Surgery: ENT Flashcards
What bones can you see during otoscopy?
The handle of the malleus and the long process of the incus
What forms the majority and minority of the ear drum?
Majority - pars tensa
Minority - pars flaccida
How many layers make up the pars tensa?
Three - outer keratinising squamous, middle vascularised fibrous connective tissue, inner nonkeratinising squamous
If you’re ever struggling to see what’s going on where should you pay close attention to?
The pars flaccida ie the attic
What is the centre point of the tympanic membrane?
Umbo which is where any growth begins
What joint pokes into the ear canal and forms the anterior recess?
TMJ
Which nerve runs over the top of the stapes?
Facial
How does otitis externa present?
Discharge +/- pain and may get closing of the EAC w swelling
Which individual should you beware of w otitis externa and why?
The elderly diabetic as it may lead to skull base osteomyelitis
What bacteria are responsible for otitis externa?
Staph or Strep -> klebsiella, e coli, pseudomonas
Which group of abx are ototoxic?
Aminoglycosides
What can otitis externa as the result of strep become? And tx?
Spreading cellulitis of the face which requires admission and IV abx
How does acute otitis media present?
Pain -> Discharge
Which individual should you beware of w acute otitis media and why?
The immunocompromised diabetic male teenager w a headache as they’re more at risk of intracranial comps
What are the features of the ear drum that is affected w acute otitis media?
It bulges out towards you esp the pars flaccida + the tympanic membrane is erythematous and injected w dilated blood vessels
What can acute otitis media progress to?
Mastoiditis
What are worrying signs in a child w mastoiditis?
Look: a clear defined swelling, displacement of the pinna, loss of post auricular creases
Feel: boggy + fluctuant
Move: take the pt to theatre for abscess drainage
What happens if you don’t do anything for a mastoiditis?
It can progress to form a posterior mastoid fistula, track down a muscle and become a neck abscess, track back and become a brain abscess
By what route does the pus get from the mastoid into the brain?
Through or alongside the veins
What do veins in the head and neck lack?
Valves
What is glue ear?
Otitis media w effusion
Which individual should you beware of w OME and why?
Unilateral glue ear in an adult may indicate nasopharyngeal cancer
What does OME look like down the otoscope?
The tympanic membrane looks stretched around the malleus handle and sucked inwards
Tx of OME
Arrange a hearing test, watch and wait for 12wks as 90% get better by themselves, otherwise surgical insertion of a grommet
Acute Perf
Due to trauma (head injury, barotrauma, cotton buds) + acute otitis media
Often spontaneous recovery which heals from bleeding edges inwards
Chronic Perf
If the edge rolls over it will not heal and become chronic
It can be dry/wet if it is wo/w exudate which inc risk of infection
What should you beware of w trauma to the ear?
Injured ossicles and inner ear resulting in hearing loss up to 60dB
Tx of TM perf
Keep the ear clean and dry, leave alone for 12wks, if persistent surgical mx
Are pts w TM perf allowed to fly?
Yes
What is a cholesteatoma?
Destructive cyst of middle ear made of keratinised squamous epithelium
What does a cholesteatoma look like on otoscopy?
Wax high up in the ear w white shiny appearance
Comps of Cholesteatoma
If it grows into the mastoid it will erode local structures - ossciles, facial nerve, chorda tympani, lateral semicircular canal, middle cranial fossa
What would you worry about if a pt w recurrent unilateral ear infections presents w loss of taste?
A cholesteatoma that has erroded the chorda tympani
What surgical approach would you take to tx a cholesteatoma?
From behind the ear through the mastoid
Which structures should you beware of when approaching from behind the ear? (2)
Sigmoid sinus + dura on posterior cranial fossa
Why is unilateral sensorineural hearing loss a red flag?
