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ENT Flashcards

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1
Q

Causes of gingival hyperplasia

A

phenytoin, ciclosporin, calcium channel blockers and AML

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2
Q

What would you see with Rinne and Webers if there was RIGHT sensorineural hearing loss.

A

Rinnes - Air conduction louder than bone conduction bilaterally

Webers - localises to the left

WAC - Webers goes to associated side in conductive hearing loss.

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3
Q

What to do if you have a patient with acute sensorineural hearing loss?

A

Urgent referral to ENT and consider high dose steroids.
MRI is usually done by ENT to exclude a vestibular schwannoma.

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4
Q

Acoustic neuroma presentation

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex
Associated with neurofibromatosis T2

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5
Q

After how long would you 2ww a mouth ulcer

A

After 3 weeks

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6
Q

Would quinine cause hearing loss?

A

Yes

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7
Q

In a conductive hearing loss, does Webers lateralise?

A

Yes. To same side.

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8
Q

Symptoms of otitis externa

A

Ear pain
Itch
Discharge
Might get hearing loss due to occluded canal but less common.

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9
Q

How to manage otitis Externa

A
  1. over-the-counter acetic acid 2%. - am, pm, after getting wet.
    Max 7d.
  2. ‘Aural toilet’ if needed for other tx to work (clean out debris)
  3. topical abx +/- steroid for 7-14d
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10
Q

Most common causative organism for acute OE

Common causative organism for chronic OE

A

pseudomonas/ s aureus

Persistent inflammation in chronic could be caused by fungus - aspergillum or Candida albicans.

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11
Q

How to distinguish between labyrinthitis/ vestibular neuronitis

A

Labyrinthitis - loss of hearing.

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12
Q

Definition of acute OE

Definition of chronic OE

What is malignant OE

A

Acute OE - lasts less than 6 weeks

Chronic OE - lasts over 3m.

Malignant: Progression of infection to cause osteomyelitis of the temporal bone and adjacent structures

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13
Q

When to swab in the context of OE

A
  • Treatment failure
  • Severe, recurrent, or chronic otitis externa
  • Ear canal occlusion due to swelling and debris, causing difficulty using topical treatment effectively.
  • Suspected spread of infection beyond the external ear canal.
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14
Q

When to follow up acute OE

A

Symptoms are not improving within 48–72 hours

Symptoms have not fully resolved after 2 weeks

Symptoms are severe and/or there is cellulitis spreading beyond the external ear canal. S

Immunocompromised and at risk of severe infection. *** immunocompromised/ diabetes is mentioned a lot - hba1c if bad **

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15
Q

Key features of Menieres

A

DVT
Deafness (reduced hearing in one side) also ear fullness
Vertigo
Tinnitus

Episodes last minutes to hours

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16
Q

Menieres management

A

Tell DVLA - current advice is to cease driving until satisfactory control of symptoms

Acute attacks: buccal or IM prochlorperazine can be given for 7d

Prevention: betahistine and vestibular rehab exercises may be of benefit

**Rehab exercises also recommended in vestibular neuritis but NOT betahistine. Betahistine only in Menieres

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17
Q

What would you see with Rinne and Webers in a conductive hearing loss

A

WAC - webers goes to affected side in conductive

Rinnes - Bone conduction is louder than air conduction in the AFFECTED ear.

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18
Q

What investigations does NICE say to consider with mouth ulcers and why

A

FBC/B12/Folate - deficiency

Coeliac screen - this can cause them

ESR/CRP - ?inflammatory disorder that could cause it e.g. Bechets

HIV/EBV

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19
Q

NICE management of mouth ulcers

A

> 3 weeks 2ww
Consider B12 supplement even if B12 normal
Simple:
- Topical anaesthetic: Lidocaine
- Topical anaesthetic/anti inflammatory: benzydamine (difflam),
- Topical antimicrobial agents such as chlorhexidine gluconate oral solution, or doxycycline rinses.

If these are no good then:
- Topical corticosteroid such as hydrocortisone oromucosal tablets, beclomethasone spray (delivered via an inhaler device — off-license use), or betamethasone soluble tablet

If still not helped then PO pred

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20
Q

Definition of recurrent otitis media

A

3 or more episodes in 6 months

Or

Four or more episodes in 12 months with at least one episode in the past 6 months

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21
Q

In the context of acute otitis media when does nice say to consider admitting a kid

A

Children younger than 3 months of age.
Children 3–6 months of age with a temperature of 39°C or more.

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22
Q

Who does NICE say might benefit from abx for AOM

A

-Kids under 2 with bilateral sx
- Ottorhoea
- High risk of complications
- Systemically unwell

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23
Q

When does NICE say AOM should get better

A

Within 3d.
Could consider a back up px for use if no better within this time.

