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ENT Questions for Applied Knowledge Test Dr Azhar Siddiqui GPST1 2009.

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Presentation on theme: "ENT Questions for Applied Knowledge Test Dr Azhar Siddiqui GPST1 2009."— Presentation transcript:

1 ENT Questions for Applied Knowledge Test Dr Azhar Siddiqui GPST1 2009

2 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 1) 1) 45 yr old clarinet player presents with neck swelling that expands with forced expiration

3 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 1) 1) 45 yr old clarinet player presents with neck swelling that expands with forced expiration Laryngocele

4 Causes of Neck Lumps   Laryngocele :   Air filled sac associated with larynx becomes dilated   High pressure in larynx pushes laryngeal mucosa through thyrohyoid membrane   Found in wind instrument players   Symptoms include:   Neck mass   Hoarseness   Stridor   Treatment usually surgical – dependant upon size

5 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 2) 2) 4 yr old boy presents with small midline neck swelling that moves on swallowing. It is painless, mobile, transilluminates and fluctuates

6 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 2) 2) 4 yr old boy presents with small midline neck swelling that moves on swallowing. It is painless, mobile, transilluminates and fluctuates Thyroglossal Cyst

7 Causes of Neck Lumps   Thyroglossal Cyst :   Arise from persistent epithelial thyroid duct formed with the descent of thyroid from foramen caecum to its final position in the front of the neck   Occur at any age, but commonly between 15 – 30 yrs of age   Presents with painless smooth cystic midline swelling in region of hyoid bone   Cyst rises when the patient protrudes their tongue

8 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 3) 3) 30 yr old male presents with 5cm neck swelling anterior to the sterno-mastoid muscle on the left in its upper third. He states the swelling has been treated with antibiotics for infections in the past

9 Causes of Neck Lumps > Branchial Cyst> Ludwigs Angina > Parotitis> Thyroglossal Cyst > Dermoid Cyst> Parapharyngeal Abscess > Thyroid Swelling> Laryngocele > Pharyngeal pouch> Reactive lymphadenitis 3) 3) 30 yr old male presents with 5cm neck swelling anterior to the sterno-mastoid muscle on the left in its upper third. He states the swelling has been treated with antibiotics for infections in the past Branchial Cyst

10 Causes of Neck Lumps   Branchial Cyst:   Arises from embryonic remnants of second branchial cleft in the neck   Most common in young adults   Presents as smooth swelling in front of the anterior border of sternomastoid, at the junction of upper and middle thirds   Treatment is by excision   Treatment may need to be delayed if cyst is acutely infected, leading to branchial fistula

11 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 1) 1) A 25 yr old man presents with worsening sore throat. On examination he has trismus and unilateral enlargement of his right tonsil.

12 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 1) 1) A 25 yr old man presents with worsening sore throat. On examination he has trismus and unilateral enlargement of his right tonsil. Quinsy

13 Diagnosis of ENT Diseases   Quinsy :

14 Diagnosis of ENT Diseases   Quinsy :   Aka peritonsillar abscess   Complication of acute tonsillitis   Usually due to streptococcal infection   Collection of pus arising outside tonsil capsule.   Symptoms include: sore throat, fever, halitosis, dysphagia, trismus, referred ear ache.   Uvula may be very oedematous and displaced downwards and medially by the infected tonsil   Treatment is with penicillin based antibiotics ( IV Benzylpen, or oral penicillin V, + IV hydrocortisone)   Drainage of abscess by aspiration or incision   Consider tonsillectomy 6 weeks post acute infection

15 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 2) 2) A 60 yr old woman noted to have unilateral tonsillar enlargement. She denies having sore throat

16 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 2) 2) A 60 yr old woman noted to have unilateral tonsillar enlargement. She denies having sore throat Lymphoma

17 Diagnosis of ENT Diseases   Lymphoma :   Varied presentation – mainly painless lump or swelling   Not conclusive without histology   Be wary of lymphoma for unilateral tonsillar enlargement, or unresolving / recurrent lymphadenopathy

18 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 3) 3) 30 year old woman complaining of otalgia and purulent discharge from right ear. External auditory meatus is swollen and inflammed and filled with white discharge

19 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 3) 3) 30 year old woman complaining of otalgia and purulent discharge from right ear. External auditory meatus is swollen and inflammed and filled with white discharge Otitis Externa

