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92 Cards in this Set
- Front
- Back
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List some causes of otalgia. |
Acut otitis media/externa Furunculosis Barotrauma Ramsay Hunt Syndrome Neoplasia Perichondritis Myringitis (inflammation of the tympanic membrane) Referred pain (tonsillitis, dental disease, TMJ disease, arthritis, sinusitis, cervical spondylosis...). |
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What are the main symptoms of otitis media externa? |
Pain Itch Hearing loss -> also, swollen meatus, tender auricle, swollen EAM full of debris |
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How is otitis media externa treated? |
Swab for microbiology Aural toilet Topical antibiotic/steroid on a wick (Antifungals, glycerine and inchthammol, Al acetate) Systemic antibiotics for gross cellulitis Don't scratch ear/use cotton buds/allow water in |
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What organisms are typically present in otitis media externa? |
Pseudomonas Staphylococcus Candida Aspergillus |
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What causes malignant (necrotising) otitis externa? |
Pseudomonas infection spreads to the bone and causes osteomyelitis/osteitis of the skull base. |
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How does malignant otitis externa present and how is it treated? |
Great pain Granulations in the meatus CN palsies (those exiting the jugular foramen: VII, IX, X and XI) Treatment: prompt high dose IV antibiotics with/out surgical debridement. |
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What is cauliflower ear? |
Haematoma auris (blood between the perichondrium and the cartilage) causes necrosis of the cartilage, dense scarring, thickening and deformity of the ear. |
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What are bony exotoses? |
Benign outgrowths of cartilaginous tissue on bone, occur in the bony meatus of the ear and can slowly occlude the meatus causing failure of wax extrusion and deafness. Occur in those who spend a lot of time in the cold. Excise with a drill. |
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How does acute otitis media present? |
Hearig loss Pain Ottorhoea Pyrexia Systemic upset -> if 6wk course of antibiotics (e.g. amoxicillin) doesn't help, consider grommet insertion. |
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What are the commonest organisms of acute otitis media? |
Haemophilus influenzae Streptococcus pneumoniae |
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What are some possible complications of acute otitis media? |
Residual perforation/effusion Necrosis of the ossicles Tympanosclerosis Ossicular adhesions |
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What are some causes of otitis media with effusion (glue ear)? |
Sequelae of otitis media Infection/allergy of middle ear mucosa Eustachian tube dysfunction: - poor/delayed development - obstruction by large adenoid -nasal abnormalities/conditions - cleft palate |
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When is glue ear treated? |
If doesn't resolve in over 3 months and is symptomatic, consider grommet insertion. |
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How does chronic suppurative otitis media present? |
Mild hearing loss (20-30dB, more seveer if ossicular chain is involved) Otorrhoea (can be from mastoid system, leaks through perforated tympanic membrane; mucoid/mucopurulent). |
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How is chronic suppurative otitis media treated? |
Regular aural toilet Combination antibiotic/steroid ear drops Keep the ear dry to settle active infection Myringoplasty to prevent reinfection Nothing if few/no symptoms |
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What is a cholesteatoma? |
A cyst/sac of keratinising squamous epithelium, thought to be caused by a retraction pocket of tympanic membrane which becomes infected by pseudomonas and slowly enlarges from the epitympanic area to the attic and backwards into the mastoid. Cholesteatoma is full of foul smelling debris and can eroide bone. |
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How does cholesteatoma present? |
Foul smelling discharge Conductive hearing loss Discharging attic perforation Attic aural polyp Or with complications: - facial nerve palsy (erosion of facial nerve) - vertigo (erosion of labyrinth) - intracranial sepsis (erosion of tegmen) |
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What is Ramsay Hunt Syndrome? |
Infection of the facial nerve ganglion by herpes zoster virus. It causes otalgia, facial nerve palsy, hearing loss, imbalance and vesicles in EAM. |
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What does a -ve Rinne's Test mean? |
Conductive deafness >20dN (BC>AC). |
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What does a +ve Rinne's Test mean? |
Normal/sensorineural hearing loss. |
