’s BC > AC, Weber localises to affected side)

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33
Q

Pulsatile tinnitus should rise suspicion of what next to the ear?

A

Vascular tumour

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34
Q

Why does glue ear cause intense otalgia? What can relieve this pain?

A

Effusion stretches the ear drum

Relieved when drum perforates

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35
Q

What kind of discharge do you get from middle ear pathology?

A

Mucopurulent

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36
Q

What things may raise your suspicion that a child has a congenital middle ear problem?

A

Outer ear deformity, hearing issues

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37
Q

What is inflammation of the middle ear characterised by?

A

Formation of an effusion

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38
Q

What kinds of effusion can you get in otitis media?

A

Sterile = glue ear

Suppurative (pus forming in AOM)

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39
Q

What happens in chronic suppurative otitis media?

A

Repeated suppuration leads to weakening of the ear drum –> non healing perforation

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40
Q

What tends to cause AOM?

A

URTI that spreads to middle ear via Eustachian tube

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41
Q

What causes the pain in AOM?

A

Pus accumulates in middle ear and puts pressure on the tympanic membrane

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42
Q

What are the symptoms of AOM?

A 
Hearing loss
Pyrexia
Otorrhoea
Pain 
Systemic upset
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43
Q

What happens in the healing phase of AOM?

A

Infection abtes, mucosal oedema subsides, effusion slowly resolves and any TM perforations heal

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44
Q

What organisms tend to cause AOM?

A

H. influenzae and strep pneumoniae are most common

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45
Q

How is AOM treated?

A

Analgesia, amoxicillin
Keep ear dry if perforation
Nasal decongestants may help by improving Eustachian tube dysfunction

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46
Q

What are the possible complications of AOM?

A 
Residual perforation 
Residual effusion 
Necrosis of ossicles
Tympanosclerosis (white scarring of TM)
Ossicular adhesions
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47
Q

What causes glue ear?

A

Poor ventilation to middle ear –> sterile effusion

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48
Q

What things may cause glue ear?

A

Sequelae of AOM
Infection or allergy of middle ear mucosa
Eustachian tube dysfunction, e.g. due to obstruction by large adenoids

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49
Q

What is the main symptom of glue ear?

A

Hearing loss –> disrupts school/behaviour

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50
Q

What can glue ear predispose to?

A

Repeated bouts of AOM

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51
Q

How should suspected glue ear be investigated?

A

Otoscopy
Hearing assessment
Tympanometry

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52
Q

What is the name of the procedure to fix a perforated ear drum?

A

Myringoplasty

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53
Q

What is a cholesteatoma?

A

Sac of keratinising squamous epithelium (skin)

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54
Q

Where do cholesteatomas most commonly occur?

A

In the attic of the middle ear

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55
Q

How do cholesteatomas tend to present?

A

Foul smelling discharge
Conductive hearing loss
Attic retraction filled with squamous debris

May present with complication of cholesteatoma (e.g. facial palsy, vertigo, intracranial sepsis)

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56
Q

What substances can the cholesteatoma erode into?

A

Bone
Can therefore erode into ossicles (–> conductive deafness), facial nerve (–> facial nerve palsy), labrinyth (–> vertigo), roof of middle ear (–> intracranial sepsis)

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57
Q

How is cholesteatoma managed?

A

Surgical removal (may req. radical mastoidectomy)

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58
Q

How is cholesteatoma diagnosed?

A

Clinically

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59
Q

What complications can occur with cholesteatoma/middle ear infection?

A 
Mastoiditis
Facial nerve palsy 
Labyrinthitis
Petrositis
Temporal lobe/cerebellar abscess
Sigmoid sinus thrombosis
Meningitis
Jugular venous thrombosis
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60
Q

What is mastoiditis?

A

Mastoid air cells fill with pus

Erosion of bone can –> swelling behind ear and thickening of post-auricular tissues –> pinna being pushed out

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61
Q

What is petrositis?

A

Inflammation of petrous bone

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62
Q

What kind of traumas can occur to the middle ear?

A

FBs can perforate tympanic membrane –> hearing loss

Air pressure e.g. loud explosion can cause perforation due to a forceful air-pressure wave

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63
Q

How can you confirm the diagnosis of otosclerosis?

A

Surgical exploration of the stapes footplate

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64
Q

How can you treat otosclerosis?

