1
Q
What is labyrinthitis?
A
Infection of the inner ear
2
Q
What causes labyrinthitis?
A
Bacterial
Viral (most common)
Systemic disease
3
Q
What anatomical structures are affected in labyrinthitis and how is it different to vestibular neuronitis?
A
L: vestibular nerve and the labyrinth aka cochlear nerve -> vertigo and hearing issues (Labyrinthitis=Loss)
VN: just vestibular nerve -> no hearing issues, just dizziness (Neuronitis=No loss)
4
Q
What age is typically affected by labarynthitis?
A
40-70
5
Q
What are the symptoms of labarynthitis?
A
vertigo: not triggered by movement but exacerbated by movement
nausea and vomiting
hearing loss: may be unilateral or bilateral, with varying severity
tinnitus
preceding or concurrent symptoms of upper respiratory tract infection
6
Q
How is gait affected in labarynthitis?
A
the patient may fall towards the affected side
7
Q
What sort of hearing loss does labarynthitis cause?
A
Sensorineural
8
Q
What eye signs might be present in labyrinthitis?
A
spontaneous unidirectional horizontal nystagmus towards the unaffected side
9
Q
How is labyrinthitis diagnosed?
A
History and exam
10
Q
How is labyrinthitis managed?
A
episodes are usually self-limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness
11
Q
What causes vestibular neuronitis?
A
Inflammation of the vestibular nerve, often caused by a viral infection
12
Q
What test can be used to diagnose peripheral causes of vertigo?
A
Head impulse test
Examiner holds the patient’s head and rapidly jerks it 10-20 degrees in one direction while the patient continues looking at the examiner’s nose. The head is slowly moved back to the centre before repeating in the opposite direction
Patient with a normally functioning vestibular system will keep their eyes fixed on the examiner’s nose.
Patient with an abnormally functioning vestibular system (e.g., vestibular neuronitis or labyrinthitis), the eyes will saccade (rapidly move back and forth) as they eventually fix back on the examiner.
12
Q
What is the pathophysiology of vestibular neuronitis?
A
Inflammation in the vestibular nerve distorts the signals travelling from the vestibular system to the brain, confusing the signal required to sense movements of the head. This results in episodes of vertigo, where the brain thinks the head is moving when it is not.
13
Q
How does vestibular neuronitis present?
A
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
14
Q
How is vestibular neuronitis managed?
A
Buccal or intramuscular prochlorperazine - provides rapid relief for severe cases
Short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) - relief for less severe cases
15
Q
What are the causes of otitis externa? Which is most common?
A
Bacterial/viral/fungal infection, allergic, skin irritation (such as dermatitis)
Bacterial is most common
16
Q
Which bacteria most commonly cause otitis externa?
A
P. aeruginosa, S. aureus
P.aer.. is ear misspelled
17
Q
What is acute otitis externa?
A
≤ 3 weeks of symptoms and signs of ear canal inflammation, usually with rapid onset (generally within 48 hours)
18
Q
What is chronic otitis externa?
A
≥3 months of symptoms and signs of chronic inflammation of the middle ear and mastoid cavity (e.g. persistent on recurrent ear discharge).
19
Q
What age group is most affected by otitis externa?
A
5-15
20
Q
What are the risk factors for otitis externa?
A
Swimming
Humid air
Young age
Diabetes
Trauma
Narrow external auditory meatus
Obstructed external auditory meatus
Eczema, psoriasis
Radiotherapy
21
Q
How does otitis externa present?
A
Itchy
Tenderness
Ear pain
Hearing loss
Discharge
Inflamed externa auditory canal
Pre-auricular lymphadenopathy
22
Q
How is otitis externa managed first line?
A
Analgesia
Topical antibiotics +/- steroids (e.g. Otomize)
Avoid water
Avoid cotton swabs in the ear
23
Q
How is otitis externa managed second line if topical antibiotics +/- steroids aren’t working and the infection is spreading?