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How is conductive hearing loss detected by Weber's test? |
Sound localises to the affected ear (>10dB loss). |
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How is sensorineural hearing loss detected by Weber's test? |
Sound localises to the contralateral ear. |
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List some causes of conductive deafness. |
Wax Otosclerosis Otitis media Glue ear |
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What is it called when acuity for high-frequency sounds is lost in someon under the age of 30? |
Presbyacusis. |
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List some causes of sudden onset sensorineural hearing loss. |
Noise exposure Acoustic neuroma Mumps MS Stroke Vasculitis TB |
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What investigations should be ordered for sudden onset sensorineural hearing loss? |
Bloods: ESR, FBC, LFT, pANCA, viral titres, TB Elispot Evoked response auditometry CXR MRI Lymph node and nasopharyngeal biopsy for culture |
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What is otosclerosis? |
AD metabolic dysplasia causing bony turnover -> ankylosis of the stapes footplate -> sclerosis and failure of the sound coundiction mechanism. |
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What are the main features of otosclerosis? |
Slowly progressive conductive hearing loss (typically bilateral and low tone loss) Tinnitus Schwartze's sign |
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How is otosclerosis managed? |
Hearing aids Bisphosphonates Stapedectomy/Stepedotomy (Sodium fluoride) |
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What is the columella? |
The midline strip of skin connecting the upper lip and nasal tip. |
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Which bones and cartilages make up the nasal septum? |
Ethmoid, vomer, palatine and maxilla bones. Septal and greater alar cartilages. |
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What is the blood supply of the nasal septum? |
IC: anterior and posterior ethmoidal arteries (from ophthalmic branch ) EC: - greater palatine and sphenopalatine (from maxillary branch) - septal branch of superior labial artery (from facial branch) |
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Branches of which arteries make up Little's Area (Kiesselbach's plexus)? |
Sphenopalatine artery Greater palatine artery Superior labial artery Anterior ethmoidal artery |
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What is the histology of the covering of the nasal turbinates? |
Vascular mucoperiosteum and ciliated columnar epithelium. |
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Where do the eustachian tubes open into medially? |
Postnasal space (/nasopharynx). |
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What are three vague causes of a blocked nose? |
Structural/anatomical abnormality Mass Swelling of nasal lining due to inflammatory stimulus |
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List four causes of nasal septal perforation. |
1) Trauma 2) Avascular necrosis -> cocaine, septal haematoma/abscess, sickle cell disease 3) Granulomatous inflammation 4) Tumours of the nasal cavity -> T cell lymphoma = lethal midline granuloma. |
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What complications might occur from a septal haematoma if not treated immediately? |
Avascular necrosis of cartilaginous septum -> collapse of nose Infection -> abscess -> destroted cartilage. |
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What is choanal atresia? |
Congenital; a membrane covers one/both choanae; fatal soon after birth as newborns are obligate nose breathers. |
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What are the symptoms of rhinitis? |
Nasal congestion Rhinorrhoea Postnasal drip Sneezing Nasal irritation |
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What type of hypersensitivity response occurs in allergic rhinitis? |
Type 1 IgE-mediated hypersensitivity -> vascular congestion, oedema, rhinorrhoea and irritation. |
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How is allergic rhinitis treated? |
1) Avoid allergens 2) Topical steroid sprays/drops for symptoms 3) Oral/topical antihistamines 4) Sodium cromoglicate nasal spray (4xdaily) 5) Leukotriene receptor antagonist 6) Turbinate surgery |
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How do simple inflammatory polyps appear on examination? |
- Often in middle meatus - Grey/white/slightly translucent - Soft and mobile (unlike turbinates) - Can become fleshy and ulcerated if they prolapse through the nose |
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When should you biopsy nasal polyps? |
Unilateral Look suspicious Bleed |
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What triad are nasal polyps commonly a part of? |
Nasal polyps Asthma Aspirin sensitivity |
