Phase 4 Emily > ENT > Flashcards

ENT Flashcards

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1
Q

Define: acoustic neuroma

A

Benign tumours of Schwann cells surrounding the auditory nerve that enervates the inner ear

aka vestibular schwannomas

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2
Q

Presentation: acoustic neuroma

A

cerebeloopontine angle, unilateral

aged 40-60yrs
- Unilateral sensorineural hearing loss (often the first symptom)
- Unilateral tinnitus
- Dizziness or imbalance
- A sensation of fullness in the ear

  • facial nerve palsy
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3
Q

What condition is bilateral acoustic neuromas associated with?

A

Neurofibromatosis type II

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4
Q

Investigations: acoutsic neuroma

A

audiometry = sensorineural

MRI of internal acoustic neuroma

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5
Q

Mx: acoustic neuroma

A

conservative = monitoring
surgery = remove tumour
radiotherapy = reduce growth

complications
- vestibulocochlear and facial nerve injury

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6
Q

Define: benign paroxysmal positional vertigo

A

ommon cause of recurrent episodes of vertigo triggered by head movement. It is a peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain. It is more common in older adults.

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7
Q

Px: BPPV

A
  • head movements trigger vertigo
    turning over in bed
  • settle around 20-60s later
  • episodes occur over several weeks

no hearing loss or tinnitus

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8
Q

Patho: BPPV

A

Crystals of calcium carbonate called otoconia become displaced in semicircular canals
- by viral infection, head trauma, age

disrupt normal flow of endolymph

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9
Q

Mx: BPPV

A

Dix-hallpike manoeuvre = diagnosis (rotatory nystagmus)

Epley = treat

brandt darobff exercise = done by pt at home to improve sx

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10
Q

Location of epistaxis?

A

Bleeding usually originates from Kiesselbach’s plexus, which is located in Little’s area. This is an area of the nasal mucosa

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11
Q

Causes + Px: epistaxis

A

Nose picking
Colds
Sinusitis
Vigorous nose-blowing
Trauma
Changes in the weather
Coagulation disorders (e.g., thrombocytopenia or Von Willebrand disease)
Anticoagulant medication (e.g., aspirin, DOACs or warfarin)
Snorting cocaine
Tumours (e.g., squamous cell carcinoma)

unilateral
and can cause blood in vomit due to swallowing

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12
Q

Mx: epistaxis

A

Mx = learn how to manage, tilt head forwards and squeeze soft part of nostril and spit out any blood

  • Nasal packing using nasal tampons or inflatable packs
  • Nasal cautery using silver nitrate sticks

Naseptin = QID for 10 days to reduce crusting, inflammation, infection

if caused by trauma = nasal haematomas require immediate ENT referral

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13
Q

Define meunière’s

A

long-term inner ear disorder that causes recurrent attacks of
1. vertigo,
2. hearing loss,
3. tinnitus
and a feeling of fullness in the ear.

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14
Q

Patho: Menieres

A

excessive buildup of endolymph in the labyrinth of the inner ear
causes increased pressure = end-lymphatic hydrops

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15
Q

Px: meniere

A

40-50yrs
- unilateral
- vertigo
- hearing loss
- tinnitus
- fullness
- unexplained falls without loss of consciousness
- imbalance

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16
Q

Mx: Menieres

A

Management involves:

Managing symptoms during an acute attack
Prophylactic medication to reduce the frequency of attacks

For acute attacks, short-term options for managing symptoms include:

Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Prophylaxis is with:

Betahistine

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17
Q

Define: obstructive sleep apnoea

A

collapse of pharyngeal airway
- causes episodes of apnoea in sleep

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18
Q

RF: OSA

A

Middle age
Male
Obesity
Alcohol
Smoking

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19
Q

Px: OSA

A

Episodes of apnoea during sleep (reported by their partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep

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20
Q

What scale is used for assessing OSA?

A

Epworth sleepiness scale
- assess symptoms of sleepiness associated with obstructive sleep apnoea.

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21
Q

Mx: OSA

A
  • ENT referral
  • sleep studies

1) correct lifestyle = stop alcohol, smoking, weight lose

2) CPAP

3) surgery = uvulopalatopharyngoplasty (UPPP).

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22
Q

define: otitis externa

A

inflammation of the skin in the external ear canal.

The infection can be localised or diffuse. It can spread to the external ear (pinna). It can be acute (less than three weeks) or chronic (more than three weeks).

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23
Q

Px: otitis externa

A

Ear pain
Discharge
Itchiness
Conductive hearing loss (if the ear becomes blocked)

Examination can show:

Erythema and swelling in the ear canal
Tenderness of the ear canal
Pus or discharge in the ear canal
Lymphadenopathy (swollen lymph nodes) in the neck or around the ear

The tympanic membrane may be obstructed by wax or discharge. It may be red if the otitis externa extends to the tympanic membrane.

