ENT Overview - Ear, Nose, Throat - PDF

**[ENT Overview (Oto-rhino-laryngology)]** **[Why Know Something About ENT?]** - Understand common conditions. - Overlap with OS/OMFS. - Oro-facial differential diagnosis. - Communication. - Exams! (Often MCQ/OSCE). **[THE EAR]** 1. **External Ear** 2. **Middle Ear** 3. **Inne...

**[ENT Overview (Oto-rhino-laryngology)]** **[Why Know Something About ENT?]** - Understand common conditions. - Overlap with OS/OMFS. - Oro-facial differential diagnosis. - Communication. - Exams! (Often MCQ/OSCE). **[THE EAR]** 1. **External Ear** 2. **Middle Ear** 3. **Inner Ear** **[History]** 1. **Earache (Otalgia)** - Proximity to **TMJ**. - *[Can present]* **very similarly** to **TMJ ISSUES** 2. **Deafness** 3. **Discharge** 4. **Tinnitus - Ringing sound**, can be **Idiopathic** 5. **Vertigo - Pts** *[feel]* **sick** & **vomit** - Not just dizziness - \"External world revolving around the patient.\" **[Examination]** 1. **External Examination**  **[Tuning Fork Tests:]** Two main types of tests: - *[Place]* on the **Mastoid Process** & *[check]* if they can **Hear It** - *[When they]* **Can't Hear** it *[move it away]* to **Air** *[see if they can]* **Hear It** - *[Tests]* **Air** Vs **Bone** **Conduction** - In a **Normal pt** **Air Conduction** \> **Bone Conduction** - Diseased Pt (**[CONDUCTIVE DEAFNESS]**): - **BC\>AC** = Conductive Deafness - **False Negatives** Not 100% reliable test - *[Placed]* in the **Middle Of The Head** *[Sound]* **Lateralises** to **One Side** or the *[other]* - **Ipsilateral** in **Conductive Deafness** - The *[affected]* **Ear** will **Hear I**t *[More]* **Conduction** *[through]* **Bone** - **Contralateral** in **Sensorineural Deafness** **[DEAFNESS]:** **Two Main Types**: - **Conduction** **Deafness** **Sound waves** are *[blocked]* from **reaching** the **Inner Ear** - **Sensorineural** **Deafness** **Nerve** to the **Brain** **Defect** **[Investigations]** 1. **[Pure Tone Audiometry:]** - **Soundproof** **Booth** with **Headphones** & *[various]* **Pitches** of **Beeping Sounds** played **TESTS SENSITIVITY** (db) - *[Both]* **Air** and **Bone** **Conduction Tested** - *[Requires]* **Pt** co**-operation** *[Very easy]* to skew results - Sensitivity (db) 2. **[Electric Response Audiometry:]** - **Brainstem** or **Cortical Testing** - **Co-operation** ~~not needed~~ *[More]* **OBJECTIVE TEST** **[External Ear]** **~~Don't need to remember all these~~** *[Just]* **REMEMBER** the **HELIX** (*[important]* in *[terms]* of **Malignancies** & **injuries** *[because it is exposed]* to the **Sun** the *[most high]* chance of **Malignancy**) [**Features** of the **External Ear**:] - **Outer 2/3 cartilaginous** - **Specialized Squamous Epithelium** - *[Devoid]* of **Follicles** *[No]* **Hair** *[inside]* the **Ear Canal** - *[Does not]* **Desquamate** **No** **Flaking** or **Shedding** - **Outer Ceruminous Glands** **Ear Wax** *[producing]* **Glands** - **Multiple Sensory Supply** **[Common Disorders of the Outer Ear]** 1. **Inflammatory** - **Otitis Externa.** - **Necrotising (Malignant) Otitis Externa.