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24
Q

What does NICE say you should px for kids/ young people u18 if not giving abx for AOM

Study These Flashcards
A

Analgesic and anaesthetic ear drops (otigo - Phenazone with lidocaine)
As long as no perf.

25
First and 2nd line AOM
5–7d amox clarithromycin or erythromycin if allergic. Erythromycin in pregnant women 2nd: co-amoxiclav if worsening sx with the first choice antibiotic taken for at least 2-3 days.
26
When to suspect Chronic supporative otitis media
- If ear discharge for 2 weeks - usually absence of pain because TM is perforated - Hearing loss in affected ear - Might get tinnitus and a fullness
27
How to manage acute supprative otitis media
DONT swab or start tx. Ref ENT
28
What is otitis media with effusion also called? What is it?
Glue ear Fluid in the middle ear without signs of infection
29
Risk factors for otitis media with effusion
Primary ciliary dyskinesia Cleft palate T21 Allergic rhinitis
30
What Ix might confirm glue ear
Pneumatic otoscopy Tympanometry Audiometry
31
How might you differentiate between AOM and AOME
AOME - usually has retracted drum. AOM - usually has bulging drum
32
Non surgical management for AOME
Monitor for 3m with regular follow up Autoinflation if age appropriate - blow your nose to pop ears Hearing aids if needed and unlikely to be surgical candidate
33
Surgical management of AOME
Myringotomy and insertion of grommets Avoid water for 2 weeks Should fall out after a few weeks to months.
34
What would you do with someone who has grommets but reports ear discharge
This is the most common complication occurring between 1 in 5 to 1 in 10 children. Consider a course of topical non-ototoxic antibiotics (such as ciprofloxacin) for 5-7 days
35
What would you do with a patient who has acute sensorineural hearing loss
Same day ENT who might do MRI to exclude vestibular schwannoma and give high dose steroids
36
How might ENT investigate a cholesteatoma
CT or MRI of the temporal bone
37
Vestibular neuronitis management
prochlorperazine/ vestibular rehab Might get horizontal nystagmus with this condition
38
Which class of diuretic can cause tinnitus
loop
39
Chinese origin, painless middle ear effusion - what to do?
2ww ENT - ?nasopharyngeal ca Might also have otalgia
40
Management of sinusitis
intranasal steroids if sx have been present for more than 10 days. Abx in severe cases - Pen v 1st line Co-amox if v unwell or at risk of complications
41
Chroni sinusitis definition
sx lasting 12 weeks or more
42
Chronic sinusitis management
Nasal irrigation Consider 3m nasal steroids refer if no improvement 6-12 weeks or other red flags
43
How to manage gingivitis
If it's simple tell them to go see dentist routinely. If you think its acute necrotising ulcerative gingivitis : Refer the patient to a dentist and in the meantime give oral metronidazole +/- amox for 3 days chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash Phenytoin, ciclosporin, CCBs and AML causes it (Anna got it on ciclosporin)
44
What to do if you have a patient with T21 and suspect glue ear
refer immediately to ENT, Same for patients with cleft palate. ? due to existing risk factors for hearing/speech delay and LD
45
Wat is Ludwigs angina?
Life threatening complication of usually dental infection. - Progressive cellulitis that affects the floor of the mouth. neck swelling dysphagia fever 999 ambo for IV abx +/- intubation if e.g. trismus (can't open mouth) and severe swelling
46
How long does it usually take for perforated TM to heal
6-8 weeks and need to avoid swimming in this time
47
define persistent rhinitis
sx on 4d a week for 4 weeks
48
Management of allergic rhinitis
If the person has mild-to-moderate intermittent, or mild persistent symptoms: oral or intranasal antihistamines or intranasal steroid. Antihistamine if a kid. Moderate-to-severe persistent symptoms/or initial tx ineffective: intranasal corticosteroids If still no good could try intranasal steroid AND intranasal antihistamine 2. PO steroids 0.5mg/kg for 5-10 days (specialist)
49
What to do with a patient who has persistent watery nasal discharge in context of allergic rhinitis If they have Persistent congestion?
If already on nasal steroid add nasal ipratropium if over 12 Add xylometazoline short term. Careful because it can make it worse
50
When would someone with hearing aids be offered cochlear implant
If they've tried hearing aids for 3m but not working
51
Tonsillectomy referral criteria
more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years,
52
Can Aspirin and NSAIDs cause tinnitus
yes
53
What type of hearing loss would you see in Menieres?
Fluctuating sensorineural affecting low to medium frequencies
54
NICE indications for abx in tonsillitis
- Systemically unwell - Unilateral peritonsillitis - History of rheumatic fever - Increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency) - Patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
55
Causes of gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers and AML
56
Menieres dietary modification
Low salt, low caffeine, no alcohol
57
Nasal polyps are linked to CF
58
Pulsatile tinnitus = BAD Unilateral tinitus = BAD
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