RCSI: ENT Flashcards
What is a common issue when attempting to remove a foreign body from a child’s ear?
Attempts by an adult may compound the problem.
This is particularly true if the child is non-compliant.
What are potential presentations of a foreign body in the ear?
Otitis externa or perichondritis.
These conditions can arise from the presence of the foreign body.
How should insects in the ear be treated?
First killed with an oil-based solution and then removed.
What is a common presentation of a foreign body in the nose?
Unilateral rhinorrhoea.
What imaging should be done for unwitnessed foreign body insertion in the nose?
Lateral nasal, inspiratory and expiratory chest X-ray (CXR).
What is the urgency of removing nasal foreign bodies?
All nasal foreign bodies should be removed on an urgent basis to prevent aspiration.
What should be done if initial attempts to remove a nasal foreign body fail?
Removal under general anaesthetic is indicated.
What are potential complications of button batteries in the nose?
Burns and septal perforation.
What are the four constricted sites where a foreign body can obstruct the oesophagus?
- Level of the cricoid cartilage
- Arch of aorta
- Left main bronchus
- Diaphragm
What is the definition of acute tonsillitis?
Tonsils are paired lymphatic organs that form part of Waldeyer’s ring and are thought to have a protective/immunological role.
What is the blood supply to the tonsils?
Branches of the external carotid artery: * Ascending pharyngeal artery
* Lesser palatine artery
* Facial artery branches
* Dorsal lingual artery
* Ascending palatine artery
What are the predominant pathogens causing acute tonsillitis?
- Viral (influenza, parainfluenza, adenovirus, enterovirus)
- Streptococcus pneumoniae
- Haemophilus influenzae
- Anaerobes
List symptoms of acute tonsillitis.
- Sore throat
- Odynodysphagia
- Otalgia (referred pain)
- Dysphonia
- Trismus
- Painful cervical lymphadenopathy
- Pyrexia
- Malaise
What is the Centor Score used for?
To indicate the likelihood of bacterial infection as a cause of tonsillitis.
What does a Centor Score of 0-2 indicate regarding antibiotic treatment?
Do not treat with antibiotics.
What complications can arise from acute tonsillitis?
- Quinsy
- Parapharyngeal abscess
- Retropharyngeal abscess
- Chronic tonsillitis
- Acute otitis media
- Rheumatic fever
- Post-streptococcal glomerulonephritis (PSGN)
- Scarlet fever
What is the management for most cases of acute tonsillitis?
Managed in the community with analgesia, bed rest, and continued oral intake.
What is peritonsillar abscess also known as?
Quinsy.
What are the symptoms of a parapharyngeal abscess?
- Sore throat
- Odynodysphagia
- Lateral neck mass
What is the clinical presentation of a retropharyngeal abscess?
- Sore throat
- Neck stiffness
- Odynodysphagia
- Stridor
What is the immediate management for a pinna (auricular) hematoma?
Urgent incision and drainage under local anaesthetic.
What causes otitis externa?
Infective inflammation of the external auditory canal.
What are the key risk factors for acute otitis media (AOM)?
- Water exposure (swimmers)
- Immunosuppression
- Retained foreign body
- Auditory canal stenosis
- Dermatological conditions (eczema, psoriasis, dermatitis)
- Canal trauma (cotton bud)
What are common pathogens associated with acute otitis media?
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Fungal (aspergillus, candida)
What is the definition of otitis media with effusion (OME)?
Chronic accumulation of non-purulent effusion within the middle ear and mastoid air cell system.
What is the most common cause of conductive hearing loss in children?
Chronic suppurative otitis media.
What are common symptoms of cholesteatoma?
- Painless foul-smelling discharge
- Hearing loss
- Vertigo
- Tinnitus
- Facial nerve palsy
- Meningitis–intracranial extension
What are the two classifications of cholesteatoma?
- Congenital
- Acquired
What is an acoustic neuroma?
Common benign tumour of the cerebellopontine angle.
What is a key characteristic of cholesteatoma?
Locally destructive and has a tendency to recur after surgical management.
What is a mastoidectomy?
A surgical procedure to remove disease from the mastoid bone.
What is acute otitis media?
An infection of the middle ear characterized by inflammation and fluid buildup.
What indicates urgent mastoid exploration?
Intracranial complications caused by cholesteatoma, such as meningitis or cerebral abscess.
Define acoustic neuroma.
A common benign tumour of the cerebellopontine angle arising from schwann cells.
What is the typical clinical presentation of acoustic neuroma?
Unilateral sensorineural hearing loss, tinnitus, vertigo, facial nerve palsy, headaches, ataxia.
What investigations are used for acoustic neuroma?
- Audiology for unilateral SNHL
- MRI of the internal auditory meatus.
What are local causes of epistaxis?
- Idiopathic
- Traumatic
- Inflammatory
- Neoplastic
- Iatrogenic.
What are systemic causes of epistaxis?
- Anticoagulation drugs
- Inherited bleeding disorders
- Acquired coagulopathy
- Hypertension.
What is the most common area from which epistaxis originates?
