ENT Treatments Flashcards
Temporal bone fracture
(2 points)
Usually just let recover
May need facial nerve decompression (only decompress if it is unlikely the facial nerve will begin to work)
…
Sudden sensorineural hearing loss
Steroids 1mg/kg
(urgent referral to ent)
Otitis externa management
Avoid water
1st line: aural toilet then topical aminglycosides (not if perforated!!)/ciproflaxin drop + steroid drop
2nd line: oral flucox
if not responding to antibiotics then refer to ENT
Acute otitis media management
supportive unless…
persistent for 4days or more
and/or systemicslly unwell - antibiotics
systemically unwell
BPPV treatment
1st line; Epley maneuvre,
other: Brandt daroff,selmont
…
Vestibular neuronitis treatment
(3)
Supportive, generally self-limiting,
1st: 3 day course of prochlorperazine/ antihistamine
peristent (>1week): refer to specialist for rehabillitation excerises
Mernieres disease treatment 1st line prophylaxis,
1st line: bitahistine
when are aminoglycasides contraindicted for ear treatment
tympanic membrane perforation/grommets
Diagnose glandular fever
Atypical lymphocytes
+ve monospot/ paul bennet
Low CRP
Moderate to severe OSA (obstructive Sleep Apnoea) in kids treatment
Surgery (remove adenoids)
a 36 yr old patient walks in with stridor and fever, what is the initial management
oxygen
patient has a nose bleed needing a nasal pack and is on warfarin & bp is 170/110
what medication should be given
anti hypertensive
different story if the patient had already been given the nasal pack and was still bleeding heavily
nocturnal cough + throat clearning with no nasal symptoms and normal nasal examination. what treatment should be trialled?
PPI and gaviscon
patient presents with anosmia (loss of sense of smell) for 3 months and nasal blockage with clear discharge. what is the appropriate management
intranasal steroids
otitis media with effusion treatment
when to refer
supportive, ‘watch and wait’ then recheck ears 12 weeks later
refer if downs syndrome or cleft palate patient
persistent for >3months refer for surgery (grommets)
if in an adult and no history of URT refer (2 wk wait & CT scan)
treatment for perforated ear
it should heal itself within 6-8 weeks. if not do a myringoplasty
acute sinusitis treatment
(3 points)
analgesia
if lasts >10days intransal corticosteroids
if severe/systemically unwell then antibiotics (penicillins). of penicillin allergic give doxcy
initial management of mastoiditis
iv antibiotics
diagnosis is clinically made
acute otitis media with perforation/discharge management
and what to avoid
1st line: ORAL amoxicillin
2nd: erythomcyin
avoid aminoglycasides (eg. gentamicin)
give ciprofloxacin if it is caused by pseudomonas
acute otitis media management for a patient that is less than 2 years old
give drug names
!st line: amox
2nd: erythomycin
acute necrotising ulcerative gingitus treatment
paracetemol + oral metronidazole + chlorexidihine
light bleeding after tonsillectomy management ( 6-8 hrs after tonsillectomy)
urgent ENT assessment and return to theatre
(v big risk of haemorraghe)
treatment for a child with persistent otitis media with effusion
1st line: grommets
2nd: repeat frommet insertion and consider adenoidectomy
ramsay hunt syndrome treatment
(2 points)
systemically well- oral aciclovir and corticosteroids
systemically unwell- IV the above^
tonsillitis 1st line antibiptocs
give alternative for if allergic
tx course
phenoxymethylpenicillin
clarithromycin if penicillin allergic
give a 7/10 day course
secondary haemorraghe after tonsillectomy (secondary:3-10 days after) management
Admit to hospital for ENT review and antibiotic therapy
Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics
chronic sinusitis treatment
chronic sinusitis is defined as 3 months + of sinusitis symptoms
treatment:
intranasal steroid- 14 day course
2nd: nasal irrigation with saline
if symptoms perisist for 3 months with treatment then refer
treatment for otosclerosis
hearing aid
vestibular shwannoma treatment
<40mm, 6 monthky check ups
>40mm surgical removal
benign pleomorphic adenoma tx
routine surgical resection
tinnitus tx
hearing loss: hearing aid
no hearing loss: counselling and sound wave therapy