Vestibular Schwannoma
‘If they need the volume high don’t forget the MRI’
Rhinitis v Rhinosinusitis v Acute Sinusitis
Rhinitis - inflam of mucosa inside nose, allergic or non-allergic, asthma of the nose
Rhinosinusitis - above + paranasal sinuses usually chronic +/- polyposis
Acute Sinusitis - painful bacterial infection
Rhinitis: Allergic vs Non-Allergic
Allergic: seasonal, sx of irritation, mucosa swollen pale bluish
Non-Allergic: year round, block and thick mucus, mucosa swollen speckled pink
What is the instrument used to open the nostril to examine the nose?
Thudichum Nasal Speculum
What structures are viewed when looking in a nostril?
Septum, inferior turbinate, nasal vestibule
What do children w allergic rhinitis do to
relieve the itch and running watery mucus?
The Allergic Salute
What can the allergic salute lead to?
The Allergic Crease
How do you dx allergic rhinitis?
Clinical Examination + Allergy Testing
How do you classify allergic rhinitis?
Mild: normal sleep + no impairment of daily activities
Mod-Sev: abnormal sleep + impairment of daily activities
Intermittent: <4d/wk + <4wks
Persistent: >=4d/wk + >=4wks
Tx of allergic rhinitis
Mild Intermittent: avoid allergen, saline nasal douche, non-sedating antihistamine
Mod-Sev Intermittent: add intranasal steroid spray +/- leukotriene receptor antagonist
Mild Persistent: add topical cromone to potentiate the steroid or add an antihistamine
Mod-Sev Persistent: immunotherapy
How do you dx rhinosinusitis?
Nasal block + facial pressure, hyposmia, examination findings w nasal endoscope
When does rhinosinusitis become chronic?
> 12wks
Where do nasal polyps tend to arise from?
The middle turbinate
You find pale fleshy blobs on speculum: swollen turbinate vs polyps
Upon prodding it turbinates are highly sensitive + CT scan
Samter’s Triad
Asthma
Nasal Polyps
Aspirin Sensitivity
Which pts should you beware of w chronic rhinosinusitis?
If sx are unilateral may indicate tumour which the CT scan should pick up
Tx of chronic rhinosinusitis
Long term topical steroids to prevent recurring polyps +/- surgery
How does acute sinusitis px?
Bilateral facial pain w purulent discharge following a viral URTI
‘Double Sickening’
Which pts should you beware of w acute sinusitis?
The immunocompromised diabetic male teenager, may have spread into cranial cavity, scan if px w headache
Tx of acute sinusitis
Analgesia, abx, one off nasal decongestant
What is the problem w prolonged use of nasal decongestants?
Rhinitis Medicamentosa + Tachyphylaxis
They work by reducing blood supply to the nose, when it wears off rebound inc of blood flow and congestion, therefore when you have to use more to get the same desired affect
It’s a slow recovery ~12wks whilst the nose unblocks
What is the spectrum of sleep-disordered breathing?
Simple snoring
Upper airway resistance syndrome
Obstructive sleep apnoea mild-mod-sev
Alveolar hypoventilation syndrome
What is the pathophysiology of SDB?
Extreme neg intrathoracic pressure, central venous pooling, raised CVP+ICP, increased right+left heart pressure, pulm HTN+cor pulmonale
How would you mx SDB?
Hx: ask intimate partner + Epworth scale
O/e: check for airway collapse + lymphoid hypertrophy
Ix: flexible endoscopic exam +/- sedation
Tx: wt loss, red alcohol, legal+safety, mandibular advancement device, CPAP available following sleep study, cause dependent surg
Which questionnaire measures risk of daytime somnolence?
Epworth Scale
What is the legal and safety aspect surrounding SBD?
Driving or working w heavy machinery
Ddx of enlarged neck LNs (5)
Reactive Metastatic Lymphoma Sarcoid TB
What is the workup for neck lymphadenopathy?
Hx, examine neck/lungs/ENT inc flexi endoscopy, imaging w USS+FNAC, CT for malignancy, CXR for sarcoid
Tx for cancer in the neck
H+N Cancer MDT
Which muscle does the ant tonsil pillar enclose?
