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Clin Specialties - EMed > Lecture 1 - ENT > Flashcards

Lecture 1 - ENT Flashcards

1
Q

What questions are important to ask when assessing a pt with hearing loss?

A 
Sudden or gradual?
One ear or both?
Associated sxs? Tinnitus?
Conductive or sensory?
Recent illness?
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2
Q

What can cause sensory hearing loss?

A 
Acoustic trauma 
Acoustic neuroma
Presbycusis
Menieres disease
Noise damage 
Ototoxic drugs 
Infectious (Mumps, measles, herpes, syphilis, meningitis)
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3
Q

Hematoma of the pinna can cause what kind of hearing loss?

A

Conductive hearing loss

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4
Q

What is the treatment for hematoma of the pinna?

A

Incision or needle aspiration of hematoma
Auricular pressure dressing with 48 hour follow up
ABX prophylaxis

Fill in the ear with vaseline gauze
Then take 4x4 and cut out the shape of the ear

“If the dressing falls off, come back in and we’ll put it back on”

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5
Q

Cerumen impaction treatment

A

Not usually an emergency, but can cause pain, pressure, vertigo, and hearing loss

Irrigation is the best way

30-60 cc syringe with a soft silicone catheter and warm water

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6
Q

What age group is most common to have otic foreign bodies?

A

<8 years age

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7
Q

What is the ideal way to remove a foreign body from the ear canal?

A

Irrigation

DO NOT use if TM is ruptured or if the FB is an insect

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8
Q

Otitis Externa

A

Inflammation or infection of canal or auricle (or both)

May have fever, hearing changes, otorrhea, canal swelling/fullness

Often seen with recent water exposure

Tenderness with tragal palpation or with traction of the external ear
Periauricular adenitis may be present, but it is not necessary for the dx

TM may be inflamed but it should be normally mobile on insufflation

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9
Q

What are the different types of otitis externa?

A

Acute: MC (swimmers ear)

Chronic: >6 weeks (FB, hearing aids)

Eczematous: dermatologic conditions

Necrotizing/malignant

Abscess, folliculitis, cellulitis

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10
Q

How do you dx otitis externa?

A

Typically just by hx and pe

Can do blood glucose
High res CT “thin temporal cuts” —if progression to malignant OE or mastoiditis

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11
Q

What is the treatment of otitis externa?

A

Topical
Non-ototoxic only
ABX drops (psuedomonas coverage)

Ofloxacin (3-4 drops bid or ciprodex)

Acetic acid solution (for bacterial, eczema and fungal etiologies)

Admission if necrotizing

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12
Q

What are the signs and sxs of mastoiditis?

A 
Fever or chills 
Pain 
Swelling
Erythema at mastoid process
Typically an extension of AOM or AOE

S. Pneumoniae
S pyogenes
S aureaus

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13
Q

What is the treatment for mastoiditis?

A 
ENT consultation 
Admission 
IV abx: cefotaxime 1g IV q24h 
Or 
Ceftriazone 1-2g IV q 24 hours
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14
Q

What can cause TM perforation?

A 
Trauma (red flag for abuse) 
FB 
Iatrogenic
OM
Scuba, air travel
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15
Q

What are the signs and sxs of TM perforation?

A

Sxs

  • otorrhea
  • hearing changes/tinnitus
  • pain

Signs

  • size perforation as percent of membrane
  • traumatic perforations often lack discharge
  • weber lateralizes to side of perforation
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16
Q

What is the treatment for TM perforation?

A 
Keep ear dry 
Refer to ENT and audiology 
TM perforation from infectious etiology 
-cortisporin otic suspension 1 drop qid
-ciprofloxacin ophthalmic 
Traumatic TM perforation 
-no ABX needed unless signs of infection develop 
-urgent referral if hearing loss and/or vertigo
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17
Q

What are the signs and sxs of barotrauma?

A 
Abrupt onset of pain, feeling of fullness in ear
Conductive hearing loss
Dizziness
Tinnitus
Vertigo
N/V
Transient facial paralysis 
TM rupture with valsalva maneuver 
Crying in children
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18
Q

Who is most common to experience barotrauma?

A 
Air travelers
Scuba divers
Decompression 
Hyperbaric oxygen chambers 
Rapid pressure change 
Blast injuries
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19
Q

What is the treatment for barotrauma?