Little’s area (Kiesselbach’s plexus).
What is allergic rhinitis?
An IgE mediated type 1 hypersensitivity reaction in the nasal mucous membranes.
List typical allergens that cause allergic rhinitis.
- Pollens
- Mould
- House dust mite
- Animals.
What are the symptoms of nasal polyps?
- Rhinorrhoea
- Sneezing
- Nasal itch
- Epiphora
- Nasal obstruction
- Postnasal drip.
What is the management for nasal polyps?
- Avoid allergen
- Oral antihistamines
- Topical steroid nasal sprays
- Oral steroids if severe.
- Surgical intervention if necessary.
What defines chronic rhinosinusitis?
An inflammatory condition of the paranasal sinuses and nasal passage lasting three months or longer.
What are common symptoms of chronic rhinosinusitis?
- Rhinorrhea
- Nasal congestion
- Facial pain/pressure/fullness
- Hyposmia
- Mucopurulent drainage.
What are complications of sinusitis?
- Orbital complications
- Pott’s puffy tumour
- Intracranial complications
- Mucocele.
What is the role of the larynx?
- Phonation
- Prevent aspiration during deglutition.
What are the histological subtypes of laryngeal cancer?
- Squamous cell carcinoma (SCC)
- Neuroendocrine tumours
- Lymphoma
- Metastasis.
What is the TNM system used for?
Staging cancer based on Tumor size, Node involvement, and Metastasis.
What are the risk factors for head and neck cancer?
- Tobacco use
- Excessive alcohol intake
- HPV infection
- Radiation exposure.
What is the Gardasil vaccine used for?
Prevention against HPV types 6, 11, 16, and 18.
What is the typical management approach for laryngeal cancer?
- Multidisciplinary meeting discussion
- Surgical resection
- Radiotherapy
- Chemotherapy.
Fill in the blank: 90% of HPV 16 targeting reticulated tissue of the _______.
tonsils.
What is the significance of the HPV oncogenes E6 and E7?
E6 binds to p53 and E7 binds to Rb, disrupting tumor suppression.
What is the most common histological subtype of head and neck cancer?
SCC (Squamous Cell Carcinoma)
SCC accounts for approximately 90% of cases.
What percentage of Laryngeal Squamous Cell Carcinoma (LSSC) arises in the glottic or supraglottic region?
Approximately 98%
Glottic LSSC is more common than subglottic LSSC, which makes up only 2% of cases.
List the variants of Squamous Cell Carcinoma (SCC).
- Spindle cell carcinoma
- Verrucous carcinoma
- Basaloid carcinoma
- Adenosquamous carcinoma
What are the primary treatment options for stages I and II head and neck cancer?
Single modality therapy
Options include surgery or radiotherapy.
What treatment is often required for stages III and IV head and neck cancer?
Combined therapy
This may include surgery with adjuvant radiotherapy or chemotherapy.
What are the surgical options for treating laryngeal cancer?
- Transoral laser microsurgery
- Hemilaryngectomy with voice preservation
- Supraglottic or supracricoid laryngectomy
- Total laryngectomy
What is the preferred treatment for oral cavity cancer?
Surgery with or without radiotherapy
Adjuvant radiotherapy is considered for positive margins or perineural invasion.
What are the key risk factors for oropharyngeal cancer?
- Alcohol
- Smoking
- HPV infection
What is the mainstay of treatment for nasopharyngeal carcinoma (NPC)?
Radiotherapy
Concurrent chemotherapy is used for advanced stages.
What are the common clinical presentations of nasopharyngeal carcinoma?
- Epistaxis
- Nasal obstruction
- Neck mass
- Cranial nerve dysfunction
- Unilateral middle ear effusion
What are the indications for tonsillectomy?
- 7 episodes of tonsillitis in 1 year
- 5–6 episodes per year over 2 years
- 3 episodes per year over 3 years
- 2 or more episodes of peritonsillar abscess
What is the definition of ventilation (tympanostomy) tubes?
Small tube inserted into the tympanic membrane to keep the middle ear aerated for a prolonged period of time.
What are the indications for tympanostomy tubes?
- Otitis media with effusion
- Recurrent acute otitis media
- Persistent Eustachian tube dysfunction
- Barotrauma
- Acute otitis media with bulging tympanic membrane or facial paralysis
What is the definition of mastoidectomy?
Operative procedure to gain access to mastoid air cells, middle and inner ear structures.
List the types of mastoidectomy.
- Cortical mastoidectomy
- Radical mastoidectomy
What are the complications associated with parotidectomy?
- Facial nerve dysfunction
- Hearing loss
- Tinnitus
- Vertigo
- Intracranial complications
- Sigmoid sinus thrombosis
What is the definition of neck dissection?
Surgical excision of the cervical lymph nodes.
What are the types of neck dissection?
- Radical neck dissection
- Modified radical neck dissection
- Selective neck dissection
What are common complications of neck dissection?
- Wound infection
- Flap necrosis
- Frozen shoulder syndrome
- Vagus nerve injury
- Hematoma
- Thoracic duct injury