Palatoglossus
Which muscle does the post tonsil pillar enclose?
Palatopharyngeus
What are the posterior pillars a good landmark for?
Tonsils + Airway Difficulty
What is the last bit of the mandible before it becomes the ramus?
Retromolar Trigone
Which is the most common cancer of H+N?
Tonsil
What is tonsil and oropharynx cancer a/w?
Young - HPV
Old - Smoking
How does nasopharyngeal cancer typically present?
As a neck lump
Which oral cancers are a/w chewing tobacco?
Gingiva + Palate
Where does nasopharyngeal cancer develop?
Fossa of Rosenmüller ie the pharyngeal recess
Which ethnic group are at inc risk of nasopharyngeal cancer?
SE Asia
Which virus are nasopharyngeal cancers a/w?
EBV
How does laryngeal cancer typically present?
Hoarseness +/- worsening dysphagia, aspiration, red tongue movement, neck lump, smoker
How many weeks of hoarseness requires an urgent ENT referral?
6wks -> Endoscopy
What happens if early sx of laryngeal cancer isn’t ix?
May px as an airway emerg requiring a tracheostomy
What should you do if you find leukoplakia?
Biopsy to dx how bad the dysplasia is
What do oral papillomas look like?
They have a ‘bunch of grapes’ or ‘soap-bubble’ appearance
Do papillomas have the potential for malignant transformation?
Yes
What should you always do before removing a thyroglossal cyst?
An USS to ensure theres other thyroid tissue
Which procedure is used to mx thyroglossal cysts surgically?
Sistrunk’s, removal of the whole tract and middle third of hyoid, prevents recurrence
What is a branchial cyst?
Embryological remnant from the development of the pharyngeal arches: internal surface (endoderm-pouches) + external surface (ectoderm-clefts)
What are the pharyngeal pouches formed by the arches?
I: eustachian tube + middle ear
II: palatine tonsil
III: inferior parathyroid glands + thymus
IV: superior parathyroid glands, ultimobranchial body (along w 5th), musculature and cartilage (along w 6th)
How do branchial cysts px?
Young adult with a smooth firm fluctuant swelling classically a third the way down ant border of SCM
What would be the ddx for a branchial cyst?
Lipoma
Cyst vs Lipoma
Transilluminate
Sinus vs Fistula
Further abnormalities in the embryology
Sinus: blind ending epithelial tract to one surface
Fistula: abnormal communication b/w two epithelial surfaces
Mx of Branchial Cyst
Dx: USS
Tx: complete excision of cyst and any underlying tract
Pleomorphic Adenoma vs Warthin’s Tumour
Both benign parotid tumours
PA: any age + slow growing
WT: older men, a/w smoking, ~15% bilateral
What should you examine following clinical suspicion of a parotid swelling?
The facial nerve as malignant tumours may invade resulting in a palsy
Ddx of Parotid Swelling
Infection: mumps, syphilis, TB
Inflammation: stones + sarcoidosis
Malignancy: benign, malignant, metastatic, lymphoproliferative
Mx of Parotid Tumour
Dx: USS+FNAC
Tx: watch and wait -> surgery
Ddx of Submandibular Swelling
Infection, Stone, Pleomorphic Adenoma
Mx of Submandibular Swelling
Dx: hx, bimanual palpation, USS+FNAC
Tx: stone retrieval or gland excision
What is perichondritis?
Spreading infection of the pinna classically from an insect bite
What can perichondritis lead to if left untreated?
Osteomyelitis via spread through the temporal bone
Tx of Perichondritis
Remove insect remnants/piercings and broad spectrum abx
What is a pinaa haematoma?
Blood collects in subperichondrial space resulting in cartilage ischaemia
What can a pinna haematoma lead to if left untreated?
Cauliflower Ear
Tx of Pinna Haematoma
Tx the head injury, look in the ear for other injury, incise and drain the pinna
Why is oil > water used to flush the ear?
