WCS30 ENT 2: Common ENT Diseases - Symptoms, Signs And Surgery Flashcards
Common ear problems
- Discharge
- Otitis externa
- Chronic suppurative otitis media - Hearing loss
- Conductive: external ear, eardrum, ossicles —> Perforated drum, Otitis media with effusion
- Sensorineural: cochlea, auditory nerve, brain —> Acoustic neuroma / Vestibular schwannoma
- Mixed - Tinnitus
- Dizziness / Vertigo
- Pain
Discharge: Otitis externa (Swimmer’s ear)
Causative agents:
- ***Staph aureus
- Pseudomonas aeruginosa
- Proteus mirabilis
- ***Candida albicans
- Aspergillus niger (black spores)
Discharge: Chronic suppurative otitis media
Symptoms:
- Recurrent ear discharge
- Hearing loss
- ***Perforated ear drum
- Pus
Special type: ***Cholesteatoma (Misnomer: NOT cholesterol / tumour)
Collection of epithelial cells in middle ear —> Recurrent infection —> Bone reabsorption + complications
- Retraction pocket
- Epithelial debris
- Ear discharge
- Hearing loss
Complications of Cholesteatoma:
- Facial nerve palsy
- Brain abscess
Conductive Hearing loss: Perforated eardrum
- Traumatic perforation
- Chronic perforation
Conductive Hearing loss: Otitis media with effusion
- Fluid in middle ear but intact eardrum (NO discharge!)
- Retracted eardrum
- ***Fluid level
- ***Blue drum
Pathogenesis:
***Dysfunction of Eustachian tube (e.g. NPC (most common))
—> fluid cannot pass down tube
Sensorineural Hearing loss: Acoustic neuroma
Misnomer: NOT from acoustic nerve, NOT a neuroma
Correct term: ***Vestibular Schwannoma
Tumour of **Schwann cells of Vestibular nerve
—> **Internal acoustic meatus (IAM) tumour
—> Compress on Cochlear nerve
Common nose problems
- Discharge
- non-infective: no cacosmia (disorder in smell), clear
- infective: no cacosmia, turbid e.g. maxillary sinusitis - Obstruction
- deviated nasal septum
- nasal polyp - Epistaxis
- ***Little’s area (Kiesselbach’s plexus)
Nasal polyp
Special type of Sinusitis:
- Edematous prolapse of mucosa in nasal cavity
Symptoms:
- Sinusitis
- Nasal obstruction
- Opaque ethmoid, sphenoid
Little’s area (Kiesselbach’s plexus)
-
**Maxillary artery (total 13 branches) (ECA (8 branches))
- **Sphenopalatine artery: supply nasal cavity extensively
—> passes Pterygomaxillary fissure —> goes into Sphenopalatine foramen
—> into nasal cavity to distribute its branches
- **Greater palatine: supply **hard palate - ***Facial artery (ECA)
- Superior labial
- Lateral nasal - ***Ophthalmic artery (ICA) (also supply eyeball, extraocular muscles, ethmoid sinuses)
- Anterior ethmoidal
- Posterior ethmoidal
—> go up to orbit then extend down into nasal cavity —> anastomoses with Facial artery
Blood drains into:
- Pterygoid plexus
- Facial vein
- Ophthalmic vein
- Infraorbital vein
Kiesselbach area: Anteriorly 1/3 of nose —> highly vascularised —> prone to nose bleeding (Epistaxis) —> caused by trauma, infection, hypertension
Management of Epistaxis
- Cauterisation with chemicals
2. Embolisation of ***internal maxillary artery (by interventional radiology)
Common throat problems
- Snoring
- Pain
- Blood stained saliva
Snoring
- Snoring
- Upper airway obstruction during sleep - Sleep apnea
- Stop breathing >= 10 secs
- >=5 episodes of apnea per hour
Investigations:
- Polysomnography —> ***Apnea-hyponea index (AHI) (number of apnea / hyponea episodes per hour)
- Sleep endoscopy —> site of obstruction
Throat pain
- Acute pharyngitis
2. Chronic tonsillitis
Oral ulcers
- Aphthous ulcers
- painful
- sharp edge - Carcinoma
- non-painful
- ***everted edge
- hardened
Blood stained throat discharge
Nasopharyngeal carcinoma
- fossa of Rosenmuller
- irregular with abnormal vessels