A
Oral flucloxacillin
24
How is otitis externa managed third line if topical and oral antibiotics haven't worked?
Refer to ENT
25
What is a complication of otitis externa?
Malignant/necrotising otitis externa
26
What is malignant otitis externa?
Rare life-threatening condition where the infection spreads to the surrounding bone
27
How is malignant/necrotising otitis externa investigated and managed?
CT head
IV abx - tazocin or cefotaxime
28
What age group are mostly affected by otitis media?
Children aged 0-4
29
What are the most common bacterial causes of otitis media?
S. pneumoniae, H. influenzae, S. pyogenes
30
What are the most common viral causes of otitis media?
RSV
Rhinovirus
Adenovirus
Influenza
31
What is the pathophysiology of otitis media?
URTI --> pathogens transmitted to middle ear via eustachian tube --> infection in middle ear
32
How does otitis media present in neonates?
Irritability
Difficulty feeding
Fever
33
How does otitis media present in young children?
Holding or tugging ear
Irritability
Fever
34
How does otitis media present in older children?
Otalgia (ear pain)
Hearing loss
Fever
35
How is otitis media diagnosed?
Otoscopy
Red, yellow or cloudy tympanic membrane
Bulging tympanic membrane or perforated membrane
Air-fluid level behind the tympanic membrane
36
How is mild otitis media managed?
Analgesia
Antipyretics such as paracetamol and ibuprofen
Self limiting
37
When might antibiotics be required in otitis media?
Immediately: Systemically very unwell, have symptoms and signs of a more serious illness or condition, at high-risk of complications
Considered: Children with otorrhoea, children 2 with bilateral symptoms
38
What antibiotic might be considered in otitis media?
Amoxicillin 500mg TDS 7 days
39
When might hospital admission be required in otitis media?
Evidence of a severe systemic infection
Evidence of an acute complication: mastoiditis, meningitis, intracranial abscess, sinus thrombosis or facial nerve paralysis.
40
What is a complication of otitis media?
Perforation of tympanic membrane
Hearing loss
Acute mastoiditis - infection travels backwards
41
How is acute mastoiditis managed 1st line?
24 hours of IV abx - tazocin, or metro/cipro if pen allergic
42
How is acute mastoiditis managed second line?
Tympanocentesis
Myringotomy +/- grommet/ventilation/tympanostomy tube insertion
Cortical mastoidectomy
43
What is otitis media with effusion?
Glue ear - eustachian tube becomes blocked --> fluid to becomes trapped --> fluid becomes thick and sticky
44
What are the RFs for OME?
male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking
45
What are the symptoms of OME?
Hearing loss is usually the presenting feature
Earache
Fullness in the ear
Secondary problems such as speech and language delay, behavioural or balance problems may also be seen
46
How might OME look on otoscopy?
Dull, retracted eardrum
47
How is OME managed at first presentation?
Active observation for 3 months - no intervention is required as will likely self-resolve
48
How is OME managed if it does not resolve, or if there is significant hearing loss on 2 occasions 12w apart?
Referral to ENT
Grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube.
Adenoidectomy
49
How is OME managed in children with Down's or a cleft palate?
Immediate referral to ENT without observation period
50
What is a subperichondrial haematoma?
Haematoma on the auricle caused by trauma
Perichondrium lifts and bleeding occurs underneath
51
How is a subperichondrial haematoma managed? What happens if it isn't managed appropriately?
Aspiration/drainage
Cartilaginous necrosis -> cauliflower ear (rugby players)
52
How are traumatic inner ear tympanic membrane perforations managed?
Keep the ear dry
Review in a month - 90% are self-healing
53
How is a foreign body in the ear managed?
Syringe with warm water and olive oil
Don't use forceps for round objects - might push it in further
54
What are the potential causes of facial palsy?
