Highlights ENT I + II Flashcards
What is the most common cause of otitis externa? Give 3 examples
Acute bacterial infection: Pseudomonas aeruginosa, S. epidermidis, & S. aureus
Malignant external otitis is a potential complication of what?
Otitis externa
What is a mainstay of otitis externa treatment? Describe how it’s used in mild and moderate cases
Topical therapy:
1) Mild: Topical acidifying agent + glucocorticoid (i.e., acetic acid + hydrocortisone TID-QID) x 7 days
2) Moderate: Topical antibiotic + glucocorticoid (i.e., Cipro HC BID, Cortisporin TID-QID) x 7 days
What usually is the cause of obstruction of Eustachian tube, causing AOM?
Viral URI or seasonal allergic rhinits (adults)
Otalgia is a common symptom of what in children?
AOM
A bulging TM is a classic exam finding of what condition?
AOM
1) How should you treat AOM with antibiotics in children if they haven’t had antibiotics in the past month?
2) What about if they have?
3) How long should it last?
1) Amoxicillin 80-90 mg/kg/day divided q8h or q12h
2) Amoxicillin-clavulanate (Augmentin) 90/6.4 mg/kg/day PO divided BID
3) Duration of therapy: 10 days for < 2 y/o & 5-7 days for > 2 y/o
What often precedes AOM?
Middle ear effusion
What are the 3 referral criteria for AOM?
1) Recurrent otitis media (> 2 episodes in 6-month period)
2) Persistent hearing loss following AOM (> 1-2 weeks)
3) Chronic TM perforation (> 6 weeks)
1) Define chronic otitis media.
2) What’s its hallmark?
1) Recurrent infection of middle ear and/or mastoid in presence of TM perforation
2) Purulent aural discharge
Define Otitis Media with Effusion (OME) (aka Serous Otitis Media)
Presence of middle ear effusion without signs of acute infection
Retraction of the TM is possible with what middle ear condition?
Eustachian tube dysfunction
Unilateral SNHL and continuous disequilibrium are symptoms of what?
Acoustic neuroma
A sensation of motion without actual motion is what?
Vertigo
What must be distinguished from imbalance?
Vertigo
What two etiologies of vertigo do you need to differentiate between?
Peripheral and central
The Epley maneuver is used to treat what condition?
BPPV
underlined slide 97
Define otalgia
[Ear] pain out of proportion to PE findings
What is an absolute contraindication to diving?
TM perforation
You must differentiate between 2 etiologies of vertigo; describe the general symptoms of each
1) Peripheral: onset is sudden, often with tinnitus & hearing loss, usually horizontal nystagmus
2) Central: onset is gradual, not associated with auditory symptoms
What is the typical triad of Ramsay Hunt Syndrome?
1) Ipsilateral facial paralysis
2) Otalgia
-(pain out of proportion to PE findings)
3) Vesicles in EAC or on auricle
Name a peripheral cause of vertigo that has NO hearing loss or tinnitus
Migrainous vertigo
1) Most common suppurative complication of AOM is what?
2) What is the hallmark symptom of this complication?
1) Mastoiditis
2) Tenderness over the mastoid process
True or false: With mastoiditis, refer to an otolaryngologist early
True
What is a condition characterized by episodic vertigo, tinnitus, & sensorineural hearing loss?
Meniere’s disease
What is characterized by episodes (plural) of vertigo?
Meniere’s disease
How is mastoiditis diagnosed?
Clinically
How should you first try to treat Meniere’s?
Diet & lifestyle adjustment: Low-salt diet
True or false: tinnitus is a symptom, not a disease
True
Name a condition that you should think of when a pt complains of ear fullness
Meniere’s Disease
What is the most common cause of tinnitus?
Sensorineural HL
Fluctuating aural symptoms (reduced or distorted hearing, tinnitus, or fullness) in affected ear is typical of what condition?
Meniere’s disease
The most common risk factor for tinnitus is what?
Sensorineural HL
What two things should you examine the ear for when a pt complains of tinnitus?
Cerumen impaction & effusion
1) Audiometry is necessary to Dx what type of tinnitus?
2) When is MRI indicated to Dx tinnitus?
1) Non-pulsatile cases
2) Unilateral cases
MRA/MRV & temporal bone CT are necessary to Dx what type of tinnitus?
Pulsatile
List 2 important ways to treat tinnitus
1) Avoidance of exposure
2) Masking [with music, etc]
What is the goal of tinnitus treatment?
Decrease awareness & impact on quality of life
Obstruction is a mechanism of what type of HL?
Conductive (CHL)
CHL (conductive HL) is most commonly due to what two things?
1) Cerumen impaction
2) Transient ETD
What type of HL is usually correctable?
CHL
1) What is the most common form of SHL (sensory HL)?
2) Is it correctable/ reversible?
1) Presbycusis
2) Usually not
MRI or CT is indicated for what two types of HL patients?
Progressive or sudden asymmetric SNHL
What type of HL is also known as age related HL (ARHL)?
