Therapeutics: Ear, Nose, Throat Flashcards
Describe what is in the outer ear
Air filled
Comprised of auditory and auricle canal
Describe what is in the middle ear
Air filled
Contains timpani membrane (eardrum)
Chain of small bones in body (auditory ossicles) called malleus, incus and stable
Describe what is in the inner ear
Fluid filled shaped
Consists of three semi circular canals
Cochlea (spiral three-piece shaped series of tubular canals)- contains Corti/organ of sound
Describe what is in the cross section of cochlea
Ducts:
Scale Vestibule
Scala Media
Scala tympani
Describe what is in the Organ of Corti
Inner and outer hair cells: for auditory transduction
Bodies of hair cells in contact with auditory nerve fibres
Cilia of the hair cells in contact with tectorial membrane
Describe the physiology of the inner ear (hair cells)
Vibration of basement membrane activates inner/outer hair cells to cause cilia bending
Hair cells are depolarised, excitatory neurotransmitters are released to activate afferent cochlear auditory nerves
Hair cells are hyper polarised: afferent cochlear auditory nerves are inhibited
Describe the vestibular region role and what is consists of
Used to maintain equilibrium of the head by detecting angular and linear accelerations of the head
Semi circular canals: detects angular rotation
Otolithic organs: detect linear accelerations
Describe what is in a hair cell
- 50 to 70 small cilia called Stereo cilia
- One large cilium called kino-cilium
- Stereo cilia bends in direction of kino-cilium to cause ion channels to open and cause membrane depolarisation and nerve fibre activation
- Other way round (stereo cilia to kinocilium) does reverse effect and hyperpolarisation
What is otitis externa
Inflammatory disease caused by bacterial infection (staphylococcus aureus) or fungal infection (candida and aspergillus)
How do you treat acute otitis externa
Anti-inflammatory corticosteroid
Anti-infective chloramphenicol ear drops
Astringent: aluminium acetate
2% acetic acid (EarCalm)
What are the anti-infective antibiotics used for otitis externa
- Topical antibiotic and glucocorticoid: Neomycin and polymyxin
- Bumethasone/dexamethasone and hydrocortisone: such as otomize spray
- Flumetaozone and clioquinol
How do you treat chronic otitis externa
Antibiotics: oral flucloxacillin (or Clarithromyin if penicillin allergic
IV cephalosporin: used if patient seem unwell
Anti-fungal agent: Neomycin, polysorbate, gentian violet
How do you remove ear wax
Use of olive oil, almond oil, sodium bicarbonate ever drops
Cerumenolytic products soften ear wax
If otitis externa comes with a perforated eardrum, what is the likely cause
Amino glycoside antibiotics such as gentamicin and neomycin which may cause ototoxicity
What does otitis media present itself as and caused by
- Sudden onset of otalgia (ear ache), fever, hearing loss
- Preceded by upper respiratory tract infection that lasts a couple of days
- Bacterial (streptococcus pneumoniae, Hemophilus influenza)
- Fungal (candida or aspergillus) infection
How do you treat otitis media
Local cleansing
Anti-infective antibiotics
Systemic antibacterial like oral amoxicillin (or clarithromycin)
Ciproflolaxin or oflolaxin are both unlicensed ear drops
What is labyrinthitis and its symptoms
Inner ear dizziness
Symptoms: vertigo, loss of balance, loss of hearing, tinnitus
How do you treat labyrinthitis
Antibacterial: Oral amoxicillin or IV cephalosporin
Anti-viral: valacyclovir
Treatment of vertigo and nausea: prochlorperazine (dopamine D2 receptor antagonist)
Symptomatic treatment:
Anxiety (benzodiazepines)
Depression (SSRIs)
Vestibular rehabilitation therapy
Give examples of drugs that cause ototoxicity
Analgesics: salicylates, quinine
Antibacterials: Amino glycosides: gentamicin, neomycin Glycopeptide: Vancomycin Macrolide: Erythromycin Antineoplastics: Cisplatin Loop Diuretics: Furosemide
What is rhinitis
Allergic acute or chronic inflammation of the nasal mucosa (hay fever)
What is Rhinorrhoea and its causes
Production of excessive watery secretions by nasal mucosa
Viral infection of the nasal mucosa or interaction between antigens and tissue bound Ig-E antibodies within nasal mucosa
Leads to increased nasal mucosal blood flow and/or blood vessel permeability
How do you treat nasal blood flow on rhinitis and rhinorrhoea treatment
Sympathomimetic agents (ephedrine): leads to vasoconstriction
How are you able to have an anti-inflammatory effect on rhinitis and rhinorrhoea treatment
Glucocorticoids (beclomethasone, momethasone)
Anti inflammatory steroid
How are you able to suppress mediator release on rhinitis and rhinorrhoea treatment
Cromolyn sodium
Omalizumab
Inhibits histamine release and monoclonal antibody prevents Ige interaction
How are you able to perform mediator receptor blockade on rhinitis and rhinorrhoea treatment
H1 receptor antagonists- azelastine
Leukotriene antagonists (montelukast)
Blocks vasodilation and inflammation
How do you treat nasal congestion
Ephedrine or pseudo ephedrine- indirect sympathomimetic acts as substrate for noradrenaline release
Sodium chloride used to liquefy mucous secretions
How do you treat nasal staphylococci
Mupirocin (inhibits bacterial protein and RNA synthesis): eradicates MRSA
Where is the oropharynx located
back of the mouth behind oral cavity, includes back third of tongue, soft palate, side walls and back walls of throat
Why do oral ulceration and inflammation occur
Infections, trauma, dietary deficiencies, carcinoma, haematopoietic disorders, drug therapies
How do you treat oral ulceration and inflammation
Benzydamine (NSAID oromucosal spray): oropharyngeal inflammation
Choline salicylate gel: mild to moderate oral perioral lesions aka bonjela
Croscarmellose gelatin paste
Inflammation: treated by hydrocortisone or betamethasone
What causes oropharyngeal fungal infection and how do you treat them
Candida species (candidiasis)
Thrush: nystatin or miconazole
Fluconazole
Amphotericin: severe one
How do you treat primary heretic gingivostomatitis
Bezydamine or chlorhexidine mouthwash
What are mouthwashes used for and give an example of the active ingredient of one
Oral candidiasis, gingivitis
Chlorhexidine: corsodyl
How do you treat dry mouth caused by antimusicarinic or diuretic drugs
Artificial saliva in forms of lozenges
