AKT > ENT > Flashcards

ENT Flashcards

(86 cards)

Study These Flashcards
1
Q

Who does otitis media usually affect

A

Children. Rare in adults, consider alternative diagnoses in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Should we give antibiotics to children with otitis media

A

Usually not, antibiotics make little difference in time to recovery and symptomatic relief.
Most get better within 3 days without antibiotics, though it can take up to 7 days (tell parents this).
Antibiotics have minimal impact on recurrence, short term hearing loss or eardrum perforation.
Complications of otitis media are rare with or without antibiotics (however, complications from antibiotics diarrhoea and nausea are relatively common!).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who should we offer immediate antibiotics to in otitis media

A

Those who are systemically very unwell.
Signs or symptoms of serious complication such as mastoiditis and meningitis.
High risk of complications due to underlying comorbidities.

In these people - give immediate antibiotics AND consider if they need admission.
If managing in the community need very clear safety netting!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management for low risk otitis media (children more than 2 years old with no otorrhoea bilateral or unilateral, and children less than two if only 1 year affected and no ottorhoea)

A

Offer self care with paracetamol or ibuprofen.
No antibiotics (or delayed if no improvement in 3 days or symptoms worsen).
Consider eardrops containing an anaesthetic and analgesic if no oerformation and immediate antibiotics not being prescribed.
Clear safety netting to seek medical help if symptoms worsen rapidly or significantly (likely duration 7 days).
DO NOT recommend decongestants or antihistamines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a high risk case of otitis media

A

Child <2 years old with bilateral otitis media, or child of any age with otorrhoea secondary to perforated ear drum. These children MAY benefit from antibiotics (as they are at higher risk of complications and prolonged recovery time).

Can do delayed strategy or immediate antibiotics.

Antibiotic choice is 5-7 day course of amoxicillin or clarithromycin first line, co-amox if worsening after 3 days first line (and review diagnosis and assess if needs admission).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Analgesic eardrops for otitis media in children?

A

Now suggested in the 2022 NICE guidance.
Eardrop containing anaesthetic and analgesic.
eg phenazone 40mg/g with lidocaine 10mg/g. 4 drops 2-3 times daily for up to 7 days.
Give alongside oral analgesia.

Can also use if immediate oral antibiotic px not given and no eardrum perforation or otorrhoea.

NNT 5 for 50% reduction in pain in 10 minutes.

Causes significant reduction in use of antibiotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Should topical antibiotics ever be used in otitis media

A

Occasionally, if you want to prescribe antibiotics (high risk) but concerned about the side effects of oral. If used, should be non-aminoglycoside ear drops.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to prevent recurrent otitis media in children?

A

Grommet insertion (tympanostomy tube placement) may reduce the frequency and severity of OM episodes, especially in younger children.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the general criteria for grommet insertion?

A

In children:
recurrent otitis media (>3 in 6 months or >4 in 1 year)
- otitis media with effusion lasting more than 3 months with hearing loss (25dBHLs or worse) or significant developmental, educational or social impact.

Adults
- persistent middle ear effusion or retraction for 6 months with significant hearing loss, or significant pain from middle ear pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is otitis media with effusion

A

This is thick or sticky fluid behind the ear drum. It can often occur with/after ear infections and upper respiratory tract infections.
If it persists for more than 6 weeks it is labelled otitis media with effusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is otitis media with effusion (glue ear) a problem in children

A

It can impact hearing which in turn can affect speech and language development, educational progress and or behaviour.

Children may be withdrawn and irritable, or have balance/clumsiness problems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When to suspect otitis media with effusion

A

Children who present with hearing difficulties, delayed speech and language development, ear discomfort, or tinnitus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other features raise the index of suspicion for OME (glue ear)

A

URTI or OM
Conjuctivitis
Atopy
Snoring
Craniofacial abnormalities (downs, cleft palate)
Dyspnoea
Mouth breathing or sucking habits.
Nasal obstruction
rhinorrhoea
adenoid hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What to do if you suspect OME

A

Refer all children for formal assessment which should include otoscopy, audiology and tympanometry - AS SOON AS WE SEE GLUE EAR - improves outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What to do if hearing loss present with OME

A

review at 3 months (sooner if hearing loss significant affecting QOL).
At 3 months
- if no hearing loss, discharge with advice
- if unilateral hearing loss - reiterate advice and consider further 3 month review unless significant affect on QOL in which case do mx strat instead)
- if bilateral hearing loss, straight to mx strat

mx strat
- hearing aids - either air or bone conduction device
- consider autoinflation if patient able to do this - otovent
- surgical options - grommets +/- adjuvant adenoidectomy. Need 6 week post op hearing test to ensure no further invx required.

