ENT treatments Flashcards
cholesteatoma
surgery
otosclerosis
1st line - hearing aid
stapedectomy, CO2 laser, cochlear implant
treatment of OME (glue ear) in < 3 year olds
grommets
treatment of OME (glue ear) in > 3 year olds 1st episode
grommets
treatment of OME (glue ear) in > 3 year olds 2nd episode
grommets and adenoidectomy
presbycusis
hearing aid
ix vestibular schwannoma
contrast MRI of cerebellopontine angle
tx vestibular schwannoma
watchful waiting
radiotherapy
surgical excision
ix if persistent unilateral otitis externa
biopsy - may be maligancy
tx mild otitis externa
topical acetic acid (OTC) + topical antibiotic +/- topical steroid
tx moderate otitis externa
topical otomize (dexamethasone + neomycin + acetic acid)
are swabs usually taken in otitis externa
no - only in non-resolving cases
tx otitis externa that is spreading despite treatment
oral flucloxicillin
tx malignant otitis externa
refer urgently to ENT and IV ciprofloxacin
1st line treatment in acute otitis media
rest analgesia and fluids - usually self limiting
when are antibiotics given in acute otitis media
o >4 days or not improving
o Systemically unwell
o Younger than 2 years old with bilateral OM and marked symptoms
o Otitis media with perforation
o Immunocompromise or high risk of complications due to significant heart/lung/kidney/liver/neuromuscular disease
antibiotic of choice in acute otitis media if being given
500mg Amoxicillin TDS 5-7 days
2nd line antibiotic of choice in acute otitis media if being given
500mg Clarithromycin or erythromycin TDS 5 days
tx ruptured tympanic membrane
majority heal on own, review in 6-8 weeks
if fails to heal - myringoplasty
tx mastoiditis
IV tazocin +/- mastoidectomy
tx epiglottitis/supraglottitis
IV ceftriaxone
tx acute attack menieres
buccal or IM prochlorperazine
tx preventing menieres
beta histine and vestibular rehabilitation exercises
life style advice for menieres
reduce salt, alcohol, caffeine and stress
dx BPPV
dix hallpike - rotational nystagmus
tx BPPV
epley
teach patient exercises to do at home
tx vestibular neuronitis
- buccal or IM prochlorperazine for rapid relief
- short course oral prochlorperazine or antihistamine
tx chronic vestibular neuronitis
vestibular rehab exercises
tx labyrinthitis
prochlorperazine or antihistamine may help
what nystagmus is seen in labyrinthitis and vestibular neuronitis
horizontal
1st line nose bleed treatment haemodynamically stable
first aid measures:
sit forward and mouth open
pinch cartilaginous area of nose firmly for 20 mins
breath through mouth
o Avoid blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks
2nd line nose bleed treatment
naseptin cream (chlorhexidine and neomycin)
when is naseptin contraindicated
peanut soy or neomycin allergy
what is an alternative to naseptin cream in peanut allergy
mupirocin
treatment nosebleed rhyme
NCP-SLE naseptin cautery packing sphenopalatine ligation embolisation
treatment nosebleed after naseptin/bleeding continuing after 10-15 mins
cautery - if source of bleed is visible
do you cauterise both sides of septum
no just one - risk of perforation
treatment nosebleed after cautery or if bleeding source not visible
admit to hospital and packing
- anterior then posterior
how long does anterior packing stay in for
24 hours
how long does posterior packing stay in for
48 hours
treatment nosebleed if haemodynamically unstable
admit to A+E
treatment nosebleed after packing / all other treatment failed
sphenopalatine artery ligation
treatment nosebleed after sphenopalatine ligation
ligation of ECA
treatment nosebleed after ligation of ECA
embolisation
symptomatic tx rhinosinusitis
analgesia
intranasal corticosteroids
nasal irrigation with saline
decongestants - pseudophedrine,oxymetazoline
tx rhinosinusitis if symptoms last longer than 10 days
inhaled steroids
what is the problem with use of decongestants e.g. pseudophedrine, oxymetazoline
cause rebound congestion and necrosis of septum if used LT (rhinitis medicamentosa)
treatment chronic rhinosinusitis
avoid allergens
intranasal corticosteroids
nasal irrigation
1st line treatment allergic rhinitis
allergen avoidance
treatment mild/moderate allergic rhinitis
oral or intranasal antihistamine
treatment severe allergic rhinitis
intranasal steroids
treatment allergic rhinitis if important life event coming up
short course oral steriod
when should antibiotics be used in sinusitis
symptoms persist / worsening after 7-10 days
1st line treatment of infective sinusitis
penicillin V 500mg TDS 7 days
2nd line treatment infective sinusitis
doxycycline 100mg
tx infective sinusitis if high risk of comps or very serious illness
co-amox
tx vasomotor rhinosinusitis
inhaled ipratropium
tx nasal polyps 1st line
topical steroid +/- montelukast
2nd line tx nasal polyps
endoscopic polypectomy
tx viral tonsillitis
paracetamol bed rest
difflam analgesic spray can help
tx bacterial tonsillitis
penicillin V 10 days
2nd line treatment bacterial tonsillitis
clarithromycin 5 days
tx quinsy
needle aspiration and drainage and IV antibiotics
cause of infectious mononucleosis
EBV
scoring system for bacterial tonsillitis
centor
- tender anterior lymphadenopathy
- absence of cough
- fever
- enlarged tonsils with exudate
tx of infective mononucleosis
supportive
avoid contact sport for 4 weeks
white pseudomembrane
systemically very unwell
bull neck appearance
diphtheria
ix diphtheria
throat swab for culture - tellurite agar or loefflers media
tx diphtheria
diphtheria antitoxin + IM penicillin
salivary gland infection
flucloxicillin + metronidazole if bacterial
ix parotid gland tumour
plain x-ray - exclude calculi
FNAC
superficial parotidectomy - diagnostic and therapeutic
CT/MRI staging in cases of malignancy
ix submandibular tumour
FNAC
CT and MRI
all should be excised
RF for nasopharyngeal (SCC) cancer
EBV
asian populations
RF for oral, oropharyngeal and oesophageal cancer
HPV
IX for nasal and nasopharyngeal cancers
combined CT and MRI
tx nasopharyngeal cancers
radiotherapy
ix oropharyngeal cancer
biopsy
tx oropharyngeal cancer
o Early, small: radical radiotherapy or surgery.
o Locally advanced but resectable: surgery + post op radiotherapy.
o Locally advanced but not resectable: chemo-radiotherapy.
ix for laryngeal cancer
laryngoscopy and biopsy
tx largyneal cancer
surgery
- laryngeal sparing (T1 or T2)
- total or partial laryngectomy
chemo-radiotherapy can be used as an alternative to surgery in advanced disease
tx motion sickness and vertigo
prochlorperazine
SE of LT use of prochlorperazine
EPSEs
auricular haematoma
urgent incision and drainage - same day ENT assessment
ear wax impaction treatment
ear drops - olive oil, sodium bicarb
syringing
tx ramsay hunt
oral aciclovir and steroids
tx bells palsy
< 72 hours - oral prednisolone
