entmrt Flashcards
- Symptoms and clinical features of diffuse otitis externa
− Symptoms • Earache • The external part of the ear canal is painful (especially tragus) • Discharge, itching • Ear congestion, hearing loss • Fever is uncommon
− Clinical findings
• Swelling and hyperemia of the skin of the ear canal
• Serous or purulent discharge
• Accumulation of debris in the ear canal
• Tympanic membrane appears to be normal
- Symptoms and clinical features of acute otitis media (AOM) – suppurative form
− Symptoms • Earache • Hearing loss • Nasal discharge and congestion • Fever, malaise • If perforation is present: otorrhea
− Clinical findings
• Ear canal appears to be normal
• Hyperemia of tympanic membrane
• Later in the course of the disease: marked bulging of the tympanic membrane, subsequently spontaneous perforation can develop
- Causes of acute hearing loss
− Conductive type:
• Wax, foreign body
• Acute tubal occlusion, otitis media (OME/AOM)
• Trauma (e.g. perforation of the tympanic membrane)
− Sensorineural type: • Noise (acute) induced hearing loss • Viral infection • Vascular causes • Toxical damage (medication, chemicals) • Traumas
- What is to be done in case of acute sensorineural hearing loss?
In case of acute sensorineural hearing loss, immediate intravenous nootropic/vasodilatating therapy or steroid bolus treatment is necessary with hospitalization; meanwhile detailed investigation is required to be carried out to clarify the etiology. The earlier the treatment is started, the better the outcome is.
- Recognition of hearing loss in childhood
− Signs of hearing loss in childhood: • The newborn does not react to sounds • Tone of crying is unusual • Babbling period does not appear • Visual orientation is dominant • Speech development is delayed • Tone, pitch, intensity, melody and rhythm of the speech is pathologic • Articulation disorders • Worse reading and writing skills
- Causes of ear pain
− Primary otalgia
• Otitis
• Tumors of the ear
− Referred ear pain
• Tumors and inflammations of the larynx, pharynx, tonsils, base of the tongue
• Dental inflammations, temporomandibular joint syndrome, neuralgic pain
- Complications of acute otitis media (AOM)
• Extracranial ♣ Intratemporal • Acute mastoiditis • Zygomaticitis • Petrositis • Facial nerve palsy • Labyrinthitis ♣ Extratemporal • Abscess: subperiosteal, preauricular, suboccipital, Bezold's abscess
• Intracranial ♣ Extradural abscess ♣ Sinus phlebitis - sinus thrombosis ♣ Subdural abscess ♣ Meningitis, encephalitis ♣ Brain abscess
• General: sepsis
- Clinical features and symptoms of acute mastoiditis
− Associated with, or following acute otitis media
− The pinna is pushed forward
− Retroauricular pain, erythema
− The posterior wall of the external ear canal is swollen, seems to be lowered
− Pulsating, severe pain
− Pulsating otorrhea
- Causes of unilateral otitis media with effusion (OME) in adults and childhood
Chronic dysfunction of the Eustachian tube (adenoid vegetation or nasopharyngeal tumor)
In adults, the possibility of a nasopharyngeal tumor must not be left out of consideration!
- How to diagnose vertigo caused by vestibular disorders
− Patient history:
• Type of vertigo (sensation of spinning or falling)
• Vegetative symptoms, nausea, vomiting
− Examination:
• Deviation, tilting
• Spontaneous nystagmus and nystagmus provoked by head movements
- Causes of peripheral facial palsy (list)
− Bell’s palsy
− Herpes zoster oticus
− Other viral or bacterial infections (HSV, EBV, Lyme)
− Acute and chronic middle ear diseases (acute and chronic middle ear infections, cholesteatoma, rarely tumors)
− Tumors of the pontocerebellar angle, vestibular schwannoma
− Cranial traumas (pyramid bone fractures), extratemporal traumas
− Malignant tumors of parotid gland
- Primary management of epistaxis/nosebleeding (at home/ambulance/by GP)
− The patient should lean forward with open mouth, firm digital pressure should be applied to both nasal alae for 10 minutes
− Ephedrine/nasal drop/vasocontrictor solution-imbibed cotton or spongostan should be applied in nasal cavity
− Cold compress should be applied to the nape of the neck and to the nasal dorsum
− Blood pressure-measurement, antihypertensive treatment if needed
- Management of epistaxis/nosebleeding (anterior, posterior) by ENT professionals
− Blood pressure-measurement, antihypertensive treatment - if needed
− Visible bleeding source: chemical cauterization (trichloroacetate, silver nitrate) or coagulation (bipolar electrocoagulation)
− Anterior nasal bleeding: anterior nasal packing
− Posterior nose bleeding: posterior nasal packing (Bellocq tamponade), balloon catheter
- Management and complications of nasal folliculitis and furuncles
− Circumscript folliculitis: local therapy with antibiotic and steroid containing creams, vapor coverage
− The patient should be told not to pick or squeeze the lesions
− For furunculosis and/or phlegmonous reaction, parenteral antibiotics should be administered, along with vapor coverage
− The infection is usually caused by Staphylococcus aureus
− Possible complications: Facial phlegmone, angular vein thrombophlebitis, cavernous sinus thrombosis
- Types of rhinitis (list)
− Common infections: Simple acute rhinitis, purulent rhinitis
− Specific forms of Rhinitis: TB, syphilis, sarcoidosis
− Allergic rhinitis
− Atrophic rhinitis (oezena)
− Rhinitis sicca anterior
− Other causes: idiopathic, vasomotoric, hormonal, drug-induced, rhinitis medicamentosa, occupational (caused by irritants) foodstuffs. (3 causes are required from the “other” group)