No role of antibiotics, oral or nasal streroids, antihist or any other medical treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What other advice to give to children with glue ear

A

Avoid tobacco exposure
hearing may fluctuate and glue ear may resolve in weeks or months
face the child and be close to them when speaking
minimise background noise
inform teachers of hearing loss so adaptations can be made in classroom too.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

risks of grommets

A

Perforation, atelectasis (inward collapse of the ear drum), tympanosclerosis and infection.
Ear needs to be dry for 2 weeks following surgery.
If recurrent otorrhoea after grommet surgery, advise to keep ears dry and use headband if going in water.
If otorrhoea after grommet surgery, 5-7 days ciprofloxicin ear drops (off label).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is adenoidectomy sometimes done at same time as grommets

A

minimal additional risk to child already having GA
adenoidectomy may improve hearing over and above grommet insertion alone.
benefits outweigh risk for most children.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how to use autoinflation devices for children with glue ear?

A

NICE advises to use if children are able to use them (definitely if ongoing hearing loss for 3 months but maybe sooner).
- evidence it improves hearing loss in the short term compared to no intervention.
Use TDS for 2-4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the role of oral or nasal steroids in glue ear

A

no role

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In which people can we use FeverPAIN or centor criteria

A

Sore throat in adults
Sore throat in children but not if child <3YO. And not if child <5YO with fever (then use the NICE fever guidance instead).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Centor criteria for giving antibiotics in sore throat

A

1 point each for tonsillar exudate, tender anterior cervical LN, fever, no cough

Centor 0-2 - no antibiotics
Centor 3-4 - immediate antibiotics or back up script

higher score means higher risk of group A strep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

fever pain criteria for sore throat

A

1 point each for fever in last 24hrs,
purulent tonsils
attended rapidly (within 3 days onset)
inflamed tonsils
no cough/coryza.

FeverPAIN 0-1 - no script
FeverPAIN 2-3 - non or back up script
FeverPAAIN 4-5 - immedate script or back up.

Higher score means higher risk group A strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to advise patients about back up scripts for sore throat