A

Removal of the stapes footplate and replacement with prosthesis

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65
Q

What does the membranous labyrinth consist of?

A

Cochlea (hearing), saccule, utricle and semi-circular canals (balance)

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66
Q

What is the membranous labyrinth surrounded by?

A

The bony labyrinth which surrounds and protects it

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67
Q

What fluid is in the membranous labyrinth?

A

Endolymph (similar to plasma)

68
Q

What fluid surrounds the membranous labyrinth as it sits in the bony labyrinth?

A

Perilymph (similar to CSF)

69
Q

What is the vestibular system made up of?

A

Posterior, lateral, superior semi-circular canals which communicate via the utricle
Each semi-circular canal has a dilatation at the end (=ampulla)

70
Q

What is found in the ampulla?

A

Neuroepithelium which can detect movement

71
Q

What is found in the utricle and saccule?

A

Also has neuroepithelium capable of sensing movement

72
Q

What does the neuroepithelium capable of sensing movement found in the ampullae, utricle and saccules have?

A

Hair cells

73
Q

What are the hair cells in the utricle and saccule in contact with?

A

Crystals known as otoliths

74
Q

What are the utricle and saccule collectively known as?

A

Macula

75
Q

What fluid are the sensory organs (i.e. neuroepithelium in the utricle/saccule) of the ear suspended in?

A

Endolymph

76
Q

How do the sensory organs of the ear communicate movement with the brain?

A

When head moves, endolymph (which has its own inertia), takes longer to accelerate than the surrounding labyrinth and neuroepithelium –> shearing movement of hairs/change in otoliths –> stimulation of the vestibular nerve

77
Q

What kind of movement do the semi-circular canals detect?

A

Rotatory movement

78
Q

What kind of movement do the utricle and saccule detect?

A

Horizontal/vertical acceleration

79
Q

What is the name of the bony shelf that projects into the centre of the cochlear tube?

A

Osseous spiral lamina

80
Q

What are the two membranes into the cochlea?

A

Reissner’s membrane and basilar membrane

81
Q

How many spaces are present in the cochlea and what are they called?

A

3

  1. Scala media
  2. Scala vestibuli
  3. Scala tympani
82
Q

What fluid does the scala media contain? What structure is it linked to?

A

Endolymph, linked to saccule

83
Q

What fluid do the scala vestibuli and tympani contain and what are they linked to?

A

Joined to each other and they contain perilymph

84
Q

What is the sensory unit of the cochlea called? Where is it found?

A

Organ of corti

Sits on basilar membrane

85
Q

What is the organ of corti composed of?

A

Hair cells associated with the tectorial membrane which arises from the osseous spiral lamina

VII nerve endings supply the hair cells

86
Q

Describe how we are able to hear sounds

A

Sound collected + transmitted to TM by external ear
TM vibrates and converted by ossicles into a rocking motion of the stapes
Stapes footplate overlies oval window and its movement sets up a pressure wave in the perilymph o the scala vestibuli
Scala vestibuli communicates with scala tympani so the perilymph wave travels along these channels and ends at the round window

Movement in perilymph –> vibration of basilar and tectorial membranes, these membranes move in different directions –> shearing of hair cells of organ of corti –> stimulation of hair cells + therefore cochlear nerve

87
Q

Complete the sentence:

The greater the sound the larger/less the perilymph pressure wave and the more/less hair cells are stimulated

A

The greater the sound the larger the perilymph pressure wave and the more hair cells are stimulated

88
Q

How can the cochlea perceive different frequencies?

A

Different frequencies detected by different parts of areas of cochlea

89
Q

How does inner ear disease tend to present?

A

Vertigo, sensorineural deafness, tinnitus

90
Q

What interuterine infection may cause congenital deafness?

A

Rubella

91
Q

What can be used if someone has profound hearing loss that cannot be helped by hearing aids?

A

Cochlear implant

92
Q

What is presbycusis?

A

Old age hearing loss

93
Q

What causes presbycusis?

A

Gradual loss of outer hair cells of cochlea

94
Q

What are the symptoms of presbycusis?

A

Gradual hearing loss in both ears with or without tinnitus

Difficulty to hear when there is a lot of background noise (confusion in sound)

95
Q

What frequency is primarily lost in presbycusis?

