General facts Flashcards
Two causes of deafness
Conductive and sensorineural
5 causes of conductive deafness
wax acute otitis media otitis media externa otosclerosis perforated ear drum
4 causes of sensorineural deafness
presbycusis
noise induced
congenital
vestibular schwannoma
Presbycusis =
deterioration in hearing as patients age
main cause of presbycusis
loss of sensitivity of delicate hair cells in the cochlea
otosclerosis =
abnormal bone formed around stapes foot plate
otosclerosis causes what type of deafness
conductive
treatment of otosclerosis
stapedectomy
how far away must you stand to perform the whisper test
1m
What does Rinne’s test check?
Checks air compared to bone conduction
AC>BC =
middle and outer ear functioning normally
BC > AC
conductive deafness
In webers test the noise lateralised towards ….
the ear with conductive hearing loss
In webers test the noise lateralises away …..
from the ear with sensorineural deafness
In a dead ear the result is …. .
false -ve
Tympanometry tests
the compliance of middle ear structures
why might bone anchored hearing aids be used? (2)
chronic infection or shape of the ear canal
Croup =
acute laryngotracheobronchitis
main treatment of croup =
dexamethasone single dose
Nebulised ventolin
Paracetamol
Usual cause of acute epiglottitis
Haemophilus influenzae (B)
What musn’t you do in children with acute epiglottitis?
persist in examining the child’s throat
Treatment of epiglottitis
Admit and give IV amoxycillin
Quinsy =
peritonsillar abscess
Quinsy presentation (4)
Acute tonsilitis
+ spike temp
+ severe dysphagia
+ referred otalgia
What is found on examination w/ quinsy?
Trismus
Buccal mucosa is furred
Foetor (strong foul breath)
Treatment of a quinsy
IV AB and drainage of the abscess
Drugs causing ototoxicity (4)
Aminoglycosides e.g. streptomycin
Cisplatin (chemo)
Furosemide
Quinine
5 key questions in a nose history
Nasal obstruction Ant. rhinorrhea Hyposmia Epistaxis Facial pain
5 key questions in an ear history
Otalgia Otorrhea Hearing loss Tinnitus Dizziness
5 key questions in a throat history
Dysphagia Sore throat Odynophagia Dysphonia Regurgitation
Pathogenesis of rhinits
Type 1 allergic reaction - release of inflammatory mediators
Test in rhinitis
Radioallergosorbent test - detects allergis
Treatment of rhinitis
Antihistamine and nasal steroid spray (takes 6m to take effect)
Feature of long standing rhinitis
nasal polyps
Treatment if non resolving small nasal polyps in rhinitis
Prednisolone
Treatment if nasal polyps are large
Nasal polypectomy
synechiae =
adhesions in the nasal cavity
epiphora =
damage to nasal lacrimal duct
Specific important risk factor questions for neck lump (5)
smoking + alcohol Recent foreign travel HIV status Dental problems TB contact
red flags for neck lump (6)
dysphagia hoarseness odynophagia weight loss fevers night sweats
Neck lump investigation
USS neck
CT neck and chest
FNAC
Ototrrhoea =
ear discahrge
otitis externa =
diffuse inflammation of the skin lining the outer ear canal
risk factors for OE (4)
narrow external canal
trauma
eczema / psoriasis
swimming
common organisms for OE (4)
staph pyogenes
staph aureus
candida albicans
e.coli
4 symptoms for OE
irritation
dischrage
pain (tismus)
mild deafness
examinations signs for OE (3)
meatal tenderness
moist debris
smelly + keratotic
red desquamated skin
What can OE lead to if not managed
OM with discharging perforation
What can OE lead to in the immunosuppressed
osteomyelitis of skull base
When to suspect osteomyelitis of skull base
Immunocompromised and OE symptoms not settled in two weeks
Treatment of Osteomyelitis
Topical and IV AB for 6 weeks
4 symptoms of a perforated ear drum
pain (transient)
conductive deafness
tinnitus
vertigo
3 causes of perforated eardrum
trauma
iatrogenic (grommet surgery)
recurrent infections
acute OM lasts for
1-5 days
what does chronic OM imply
eardrum is perforated
failed to heal and ongoing infection
cholesteatoma is an accumulation of?
squamous epithelium in the middle ear
two symptoms of acute OM
earchache and conductive deafness
2 causes of acute OM
Strep pneumonia
H. influenzae
Treatment of OM
analgesics (usually self limiting)
Two types of chronic otitis media
1) mucosal disease
2) bony
a) osteitis
b) cholesteatoma
Treatment for chronic OM
- topical ciprofloxacin
- water precautions
- regular aural toilet
myringoplasty =
repaire of the tympanic membrane perforation
where is the perforation usually in cholesteatoma
pars flaccida
treatment of cholesteatoma
mastoidectomy
key points in PMH for epistaxis
HTN
Chronic granulomatous disease
bleeding disorders
rhinitis
littles area is where which 3 arteries join?
ant. ethmoid
sphenopalatine
greater palatine
Key epistaxis Q. (5)
frequency and duration which side down nose / back of throat what have they done? previous history / treatment
what is used to cauterise in epistaxis
silver nitrate
to avoid epistaxis recurrence (4)
for 2 weeks
- avoid hot drinks
- avoid hot baths / showers
- avoid nose picking
- avoid hot and spicy food
CENTOR CRITERIA
The criteria are: Tonsillar exudate Tender anterior lymphadenopathy or lymphadenitis History of fever Absence of cough
In which part of the neck does a pharyngeal pouch present?
posteriomedial
In which part of the neck does a cyctic hygroma present?
posterior
In which part of the neck does a thyroglossal cyst present?
midline anterior
In which part of the neck does a carotid body tumour present?
anterior
In which part of the neck does a branchial cyst present?
anterolateral
most common cause of a swelling in the neck
reactive lymphadenopathy
lymphoma systemic symptoms
night sweats and splenomegaly
pharyngeal pouch presentation
posteromedial outpouch, gurgles on palpation
dysphagia
regurg
aspiration
chronic cough