It won’t be absorbed by the insect
What must be ruled out before dx bells palsy? (4)
Stroke
Parotid Ca
Cholesteatoma
Ramsay-Hunt Syndrome
Tx of Bells Palsy
Eye drops and patch alongside steroid tx +/- vaciclovir
Epistaxis: Ant vs Post
Ant: 90%, young, trauma irritants preg
Post: 10%, elderly, vasculopathy hypertension atherosclerosis
What is the name of the anastomosis b/w the ethmoid and sphenopalatine arteries?
Ant: Kiesselbach’s plexus ie Little’s area
Tx for Ant Epistaxis
Squeeze soft part of the nose for ten mins w the head leaning forwards + if recur consider AgNO3 cautery
Tx for Post Epistaxis
Pack back>up, probable admission, drug hx, check pharynx for clots, bloods inc G+S
What are the diff packing options for post epistaxis?
Rapid Rhino
Brighton Balloon
BIPP Ribbon
What is the most important part of tx for a fractured nose?
Timing: move back on day 0 or ~10 ie before/after the swelling
Comp of Nose #
Septal Haematoma -> Saddle Nose Deformity
What should you worry about w a head injury in a child?
NAI
How can you tell if the uvula if acc deviated?
Look at the base not the tip
Where should you first attempt quinsy drainage?
Where the lines from the side of the tongue and base of the uvula intersect
What is the standardised progression of a quinsy?
Tonsillitis, peritonsillar cellulitis, quinsy, parapharyngeal abscess, retropharyngeal abscess, mediastinitis
What voice are pts w a quinsy typically said to have?
‘Hot Potato’
What is Ludwig’s angina?
A deep expanding infection around the mylohyoid usually following dental infection
How does Ludwig’s angina px? (3)
Rounded neck swelling, tongue displacement, stridor
Tx of Ludwig’s Angina
Secure airway, IV fluids and abx, CT scan and ultimately admit for abscess drainage
What position are pts w epiglottitis or other lower airway obstrc said to sit in?
Tripod position: neck pushed forward, leaning forward, supporting themselves on their knees
Why has the incidence of epiglottitis declined?
The HiB vaccine
What senior help should you get for a pt w epiglottitis? And tx?
A+E, ENT, Anaesthetist
Give adrenaline nebs and consider heliox
What is heliox? And why is it effective?
80% Helium + 20% Oxygen
As helium has a lower density than nitrogen it makes breathing through a smaller space easier due to Pascal’s law
Stridor vs Stertor
Stridor: insp (supraglottis-glottis), biphasic (subglottis), exp (tracheal-bronchi)
Stertor: snoring
Where is the narrowest diameter in the airway?
Subglottis
What are possible causes of stridor? (4)
Infection
Inflammation
Foreign Body
Trauma
What is the most important thing to check in a pt w stridor?
Sats > Noise: if the pt starts to tire or the sats drop this is when you escalate
What is the life saving emerg trachy?
Cricothyroidotomy
Skin - Fat - Membrane - Air
What are your thoughts if a pt px w otitis externa has a perf TM?
Media -> Externa
When would you use a pack > cautery for an epistaxis?
Profuse bleeding w site difficult to localise
What cancers is the EBV involved with?
Nasopharyngeal + Hodgkin’s
When do you refer for tonsillectomy?
Recurrent acute tonsillitis or quinsy, chronic tonsillitis >3m w halitosis, any airway obstrc
Pt px w biting R inner cheek when closing mouth, R lower teeth numbness, R lower jaw pain
- Examine oral cavity, oropharynx, mandible
- Perform secondary survey for concurrent injuries
- Assess for motor dysfunction + sensory disturbances
- Referral to the maxillofacial surgical team
What are Le Fort fractures?