A

High frequency

96
Q

What is labyrinthitis?

A

Inflammation of the inner ear

97
Q

What does labyrinthitis usually follow?

A

URTI

98
Q

What tends to be the most pronounced symptom of labyrinthitis?

A

Vertigo

99
Q

How is labyrinthitis treated?

A

Vestibular sedatives, e.g. prochloperazine
Rest
Vestibular rehabilitation exercises

100
Q

What must you suspect if there is bleeding from the ear following a trauma to the head?

A

Temporal bone fracture

101
Q

What drugs are ototoxic?

A

Aminoglycosides e.g. gentamicin
Furosemide
Antimalarials

102
Q

What is the classic presentation of menieres?

A

Episodes (usually about 30m-4h):

  • spinning vertigo
  • sensorineural hearing loss
  • tinnitus and aural fullness

Usually unilateral

Hearing loss + tinnitus can become permanent over time

103
Q

How is menieres managed?

A

Vestibular sedatives for acute episodes
Long term - betahistine, diuretics, avoidance of caffeine, salt and reassurance
If becomes debilitating - ablate with gentamicin injection or surgically drill out inner ear/cut VII nerve

104
Q

How does BPPV tend to present?

A

Episodic vertigo brought on by certain movements, esp. turning head in bed

105
Q

How is BPPV diagnosed?

A

Dix Hallpike manoeuvre - observe for rotation nystagmus (towards affected ear)

106
Q

What causes BPPV?

A

Dislodged otoliths settling in the posterior semi-circular canals which certain movements causing irritation of the sensory epithelium –> vertigo

107
Q

How is BPPV managed?

A

Epley manovure
Can also resolve on its own
Vestibular exercises

108
Q

What meatus does the vestibulocochlear nerve leave the inner ear?

A

Internal acoustic meatus

109
Q

Where does the vestibulocochlear nerve enter the brainstem?

A

Cerebral pontine angle

110
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular portion of the vestibulocochlear nerve –> vertigo
HEARING USUALLY UNAFFECTED
thought to be viral cause

111
Q

How is vestibular neuronitis managed?

A

Vestibular sedatives, rest

112
Q

Any patient that presents with unilateral hearing loss or tinnitus that cannot be explained must be considered for what diagnosis?

A

Vestibular schwannoma aka acoustic neuroma

113
Q

What is gold standard Ix for diagnosing acoustic neuroma?

A

MRI

114
Q

How are acoustic neuromas managed?

A

Radiotherapy/surgery

115
Q

Where is the nucleus for the facial nerve?

A

Pons

116
Q

Where does the facial nerve emerge from?

A

Cerbellar pontine angle

117
Q

Through what passage does the facial nerve enter the middle ear?

A

Internal acoustic meatus

118
Q

Where is the lesion in an UMN lesion?

A

Above the level of the nucleus, i.e. motor cortex/pons

119
Q

How can you differentiate a LMN and UMN facial nerve lesion?

A

UMN –> sparing of forehead (forehead receives innervation from the contralateral motor cortex as well)

120
Q

What is bells palsy probably due to?

A

Viral infection of facial nerve (as it is often preceded by an URTI)
Increased pressure on nerve due to swelling in bony canal thought to cause its dysfunction

121
Q

How is bells palsy managed?

A

High dose steroids

122
Q

What causes Ramsay Hunt syndrome?

A

Herpes zoster virus

123
Q

How does Ramsay hunt syndrome present?

A

Facial palsy, vesicles in ear drum/canal/pinna and ear pain

124
Q

How is Ramsay Hunt syndrome treated?

A

Aciclovir

125
Q

What tumours can cause facial nerve palsy?

A

Parotid tumours
External and middle ear tumours, e.g. SCC
Tumours of the cerebellar pontine angle, e.g. acoustic neuromas

126
Q

What causes peripheral vertigo?

A

Problems with labyrinth and ear

127
Q

What causes central vertigo?

A

Problems with brain and cranial nerves

128
Q

What is actual vertigo like?

A

Room is spinning, pt spinning in room

Anything else is not true vertigo

129
Q

What are central causes of vertigo?

A 
MS
Vestibular neuronitis
Acoustic neuroma
Head injury
Drug induced
Vascular occlusion
130
Q

What are peripheral causes of vertigo?

