What is a cholesteatoma? Describe the presentation
Locally destructive proliferation of squamous epithelium in the middle ear.
- Foul smelling white discharge
- Pain
- Hearing loss
- Vertigo
- Facial paralysis (CN destruction)
Define tinnitus. What are some causes and red flags?
Sensation of sound without external stimulus
- Idiopathic
- Meniere’s disease
- Acoustic neuroma
- Drugs: aminoglycosides, aspirin, loop diuretics
Red flags: unilateral, vertigo, deafness
Define vertigo. What are some causes and red flags?
Illusion of movement
Peripheral:
- Meniere’s
- BPPV
- Labyrinthitis
- Vestibular neuronitis
Central:
- Acoustic neuroma
- BS, cerebellar lesion
Drugs: gentamicin, loops
What is the difference between labyrinthitis and vestibular neuronitis?
Vestibular neuronitis: no hearing loss or tinnitus
Labyrinthitis: hearing loss and tinnitus
Describe the pathophysiology and presentation of BPPV
Crystals in the semicircular canals that move when patient changes position -> rotational vertigo that lasts for seconds-minutes
*No hearing changes, no tinnitus
Describe the pathophysiology and presentation of Meniere’s disease
Dilatation of endolymph spaces in the semicircular canals
Spontaneous episodes of vertigo + tinnitus, hearing loss, aural fullness lasting 20 mins- 12 hours
Describe the pathophysiology and presentation of vestibular neuronitis
Inflammation of the vestibular nerve following viral infection
Vertigo, vomiting lasting several days
Describe the investigations and management of BPPV
Ix:
-Hallpike manoeuvre (vertigo + nystagmus elicited)
Mx:
- Epley manoeuvre
- Betahistine
Describe the management of Meniere’s disease
Anti-emetics: cyclizine, betahistine
Surgical
Describe the management of vestibular neuronitis
Conservative. Anti-emetics if needed (cyclizine)
Name some causes of hearing loss
Conductive:
- Earwax
- Foreign body
- TM perforation
- Cholesteatoma
- Otosclerosis
Sensorineural:
- Meniere’s disease
- Viral labyrinthitis
- Acoustic neuroma
- Presbyacussis (age-related)
- Drugs: aminoglycosides
- Infections: meningitis, mumps
Describe the presentation of acoustic neuromas
Unilateral progressive hearing loss, tinnitus, vertigo
- Headache
- CN palsy: 7, 8
- Cerebellar signs
Describe the investigations and management of acoustic neuromas
Ix:
- Audiometry
- MRI cerebellopontine angle
Mx:
-Surgical
Describe the causes of epistaxis
Unknown Trauma: nose picking, fractures Coagulopathy Pyogenic granuloma Osler-Webber-Rendu/HHT
Describe the management of epistaxis
Not shocked:
- Sit upright, tilt head down
- Pinch over Little’s area for 15 minutes
Anterior:
- > examination and cautery (silver nitrate stick) or gauze with vasoconstrictor
- > packing
- > referral to ENT
Posterior:
-Posterior packing: insert catheter w balloon + fill, admit for 48 hours
What is a myringotomy and what is it used for?
Procedure to make an incision in TM and allow release of fluid/pus/blood to relieve raised pressure in the middle ear
What is grommet insertion and what is it used for?
Insertion of a grommet (small device) into the TM to allow drainage of fluids eg. chronic OME
Describe the risk factors for nasopharyngeal carcinoma
Smoking
Salt-cured fish + meats
Being from HK or Southeast China
Describe the presentation of nasopharyngeal carcinoma
- Neck lump (common)
- Hearing loss, ear pain, tinnitus
- Nasal obstruction
- Sore throat
- Weight loss
Describe the cause and presentation of thyroglossal cysts
Cyst forms in persistent thyroglossal duct
Midline neck lump
-Moves with swallowing and tongue protrusion
Describe the causes of neck lumps
Midline:
- Thyroglossal cysts
- Thyroid lumps: TMNG, adenoma, carcinoma
Anterior triangle:
- Branchial cyst
- LNs
Posterior triangle:
- LNs
- Pharyngeal pouch
- Cystic hygroma
- Cervical rib
Describe the presentation of epidermoid cyst
Smooth, well-circumscribed, rubbery lump with central punctum
Fixed to skin but mobile over deeper layers
Describe the presentation of a lipoma
A soft and smooth dome-shaped lump easily movable under skin