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How are simple inflammatory nasal polyps managed? |
Topical steroids (long-term inhaled = mainstay) Antihistamines Nasal decongestants If severe: medical polypectomy (topical agents and steroids) Intranasal polypectomy - tend to recur. |
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What is an antrochoanal polyp? |
Benign solitary polyp arising from mucosa of maxillary antrum, mostly in men. Uncommon. |
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How do antrochoanal polyps cause unilateral nasal obstruction? |
Enlarge through maxillary sinus ostium into nasal cavity and cause ball-valve effect in posterior choana - unilateral obstruction on expiration. Can even extend into mouth. |
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How are inverted papillomas treated? |
Complete resection - commonly recurrent and can become malignant (look similar to simple inflammatory polyps). |
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How should juvenile angiofibromas be managed? |
CT to access IC extension Do not biopsy before complete surgical excision (which is itself very risky; can pre-operatively embolise the feeder vessels to reduce intra-operative haemorrhage). |
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Which 3 benign neoplasms present in the nasal cavity? |
Simple papillomas (viral warts) Inverted papillomas Juvenile angiofibroma |
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Which 5 malignant neoplasms present in the nasal cavity? |
SCC Adenocarcinoma Adenoid cystic carcinoma T-cell lymphoma Nasopharyngeal carcinoma |
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How is SCC of the nasal cavity treated? |
Surgical excision and RT (some poorly differentiated need chemo) |
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SCC in the nose is linked to exposure to what? |
Nickel |
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Adenocarcinoma in the nose is linked to exposure to what? |
Hardwood dust |
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How is adenocarcinoma of the nose treated? |
Surgical excision + RT (/chemo in some places). |
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What is an adenoid cystic carcinoma? |
Tumour of the minor salivary glands (not adenoids). Tend to spread along nerves but rarely metastasise. Most die within 10-20yr. |
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What does T-cell lymphoma of the nose cause? |
Massive destruction of the nose, face and sinuses; usually rapidly fatal. Treat with RT. |
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How might granulomatosis with polyangitis present in the nose? |
Septal perforation, a patch of ulceration or a raised, abnormal-looking area. |
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What investigations should be done for granulomatosis with polyangitis? |
Raised ESR ANCA +ve Biopsy usually diagnostic |
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How is granulomatosis with polyangitis in the nose treated? |
High dose steroids + cyclophosphamide +/- azathioprine. |
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How do syphilis and TB affect the nose? |
Both cause granulomatous inflammation -> ulceration and septal perforation. |
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What three non-granulomatous infections cause polyposis/sinusitis? |
Klebsiella (scleroma ) Aspergillosis (low-grade sinusitis) Rhinosporidiosis (bleeding polyp of septum) |
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What are some systemic causes of epistaxis? |
HT Anticoagulants Coagulopathy Hereditary heamorrhagic telangiectasia (HHT) |
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What is HHT and how is it treated? |
Hereditary heamorrhagic telangiectasia = Condition where multiple abnormal capillaries are found throughout the respiratory, GI and urogenital tracts and the skin. Treatment: argon laser cautery of telangiectasias and closure of the nostril (poorly tolerated). |
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What triangles make up the anterior triangle of the neck? |
Submental Submandibular Carotid Musclular |
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What triangles make up the posterior triangle of the neck? |
Occipital Subclavian |
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What separates the submental and submandibular triangles of the anterior neck? |
Mylohyoideus muscle |
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What separates the muscular and carotid triangles of the anterior neck? |
The omohyoideus muscle |
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What separates the occipital and subclavian triangles of the posterior neck? |
The omohyoideus muscle |
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Which nerve supplies the cricothyroid muscle and vocal cords? |
Superior laryngeal nerve. |
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Which muscles does the recurrent laryngeal nerve supply? |