Forehead sparing (central):
Stroke
Non-forehead sparing (only the facial nerve):
Otologic
Parotid
Idiopathic (Bell's palsy)
55
How is Bell's palsy managed?
Prednisolone 1mg/kg
Eye drops / taping eyes at night / artificial tears
56
What are potential complications of a nasal fracture?
Septal haematoma
Orbital fracture
Skull base fracture - blood from ears, racoon eyes, Battle's sign
57
How is a septal haematoma managed?
Drainage - done quickly to avoid permanent damage to the septum
58
How is a nasal fracture managed?
Correction within 14 days
If not possible, rhinoplasty after 6 months
59
What is the difference between acute and chronic rhinosinusitis?
Acute <12 weeks
Chronic >12 weeks
60
What is the most common cause of acute rhinosinusitis?
Viral - rhinovirus, parainfluenza, influenza
61
62
What are the bacterial causes of acute rhinosinusitis?
S. pneumoniae
H. influenzae
etc
63
What causes chronic rhinosinusitis?
Bacterial infection, allergy, defective mucocillary clearance - multifactorial and complex
Systemic disorders like sarcoidosis, granulomatosis with polyangiitis
64
What are the risk factors for acute rhinosinusitis?
Smoking, older age, air travel, deep sea diving, swimming and asthma
65
What are the risk factors for chronic sinusitis?
Allergic rhinitis
Environmental irritants
Immunodeficiency
Defective mucocilliary clearance
Recurrent URTIs
Abnormal anatomy leading to sinus obstruction (e.g. deviated septum)
Smoking
Asthma
66
How does acute rhinosinusitis present?
Nasal congestion, nasal discharge, loss of smell, coryza, and facial pressure/pain that is worse on bending forward, headache
67
What symptoms of acute rhinosinusitis might indicate a bacterial infection?
Symptoms >10 days, discoloured/purulent discharge, severe local pain, fever >38º, ‘double worsening’. ‘Double worsening or sickening’ describes worsening symptoms after an initial period of symptom resolution.
68
What are the signs of acute rhinosinusitis?
Facial tenderness
Post nasal exudate
Tender maxillary dentition
Middle ear effusion
69
What are the symptoms of chronic rhinosinusitis?
Nasal congestions, nasal discharge, facial pain/pressure, reduced/absent smell
May have polyps
70
What are the diagnostic criteria for acute sinusitis in adults?
Inflammation <12 weeks plus 2 of:
- Nasal congestion/discharge
- Facial pain/pressure/headache
- Loss of smell
71
What are the diagnostic criteria for acute sinusitis in children?
Inflammation <12 weeks plus 2 of:
- Nasal congestion
- Discoloured nasal discharge
- Cough
72
What are the diagnostic criteria for chronic rhinosinusitis in adults?
Clinical features (≥2): Nasal congestion, nasal discharge, facial pain or pressure, absent or reduced smell
Objective mucosal inflammation (≥1): Purulent mucus or oedema in the nasal cavity, mucosal thickening or paranasal sinus opacification on imaging, and/or nasal polyps
73
What can be done to confirm evidence of sinonasal inflammation in chronic sinusitis?
Mucopurulent mucus, oedema, or polyps on examination.
Radiographic evidence of sinonasal inflammation.
Endoscopic or CT (computed tomography) evidence of sinonasal inflammation.
74
What are the diagnostic criteria for chronic rhinosinusitis in children?
Clinical features (≥2): nasal congestion, facial pain/pressure/headache, cough
Objective mucosal inflammation (≥1): Purulent mucus or oedema in the nasal cavity, mucosal thickening or paranasal sinus opacification on imaging, and/or nasal polyps
75
What is a red flag for chronic rhinosinusitis?
Unilateral symptoms
76
How is acute sinusitis managed?
Supportive measures - antipyretics, analgesia, saline irrigation, steam inhalation
Nasal decongestants (oxymetazoline)
Nasal saline irrigation
Nasal corticosteroids 14 days (momestasone)
77
What is a complication of using prolonged nasal decongestants?