A

Advise do not need antibiotics immeidatly but to use script if no improvement in 3-5 days or if symptoms worsen. Seek medical help if symptoms worsen rapidly or significantly or if they become very unwell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How long do sore throats usually last
self resolve within 2 weeks, regardless of whether bacterial or viral.
26
Quinsy presentation
most commonly 20-40YO sore throat, fever, neck pain, muffled voice may struggle to swallow saliva. struggle to open mouth (trismus) OE tonsil asymmetry, deviated uvula. Note retropharyngeal abscess presents in the same way. Mx with ENT same day referral for possible incision and drainage and IV antibiotics.
27
Presentation of epiglottis
Severe rapid onset sore throat with fever, muffled voice, drooling and stridor. May prefer to sit forward (tripoding). If suspected, transfer to hospital by 999 ambulance. Do not examine the throat as this may cause life threatening airway obstruction.
28
Scarlet fever
Caused by strep pyogenes (group A strep). Usually clinical diagnosis but throat swabs may be recommended during outbreaks. Consider in sore throat, fever, red blanching rash that starts on torso within 48hrs illness. Rash starts as spots or blotches then becomes more widespread (sunburn with goosepimples). Rough. May have strawberry tongue, cervical adenopathy, flushed face with perioral pallor. Management with antibiotics to reduce risk of complications. Notifiable disease in E&W.
29
Features of infectious mononucleosis
Due to EBV virus Commonly 15-24YO Spread through contact with saliva. Consider in prolonged pharyngitis, often with significant adenopathy and splenomegaly. Invx: FBC lymphocytosis and atypical lymphocytes, and serum monospot test (in those aged >4YO). Usually self-limiting with typical time course 2-4 weeks. Fatigue common, lasts few weeks or longer. Avoid heaby lifting and contact spots for 1 month due to risk of splenic rupture.
30
Oropharyngeal cancer presentation
Remember that acute tonsilitis is rare in people over 45YO. Oropharyngeal cancer can present with: Sore throat, non-tender cervical LN, difficulty swallowing, and ear pain. especially consider if unilateral presentation. RF: smoking hx.
31
Red flags with asymmetrical tonsils in children
Rapid enlargement of single tonsil Gross asymmetry (>50% different) Persistent cervical LN asymmetry consistency of tonsils on palpation. changes in appearance or ulceration of tonsils constitutional symptoms (B symptoms) obstructive symptoms snoring apnoea dysphagia any history of malignancy palpable mass suggetive of parapharyngeal mass displacign a tonsil, or CN dysfunction which is late sign of parapharyngeal mass.
32
How to manage an isolated enlarged tonsil in children
If no cervical LN - watch and wait for 6 months, review monthly for 3 months to ensure no new red flags. at 6 months refer if ongoing If any red flags - refer to secondary care on suspected head and neck cancer pathway.
33
Self managemetn of sore throats
Analgesia, fluids, medicated lozenges.
34
Choice of antibiotics for sore throat if giving (centor 3-4 or feverpain 4-5)
phenoxymethylpenicillin 5000mg QDS for 5-10d. alt clarithromycin or erythromycin if pregnant. Evidence suggests for most people 5 days is appropriate course length (especially if giving delayed script).
34
what makes you more likely to have complications of a sore throat (eg quinsy, OM, sinusitis, impetigo, cellulitis).
Independent predictors of complications are 1. severe tonsillar inflammation 2. severe earache if both of above, 1 in 20 chance of complications higher CENTOR and FEVERPAIN scores increased chance of complications. antibiotics make no difference to this.
35
Tonsilectomy referal criteria for children and adults
7 or more episodes in 1 year 5 or more episodes per year past 2 years, 3 or more episodes per year past 3 years. (Episodes of acute tonsilitis that have required treatment) Other indications suspected tonsillar tumour, periodic fever, severe guttate psoriasis, renal disease resulting as a complication of acute bacterial tonsillitis, OSA in children.
36
Risks of tonsillectomy in children
14 days recovery at least risk of any GA in children! Mortality associated with this.
37
Hearing loss in adults - risk factors
increasing age, being male, noise exposure hx, microvascular risk factors such as diabetes, htn, smoking.
38
2 common reversible causes of hearing loss in adults
wax otitis externa
39
What is the presentation of vestibular schwannoma (acoustic neuroma)
Gradual unilateral hearing loss, tinnitus, dizziness or balance problems. It is a benign tumour of the vestibular nerve. Management includes observation, focused radiation or surgery.
40
Webers and Rinnes test result in SNHL.
Webers - will lateralise to the non-affected ear in SNHL, and to the affected side in conductive deafness. Rinnes - air > bone is normal (and in SNHL). In conductive deafness, bone >air.
