Midterm - ENT disorders Flashcards
Sinusitis
Inflammation and swelling of the sinuses.
Infection of adjacent structure (mastoiditis, meningitis) referral required.
Where is pain felt in ethmoid sinus problems?
Behind the eyes and high on the nose
What is the most commonly affected sinus in sinusitis?
Maxillary - largest sinus
Signs and symptoms of sinusitis
- Pain and pressure over the cheek
- Inability to transilluminate the cavity indicates it is full of purulent material
- Discolored nasal discharge
- Poor response to decongestants
How to diagnose sinusitis?
URI for rat least seven days and two of the following symptoms
1. Colored nasal drainage
2. Poor response to decongestants
3. Facial/sinus pain
4. Headache
Viruses may produce all of the clinical manifestations, patient with 7-day criteria more likely to have bacterial rather than viral URI
Otitis externa
Tenderness on traction of the pinna or pressure over the tragus. Erythematous ear canal history of recent swimming
Otitis media
Diagnose with otoscopic exam. Tympanic membrane is red and bulging without visible effusion. Light reflex absent or diminished. Mobility is decreased. External auditory canal is erythematous.
Treatment for otitis media
- Treatment for peds with mild symptoms and no daycare attendance and no abx in the last 90 days then amoxicillin 40-45mg/kg/day PO in two doses for 10 days
- Followup 48-72 hours if symptoms have not resolved or followup after completion of abx
- Change in hearing and speech and language delays indicate more aggressive treatment and referral is needed.
Acute angle-closure glaucoma
Increased intraocular pressure. Medical emergency when left untreated and can cause blindness. Sudden onset of symptoms:
- Blurred vision
- Red eye
- Unilateral pain
- Pressure
- Headache
- Seeing halos around lights
- Photophobia
- Peripheral vision loss
- Central vision loss
NP MUST ASSESS VISION LOSS ON PRESENTATION
Can cause severe damage to the optic nerve
Strategy to relieve middle ear pressure due to barotrauma
Use of nasal steroids and decongestants.
Sensorineural hearing loss
Comes from exposure to loud noises, inner ear infections, tumors, congenital and familial disorders and aging
Example: presbycusis
Any client that presents with sudden sensorineural hearing loss should be referred to otorhinolaryngolist for further diagnosis and treatment
Conductive hearing loss
Bone conduction is greater than air conduction so the patient will report bone conduction sound longer than air conduction sound
Serious otitis media can result in conductive hearing loss
Produces high-frequency hearing loss that is bilateral and symmetrical
Cerumen impaction
- Cause of conductive hearing loss,
- Differential diagnosis, otitis media
Weber test
Tuning fork placed on top of the head equal distance from the ears. Sound should be the same in both ears.
Conductive loss – louder in the bad ear
Sensorineural loss – louder in good ear
Perform the Weber and Rinne test to determine if it is primarily conductive or sensorineural
Tinnitus
Ringing or buzzing noise in one or both ears, may be constant or come and go. Often associated with hearing loss. May be caused by fluid in the ear.
Bilateral high pitched tinnitus may be caused by…
- Severe HTN diastolic over 120
- Evaluate with orthostatic measurements
- Refer patient
How to minimize symptoms of tinnitus
- Background music during the day and sleep
- Smoking cessation
- Decrease caffeine, chocolate, alcohol, salt
- Fatigue makes it worse
a. Good sleep hygiene
b. encourage rest - encourage gum and swallowing on airplanes to promote estuation tube opening and equalization of pressure
What type of disorders is tinnitus usually associated with?
Depressive disorders
1. Screen for psychological disorders and depression
Mononeucleosis
Viral syndrome characterized by prolonged malaise and fatigue, fever, sore throat, and tender cervical lymphadenopathy.
Symptoms of mononucleosis
- Fatigue
- Sore throat
- Mild nasal and throat erythema
- Edematous, enlarged tonsils bilaterally, erythema of pharyngeal wall and tonsillar exudates
- Inflamed posterior cervical lymph nodes
- Monospot test if strep has been ruled out
What is the hallmark symptom of mononeucleosis?
Inflamed posterior cervical lymph nodes
Epiglottitis
A life-threatening, rapidly progressive cellulitis of the epiglottis that may cause complete airway obstruction.
Epiglottitis begins as a cellulitis between the tongue base and the epiglottis; the epiglottis is then pushed posteriorly. The epiglottis becomes swollen and threatens airway patency.
Epiglottitis is more common and more severe in young children, but it may occur in older children and adults
Symptom cluster of epiglottitis
- Sore throat
- Difficulty swallowing
- Copious oral secretions
- Respiratory difficulty
- Stridor
- Fever
- No pharyngeal erythema or cough
Symptoms of epiglottis in pediatrics that may indicate airway obstruction
- Stridor
- Restlessness
- Nasal flaring
- Use of accessory muscles
Pharyngitis
Inflammation of the pharynx that cause discomfort, scratchiness, pain and difficulty swallowing
Symptoms of pharyngitis
- Fever
- Fatigue
- Cervical lymphadenopathy
Evaluate pharyngitis with which tests?
- Monospot
- Strep test
- Throat culture
Treatment for strep throat
10-day course of penicillin V potassium (500mg PO 2x/day) or benzathine penicillin IM once (1.2 million units)
Hoarseness/Dysphonia
Changes in the pitch or quality of voice – weak, scratchy, husky.
Diagnostic laryngoscopy.
Differential diagnosis papillomatosis (related to infection)
Causes of dysphonia
- Overuse or misuse of voice
- Viruses
- Growth on vocal chords (cysts, papillomas, polyps & nodules)
- GERD
Peritonsillar abscess
Acute pharyngeal infection common in young adults and adolescents
INFECTION IS USUALLY UNILATERAL AND LOCATED BETWEEN THE TONSIL AND SUPERIOR PHARYNGEAL CONSTRICTOR MUSCLE
Symptoms of peritonsillar abscess
- Gradual onset of severe unilateral sore throat
- Odynophyagia
- Fever
- Otalgia
- Asymmetric cervical lymphadenopathy
- Lock jaw
- Hot potato voice
- Toxic appearance
- Failure to recognize parents
- Irritability
- Inability to be consoled/distracted
- Drooling
- Severe halitosis
- Tonsillar erythema
- Exudates
- Bulge with deviation in the soft palate and uvula
Refer to emergency if concerns for airway or sepsis.
Allergic Rhinitis
Hypersensitivity (IgE mediated) to airborne irritants affecting eyes, nose, sinuses, throat and bronchi. Diagnosed with patient history and physical exam. Teach patients to avoid environmental triggers.
Symptoms of allergic rhinitis
a. Persistent
b. Seasonal in nature
c. Turbinates are pale due to venous engorgement
Symptoms of viral rhinitis
a. Watery rhinorrhea
b. Nasal congestion
c. Nasal speech
d. Forced mouth breathing
Rebound rhinitis caused by…
Overuse of nasal sprays
Stop use, resolves in 2-3 weeks
Atopic triad
Genetic predisposition toward allergic reactivity may be the most important etiological factor in atopic conditions
Personal or family history of ASTHMA, ALLERGIC RHINITIS, ECZEMA is often present
Tests for tinnitus
- Tympanometry
- acoustic reflex measurement
- acoustic refletrometry
Differential diagnosis for dysphonia
Papillomatosis (related to infection)