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24
Q

Causes: otits externa

A

swimming
trauma = cotton buds, earplugs

Bacterial infection = Pseudomonas aeruginosa
Staphylococcus aureus
Fungal infection (e.g., aspergillus or candida)
Eczema
Seborrhoeic dermatitis
Contact dermatitis

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25
Mx: otitis externa
1) acetic acid 2% 2) topical abs and steroids e.g. otomise spray - neomycin, dexamethasone and acetic acid 3) oral abs /ent referral
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Malignant otits externa
infection spread to bones surrounding ear canal and skull it progresses to osteomyelitis of the temporal bone of the skull. Malignant otitis externa is usually related to underlying risk factors for severe infection, such as: Diabetes Immunosuppressant medications (e.g., chemotherapy) HIV
27
Define: otitis media
infection in the middle ear This is where the cochlea, vestibular apparatus and nerves are found. Bacteria enter from the back of the throat through the eustachian tube. A viral upper respiratory tract infection often precedes bacterial infection of the middle ear.
28
Common bacterial causes: otitis media
streptococcus pneumoniae. This also commonly causes other ENT infections such as rhino-sinusitis and tonsillitis. Other common causes include: Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus
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Px: otitis media
ear pain Reduced hearing in the affected ear Feeling generally unwell, for example with fever Symptoms of an upper airway infection such as cough, coryzal symptoms and sore throat
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Mx: otitis media
most will resolve without abs within 3 days 1) delayed abx 2) immediate abx 3) no abx Amoxicillin for 5-7 days first-line Clarithromycin (in pencillin allergy) Erythromycin (in pregnant women allergic to penicillin)
31
Complications: otitis media
Otitis media with effusion Hearing loss (usually temporary) Perforated tympanic membrane (with pain, reduced hearing and discharge) Labyrinthitis (causing dizziness or vertigo) Mastoiditis (rare) Abscess (rare) Facial nerve palsy (rare) Meningitis (rare)
32
Define: sinusitis
inflammation of paranasal sinuses aka rihnosinusitis acute <12 weeks chronic >12 weeks
33
What are the different sinuses?
Frontal sinuses (above the eyebrows) Maxillary sinuses (either side of the nose below the eyes) Ethmoid sinuses (in the ethmoid bone in the middle of the nasal cavity) Sphenoid sinuses (in the sphenoid bone at the back of the nasal cavity)
34
Causes: sinusitis
Infection, particularly following viral upper respiratory tract infections Allergies, such as hayfever (with allergic rhinitis) Obstruction of drainage, for example, due to a foreign body, trauma or polyps Smoking
35
Px: sinusitis
ecent viral upper respiratory tract infection presenting with: Nasal congestion Nasal discharge Facial pain or headache Facial pressure Facial swelling over the affected areas Loss of smell Examination may reveal: Tenderness to palpation of the affected areas Inflammation and oedema of the nasal mucosa Discharge Fever Other signs of systemic infection (e.g., tachycardia)
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Ix: sinusitis
if persistent Nasal endoscopy CT scan
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Mx: sinusitis
No abx for up to 10 days Sx not improving post 10 days - high dose steroid nasal spray fro 14 days - delayed abx prescription e.g phenoxymethylpenicillin systemic infection/sepsis = admission Options for chronic sinusitis are: Saline nasal irrigation Steroid nasal sprays or drops (e.g., mometasone or fluticasone) Functional endoscopic sinus surgery (FESS)
38
Causes of tonsillitis?
viral infection MC bacterial MC = group A strep --> pen V
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Centro criteria
Fever over 38ºC Tonsillar exudates Absence of cough Tender anterior cervical lymph nodes (lymphadenopathy) >3 = more likely bacterial, can give abx
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FeverPAIN score
Fever during previous 24 hours P – Purulence (pus on tonsils) A – Attended within 3 days of the onset of symptoms I – Inflamed tonsils (severely inflamed) N – No cough or coryza >4 = abx
41
Mx: tonsillitis
admission: - immunocompromised - systemically unwell - dehydrated - stridor - resp distress - peritonsillar abscess - cellulitis pen V for 10days clarithromycin = pencillin allergy
42
Complications of tonislitis
Peritonsillar abscess, also known as quinsy Otitis media, if the infection spreads to the inner ear Scarlet fever Rheumatic fever Post-streptococcal glomerulonephritis Post-streptococcal reactive arthritis
43
Indications for tonsillectomy
7 or more in 1 year 5 per year for 2 years 3 per year for 3 years Other indications are: Recurrent tonsillar abscesses (2 episodes) Enlarged tonsils causing difficulty breathing, swallowing or snoring all post tonsillectomy haemorrhages = referral to ENT
44
Complications of tonsillectomy
bleeding within 6-8hrs = immediate return to theatre secondary haemorrhage 5-10days post surgery = wound infection = admission and abx
45
Types of peripheral vertigo
- BPPV - meniere - Vestibular neuronitis - labyrinthitis
46
Define: acute vestibular neuritis
inflammation of vestibular nerve - due to viral infection
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Px: vestibular neuronitis
- vertigo - n+V - sometimes horizontal nystagmus - NO hearing sx recent hx of viral infection
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Mx: Vestibular neuritis
HiNTs exam = used to distinguish from poster circulation stroke Buccal or IM prochlorperazine for severe cases Normal = oral prochlorperazine or an antihistamine
49
Define: labyrinthitis