20 Diagnosis of ENT Diseases   Otitis Externa :

21 Diagnosis of ENT Diseases   Otitis Externa :   Causes :   Infection – bacteria (esp staph), fungi   Allergy – eczema, contact allergy   Iatrogenic – frequent ear syringing, trauma   Swimmers more commonly affected   Symptoms – irritation, discharge, pain, hearing loss   Refer to hospital if :   Malignant otitis externa   Uncontrolled symptoms   Previous history of complex ear problems   Treatment:   Antibiotic eardrops +/- oral fluclox   Aural toilet   If symptoms not resolving after 1/52, consider alternative drops +/- erythromycin

22 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 4) 4) A 60 yr old diabetic woman complains of severe otalgia. On examination, she has granulation tissue in ear

23 Diagnosis of ENT Diseases > Malignant Otitis Externa> Otitis Externa > Rhinocerebral mucormycosis> Quinsy > Lymphoma> Acute Otitis Media > Nasal Polyposis> Otitis media with glue ear > Rhinosinusitis> Glandular Fever 4) 4) A 60 yr old diabetic woman complains of severe otalgia. On examination, she has granulation tissue in ear Malignant Otitis Externa

24 Diagnosis of ENT Diseases   Malignant Otitis Externa :   Otitis externa that has spread to cause osteomyelitis of skull base   Due to Pseudomonas aeruginosa and anaerobes   Facial nerve involved in 50% of cases   Granulation tissue - diagnostic indicator   Ix – swabs for cultures, and CT/MRI to show invasion   IV cipro or ceftazidine + metronidazole   Surgical removal of granulated tissue may be needed

25 Diagnosis of ENT Diseases   Otitis Media

26 Diagnosis of ENT Diseases   Otitis Media :   Inflammation of middle ear   Classified as :   Acute suppurative – caused by viral or bacterial infection. Causes pain and tenderness   Chronic suppurative – persistent drainage from ear associated with TM perforation. Not usually painful due to chronic nature   Serous/secretory – Middle ear effusion without TM perforation. Associated with dysfunction/obstruction of eustachian tube. Important cause of hearing loss in children.   Antibiotics used in AOM – Amoxicillin   Tympanoplasty in safe CSOM   Aural toilet, antibiotics, exploration of the ear in unsafe CSOM

27 Diagnosis of Hearing Loss > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 1) 1) Man treated with gentamicin for peritonitis for 10/7 presents with deafness

28 Diagnosis of Hearing Loss > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 1) 1) Man treated with gentamicin for peritonitis for 10/7 presents with deafness Ototoxicity

29 Diagnosis of Hearing Loss   Ototoxicity :   Various drugs can damage inner ear and cause sensorineural deafness and tinnitus   Ototoxic drugs :   Aminoglycoside antibiotics   Diuretics   Antimalarials   Cytotoxic drugs   Analgesics – salicylates, ibuprofen   Chemicals – alcohol, tobacco, marijuana

30 Diagnosis of Hearing Loss > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 2) 2) A woman presents with deafness and corneal numbness. MRI showed widened internal auditory meatus

31 Diagnosis of Hearing Loss > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 2) 2) A woman presents with deafness and corneal numbness. MRI showed widened internal auditory meatus Acoustic neuroma

32 Diagnosis of Hearing Loss   Acoustic Neuroma :   Benign slow growing neoplasm of the schwann cells of CN VIII   Lesions located in internal auditory canal or cerebellopontine angle causing compression of vestibular nerve   Clinical features   Occipital pain on side of tumour   CN VIII damage - Unilateral senssorineural deafness   CN V damage – depression of corneal reflex, facial pain, numbness   CN VII, IX, X, XI damage - rare   Ix – audiometry, CT with contrast, MRI   Treatment   Conservative – watch and wait   Radiosurgery – small to medium sized tumours   Microsurgery – large neuromas

33 Diagnosis of Hearing Loss

34 > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 3) 3) A 20 yr old male presents with head injury, bruising to right side of the head with hearing loss

35 Diagnosis of Hearing Loss > Acoustic neuroma> Ototoxicity > Blast injury> Fracture base of skull > Petrous temporal bone fracture> CSOM > Wax impaction> Glue ear > Acute otitis media> Herpes Zoster 3) 3) A 20 yr old male presents with head injury, bruising to right side of the head with hearing loss Petrous temporal bone fracture

36 Diagnosis of Hearing Loss   Petrous temporal bone fracture :   Head injury can cause hearing loss due to:   Ossicular disruption   Haemotympanum   CSF otorrhoea   CN VIII nerve palsy   All these can occus in fractures petrous temporal bone   Complaint of reduced hearing in one ear after trauma poits to haemotympanum   Blood in external auditory meatus caused by basal skull fracture

37 Thank you


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