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ENT surg (Plexus BVs ant part nasal septum (Kiesselbach plexus, ‘Little’s…
ENT surg
Plexus BVs ant part nasal septum (Kiesselbach plexus, ‘Little’s area’, bleeding), palatine arteries post
Bleeding nose (epistaxis): local cause (trauma, foreign bodies, septal abnormality, inflam, tumours), systemic cause (leukaemia, aspirin & warfarin, HTN, hereditary haemorrhagic telangiectasia – dilation BVs), manage (squeeze soft front ½ of nose, examine after anaesthesia, blood investigations, if bleeding site seen silver nitrate or electro cautery, if bleeding site cannot be seen gauze or ‘Mirocel’ or ‘Gelfoam’, post nasal packing, may req exam under GA)
Nasal polyps: causes (allergic rhinitis, chronic sinusitis, cystic fibrosis, allergies aspirin/NSAIDS, asthma), signs (obstruction, discharge, post nasal drip, sinus infection, lose smell), polyps para nasal sinuses & middle meatus, endoscopy, CT scan, tx (cause - steroids, surg to remove, avoid aspirin/NSAIDS)
4 paranasal sinuses: Mx, frontal, ethmoidal, sphenoid, most open middle meatus
Sinusitis - inflam paranasal sinuses: acute or chronic, causes (viral, bacterial), tx (decongestants – pseudoephedrine, ABs, surg enlarge sinus ostium ‘FESS’, elimination course, acute mx sinusitis from OAC or abscess discharging
Mx sinusitis from OAC: eliminate infection, saline, ABs, decongestants, socket path, close com, buccal advance flap, don't blow nose/mouth, avoid smoking, OH
Chronic sinusitis: causes (bacteria acute sinusitis lead to chronic, toxins that damage cilia, reflux, abnormalities of septum & turbinates, allergic fungal sinusitis, AIDS associated, smoking), complications (orbital cellulitis, osteomyelitis)
Ext ear (air into ear drum), middle ear (ossicles convert sound waves into mechanical hydraulic waves to inner ear), inner ear (nerve impulses to brain), malleus tenses tympanic membrane, tensor tympani supplied by trigem n, stapes
Diseases middle ear: otitis media (otitis media w effusion - glue ear, acute otitis media, chronic suppurative otitis media), cholesteatoma (epithelial tissues erose middle ear), otosclerosis (hardening bones middle ear), tympanic membrane perfs
Otitis media w effusion (Glue ear): fluid middle ear w/o inflamed ear drum, causes (bacterial & virus, drainage, enlarged adenoids, passive smoking, allergy), conductive hearing loss, bulging tympanic membrane, complications – spread of infection), self limiting, ABs persistent cases, tympanocentesis, myringotomy – incision tympanic membrane, insertion tympanostomy tube – grommets), check allergies & tx hay fever, sleep w head up, valsalva manoeuvre)
Acute otitis media: effusion middle ear infected & pus (obstruction Eustachian tube, pathogens from nasopharynx, inflam, purulent effusion), kids, irritability, ear ache, fever, hearing loss, inflamed ear drum bulges outwards)
Chronic suppurative otitis media: after long standing inflam, erosion ear drum & discharge, hearing loss, ossicular chain erosion, ABs, surg repair perf ear drum
Cholesteatoma: epithelial cells trapped skull base, incr size & erode bone, causes (congenital – squamous epithelium trapped in temporal bone during embryo genesis, acq – injure tympanic membrane), hearing loss, complications w infection), surg removal
Otosclerosis: osseus dyscrasia to temporal bone, hardening middle ear, hearing loss, ? measles virus, associated w osteogenesis imperfecta, hearing aids, stapedectomy
Diseases inner ear: noise induced hearing loss, labyrinthitis, ototoxicity, sudden hearing loss, tinnitus
Noise induced hearing loss: years, bilat, high freq. loss < 75dB, low freq. < 40dB, high freq more damaging, acoustic trauma due to loud noise immediate/permanent hearing loss e.g. bomb blast
Labyrinthitis: inflam labyrinth, disturb bal & hearing, causes (viral, bacterial, trauma, stroke, DM, aminoglycosides ‘gentomycin’, alc, drugs), rest, hydration, antiemetics, anxiolytic ‘diazepam’, antiviral, steroids, ABs, surg decr pressure)
Ototoxicity: bilat high freq hearing loss & tinnitus, caused by aminoglycosides, antineoplastic, salicylates, quinine, proper use ototoxic meds, avoid excessive noise exposure during recovery)
Sudden hearing loss: 4 paths (viral infection, labyrinthine vasc compromise, rupture intra cochlear membrane, immune mediated inner ear disease)
ENT surg of kids: lymphatic tissue nasopharynx ‘Waldeyer’s ring’, indication (enlargement causing nasal obstruction, persistent otitis media, chronic sinusitis), dx (endoscopy), surg (remove adenoids w curette/punch), adenoidectomy, tonsillectomy & insertion ventilation tubes same op
ENT surg kids: tonsillectomy (remove palatine tonsil), indications (enlarged airway obstructions, peritonsillar abscess, tonsillitis, foul taste, investigation path), post op complications (pain, airway obstruction, bleeding, dehydration & weight loss due to dysphagia)