A

Open the eustachian tube: chew gum, valsalva maneuver, yawn, infants/kids should drink something during the landing/takeoff
Divers descend/ascend slowly

Meds:
Antihistamines
Decongestants
ABX to prevent infection 
Surgery if severe
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20
Q

What should you keep in mind for a pt with middle ear hematoma?

A

Trauma —evaluate for other signs of trauma

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21
Q

What is the treatment for middle ear hematoma?

A

Watchful waiting

No ABX unless signs of infection develop

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22
Q

What is the prognosis for middle ear hematoma?

A

Hearing can go back to baseline if the ossicles have no been fractured or dislocated

Hearing should return to normal in 6-8 weeks

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23
Q

What are the different types of otitis media?

A

acute otitis media
Chronic otitis media
Recurrent AOM
Otitis media with effusion

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24
Q

AOM

A

Acute otitis media

Almost always viral —will go away on their own —BUT for child under 2 we treat with ABX

Usually antecendent sxs of URI

Sxs: 
Adult: 
Ear pain, hearing loss, tinnitus (MC) 
Children: 
Fever, irritability, otorrhea, lethargy, otaliga of sudden onset, ear tugging, poor sleeping, poor feeding 
Signs: 
Eardrum mobility decreased 
Eardrum bulging 
No light reflex 
Not able to see bony landmarks 
Redness

Give the pt a prescription for ABX but tel them not to fill it for a few days and instead try NSAIDs and decongestants

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25
Q

What are the signs of AOM in adults?

A

Ear pain
Hearing loss
Tinnitus

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26
Q

What do you tell a person coming in for ear pain that is traveling tomorrow?

A

Serous? Bollous? AOM
100% they’re going to get TM perforation if they are to fly tomorrow
DOCUMENT

27
Q

What is the first line treatment for AOM?

A

Amoxicillin 500mg PO tid x 7-10 days

Second line augmentin

28
Q

Peripheral vertigo

A

Abrupt onset

Benign positional vertigo 
Acute vestibular neruonitis
Suppurrative labyinthis
Menieres disease 
Acoustic neuroma
29
Q

Central vertigo

A

Gradual process

Cerebrovascular disease 
Cerebellar degeneration 
Migraine
MS
EtOH intoxication 
Tumors of the brainstem or cerebellum 
Phenytoin toxicity
30
Q

What questions do you need to ask when evaluating vertigo?

A 
Recent use of vestibulotixic drugs 
Caffeine intake 
Nictoine use
EtOH use 
Head trauma

Spinning? Was the room spinning? Were you spinning? Which direction?

31
Q

What is the management for peripheral vertigo?

A

IV hydration (for pts with prolonged nausea or poor fluid intake)
Medications:
Mecliizine (antivert) 25-50mg PO q 8-12 hours
OR
Diazepam (valium) 5-10mg IV or 2-4mg IM

32
Q

Vestibular Neuronitis

A

Labyrinthitis

Signs/sxs:
Vertigo, dizziness, hearing loss (fluctuating), N/V, tinnitus, malaise, nystagmus

Be sure to think of other possibilities:
Stokes can cause vertigo, dehydration can cause vertigo, think of ALL the possibilities

33
Q

What advice do you have for pts with vertigo having an acute attack?

A

Lie still with eyes closed in a darken room

34
Q

What are the signs and sxs of Meniere’s disease?

A

Unilateral hearing loss
Tinnitus
Vertigo with sudden onset and short duration (1-24h)
Intense, recurrent, vertigo associated with N/V and distress, ear pressure, nystagmus during attacks

35
Q

How do you treat miniere’s disease?

A

low salt diet
meds for vertigo
surgery for severe cases
refer to ENT

36
Q

“I just KEEP getting nosebleeds”

A

Refer to ENT

Possible polyps

37
Q

Which artery is most commonly responsible for posterior nose bleeds?

A

Sphenopalantine artery

38
Q

How do you treat epistaxis?

A 
Have pt blow their nose 
Afrin (oxymetazoline) - vasoconstrict
Direct pressure for 20 minutes 
2% lidocaine with epinephrine 
Cauterize using silver nitrate (no more than 5 seconds) 
Add bactiracin to the cauterized area 
Pack the nose if cautery doesnt work
39
Q

Rapid rhino is made by what material?