Fracture of the pterygoid plates resulting in the separation of all or a portion of the midface from the skull base
Px of zygomatic arch fracture
Cheek paraesthesia and interference of mandibular movements if it impinges upon the coronoid process of the mandible
Px of mandibular fracture (5)
Bite malalignment, trismus, pain+numbness along distribution of inf alveolar nerve, buccal haematoma, dental malocclusion
Mx of mandibular fracture (2)
An orthopantomogram (OPG) and urgent referral to the maxillofacial surgical team
The classification of Le Fort fractures
I - Horizontal
II - Pyramidal
III - Transverse
Def of ulcer
A discontinuation in the epithelial surface
Px of aphthous ulceration
Discrete ulcers of gingival mucosa characterised by a centralised white ulcer w erythematous halo
Ddx of aphthous ulceration
Herpes virus, smoking cessation, squamous cell carcinoma, Bechets syndrome, Crohn’s disease
What size criteria characterises a major aphthous ulcer?
> 1cm Diameter
How do you stage primary oral cavity lesions?
MRI of the neck
Mx of aphthous ulceration
Simple oral analgesia and topical anaesthetics
Swab for HSV infection if suspected
Assess for pathological cervical lymphadenopathy
Consider 2w referral to maxillofacial department
Which factors make you suspicious of SCC?
Indurated, lateral aspect of the tongue, failure to resolve, long term smoking hx
What is the path of the facial nerve?
Pons, 1cm internal acoustic meatus, 3cm facial canal, stylomastoid foramen, parotid gland where it divides into terminal motor branches
How should you examine hemifacial paresis?
Otoscopy, palpation of parotid gland and neck, movement of facial muscles
What does the facial nerve innervate?
Motor - facial muscles, posterior belly of the digastric, stylohyoid, stapedius
Sensory - small area around the concha of the auricle + anterior 2/3 of the tongue
Parasympathetic - lacrimal, mucous, salivary glands
Which branch of the facial nerve innervates the lacrimal and mucous glands?
The greater superficial petrosal nerve
Which branch of the facial nerve innervates the anterior 2/3 of the tongue (foliate papillae) and salivary glands?
The chorda tympani
Which nerve supplies the posterior 1/3 of the tongue (vallate papillae)?
The glossopharyngeal nerve
Where is the internal acoustic meatus situated?
The petrous part of the temporal bone
What segments is the facial canal divided into?
Labyrinthine, tympanic, mastoidal
Which salivary glands does the chorda tympani innervate?
Sublingual + Submandibular
Which nerve supplies the parotid gland?
The glossopharyngeal nerve
Which mucous glands does the facial nerve innervate?
Nasal, palatine, pharyngeal
What are the five terminal branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular Cervical
The intracranial branches of the facial nerve
The greater petrosal, nerve to stapedius, chorda tympani
The extracranial branches of the facial nerve
The posterior auricular, nerves to digastric and stylohyoid, terminal motor branches
Consequences of intracranial lesion of facial nerve
Ipsilateral reduced lacrimal fluid production, hyperacusis, loss of taste, reduced salivation, muscle weakness
Consequences of extracranial lesion of facial nerve
Only motor function is affected
Causes of intracranial lesion of facial nerve
Middle ear pathology such as tumour or infection
Causes of extracranial lesion of facial nerve
Parotid gland pathology such as tumour, parotitis or surgery, herpes virus infection, compression during forceps delivery
What is Bell’s palsy?
Facial nerve palsy w no definitive cause
What are give away signs of hemifacial paresis?
Loss of frontal forehead and melolabial creases and ipsilateral conjunctivitis secondary to incomplete eye closure
What’s the difference b/w UMN and LMN lesions?
UMN is forehead sparing
Causes of UMN palsies
CVA, MS, SOL
Causes of LMN palsies
Bell’s, Parotids, Heerfort’s
What is the 80% anecdote regarding parotid tumours?
80% are benign and of these 80% are pleomorphic adenomas
What are mucoepidermoid carcinomas?