All intrinsic muscles of the larynx, except the cricothyroid muscle |
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What should you ask about when investigating a neck lump? |
·position · size · shape · smooth or lobulated · in the midline · solid or cystic · more than one lump · tender · attached to any viscus or skin · moves on swallowing (connected to the thyroid) · pulsatile · associated acute/chronic inflammation/ulcerationanywhere within the head and neck?Z0 |
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What investigations should be done when investigating a neck lump? |
Bloods: FBC, ESR Monospot/Paul Bunnel test HIV and toxoplasmosis (gen. lymphadenopathy) Radiology: CT/CXR, USS lump FNA cytology Endoscopy and biopsy under GA Open biopsy (excisional) |
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How should a thyroglossal cyst/fistula be managed? |
Surgical excision of the whole tract, including the body of the hyoid bone. |
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What is a branchial cyst? |
A congenital epithelial cyst that develops on the lateral side of the neck due to failure of obliteration of the second branchial cleft in embryonic development. |
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How do branchial cysts present and how are they diagnosed? |
Generally in those <30yr old Lump in middle third of SCM muscle Pain if infected Diagnosis: FNAC - pus-like aspirate rich in cholesterol crystals |
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What is a differential diagnosis of a branchial cyst and why is it important? |
SCC mets to the neck - they frequently undergo cystic degeneration and are only distinguishable by excisional biopsy. Have a high index of suspicion with branchial cysts - all need full ENT examination in O/P clinic and examination under anaesthetic before excision. |
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Where do branchial fistulae usually run? |
From the skin (close to ant. border of SCM) to the tonsillar/pyriform fossae. Resect carfeully as they run between the great arteries and close to the lower CNs. |
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What is a dermoid? |
Cysts formed as a result of fusion defects in embryo; elements of the skin become trapped subcutaneously, forming cysts lined with squamous epithelium and skin apendages such as hair follicles and sweat glands. |
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How do dermoids present? |
Painless midline swellings between suprasternal notch and chin. They don't move on swallowing/tongue protrusion. Rx.: complete surgical resection. |
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What is a cystic hygroma? |
A rare type of lymphangioma with very large, dilated vessels. |
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How do cystic hygromas present? |
In the neck and then expand between tissue planes. They are noticed at/soon after birth. May be very large, compressing vital structures (e.g. trachea). Rx.: staged, multiple excisions may be needed over years. |
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How does a pharyngeal abscess present? |
Neck swelling, usually just behind SCM Pyrexia Toxic Trismus Tonsil pushed medially. |
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How are pharyngeal abscesses treated? |
IV antibiotics - if no response after 48h, surgically drain the space. |
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What is Ludwig's Angina? |
Infection of the submandibular space, usually as a result of dental infection and most commonly from strep viridans. |
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How does Ludwig's Angina present? |
Firm swelling of tissues of floor of the mouth causing possible airway obstruction due to backward displacement of the tongue. Pyrexia Drooling Trismus |
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List some differentials for multiple enlarged non-tender lymph nodes in the neck. |
Infectious mononucleosis TB HIV Toxoplasmosis Brucellosis Cat scratch fever |
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How are neck lymph nodes staged when malignancy is suspected? |
TNM N1 = Single node, ipsi., <3cm N2 = Single node, ipsi., 3-6cm or multi ipsi nodes <6cm or contrlat nodes <6cm N3 = Any node >6cm |
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How is SCC in the neck treated? |
RT/Sx./both - radical excision of primary with en bloc resection of affected nodes via neck dissection. |
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What features make malignancy more likely when considering neck lumps? |
Unilateral sore throat Voice change Referred otalgia Swallowing pain/difficulty Unilateral nasal discharge Unilateral hearing loss due to glue ear |
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How is a laryngocoele treated/ |
Excise sac and repair any defect once carcinoma has been excluded. |