A 
Labyrinthitis
BPPV
Menieres
Middle ear disease
Drugs
Post trauma
131
Q

What things can cause tinnitus?

A 
Drugs
Labyrinthitis
Trauma
Vascular
Presbycusis
Menieres
Noise
Otosclerosis
132
Q

What are conductive causes of hearing loss?

A 
Foreign bodies (e.g. wax, object)
Neoplasms
Cholesteatoma 
Otosclerosis
Otitis media 
Neoplasm
133
Q

What are causes of sensorineural hearing loss?

A 
Presbycusis
Labyrinthitis/infection 
Trauma/ototoxicity
Menieres
MS
Acoustic neuroma 
Neurological disorders
134
Q

What kind of secretions are produced by the parotid salivary gland?

A

Serous

135
Q

Where does the parotid lie?

A

Between the mandible and mastoid process

136
Q

What symptoms to people tend to get in salivary gland disease?

A

Swelling, pain

May get dryness of the mouth if dysfunction is widespread

137
Q

Facial nerve palsy and parotid swelling should raise suspicion of what?

A

A malignant lesion

138
Q

What is the most common cause of bilateral parotid gland enlargement?

A

Mumps

139
Q

What causes pain in parotid swelling?

A

Stretching of the capsule

140
Q

What are risk factors for parotitis?

A

Dehydration

Poor oral hygiene

141
Q

What are features of parotitis?

A

Pain
Swelling
Pus coming from parotid duct

142
Q

What things may cause parotid swellings?

A 
Bacterial/viral infections
Systemic infections, e.g. mumps, HIV
Granulomatous diseases, e.g. TB, sarcoidosis
Sjogrens
Drugs
Neoplasm
143
Q

What is sialothiasis?

A

Stones/calculi forming within the salivary glands

144
Q

What are the symptoms of sialothiasis?

A

Pain, swelling, may be able to palpate calculi

145
Q

What is sjogrens?

A

Autoimmune disease characterised by dry mouth and dry eyes

146
Q

How should you investigate a parotid tumour?

A

FNA, CT, MRI

Excision biopsy

147
Q

What is the most common parotid tumour?

A

Pleomorphic adenoma

148
Q

What are the recurrent laryngeal nerves branches of?

A

The vagus

149
Q

What nerve supplies most of the laryngeal muscles?

A

Recurrent laryngea;

150
Q

What do the muscles of the larynx do?

A

Adjust the position of the cords and create tension

151
Q

Larynx disease presents as one of what two things?

A

Airway or voice problems (hoarseness, aphonia, pain on speaking/swallowing)

152
Q

What things may cause the larynx itself to become inflamed?

A

Vocal abuse, voice strain, exposure to cigarette smoke or alcohol fumes

153
Q

How is laryngitis treated?

A

Rest of voice, analgesics

154
Q

How is epiglottitis treated?

A

Give IV antibiotics

Take child to theatre, intubate and give ventilatory support until the child recovers

155
Q

What tends to cause epiglottitis?

A

Hib

156
Q

What tends to cause chronic laryngitis?

A

Smoking

157
Q

What is the most common tumour of the larynx?

A

SCC

158
Q

What tends to cause laryngeal SCC?

A

Smoking

159
Q

How does laryngeal cancer tend to present?

A

Vocal cords - hoarseness (any patient w hoarseness >3w should be referred to ENT urgently)

Tumours elsewhere in larynx may –> sore throat, cough, referred otalgia, swollen LN

160
Q

What is the cardinal symptom of laryngeal disease?

A

Hoarseness

161
Q

Why is the recurrent laryngeal nerve particularly prone to palsy?

A

It has a very long course, especially on the left side

162
Q

What investigations are mandatory in hoarseness?

A

CXR - may be bronchial carcinoma

If normal - CT from skull base to lung hilum to see if any other tumours compressing recurrent laryngeal

163
Q

What does laryngeal stridor sound like?

A

high pitched noise on inspiration

164
Q

What is the first line treatment for acute airway obstruction?

A

Endotracheal intubation

165
Q

What is cricothyroidotomy?

A

Hollow tube is placed into lumen of pharynx via the percutaneous route

166
Q

What is a tracheostomy?

A

Hole is made in front wall of trachea and tube maintains airway
Usually for those that req. long term ventilation

H&N (4 decks)

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