The most common parotid malignancy in adults which px w parotid mass and concurrent facial nerve palsies
What is Heerfort’s syndrome?
A rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis and low grade fever
How do mucoepidermoid carcinomas spread?
The lymphatic system
What are the RFs of Bell’s palsy?
Diabetes, recent URTI, pregnancy
What are Warthin’s tumours?
Benign w no malignant potential that px as painless well circumscribed swelling involving the tail of the parotid gland
How can you localise the lesion in a 7th n palsy?
Plus: 6th - Pons or 5/8th - Cerebellopontine Angle
What is vestibular neuronitis?
Acute isolated, spontaneous, prolonged vertigo of peripheral origin +/- N+V w/o hearing loss, tinnitus, focal neuro sx
Ddx of Vertigo
Peripheral: bppv, vestibular neuronitis, labyrinthitis, Meniere’s
Central: migraine, stroke, cerebellar tumour, MS
When should you refer pts w vertigo?
Additional neuro sx, not improving after wk of tx, persists for >6wks
What is the preferred tx for vestibular neuronitis?
Short term prochlorperazine for sx + vestibular rehab exercises
How do you distinguish vestibular neuronitis vs posterior circulation stroke?
HiNTs
What is Ludwig’s angina?
Progressive cellulitis due to odontogenic infection spreading into the submandibular space
Why is Ludwig’s angina an emergency?
It can rapidly result in airway obstrc
Which drugs are ototoxic?
Aminoglycosides Quinine Aspirin Furosemide Cytotoxics
What are the three most common causes of hearing loss?
Wax, otitis media, otitis externa
What is presbycussis?
Age related sensorineural hearing loss w bilateral high freq loss on audiometry
What are the features of vestibular schwannomas?
CN V: absent corneal reflex
CN VII: facial nerve palsy
CN VIII: hearing loss, tinnitus, vertigo
What does bilateral acoustic neuromas suggest?
NF2
How is otosclerosis inherited? And usual age of onset?
Autosomal dominant + usually 20-40yo
What does otosclerosis cause?
The replacement of normal bone to vasc spongy bone results in a bilateral conductive pattern +/- tinnitus
What colour is the tympanic membrane in 1/10 pts w otosclerosis?
‘Flamingo Tinge’
BPPV Manoeuvres
Dx: Dix-Hallpike + Tx: Epley
Which HPV is linked w tonsillar SCC?
HPV-16
What does normal hearing look like on an audiogram?
Anything above the 20dB ie <20dB is essentially normal
Audiogram: Sensorineural v Conductive v Mixed
Sensorineural: both air and bone impaired
Conductive: only air is impaired
Mixed: both again but air worse than bone
What is black hairy tongue? And tx?
Defective desquamation of the filiform papillae, swab for Candida, tx w scrapings +/- topical antifungals
What are the CIs for cochlear implant? (5)
Chronic infective otitis media, mastoid cavity, TM perf, cochlear aplasia, deafness from CN VIII or brainstem lesion
What is the cause for the majority of SSNHL?
Idiopathic
Why should a MRI be done following SSNHL?
Exclude vestibular schwannoma
Mx for SSNHL
Urgent ENT referral + high dose oral corticosteroids
What is the biggest RF for malignant otitis externa?
Diabetes Mellitus
Which bacteria most commonly causes malignant otitis externa?
Pseudomonas aeruginosa
What does a sev sore throat + uvular deviation to the unaffected side suggest?
Quinsy
How does epiglottitis typically px? (3)
Extended head, drooling, tripoding
Why should you refrain from examining a pt w epiglottitis?
It may induce laryngospasm and obstrc the airway
What is otalgia w/o ear signs a red flag for?
H+N Malignancy
What causes Ramsay Hunt syndrome?
Reactivation of VZV in the geniculate ganglion of CN VII
When would refrain from tx ear wax? And when would you refer to ENT?
