Head and Neck Flashcards
What is acute otitis externa, and how is it managed?
Inflammation of the ear canal causing:
- Otalgia and pruritus (itching)
- Discharge
- Hearing loss
Antibiotics (gentamicin topical drops)
What is otitis media, and how is it managed?
Inflammation of the middle ear causing:
- Otalgia
- Hearing loss
- Fever
Antibiotics
What is a cholesteatoma, what are the complications and how is it managed?
A mass of keratin which grows in a pocket, producing smelly discharge
Hearing loss, facial paralysis, meningitis, intra-cranial abscess
Mastoid surgery
What is glue ear, and how is it managed?
Otitis media with effusion
Treat with grommet if >3months duration and beginning to cause pain and hearing loss
What does a negative rinne test mean?
Bone conduction is better than air conduction - this is abnormal and is caused by conductive hearing loss
What causes conductive hearing loss?
Wax, otosclerosis, otitis media, glue ear
What causes sensorinueral hearing loss?
Genetics, infection, drugs (gentamicin), congenital infection, acquired, presbyacusis
What is presbyacusis?
Loss of acuity for high frequency sounds, starting before 30 years old.
What types of hearing aids can you get for:
a) conductive loss?
b) sensorineural loss?
a) bone conduction hearing aid
b) cochlear implant (direct stimulation of cochlear nerve)
What investigations should be done for hearing loss?
Webers, Rinnes
Otoacoustic emissions, audiometry
Tympanogram (for CHL)
What is tinnitus?
Ringing or buzzing in the ears
What is the definition of vertigo?
An illusion of movement, often rotatory, which worsens with movement
What is the definition of disequilibrium?
Being off balance
What is the definition of pre syncope?
Feeling lightheaded or faint
What are some central and peripheral causes of vertigo?
Central - MS, stroke, migraine
Peripheral - BPPV, Meniere’s, vestibular neuronitis, motion sickness, trauma, ototoxic drugs
What is BPPV?
Vertigo and nausea lasting seconds, associated with head turning.
Caused by debris moving around in the semicircular canal
How is BPPV diagnosed?
Nystagmus on performing the Hallpike manoeuvre (hands on ears and lie patient down)
How can BPPV be managed?
Epley manoeuvre to clear the debris
What is acute labyrinthitis (vestibular neuronitis)?
Temporary infection of the vestibular nerve causing:
- Vertigo lasting days
- Nausea and vomiting
- Balance problems
Sometimes follows a viral URTI
How is acute labyrinthitis managed?
It is self-limiting so manage with reassurance and sedation
What is Meniere’s disease?
Recurrent attacks of vertigo lasting hours accompanied with fluctuating hearing loss and tinnitus, due to increased pressure in the labryinth
How is Menieres disease managed?
Bed rest and reassurance during attacks
Antihistamine if prolonged
What is an acoustic neuroma?
A Schwannoma arising from the vestibular nerve, presenting with unilateral hearing loss and subsequent vertigo, then damage to other ipsilateral cranial nerves.
What is herpes zoster?
Herpetic eruption of the external auditory meatus causing:
- Facial palsy
- Deafness
- Tinnitus
- Vertigo
What are the red flags for a sino-nasal malignancy?
Bloody discharge
Unilateral nasal blockage
Pain
Loose teeth
What causes nasal polyps?
Chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders
What is the classical presentation of sinusitis?
Dull, constant ache over the sinuses
Post-nasal drip
Pain worse on bending over
Coryzal symptoms
What is the classical presentation of giant cell arteritis?
Form of vasculitis in >50 yo causing…
Headache and scalp tenderness
Jaw claudication
Sudden unilateral blindness (amaurosis fugax)
How should GCA be managed?
- Investigate ESR, CRP (both raised) and USS
2. Start prednisolone immediately to prevent blindness
What is TMJ syndrome?
Pain and dysfunction of the muscles of mastication
A man has a neck lump which moves with swallowing but not tongue protrusion. What is the diagnosis?
Thyroid enlargement
A man has a neck lump which moves with swallowing and tongue protrusion. What is the diagnosis?
Thyroglossal cyst (linked to the back of the tongue)
A man has a neck lump which does not move with swallowing. What is the diagnosis?
Dermoid cyst
Chondrome
What investigations should be done for a neck lump?
Bloods: TFTs, thyroid autoantibodies
Imaging: USS, CT
Biopsy: fine needle aspiration, excision biopsy
What is sialolothiasis?
Salivary stones
What is sialadenitis?
Infection of the salivary glands
What is sialadenosis?
Non-infectious enlargement of the salivary glands
Where are salivary stones most common, and what are the symptoms?
Submandibular gland - causes intermittent colicky pain before and after eating
A man comes in with dry eyes, dry mouth and a swollen parotid gland. He has a history of T1DM. What is the diagnosis?
Sjorgens syndrome
What is the main type of head and neck cancer?
Squamous cell carcinoma (particularly tonsils)
What are the risk factors for head and neck cancer?
HPV, EBV, radiation exposure, smoking, alcohol, GORD, poor dentition, betal nut
What are the symptoms of head and neck cancer?
Mass in the neck
Neck pain
Bleeding from the mouth
Sinus congestion, especially with nasopharyngeal carcinoma
Bad breath
Sore tongue
Painless ulcer or sores in the mouth that do not heal
White, red or dark patches in the mouth that will not go away
Earache
Unusual bleeding or numbness in the mouth
Lump in the lip, mouth or gums
Enlarged lymph glands in the neck
Slurring of speech (if the cancer is affecting the tongue)
Hoarse voice which persists for more than six weeks
Sore throat which persists for more than six weeks
Difficulty swallowing food
Change in diet or weight loss
What can cause an enlarge salivary gland?
Acute - mumps, HIV
Recurrent - salivary stones
Chronic - autoimmune (hypothyroidism, sjorgens)
Fixed - tumour, sarcoid, amyloid, Wegeners syndrome, idiopathic
Where is the most common site of salivary gland tumour?
Parotid (80%)
How can head and neck pathology be investigated?
Bloods: TFTs, thyroglobulin
Imaging: USS, barium swallow, CT neck, MRI, PET-CT (these are mostly for cancer staging)
Special: Flexible nasendoscopy
What is the most common cause of facial nerve palsy?
Idiopathic Bell’s palsy - often caused by a virus
How can you differentiate stroke from bells palsy?
Stroke - UMN lesion so there will be forehead sparing
Bell’s - LMN lesion
How is Bell’s palsy managed?
Prednisolone and protect the eye from drying out
What are the DDs for facial nerve palsy?
Bell's palsy Ramsay-hunt syndrome (VZV herpes zoster reactivation) Meningitis Viruses Stroke, tumour, MS Acoustic neuroma Diabetes GBS Parotid tumours Otitis media