41
Management of sudden onset (over less than 3 days) SNHL
Causes - trauma, stroke, viral, vestibular schwannoma, ototoxicity, autoimmune. If this has occurred in the last 30 days, immediate same day referral as steroids may save hearing, ideally given in first 48hrs but up to 28 days may be helpful. If occurring longer than 30 days ago, refer urgently (2 weeks).
42
Hearing loss - who needs an immediate same day referral
Sudden unexplained SNHL occurring less than 30 days ago. Unilateral hearing loss with ipsilateral alteral facial sensation/droop - think stroke, or viral infection, or vestibular schwannoma Immunocomp patient with new hearing loss, otalgia and otorrhoea, not responding to treatment within 72hrs - may be otitis externa with necrotising, or skull base osteomyelitis.
43
In what situations is urgent (but not immediate) referral to ENT needed for hearing loss
Sudden unexplained SNHL occurring more than 30 days ago (doesnt need to be same day as too late for steroids) Rapid unexplained worsening hearing over 4-90days (not sudden <3 days) - this could be cholesteatoma, ototoxicity, vestibular schwannoma, or autoimmune problem. Chinese/SE asian person with HL and middle ear effusion not associated with URTI - refer on nasopharnygeal cancer pathway.
44
Causes of unilateral tinnitus with hearing loss
menieres disease vestibular schwannoma
45
Causes of pulsatile tinnitus with hearing loss
vascular tumours, aneurysm, benign intracranial hypertension, carotid atherosclerosis, brainstem pathology.
46
Presentation of menieres
Combination of unilateral hearing loss, unilateral tinnitus, hyperacusis, and attacks of severe vertigo, aural fullness. Over time develop permanent low to mid frequency hearing loss.
47
Presentation of presbycusis
gradual SN hearing loss in both ears, most noticable for high pitched sounds. Loss accelerates as age increases.
48
Presntation of noise induced hearing loss
often presents notch on the audiogram, especially around 4000hz, though it can affect higher frequencies at first and later impact lower frequencies. Noise induced hearing loss often shows a rapid initial progression that slows over time.
49
Most common cause of conductive deafness in children
Glue ear. 1 in 5 children aged 2 will have been affected by glue ear, by age 10, 8/10 children will have had glue ear at some point!
50
What does the newborn hearing screening programme try to pick up
cases of sensorineural deafness. is it automated otoacoustic emissions test. measures the function of the hair cells in the inner and outer ear. If not passed on 2 attempts, baby referred for automated auditory brainstem response test - which assesses the whole pathway from hair cells to brain. This detects hearing thresholds and also directs treatment (amplification or cochlea implant).
51
Causes of paediatric hearing loss
SNHL - related to syndromes, generic anomalies, bacterial meningitis, perinatal hypoxic brain injury, ototoxic medication, congenital infections, trauma. Conductive hearing loss - OME, AOM, foreign body, wax, TM perf, ossicle fixation, ossicle trauma, congenital or anatomical anomalies of the external ear. 3 key history areas to ask about are ENT history, speech and lang development history, and infections.
52
Why does everyone with a history of bacterial meningitis need a follow up hearing test
10% develop sensorineural HL.
53
Otoscopy findings in glue ear
dull drum, fluid level or bubbles, loss of light reflex. (on exam also look for mouth breathing which suggests large adenoids which are a risk factor for glue ear).
54
From what age can you do pure tone audiometry
Usually from age 5 Below this refer to community audiology.
55
When to give antibiotics in acute otitis media
immediate antibiotics in children with AOM if less than 2 years with bilateral infection or any age with otorrhoea.
56
Sialolithiasis (salivary calculi) presentation
Short history of episodic pain and swelling, worse with meals and slowly resolving afterwards. No fever. Mostly occur in the submandibular area, occasionally in the parotid glands. Most occur between 30-70YO (rare in children). 70% calculi can be visualised by occlusal and lateral oblique views on plain film.
57
Presentation of sialadenitis
inflammation and swelling of the salivary gland, unilateral, most commonly due to bacterial (strep, haemophilus influenza) or viral infection (mumps, HIV). Can also be caused by salivary stones or autoimmune conditions. Symptoms include pain, swelling, redness, fever. exudate. Manage first line with antibiotics in the community.
58
What may be the cause of sudden onset vestibular symptoms (eg vertigo) with tinnitus
May be a brain stem stroke, therefore A&E
59
Presentation of post partum thyroiditis
common self limiting condition mild neck tenderness, fever and variable thyrotoxic symptoms. Blood tests show thyrotoxicosis but anti-thyroid drugs are not indicated.
60