Sensorineural
List 3 characteristics of sensorineural HL
Gradually progressive, predominately high-frequency, & symmetrical
How is ARHL traditionally managed?
Hearing aids
What is the most common neoplasm of EAC?
Squamous cell carcinoma (SCC)
When should you suspect SCC of the EAC?
If otitis externa fails medical therapy
Are primary middle ear tumors common?
No, they’re rare
Acoustic neuroma (Vestibular Schwannoma) is also called what?
Inner ear neoplasm
Mucosal trauma or irritation, like nose picking, can cause what kind of epistaxis?
Anterior
True or false: Anticoagulation or antiplatelet medication can cause epistaxis
False; NOT a cause, just associated with
What is the most common form of epistaxis?
Anterior septum (Kiesselbach’s plexus) epistaxis
List 2 important aspects of medical history should you get for epistaxis
1) Predisposing conditions [to bleeding]
2) Comorbidities potentially exacerbated by blood loss
What type of pt should you perform a typical PE for epistaxis on?
Stable pts
1) What is the first thing to do when it comes to managing epistaxis?
2) When should you refer to the local ED?
1) Severe active bleeding & hemodynamic instability correction
2) Ongoing bleeding > 15 min
Initial tamponade is a treatment for what?
Anterior epistaxis
True or false: Cauterization and packing are two, but not all, of the appropriate treatment measures for anterior epistaxis
True
(initial tamponade is the third one)
Urgent ENT consultation is necessary for what kind of epistaxis?
Posterior
What is the 5th most common chronic disease in US?
Allergic rhinitis
Pollens & spores are the most common cause of what?
Seasonal AR (allergic rhinitis)
What is the allergic triad?
1) Allergic rhinitis
2) Asthma
3) Atopic dermatitis
Pale or violaceous/bluish turbinate mucosa with clear rhinorrhea is a symptom of what?
Allergic rhinitis
“Cobblestoning” of posterior pharynx can be associated with what common condition?
Allergic rhinitis
Infraorbital edema or darkening associated with allergic rhinitis is also called what?
“Allergic shiners”
True or false: Allergies can be diagnosed clinically based on H&P
True
What is the most important thing to treat allergic rhinitis (besides pharmacotherapy)?
Environmental control measures & allergen avoidance
Intranasal corticosteroids (i.e., fluticasone) may be appropriate for what?
Allergic rhinitis
1) The 1st line for mild allergic rhinitis in pregnancy is what?
2) What about for moderate-to-severe cases in pregnancy?
1) Intranasal cromolyn sodium
2) Intranasal corticosteroids
What should you avoid regarding allergic rhinitis during pregnancy?
1) Antihistamine nasal sprays
2) Oral and nasal decongestants
3) Initiating immunotherapy
True or false: non-allergic rhinitis can be diagnosed even if only one of the four cardinal symptoms is present
True
4 cardinal symptoms of non-allergic rhinitis
1) Nasal congestion
2) Post-nasal drainage
3) Sneezing
4) Rhinorrhea
What is the easiest way to differentiate allergic and non-allergic causes of rhinitis?
Non-allergic = later age of onset (usually > 20 y/o)
“Rebound nasal congestion” is also called what?
Rhinitis medicamentosa
What is the most important tool in treating rhinitis medicamentosa?
Pt counseling
Differentiate between acute and chronic rhinosinusitis
1) Acute rhinosinusitis: symptoms < 4 weeks
2) Chronic rhinosinusitis: symptoms persist > 12 weeks
What makes up most cases of acute rhinosinusitis?
ARS with viral etiology (common cold)
The 3 most common bacteria associated with ABRS are:
SP, HI, MC
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Purulent nasal discharge and facial pain or pressure are typical symptoms of what?
Acute rhinosinusitis
List the 5 more common features of a true bacterial sinusitis (ABRS):
1) Fever &symptom duration > 10 days
2) Maxillary toothache
3) Initial symptom improvement, then worsening of symptoms (“double worsening”)
4) Cacosmia (sense of bad odor in the nose)
5) Unilateral facial pain
True or false: CT imaging is NOT helpful in differentiating viral & bacterial etiology of acute rhinosinusitis
True
1) What pain would a pt experience when bending forward with acute rhinosinusitis?
2) Direct palpation of sinuses may provoke what in acute rhinosinusitis?
1) Pain localized to sinuses.
2) Pain
True or false: Imaging is not indicated in patients with uncomplicated ARS
True
True or false: any ARS findings on imaging are going to be nonspecific for ARS
True
True or false: antibiotics are NOT indicated for acute viral rhinosinusitis, just supportive care
True
ABRS can be treated with what 2 antibiotics?
1) If no penicillin allergy: Amoxicillin-clavulanate
2) If allergy: Doxycycline
List some signs of complicated ARBS
1) Papilledema (or basically any other eye changes)
2) Neck stiffness or other meningeal signs
3) Proptosis
