Medicine Finals > ENT > Flashcards

ENT Flashcards

(71 cards)

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1
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve

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2
Q

What causes vestibular neuronitis?

A

Recent viral infection

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3
Q

What are the 3 parts of the inner ear?

A

Semicircular canals
Vestibule (middle section)
Cochlea

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4
Q

What do the semicircular canals detect?

A

Rotation of the head

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5
Q

What do the otolinth organs detect?

A

gravity and linear acceleration

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6
Q

What fluids are in the inner ear?

A

Endolymph and perilymph

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7
Q

Role of the vestibular nerve

A

balance

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8
Q

The 8th cranial nerve is called the _________ nerve and is comprised of the _________ and _________ nerves

A

vestibulocochlear
- vestibular
- cochlear

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9
Q

How does inflammation of the vestibular nerve cause the symptoms of vestibular neuronitis?

A

distorts the signals travelling from the vestibular system to the brain, confusing the signal required to sense movements of the head

brain thinks the head is moving when it is not

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10
Q

Presentation of vestibular neuronitis

A
  • hx of viral URTI
  • vertigo (constant, worse with head movements)
  • nausea and vomiting (may be severe)
  • balance problems
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11
Q

What is an important differential to rule out when someone presents with virtigo?

A

central causes (rather than inner ear) –> stroke (posterior circulation infarct)

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12
Q

What test is used to diagnose peripheral causes of vertigo?

A

The head impulse test

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13
Q

What is the head impulse test?

A
  • Patient sitting upright and fixing their gaze on the examiner’s nose
  • 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

Results: In a 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

Only diagnoses peripheral causes of vertigo (not central)

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14
Q

Management of vestibular neuronitis

A
  • Prochlorperazine
  • Antihistamines (e.g. cyclizine, cinnarizine, promethazine)

(use for up to 3 days, extended use may slow recovery)

  • admission if dehydrated from n+v
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15
Q

If symptoms of vestibular neuronitis persist for over 6 weeks, what furhter investigation may be needed?

A

vestibular rehabilitation therapy (VRT)

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16
Q

What condition may develop after an episode of vestibular neuronitis?

A

BPPV - benign paroxysmal positional vertigo

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17
Q

What is the difference between vestibular neuronitis and labarynthitis?

A

Neuronitis = NO loss of hearing
Labarynthitis = LOSS of hearing

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18
Q

What is sialolithiasis?

A

Salivary duct claculi / stones blocking a duct

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19
Q

When does sialolithiasis occur?

A

post staph aureus infection

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20
Q

What is Menieres disease?

A

Long term inner ear disorder

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21
Q

Meniere’s disease triad

A
  • hearing loss
  • vertigo
  • tinnitus
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22
Q

Which frequencies go first in hearing loss from meniere’s disease?

A

lower frequency sounds

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23
Q

What type of hearing loss is in meniere’s disease?

A

sensioneural hearing loss

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24
Q

Howis meniere’s disease managed?

