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- Otitis externa presents with itchy, inflamed skin of the ear canal and minimal hearing loss. Pseudomonas is a common cause and is treated with gentamicin drops. Fungal otitis externa requires longer treatment. - Necrotizing otitis externa causes severe nighttime pain and is seen in diabetics, presenting as a red lump and discharge on examination. It can cause facial or eye muscle paralysis. - Cholesteatoma is a discharging ear that does not resolve with antibiotics. It requires surgical treatment like mastoidectomy and carries risks of intracranial complications or facial nerve palsy. It can be congen

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330 views

Ent Lecture Notes

- Otitis externa presents with itchy, inflamed skin of the ear canal and minimal hearing loss. Pseudomonas is a common cause and is treated with gentamicin drops. Fungal otitis externa requires longer treatment. - Necrotizing otitis externa causes severe nighttime pain and is seen in diabetics, presenting as a red lump and discharge on examination. It can cause facial or eye muscle paralysis. - Cholesteatoma is a discharging ear that does not resolve with antibiotics. It requires surgical treatment like mastoidectomy and carries risks of intracranial complications or facial nerve palsy. It can be congen

Uploaded by

Thistell Thistle
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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

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