ENT REVISION
Causes of hearing loss...
- Conductive
- Otitis media with effusion (~2y) - glue ear; speech and language delay; active
observation (unless Down’s syndrome or cleft palate then ENT review)
- Cholesteatoma (10-20y) - associated with cleft palate; foul-smelling non-resolving
discharge
- Otosclerosis (20-40y) - AD, replacement of normal bone by vascular spongy
bone; tinnitus
- Otitis externa
- Otitis media
- Sensorineural
- Presbycusis (65y) - age-related hearing loss; bilateral high-frequency
- Meniere’s disease
- Vestibular schwannoma
- Labyrinthitis
Benign paroxysmal positional vertigo (BPPV)
- Debris in semicircular canal → stimulate hairs → hallucination of rotation
- Sx: episodic vertigo lasting secs-mins, induced by change in position, no hearing loss
- Dx: Dix-Hallpike manoeuvre
- Tx: Epley manoeuvre
Meniere’s disease
- Excess fluid in the inner ear
- Sx: episodic vertigo lasting hours, tinnitus, sense of ear fullness, unilateral hearing loss
- Tx: no cure so sx relief, acute attack with cinnarizine (antihistamine) or prochlorperazine
(vestibular sedative), prophylaxis with betahistine + low salt diet
Vestibular schwannoma
- Sx: CN VIII (vertigo, sensorineural hearing loss, tinnitus), CN V (absent corneal reflex),
CN VII (CN VII palsy)
- Dx: MRI cerebellopontine angle
Epistaxis
- Most nosebleeds originate from Kiesselbach’s plexus (aka Little’s area, within anterior
nasal septum, confluence of 4 arteries)
- Blood supply to nose is sphenopalatine → internal maxillary → external carotid
- Tx:
- #1 sit forward, mouth open, pinch nose for 10-15m
- #2 cautery with silver nitrate (if bleeding source visible) or packing
COMMON INFECTIONS
Causes of hearing loss...
- Conductive
- Otitis media with effusion (~2y) - glue ear; speech and language delay; active
observation (unless Down’s syndrome or cleft palate then ENT review)
- Cholesteatoma (10-20y) - associated with cleft palate; foul-smelling non-resolving
discharge
- Otosclerosis (20-40y) - AD, replacement of normal bone by vascular spongy
bone; tinnitus
- Otitis externa
- Otitis media
- Sensorineural
- Presbycusis (65y) - age-related hearing loss; bilateral high-frequency
- Meniere’s disease
- Vestibular schwannoma
- Labyrinthitis
Benign paroxysmal positional vertigo (BPPV)
- Debris in semicircular canal → stimulate hairs → hallucination of rotation
- Sx: episodic vertigo lasting secs-mins, induced by change in position, no hearing loss
- Dx: Dix-Hallpike manoeuvre
- Tx: Epley manoeuvre
Meniere’s disease
- Excess fluid in the inner ear
- Sx: episodic vertigo lasting hours, tinnitus, sense of ear fullness, unilateral hearing loss
- Tx: no cure so sx relief, acute attack with cinnarizine (antihistamine) or prochlorperazine
(vestibular sedative), prophylaxis with betahistine + low salt diet
Vestibular schwannoma
- Sx: CN VIII (vertigo, sensorineural hearing loss, tinnitus), CN V (absent corneal reflex),
CN VII (CN VII palsy)
- Dx: MRI cerebellopontine angle
Epistaxis
- Most nosebleeds originate from Kiesselbach’s plexus (aka Little’s area, within anterior
nasal septum, confluence of 4 arteries)
- Blood supply to nose is sphenopalatine → internal maxillary → external carotid
- Tx:
- #1 sit forward, mouth open, pinch nose for 10-15m
- #2 cautery with silver nitrate (if bleeding source visible) or packing
COMMON INFECTIONS
