Surgery ENT 2 Flashcards
Quinsy is the common name for a
peritonsillar abscess
When can peritonsillar abscess arise?
Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils.
What are peritonsillar abscess usually a complication of ?
Peritonsillar abscesses are usually a complication of untreated or partially treated tonsillitis, although it can arise without tonsillitis.
Presentation of Quinsy
Patients present with similar symptoms to tonsillitis:
- Sore throat
- Painful swallowing
- Fever
- Neck pain
- Referred ear pain
- Swollen tender lymph nodes
Additional symptoms that can indicate a peritonsillar abscess include:
- Trismus, which refers to when the patient is unable to open their mouth
- Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”
- Swelling and erythema in the area beside the tonsils on examination
Quinsy is usually due to a bacterial infection. The most common organism is ______________ __________, but it is also commonly caused by ________________ ________ and _____________ ________.
Quinsy is usually due to a bacterial infection. The most common organism is streptococcus pyogenes (group A strep), but it is also commonly caused by staphylococcus aureus and haemophilus influenzae.
Management for Quinsy?
Patients should be referred into hospital under the care of the ENT team for incision and drainage of the abscess under general anaesthetic.
Quinsy typically has an underlying bacterial cause, therefore antibiotics are appropriate before and after surgery. A broad spectrum antibiotic such as co-amoxiclav would be an appropriate choice to cover the common causes, but local guidelines will guide antibiotic choice according to local bacterial resistance.
Some ENT surgeons give steroids (i.e. dexamethasone) to settle inflammation and help recovery, although this is not universal.
What should you always do if you have an infant younger than 3 months with a temp above 38ºC or 3 – 6 months with a temperature higher than 39ºC.
Always refer for specialist assessment and to consider admission
What is Glue Ear also known as?
otitis media with effusion
What is GLue ear
The middle ear becomes full of fluid, causing a loss of hearing in that ea
Cause of Glue Ear
The Eustachian tube connects the middle ear to the back of the throat. It helps drain secretions from the middle ear. When it becomes blocked, this causes middle ear secretions (fluid) to build up in the middle ear space
What is the main symptom of Glue Ear?
The main symptom of glue ear is a reduction in hearing in that ear.
What is the main complication of Glue Ear?
The main complication of glue ear is infection (otitis media).
What will show on Otoscopy with Glue Ear?
dull tympanic membrane with air bubbles or a visible fluid level, although it can look normal.
Management for Glue Ear
Referral for audiometry to help establish the diagnosis and extent of hearing loss. Glue ear is usually treated conservatively, and resolves without treatment within 3 months. Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets.
What are grommets?
Grommets are tiny tubes inserted into the tympanic membrane by an ENT surgeon. This allows fluid from the middle ear to drain through the tympanic membrane to the ear canal.
Usually grommets are inserted under general anaesthetic as a day case procedure. The procedure is relatively safe with few complications. Grommets usually fall out within a year, and only 1 in 3 patients require further grommets to be inserted for persistent glue ear.
common congenital causes of hearing loss in children
- Maternal rubella or cytomegalovirus infection during pregnancy
- Genetic deafness can be autosomal recessive or autosomal dominant
- Associated syndromes, for example Down’s syndrome
common perinatal causes of hearing loss in children
- Prematurity
- Hypoxia during or after birth
common after birth causes of hearing loss in children
- Jaundice
- Meningitis and encephalitis
- Otitis media or glue ear
- Chemotherapy
What is NHSP
**newborn hearing screening programme (NHSP) **
tests hearing in all neonates. This involves special equipment that delivers sound to each eardrum individually and checks for a response. This can identify congenital hearing problems early.
Presentation of hearing loss in children?
Children with hearing difficulties may present with parental concerns about hearing or with behavioural changes associated with not being able to hear:
- Ignoring calls or sounds
- Frustration or bad behaviour
- Poor speech and language development
- Poor school performance
What is used to differentiate conductive and sensorineural hearing loss.
Audiometry
What is a Audiogram?
Audiograms are charts that document the volume at which patients can hear different tones. The frequency in hertz (Hz) is plotted on the x-axis, from low to high pitched. The volume in decibels (dB) is plotted on the y-axis, from loud at the bottom to quiet at the top. It is worth noting that the lower down the chart, the higher the decibels and the louder the volume.
Explain the results of Audiogram
Hearing is tested to establish the minimum volume required for the patient to hear each frequency, and this level is plotted on the chart. The louder the sound required for the patient to hear, the worse their hearing is and the lower on the chart they will plot. For example, a 1000 Hz sound will be played at various volumes until the patient can just about hear the sound. If this sound is heard at 15 dB, a mark is made on the chart where 1000 Hz meets 15 dB. If this sound can only be heard at 80 dB, a mark is made where 1000 Hz meets 80 dB.
Hearing is tested in both ears separately. Both air and bone conduction are tested separately. The following symbols are used to mark each of these separate measurements:
X – Left sided air conduction
] – Left sided bone conduction
O – Right sided air conduction
[ – Right sided bone conduction