Increasing doses are required to achieve the same effect (tachyphylaxis)
78
When should antibiotics be offered in acute sinusitis?
Symptoms >10 days
79
What antibiotic is offered first line in acute sinusitis?
Phenoxymethylpenicillin (1st line)
Co-amoxiclav (if systemically unwell)
80
How long does acute sinusitis tend to last?
4 weeks
81
How is chronic sinusitis managed?
Avoid allergic triggers
Stop smoking
Consider antibiotics
Consider a 3m course of intranasal corticosteroids (mometasone)
Consider referral to ENT
82
When should patients with any form of sinusitis be admitted to hospital?
Severe systemic infection
Sepsis
Intraorbital/periorbital complications
Intracranial complications such as meningitis, focal neurology, severe frontal swelling
83
What is a complication of acute sinusitis?
Pott's Puffy (???): sinusitis erodes the bone -> subperiosteal abscess in the forehead
Periorbital cellulitis
Orbital cellulitis
Osteomyelitis
Intracranial abscess
84
How is cellulitis around the eye classified?
Chandler Classification
85
How is epistaxis managed?
Nasal packing - stops bleeding
Cautery with silver nitrate - seals the bleeding vessel
86
Where does epistaxis usually originate?
90% Little's area (Kiesselbach's plexus) - children
10% posterior - elderly
87
What are the risk factors for epistaxis?
Trauma
Elderly/young
Hypertension
Cardiac disease
Liver/kidney disease
Coagulation defect
Anticoagulants
88
What causes tonsilitis?
Viral - rhinovirus, influenza virus, EBV
Bacteria - S. pyogenes (most common), S. aureus, S. pneumoniae
89
What are the symptoms of tonsilitis?
Sore throat
Dysphagia
Generally unwell, malaise
Fevers
90
What are the signs of tonsilitis?
Enlarged and erythematous tonsils (any)
Exudative tonsils (bacterial specifically, or EBV)
Cervical lymphadenopathy (bacterial) or generalised lymphadenopathy (EBV)
91
What are the signs and symptoms of EBV?
Low grade fever
Malaise
Fatigue
Myalgia
Sweats
Anorexia
Cervical lymphadenopathy, plus more generalised lymphadenopathy
Sore throat
Exudative tonsils
Hepatosplenomegaly
92
What scores are used for diagnosis of tonsilitis?
FeverPAIN
Centor
93
What are the Centor criteria?
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough
94
What are the feverPAIN criteria?
Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)
95
How is infectious mononucleosis (EBV) diagnosed in children <4 or immunocompromised adults?
EBV antibodies after 7 days - IgM suggests acute, IgG suggests immunity
LFTs based on clinical judgement
96
How is infectious mononucleosis (EBV) diagnosed in children >4 or immunocompetent adults?
FBC in the second week of illness - raised lymphocytes
Monospot test in the second week of illness
LFTs based on clinical judgement
97
What FeverPAIN score requires antibiotics?
Those with a FeverPAIN score of 2-3 may benefit
Those with a FeverPAIN score of 4-5 will generally be offered antibiotics
98
What Centor score requires antibiotics?
Those with a Centor score of 3-4 will generally be offered antibiotics
99
When might tonsilitis be treated with antibiotics, despite a low Centor/FeverPAIN score?
Young infants, immunocompromised people, significant comorbidity, history of rheumatic fever
100
How is tonsillitis managed?
Fluids
Analgesia
+/- 10 day course of penicillin V (because you don't want to risk amoxicillin in case of glandular fever) depending on cause and severity
101
When might tonsilitis require hospital admission?
Signs of upper airway obstruction.
Difficulty swallowing fluids or signs of severe dehydration.
Severe systemic illness.
Acute upper abdominal pain (may indicate acute hepatitis or splenic rupture).
102
How is severe tonsilitis managed in hospital?