A
  • prochlorperazine
  • antihistamines (cyclizine)
  • betahistine = prophylaxis
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25
what causes meniere's disease? (pathophysiology)
excessive build up of endolymph in the inner ear, this increases the pressure in the labyrinth and disrupts sensory signals this is called endolymphatic hydrops
26
What does bppv stand for?
benign paroxysmal positional vertigo
27
Peripheral hearing loss is due to a problem in the ________
inner ear
28
Symptoms of bppv
- episodic vertigo (20-30 secs) - comes on with head movements, like turning over in bed
29
risk factors for bppv
- 50+ years - history of migraines - inner ear surgery - inner ear infections - recent viral illness - head injury - balance problems
30
Pathophysiology of bppv
- calcium carbonate crystals called otoliths displaced in the semi-circular canals (usually in the posterior) - disrupts normal flow of endolymph through the canals, confusing the vestibular system
31
Diagnostic test for bppv
Dix-Hallpike manoeuvre
32
Treatment for bppv
Epley manoeuvre Brandt-Daroff exercises for symptom relief
33
What is the facy word for nosebleeds?
Epistaxis
34
Where does bleeding usually originate from in nosebleeds?
Kiesselbach's plexus, located in little's area Area of nasal mucosa in fron t of nasal cavity which ocntains a lot of blood vessels
35
Triggers for nosebleeds:
- nose picking / blowing - colds - sinusitis - trauma - changes in weather - caogulation disorders - anticoagulant medication - snorting cocaine - tumours (scc)
36
How to manage a nosebleed
- sit up and tilt head forwards - squeeze soft part of nostrils together for 10-15 mins - spit out any blood in the mouth rather than swallowing to avoid aspiration
37
when is a nosebleed counted as severe?
- doesn't stop after 10-15 mins - bleeding from both nostrils - haemodynamically unstable
38
In hospital treatment options for severe nosebleed
- nasal packing using nasal tampons or inflatable packs - nasal cautery using silver nitrate
39
What could you consider prescribing post acute nosebleed treatment?
Naseptin nasal cream (chlorhexidine and neomycin) x4 daily for 10 days to reduce any crusting, inflammation and infection - this is contraindicated in soya and penut allergy
40
Causes of glossitis
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury or irritant exposure
41
What does glossitis look like?
swollen, smooth, red tongue
42
What is angioedema?
fluid accumulating in the tissues, resulting in it swelling - can cause tongue to swell
43
Top causes of angioedema
- allergic reactions - ACE inhibitors - C1 esterase inhibitor deficiency (hereditary angioedema)
44
Common factors which can predispose someone to develop oral candidiasis
- ICS especially with poor technique, no spacer and not rinsing mouth after - Antibiotics - Diabetes - Immunodeficiency (e.g. HIV) - Smoking
45
Treatment options for oral candidiasis
- Miconazole gel - Nystatin suspension - Fluconazole tablets (in severe / recurrent cases)
46
What is a geographic tongue?
an inflammatory condition where patches of the tongue’s surface lose the epithelium and papillae. The patches form irregular shapes on the tongue, resembling a map
47
How dows geographic tongue present?
in epsiodes which relapse and remit (can last days to weeks before resolving or changing)
48
Causes of geographic tongue
- stress and mental illness - psoriasis - atopy - diabetes
49
Two main causes of strawberry tongue
- Scarlet fever - Kawasaki disease
50
What is black hairy tongue?
Results from decreased shedding / exfoliation of keratin from the tongue's surface The papillae elongate and take on the apperance of hairs Bacteria and food cause the dark pigmentation Patients may report sticky saliva and a metallic taste
51
Causes of black hairy tongue
- dehydration - dry mouth - poor oral hygiene - smoking
52
What is thought to be the cause of primary tinnitus?
result of a background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system
53
Name some causes of secondary tinnitus
- impacted ear wax - ear infection - meniere's disease - noise exposure - medications (loop diuretics, gentamicin, chemo like cisplatin) - acoustic neuroma - MS - trauma - depression
54
Name some systemic conditions which are associated with tinnitus
- anaemia - diabetes - hyper/hyothyroid - hyperlipidaemia
55
What is objective tinnitus?
When a patient can hear an extra sound which is actually occuring within their head, can be heard with stethoscope: - carotid artery stenosis - aortic stenosis - arteriovenous malformations - eustachian tube dysfunction
56
What investigations would you request for a patient with tinnitus?
- FBC - Blood glucose - TSH - Lipids
57
Name some red flags you should be aware of in a tinnitus presentation
- unilateral tinnitus - pulsatile tinnitus - hyperacusis - unilateral hearing loss - sudden onset hearing loss - vertigo - headaches - visual symptoms - neurological symptoms - suicidal ideation related to the tinnitus
58
Management of tinnitus
- hearing aids - sound therapy (adding background noise to block out the tinnitus) - CBT
59
Where is the eustachian tube?
Between middle ear and throat
60
Role of the eustachian tube
- equalise air pressure in middle ear - drain fluid from middle ear
61
How might eustachian tube dysfunction present?
- reduced or altered hearing - popping noises or sensations - fullness - pain / discomfort - tinnitus
62
Investigations for persistent / severe eustachian tube dysfunction
- tympanometry - audiology - nasopharyngoscopy (endoscopic camera) - CT scan
63
What is tympanometry?
- small device in ear canal alters pressure in outer ear - sound waves fired at tympanic membrane - the amount of sound absorbed is measured
64
What is admittance?
The amount of sound absorbed on tympanogram
65
what would a tympanogram show in eustachian tube dysfucntion?
the peak admittance would show negative pressures
66
Treatment options for eustachian tube dysfunction
- Do nothing - Valsalva manouevre - Decongestant nasal sprays (short term) - Antihistamines / steroid nasal sprays (hayfever) - Surgery if severe / persistent
67
What is otovent?
balloon which helps to inflate the eustachian tube and balance the pressures in the imddle ear and outer ear
68
Name the 3 main surgical options for the treatment of eustachain tube dysfunction
- treat other pathology (e.g. adenoidectomy) - grommets - balloon dilation eustachian tuboplasty
69
What is a sign of a perforated tympanic membrane?
purulent ottorhoea
70
What is the treatment of tympanic membrane rupture?
no antibiotics required
71
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