A

Hydrocolloid fabric

40
Q

Who gets admitted in regards to epistaxis?

A

All posterior epistaxis

41
Q

How long are noses packed for epistaxis?

A

Actual duration will vary according to the pts particular needs

Anterior pack at least 24-48 hours —the pts need to come back to see you —moisten the packing before removing it

Posterior pack —refer to ENT —packing must retain for 72-96 hours

Prophylaxis for TSS since this is a foreign body (cephalexin, amoxicllin, bactrim)

42
Q

Perennial allergic rhinitis

A

Occurs all year and is usually caused by home or workplace airborne pollutants

43
Q

How can you tell the difference between sinusitis and rhinitis?

A

Both have nasal congestion

Sinusitis has HA, facial pain, postnasal drip, cough, fever

Rhinitis has clear rhinorrhea, itching red eyes, nasal crease, seasonal sxs

44
Q

What is the most common cause of sinusitis?

A

Viral

45
Q

Chronic sinusitis is defined by what?

A

> 12 weeks

46
Q

Septal Hematoma

A

trauma to anterior portion of nasal septum

tearing of submucosal blood vessels

blood accumulates between mucopericondrium and septal cartilage

may be unilateral or bilateral

can result in:
septal abscess
septal perforation
catilage destruction with saddle nose deformity

can occur up to 72 hours after injury

tx: I and D

47
Q

How do you treat septal hematoma?

A 
I and D 
topical anesthesia (1:1 mix of oxymetazoline and 4% topical lidocaine) 
#11 blade scalpel 
frazier suction 
nasal saline 
nasal packing
48
Q

What is a mainstay of pain treatment for dental injuries?

A

dental block

NO OPIODS

49
Q

Ellis Classification System

A

tooth fracture

1 = enamel alone (chipped tooth, cosmetic)

2 = dentin

3 = pulp (emergent)

50
Q

What is the treatment for type 3 tooth fracture?

A

at risk for bacterial penetration

irrigate with saline, dry it then cover with calcium hydroxide paste or foil
refer to dental asap (within 24 hours)

51
Q

Sialoadenitis

A

infection of the major salivary glands by retrograde transmission of bacteria from oval cavity via the salivary duct

tx:
lemon heads
ABX: Pen VK if you think its infected

52
Q

Sialolithiasis

A

formation of hardened deposits in the ductal salivary gland system

colicky postprandial pain and swelling

tx: 
lemon drops 
NSAIDs
antibiotic coverage of staph 
increase oral intake
53
Q

Why do we treat strep throat?

A

risk of bad sequele:
rheumatic fever
glomerulonephritis

54
Q

What is the treatment for pharyngitis?

A 
PCN
Erythromycin
Cefuroxime
Clarithromycin
Azithromycin
55
Q

Who get admitted for pharyngitis?

A

dehydrated pts

56
Q

What is one of the most common infections of the neck?

A

peritonsillar abscess

57
Q

Hot potato voice

A

peritonsillar abscess

58
Q

What are the signs and sxs of peritonsillar abscess?

A 
lateral, progressively worsening sore throat 
fever
dysphagia
otalgia
odynophagia

swollen tonsil with contralateral uvular deviation
trismus (inability to open your mouth)
cervical lymphadenopathy

59
Q

How do you dx peritonsillar abscess?

A

neck CT (soft tissue) with control

gold standard: needle aspiration

60
Q

What is the treatment for peritonisllar abscess?

A

I and D or needle aspiration
ABX (augmentin or clindamycin)
Fluids
Steroids

61
Q

What is augmentin is not available to treat peritonsillar abscess, what else can you use?

A

clindamycin

62
Q

How do you needle aspirate a peritonsillar aspiration?

A 
pt sitting upright 
have suction available 
benzocaine spray 
lidocaine with epinephrine 
needle guard (so you only go in ever so slightly - only 0.5cm)
63
Q

What is the workup for pharyngeal foreign bodies?

A

indirect or direct fiberoptic laryngoscopy
xray of soft tissue
Chest xray
barrium swallow or gastrografin if you suspect esophageal perforation

Clin Specialties - EMed (11 decks)

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