IV fluid, antibiotics and a dose of IV steroids, may be admitted overnight for observation and reassessed after 12-24 hours of IV therapy.
103
How is glandular fever managed?
Self resolving - painkillers and fluids
104
What advice should be given to someone with glandular fever?
Good hand and respiratory hygiene practices - avoid kissing and sharing food and utensils, and clean all items that may have been contaminated by saliva
AVoid heavy lifting and contact sports for 3 weeks to reduce risk of splenic rupture
Avoid alcohol
105
What might happen if glandular fever is treated with amoxicillin or cephalosporins?
Itchy, maculopapular rash
106
How long does EBV last?
2-4 weeks
107
What are the indications for a tonsillectomy?
Patients meet the criteria for tonsillectomy if they have had 7 documented sore throats in the last year or 5 documented in each of the last 2 years or 3 documented in each of the last 3 years
108
How should a patient experiencing bleeding <8 hours after a tonsillectomy (primary haemorrhage) be managed?
Return to theatre for surgical management
109
How should a patient experiencing bleeding >24 hours after a tonsillectomy (secondary haemorrhage) be managed?
Immediate referral to ENT
110
What is a complication of tonsillitis?
Quinsy - peritonsillar abscess
111
What causes quinsy?
Group A strep (S. pyogenes)
S. aureus
H. influenzae
Anaerobes
112
What are the symptoms of quinsy?
Sore throat, fevers, dysphagia and may complain of trismus (ability to open mouth) or altered voice.
113
What are the signs of quinsy?
Peritonsillar swelling
Exudate
Drooling
Stertor (sound caused by upper airway obstruction)
Displacement of uvula (away from the side of abscess)
Fetid breath
114
How is quinsy investigated?
Bloods - FBC, U&Es, CRP, LFTs, EBV IgM antibody if EBV is suspected
Intraoral US (rarely used)
115
How is quinsy managed?
IV antibiotics and needle aspiration/surgical drainage, and a tonsillectomy should be considered in 6 weeks
116
How is a peritonsillar abscess managed?
IV fluids
Topical analgesia
Incision and drainage
IV Antibiotics - pen + metro/clinda
IV steroids - dex
117
What is a dermoid cyst?
Lump, common in the midline of the neck, external angle of the eye and posterior to the pinna of the ear. They typically have multiple inclusions such as hair follicles that bud out from its walls.
118
What is a thyroglossal cyst?
A neck lump, usually midline, between the isthmus of the thyroid and the hyoid bone
119
What is a cystic hygroma?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side. Commonly evident at birth
120
What is a branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
121
How does a thyroglossal cyst present?
Typically present during childhood <10yo as a gradually growing painless fluctuant cervical mass
May remain asymptomatic until they become infected, in which case they can present at any time
If infected - red, hot, swollen, painful
122
What can be done in an exam to differentiate a thyroid lump and a thyroglossal cyst?
Stick their tongue out - thyroglossal cysts are attached to the hyoid bone, which is attached to the muscles of the tongue, so it will move with the tongue
Thyroid lumps will not move
123
How is a thyroglossal cyst diagnosed?
Neck ultrasound
Biopsy
124
How is a thyroglossal cyst managed?
Sistrunk procedure - resection of the middle third of the hyoid bone.
125
How does a dermoid cyst present?
A rubbery, solitary nodule 1-4
Non-compressible, non-tender, skin coloured
If infected - red, hot, swollen, painful
126
How is a dermoid cyst diagnosed?
Neck US
CT/MRI
Biopsy to rule out other conditions
127
How is a dermoid cyst managed?
Surgical excision
If infected - incision and drainage + abx
128
What are some peripheral causes of vertigo?
Vestibular neuritis
Labyrinthitis
Meniere's disease
Vestibular ototoxicity
129
What are some central causes of vertigo?
Migraine
Stroke/TIA
Vestibular schwannoma
MS
Cerebellar tumour
130
Where do acoustic neuromas arise?