** 2. **Traumatic** 3. **Neoplastic** 4. **Congenital** 5. **Idiopathic** **[Otitis Externa]** [**General Causes**:] - **Irritants**. - **Skin** **Disorders**. - **Necrotic debris** - **Pre-Existing skin condition** - *[Using]* **Earbuds** or **Cleaners** [**Local Causes**:] - **Trauma** (e.g., earphones). - **OM** **Infection**. -- Infection of the **Middle Ear** - **[Pathogens]**: - **Pseudomonas, S. aureus, HSV, Candida, Aspergillus**. [**Symptoms**:] - **Painful**. - *[Some]* (serous) **Discharge**. -- **Watery** and *[makes tit feel like]* **EAR** is **BLOCKED** - "**Blocked E**ar." [**Treatment**:] - **Gentamicin**-**Steroid** **Ear Drops**. -- **Otamise Ear Drops** -- *[Commonly]* *[Given]* by **GP** - *[Possible]* **Antifungal Treatment**. -- *[Tends to be]* **Fungal** when they are **SWIMMERS** **[External Ear Trauma]** **[Auricular Haematoma.]** Auricular Haematoma *[between]* the **Skin & Cartilage**: - *[Can develop]* **Perichondritis** (*[inflammation]* of the **Perichondrium**) - Can lead to **Cauliflower Ear** - **Aesthetic iss**ues - *[Closes]* the **External Acoustic Meatus** *[Affects]* **Hearing** - *[Can lead to]* **Necrosis** of the **Tissues** **Identify** *[this]* & **Signpost** the Pt to *[get this]* **DRAINED**: - *[Advise]* them on the **Risks** of **Necrosis** **Blood** is *[drained]* from the **Ear** *[using]* a needle **[External Ear Neoplasia]** **Neoplasms** *[are either]*: **Benign** or Malignant - **[BENIGN]** - **Osteoma (Bony Tumour)** - **Keloid. - Soft tissue** *[extends]* *[beyond]* the **Margin** of the **Trauma (Hyperplastic/Trophic Scar)-** **[MALIGNANT]** - **[BASAL CELL CARCINOMA]** - *[Diagnosed]* via **Incisional Biopsy** - *[More]* **Nibbled** **Away** **Eroded** **Ulcer** **Appearance (Rodent Ulcer)** - **[SQUAMOUS CELL CARCINOMA]** - *[Usually]* *[located]* on the **HELIX** - **Superficial**, **Keratinised Appearance** **WHITISH** **[MIDDLE EAR]** **[Disorders of the Middle Ear] -** **2^nd^ & 3^rd^** are the *[most]* **IMPORTANT** *[ones to remember]* 1. **Acute Suppurative Otitis Media** 2. **Otitis Media with Effusion (\"Glue Ear\")** 3. **Cholesteatoma** 4. \[**Acute** **Mastoiditis**\] -- 5. **Tympanosclerosis** 6. **Otosclerosis** [**Measurement** of **Infection Progression**:] - **Infection** *[either spreads]* into the **Cranium** or *[down]* into the **Mastoid** - *[Often]* **investigated** to *[show how much]* the **Disease** has *[progressed]* **Acute Suppurative Otitis Media** **Bacterial** or **Viral Infection**, *[often]* **Occurring** in **Children** *[Causes]* **Pus** to *[build up behind]* the **Eardrum** *[resulting]* in **Severe Ear Pain**, **Fever**, and **Hearing Loss** **[SYMPTOMS:]** - **Irritable** - **Pain** - **Pyrexia** - **Hearing loss** - **Discharge** - **Systemic Illness** *[Ascending]* **URTI** *[causes]* **ACUTE SUPPURATIVE OTITIS MEDIA** - ***St. pneumoniae, H. influenzae*** **[TREATMENT:]** - **Antipyretics Calpol + Paracetamol** *[is very effective]* - **Antibiotics** - **Decongestants** - **Myringotomy** - **Surgical** **Incision** is *[made]* in the **Tympanic Membrane** to **drain it** **[COMPLICATIONS:]** - **Otitis Externa** *[Spreading]* **outwards** - **Recurrent** **Otitis Media** *[Becomes]* **glue ear** - **Perforation****Fluctuates** - **Food**/**Drink** **Unaffected** - **Anxiety** - **Reflux** **MALIGNANT** - **Progressive** **impairment** - **Problem** **Swallowing** **Solids, then liquids** - **Pain** - **Neck mass** - **Hoarseness** - **Weight loss** **[Summary]** - - [**Key Takeaways**:] - - -