No tx if TM perf or grommet in situ + refer is sx >6wks
Samter’s Triad
Asthma
Aspirin Sensitivity
Nasal Polyposis
Which drugs causes gingival hyperplasia? (3)
Nifedipine
Phenytoin
Ciclosporin
What are the features of Menieres disease?
Recurrent eps of vertigo, tinnitus and hearing loss a/w feeling of aural fullness
What is found o/e of Menieres disease?
Nystagmus + Pos Rombergs
Mx of Menieres Disease
Consrv: inform DVLA
Acute: buccal/IM prochlorperazine
Prevention: betahistine + vestibular rehab exercises
How is 1°/2° haemorrhage following tonsillectomy managed?
1°: immediate return to theatre
2°: admission + abx +/- surgery
Why do viral URTIs typically precede otitis media?
It disturbs the normal nasopharyngeal microbiome allowing bacteria to infect the middle ear via the Eustachian tube
Which bacteria cause acute otitis media? (3)
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What are the possible otoscopy findings of acute otitis media?
Bulging TM, loss of light reflex, opacification erythema perf of TM
What is chronic suppurative otitis media?
Perf of TM w otorrhoea for >6wks
When should you prescribe abx for acute otitis media? (5)
Sx >4days or not improving, sys unwell, immunocomp or high risk of comps, <2yo w bilateral, perf or discharge
Comps of acute otitis media (4)
Mastoiditis
Meningitis
Brain Abscess
Facial Nerve Paralysis
Outline the centor criteria
Inc score more likely to be strep: fever, absence of a cough, exudate, tender lymphadenopathy
Outline the FeverPAIN criteria
Inc score more likely to be strep: fever, absence of a cough, sx onsent <3d, purulence, sev inflamed tonsils
Abx for bacterial tonsilitis
Phenoxymethylpenicillin or erythromycin 7-10d course
Which abx covers pseudomonas?
Ciprofloxacin
Abx for otitis media + externa
Media: Amoxicillin
Externa: Flucloxacillin
What benign tumour can cause epistaxis in adolescent males?
Juvenile Angiofibroma
What rare autosomal dominant disorder can cause prolonged epistaxis in elderly?
HHT
Rinne Test: pos vs neg
It’s normal to be pos ie AC>BC vs abnormal to be neg ie BC>AC
What is the rule of 80s for salivary tumours?
80% are in the parotid
80% of those are benign
80% of those are pleomorphic adenomas w Warthin’s tumour being the next most common
Which salivary gland gets the most stones?
Submandibular
What can go wrong w the salivary glands?
Infection
Inflammation
Malignancy
Gingivitis: simple vs acute necrotising ulcerative
Simple: painless red swelling w bleeding on contact - seek routine regular review w dentist
Acute: painful bleeding gums w halitosis and punched out ulcers - requires para, 3d oral metronidazole, chlorhexidine mouth wash whilst waiting for dentist
What should you avoid for 6wks w EBV?
Contact Sports
Outline the Centor Criteria
One point for: fever, no cough, tonsillar exudate, ant cervical lymphadenopathy
If 0-2 no abx vs 3-4 strep testing and empirical abx both w symptomatic tx
Which pts w hearing loss require urgent referral to ENT?
SSNHL <3d
Unilateral hearing loss a/w focal neurology eg altered sensation or facial droop
Hearing loss a/w head or neck injury, necrotising otitis externa, Ramsay Hunt syndrome
Ix of SSNHL
An MRI to exclude vestibular schwannoma
Tx of SSNHL
High dose oral corticosteroids by ENT
What are the ddx for hearing loss following trauma?
Perforated TM (conductive) + Base of Skull # (sensorineural)
How can nasopharyngeal cancer px?
Unilateral middle ear effusion esp if a smoker and from SE Asia
Cystic Hygroma vs Branchial Cyst
CH: 1yo - soft, non tender and transilluminates
BC: 20yo - smooth, non tender and fluctuant
Mx of Auricular Haematoma
Same day assessment by ENT for incision and drainage