Eight cranial nerve / vestibulocochlear nerve in the cerebellopontine angle (between the cerebellum and pons of the brainstem)
131
From what cells are acoustic neuromas derived?
Schwann cells
132
What genetic conditions increase risk of an acoustic neuroma?
Neurofibromatosis increases risk of bilateral acoustic neuromas
Other RFs have conflicting evidence
133
What are the symptoms of an acoustic neuroma?
Unilateral sensorineural hearing loss, tinnitus, dizziness, vertigo, headaches, gait dysfunction
Facial numbness (CNV)
Facial weakness, dry eyes, dry mouth (CNVII)
Dysarthria/dysphagia (lower CNs)
134
What are some signs of acoustic neuromas?
Cerebellar signs: nystagmus, ataxia
Papilloedema: due to raised intracranial pressure
Signs only develop at a late stage
135
What are some signs of NF2?
Bilateral acoustic neuroma
Pigmented plaque-like cutaneous lesions
Subcutaneous nodules
Cataracts
Peripheral neuropathy
Seizures
136
How is an acoustic neuroma diagnosed?
Audiometry for sensorineural hearing loss
MRI brain for localising the tumour
137
How are acoustic neuromas classified?
The Koos classification is used to grade acoustic neuromas as I-IV based on its size and location
138
How is an acoustic neuroma managed?
Surgical excision - larger tumours >3cm
Stereotactic/conventional radiotherapy - smaller tumours <3cm
Observation and 6-12 monthly MRI monitoring - smaller or asymptomatic tumours
139
What are some complications of acoustic neuromas?
Compression and damage to surrounding structures: cranial nerve palsies (e.g. facial, vestibulocochlear), hydrocephalus, and cerebellar dysfunction.
140
What causes BPPV?
Loose calcium carbonate crystals in the semilunar canals of the ear -> head movements move the crystals (otoconia) -> disrupts the movement of the endolymph -> vertigo
141
When is the peak incidence of BPPV?
50-70
142
What are the symptoms of BPPV?
Short episodes of positional vertigo typically lasting < 1 minute, triggered by head movements or positional changes
Nausea and vomiting associated with vertigo
NO hearing loss of tinnitus
143
How is BPPV diagnosed?
Dix-Hallpike manoeuvre
144
What are the contraindications to the Dix-Hallpike manoeuvre?
Neck trauma, spinal fractures, cervical disc prolapse, vertebrobasilar insufficiency, carotid sinus syncope, recent stroke or CABG, and back/spinal pain
145
What are the typical findings of a positive Dix-Hallpike manoeuvre?
Transient vertigo and torsional nystagmus following a latent period
146
What is second line following the Dix-Hallpike manoeuvre if it is negative or weak, or if there are other contradicting symptoms?
MRI or CT head to rule out neurological cause
147
How is BPPV managed?
Watchful waiting - 50% of cases resolve in 3 months
Epley manoeuvre - displace the otoconia from the semicircular canals into the utricle, done by a professional
Brandt-Daroff Manoeuvre - done by the patient
148
What causes Meniere's disease?
Abnormal production and absorption of endolymph (endolymphatic hydrops) distending and distorting the endolymphatic system
149
What age group is generally affected by Meniere's disease?
50s
150
What are the risk factors for Meniere's?
Genetic susceptibility
Autoimmune diseases
Viral infections
Migraines
Trauma
Syphilis
151
What are the signs and symptoms of Meniere's disease?
Triad of vertigo, tinnitus and hearing loss
Vertigo anywhere from 20m-24h
May start off temporary and become permanent over time
Aural fullness
152
How is Meniere's investigated?
Clinical diagnosis but tests can be done
Bloods - FBC, U&Es, TFTs, lipids, syphilis screen
Audiogram - sensorineural hearing loss
MRI - rules out acoustic neuroma
153
How is Meniere's managed?