What is hashimotos thyroiditis
Most common cause of hypothyroidism. Autoimmune thyroiditis TPO or Tg antibodies - cause inflammation of thyroid. Causes goitre, and hypothyroidism. enlarged but underactive thyroid. Commonly affects women, and runs in families. Manage with levothyroxine lifelong.
61
What is de quervains thyroiditis
self limiting inflammatory condition of the thyroid often following a viral illness, that causes neck pain, tenderness, and a predictable course of thyrotoxicosis followed by hypothyroidism, before returning to normal. mx is symptomatic, NSAID or corticosteroid for pain, b blockers for hyperthyroidism. will resolve over weeks to months
62
Appearance of nasal polyps
On examination - will be mobile, translucent, pale grey and lack sensation. They result from mucosal inflammation and are prolapses of mucosa. Generally present with progressive nasal obstruction, decreased sense of smell and taste, post nasal drip, or facial pain/pressure. They cause problems by blocking the airway. Mx with topical steroid drops or spray.
63
Management of facial nerve palsy secondary to acute otitis media
Looks like bells palsy Patients usually make a full recovery but may need emergency grommet insertion so emergency ENT referral is needed.
64
What medications can cause tinnitus
high dose aspirin, quinine, aminoglycosides, cytotoxic drugs for chemo eg cisplastin, occasionally loop diuretics.
65
Protrusion of the pinna may suggest what?
Mastoiditis
66
Retraction pocket in the tympanic membrane may suggest what?
Cholesteatoma
67
Vesicles in the ear canal may suggest what?
Ramsey hunt syndrome
68
Management of facial nerve palsy
Need same day ENT review to exclude malignant otitis externa
69
what is malignant otitis externa
It is a potentially life threatening progressive infection of the external ear canal causing osteomyelitis of the temporal bone and adjacent structures. May be associated with diabetes, other immunocomp, older age, ENT RT, previous ear surgery or irrigation. Presents with umremitting pain, purulent ear discharge, systemic illness, hearing loss, granulation tissue in the ear canal, and possible facial nerve palsy.
70
Presentation of acute otitis externa
itch, pain, discharge of the ear canal, hearing loss, tragal tenderness, or pinna tenderness, red and oedematous ear canal, TM erythema.
71
Presentation of chronic otitis externa
itch in ear canal, dry scaly skin or red moist skin in ear canal, possible signs of fungal infection.
72
Mx of otitis media includes
- self care measures - avoid trauma, ears clean and dry, consider OTC acetic acid 2% drops or spray - manage underlying RF - aural toilet if ear canal debris or exudate - topical antibx or antifungal prep +/- steroid. - FU if persistent or severe symtposm, if immunocomp, or ear canal stenosis or obstruction causing difficulty getting treatment in.
73
How might a foreign body in the nose present
Unilateral purulent nasal discharge sudden onset new snoring
74
What is the cause of hand foot and mouth disease
Coxsackie virus
75
How might coxsackie viruses present
Most commonly hand foot and mouth Can also present with herpangina - mouth and throat ulcers - vesicles appear on the soft palate, tonsillar fauces and uvula. It is highly contagious. Fever usually first sign of infection, then severe sore throat.
76
What medications commonly cause rhinitis
Alpha blockers, beta blockers, aspirin and other NSAIDs, ACEis, COCP, chlorpromazine, and alcohol. (effect of alpha and beta blockers to cause rhinitis is due to vasodilatory effect on blood vessels in the nose).
77
What is the parotid duct (or stensen duct)
Carries saliva from the parotid gland into the mouth, opens near the second upper molar.
78
Classic presentation of idiopathic intracranial hypertension
Pulsatile tinnitus
79
Criteria for acute bacterial rhinosinusitis
Presence of at least 3 of 1. discoloured nasal discharge (unilaateral predominance) 2. severe local pain (unilateral predominance) 3. Fever >38 deg 4. elevated inflam 5. double sickening whereby patients condition deteriorates.
80
When should new onset tinnitus get an immediate referral
if associated with sudden onset neuro signs or symptoms, or acute uncontrolled vestibular symptoms - need to exclude stroke.
81
Gold standard investigation of sialolithiasis
Sialogram This is where ductal opening is cannulated and radiopaque dye administered into the glad. Then XRs at time intervals to visualise ductal system, gland parenchyma, filling defects and strictures.
82
Urgent suspicion of laryngeal cancer
Over 45YO with persistent and unexplained hoarseness (more than 3 weeks). Over 45YO with unexplained lump in the neck
83
What voice problem can inhaled corticosteroids cause
Myopathy of the vocal cords. Reversible on cessation of inhaled steroid.
84
What virus increases risk of laryngeal cancer?
HPV
85
AKT
flashcards
Decks in class (33)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions