Ent for a&e
-otitis externa = very itchy, inflammation of skin, minimal hearing loss, pain = all symptoms occur at
the same time, most common cause = pseudomonas, treat with gent drops, fungal otitis externa
requires longer treatment than bacterial cause
-necrotising otitis externa = very severe pain that keeps them up at night, RF = DM, red lump
discharge on inferior floor on otoscopy, may get facial nerve palsy or abducens palsy
-cholesteatoma aka active squamous otitis media= discharging ear that does not resolve with Abx
treatment, management is surgical – mastoidectomy, atticotomy, comps = intracranial abscess,
facial nerve palsy, meningitis, cholesteatoma can be congenital, due to grommet, or idiopathic, look
for wax in weird places on otoscopy
-discharging perforation = active mucosal COM, treatment= aural toilet (microsuction), Abx + steroid
spray/drops, myringoplasty = fixing the hole
-retraction pocket can sometimes look like a boss
-acute otitis media = Abx if no improvement
-otitis media with effusion = otalgia only in early stages
-tympanis sclerosis = fibrosis following e.g. grommet, no Tx required
-remember referred ear pain
-otovent device = for OM
-thick mucus, anosmia, recurrent epistaxis = not allergic rhinitis guys
-rhinitis medicamentosa = rebound nasal congestion due to decongestant sprays
-beta transferrin for CSF leak
--understand polyp vs allergic rhinitis, in polyp the colour is paler than the rest of the nasal passage,
in rhinitis the colour of the polyp-y looking thing is the same as the nasal passage
-more than 10 days = not viral cold, = sinusitis= nasal obstruction/discharge + oedema/polyps +/-
facial pain
-acute rhinosinusitis = <12 weeks, chronic =>12 weeks
-adenoids are lumpy bumpy unlike polyps
-loose teeth, blood stained discharge = suggestive of malignancy
-septal perforation = altered airflow and crusting
-perforation with granulations think autoimmune, perforation with smooth shite etc. no weird shit
then think cocaine
-causes of hyposmia = rhinosinusitis, polyps
-Hyposmia might be a very early sign of Parkinson's disease.[2] Hyposmia is also an early and almost
universal finding in Alzheimer's disease and dementia with Lewy bodies.[2] Lifelong hyposmia could
be caused by Kallmann syndrome.[3]
-causes of airway obstruction = bleeding e.g. from tonsils, trauma, masses e.g. lymph nodes, goitres,
tumours
-cherry red spot = epiglottitis
-use adrenaline nebs to reduce oedema in throat, IV steroids and heliox??
-tracheostomy vs laryngectomy, tracheostomy = stuff above entry point is still there, laryngectomy =
take away voice box and sew it over, make a neopharynx – if they need O2 you stick O2 on the neck
not the mouth
-quinsy drainage = give local anaesthetic and go
-ludwig’s angina = raised floor of mouth + trismus, generally caused by dental infections, worry
about airway – give IV Abx and steroids
-mastoiditis pushes ears out
-big three of ent = otitis externa, epistaxis, tonsillitis
-epistaxis = frozen peas on the forehead
-bleeding point in nose silver nitrate stick blot it on the there
-bipp can be used in epistaxis
-rapid rhinos = nasal tampons
-peri-orbital cellulitis test red vision, examine for meningitis, chandler’s classification
-pott’s puffy tumour = osteomyelitis of the frontal bone
-pars flaccida = where choleastomoma tends to be, pars tensa = where perf tends to be
-endoral/preauricular scar = scar from top of tragus to root of helix
-if you are looking for ear scars, must look in pre and post auricular
-hold pinna downwards for the child and upwards for an adult
-tympanosclerosis = calcium deposition on TM, benign condition, asymptomatic, occurs most likely
following trauma – will be asked in osce to draw the distribution of tympanosclerosis that you see
-estimate dB loss based on distance away