For acute attacks:
- Prochlorperazine
- Cinnarizine, cyclizine, promethazine
- For nausea, vomiting and vertigp
For prophylaxis:
- Betahistine
154
155
What causes obstructive sleep apnoea?
Collapse of the pharynx obstructing the airways
156
How does OSA present?
Episodes of apnoea during sleep (reported by a partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep
157
How is sleepiness assessed in OSA?
Assessment of sleepiness
Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
158
How is OSA investigated?
Sleep studies (polysomnography) - ranging from monitoring of pulse oximetry at night to full polysomnography where a wide variety of physiological factors are measured including EEG, muscle activity (EMG), heart activity (ECG), respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry
159
How is OSA managed (lifestyle)?
Reduced alcohol
Weight loss
Smoking cessation
160
How is OSA managed (devices)?
Continuous positive airway pressure (CPAP) machines provide constant pressure to maintain airway patency.
161
What must be considered in patients with severe OSA and daytime sleepiness?
Informing the DVLA
Asking about their work - may need adjusted duties for a while if they do something potentially dangerous
162
What are the complications of OSA?
Hypertension
HF
Increased risk of MI and stroke
163
What is Rinne's test?
Place vibrating 512Hz tuning fork on the mastoid process -> ask patient when they can hear it when when it stops (bone conduction) -> when they can no longer hear it, move it in front of the ear canal (air conduction)
164
What is a normal Rinne's test?
If the patient can hear the sound in the air after they stopped hearing it on the bone, it suggests air conduction is better than air conduction --> normal --> "Rinne's positive"
165
What does a Rinne's negative result indicate?
Bone conduction > air conduction = issue with air conduction = conductive hearing loss
166
What is a normal Weber's test?
Sound is heard equally in both ears
167
What Weber's test result shows sensorineural hearing loss?
sound is heard louder on the side of the intact ear.
168
What Weber's test result shows conductive hearing loss?
Sound is heard louder on the side of the affected ear
169
How should a patient with unexplained hoarseness aged >45 be managed?
Urgent referral to ENT and CXR (?laryngeal cancer, excluding an apical lung lesion impinging on laryngeal nerve_)
170
When should a suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over?
Persistent unexplained hoarseness or
An unexplained lump in the neck.
171
How does Ramsey-Hunt present?
Facial nerve palsy
Vesicular rash - ear, anterior 2/3 of tongue/palate
172
How is Ramsey-Hunt managed?
Oral aciclovir and prednisolone
173
What is otosclerosis?
Replacement of normal bone by vascular spongy bone, causing a progressive conductive deafness due to fixation of the stapes at the oval window.
174
When does otosclerosis develop?
20-40s
175
How is otosclerosis inherited?
Autosomal dominant
176
How does otosclerosis present?
Conductive deafness
Tinnitus
177
How is otosclerosis managed?
hearing aid
stapedectomy
178
What is first line for impacted ear wax?
1 week of olive oil drops then review
179
On an audiogram, what is normal hearing?
>20dB
180
How should unilateral glue ear be managed in an adult and why?
2ww to ENT
Unilateral glue ear in an adult needs evaluation for a posterior nasal space tumour
181
What is presbycusis?
Presbycusis describes age-related sensorineural hearing loss. Patients may describe difficulty following conversations
182
What does audiometry show in presbycusis?
Audiometry shows bilateral high-frequency hearing loss
Phase 4
flashcards
Decks in class (19)
# Cards
-
Cardiolovascular272
-
Respiratory18
-
Gastroenterology63
-
Endocrinology12
-
Neurology12
-
Hepatobiliary25
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Nephrology32
-
Haematology26
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Dermatology379
-
Bloods and Electrolytes14
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Obstetrics and Gynaecology2
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Urology4
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ENT183
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Ophthalmology126
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Rheumatology56
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Infectious Disease30
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Psychiatry41
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OSCE171
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Things I got Wrong201