Inflammation fo structures in the inner ear - due to viral infection - acute onset that improves within a fee weeks distinguished from vestibular neuronitis due to causing hearing loss
50
Px: labrynthitis
sudden onset horizontal nystagmus hearing disturbances nausea + v constant vertigo tinnitus continuous sx (meniere is episodes) recent viral illness
51
What are central causes of vertigo?
Posterior circulation infarction (stroke) Tumour Multiple sclerosis Vestibular migraine
52
HINTs examination for vertigo
distinguish between central and peripheral vertigo. It stands for: HI – Head Impulse (jerks head in 1 direction while fixing eyes on an dr nose) N – Nystagmus TS – Test of Skew (cover 1 eye at a time, see of head moves to correct)
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Mx: vertigo
peripheral - prochloperazone - antihistamines
54
Define: infectious mononucleosis
infections with Epstein Barr virus - found in saliva of infected individuals
55
Px: EBV
Fever Sore throat Fatigue Lymphadenopathy (swollen lymph nodes) Tonsillar enlargement Splenomegaly and in rare cases splenic rupture itchy macupapular rash post amoxicillin/cefalosporins
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Ix: EBV
Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result. Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep. IgM and IgG antibody test
57
Mx: EBV
usually self-limiting 2- 3 weeks cause fatigue avoid alcohol
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Complications: EBV
Complications Splenic rupture Glomerulonephritis Haemolytic anaemia Thrombocytopenia Chronic fatigue
59
Define: Quincy
peritonsillar abscess. Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils.
60
Px: Quincy
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
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Bacterial cause of Quincy
strep progenies - group a strep
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Mx: Quincy
needle aspiration or surgical incision and drainage Dexamethasone
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Define: cholesteatoma
abnormal collection of squamous epithelial cells in the middle ear - cells proliferate and damage ossicles
64
Px: cholesteatoma
foul discharge unilateral conductive hearing loss pain fever facial nevre palsy otoscope = attic crust
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Mx : cholestateoma
referral to ENT Ct head surgical removal
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Px: nasal polyps
nasal obstruction rhinorrhoea, sneezing poor sense of taste and smell red flag = unilateral or bleeding
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Mx: nasal polyps
- all patients with suspected nasal polyps should be referred to ENT for a full examination - topical corticosteroids shrink polyp size
68
What is Samter's triad?
1. asthma 2. aspirin sensitivity 3. nasal polyposis
69
Define: mastoiditis
infection spreads from the middle to the mastoid air spaces of the temporal bone
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Px: mastoiditis
- otalgia: severe, classically behind the ear - history of recurrent otitis media - fever - swelling, erythema and tenderness over the mastoid process - external ear may protrude forwards - ear discharge = present if TM perforated
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Mx: mastoiditis
Ix: clinical but may order CT if complications suspected Mx: - IV antibiotics
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Complications: mastoiditis
facial nevre palsy hearing loss meningitis
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Px: branchial cyst
benign developmental defect - unilateral, left side - slowly enlarging - smooth, non-fluctuent - NO movement on swelling
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Ix + Mx: branchial cyst
consider and exclude other malignancy ultrasound referral to ENT fine-needle aspiration Mx - Ent surgeons
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Types of neck lumps in children?
congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation inflammatory: reactive lymphadenopathy, lymphadenitis, neoplastic: lymphoma, thyroid tumour, salivary gland tumour
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Px: thyroglossal cyst
- midline - moves with tongue protrusion
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Define: Ramsay hunt syndrome
caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
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Px: Ramsay Hunt syndrome
auricular pain is often the first feature facial nerve palsy - can't close eye vesicular rash around the ear other features include vertigo and tinnitus
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Mx: Ramsay Hunt Syndrome
- oral high dose aciclovir - oral high dose corticosteroids - eye protection
80
Define: otosclerosis
replacement of normal bone by vascular spongy bone. - esp stapes bone - Fh = autosomal dominant
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Px: otosclerosis
- progressive conductive deafness - tinnitus - FH - TM = falmingo tinge - age 20-40yrs
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Mx: otosclerosis
- hearing aid - stapedectomy
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Px: Presbycusis
age related hearing loss - bilaterally - sensorineural hearing loss - high frequency hearing loss
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Mx: sudden hearing loss
mostly idiopathic - urgent referral to ENT and high dose steroids (may help recover hearing)
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what medications can cause sensorineural hearing loss?
- loop diuretics - aminoglycoside antibiotics e.g. gentamicin - chemo drugs = cisplatin
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What systemic conditions cause tinnitus?
- anaemia - diabetes - hypothyroidism or hyperthyroidism - hyperlipidaemia
87
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