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ENT (Head and Neck Pathology, Checklist, Otology, Laryngology, Rhinology) …
ENT
Head and Neck Pathology
Salivary Gland Pathology
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Sialothiasis
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Causes
Predispositions:
- Serous secretion
- Anatomy - antigravitaional
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Thryoid Nodule Pathology
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AGES
A. Age
over 40 male
over 45 female
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Investigations / Work Up
- Thyroid Function Tests (TFTs)
- FNA Fine needle aspiration
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Differentiates solid vs cystic
Cysts more likely benign
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Surgeries
Parathyroidectomy
Indications
Hypercalcemia
Stones, bones, groans, pychic moans
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Cricothyroidotomy
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Advantaged
Accessible, minimal dissection
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Thyroidectomy
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Surgery preferred to radio in
- children with thyroid cancer
- Women of childbearing age
- Ocular symptoms of hyperthyroidism
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Pinnaplasty
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- Treat at age 4/5
- Must wear bandage for 2 weeks post op
- Low compliance in younger children
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Cancer
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Risk Factors
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- HPV
HPV likes the tonsil :)
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Red Flags
Symptoms
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- Trismus - difficulty opening mouth
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Signs
- Peristent red/white patches which are swollen / painful/ bleeding oral cavity
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- Rapidly growing thyroid mass
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Cysts
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Thyroglossal Duct Cyst
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- Thyroglossal duct descends from the forament cecum of the tongue
- Cysts must be removed due to risk of infection, fistula, cancer
- Recurrence ~3% when hyoid removed
Treatment
Sistrunk's Procedure
- Removal of middle portion of hyoid bone as well as cysts
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Moves with tongue protrusion
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Otology
Pathologies
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Quinsies
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Presentation
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- Trimus (can't open mouth)
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Otis Externa
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Causes
- 90% bacterial
Often pseudomonas
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Cholesteatoma
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Risks
- PT with chronic Eustachian tube dysfuntion
- PT with middle ear issues leading to negative pressure
Disease Progression
- Negative pressure pulls pars flaccida into middle ear forming "attic pocket"
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Mastoiditis
Presentation
- Ear pushed down and out with visible external swelling
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Complications
- Meningitis
Thin tegmen tympani
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- Intracranial complications
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Symptoms
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Classification
- Benign Positional Vertigo (BPV)
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- 2% chronic
- 20% will suffer at some point in their life
- Onset ~ 50yrs
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Treatment
Eply Manoeuvre
Repositions free floating particles in semicircular canals
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- 40-60 yrs
- Genetic link - more endolymph production
Presentation
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- Hearing loss (low Hz sensorineural)
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- 30-60 yrs
- Pt appears very unwell compared to other causes of vertigo
Causes
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Viral, bacterial, autoimmue
Treatment
- Supportive therapy
- Bed rest
- Fluids
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Balancing Monkey Acrobat
BPV, Meniere's, Acute Labyrinthitis
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Causes
KITTENS
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Idiopathic (Bell's)
Infective (mumpes, herpes, Lyme's)
Iatrogenic (Parotidectomy/ maistoidectomy)
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N
Neoplasia
Neurological (stroke, TIA, MND)
Neurogenic
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Surgeries
Tonsillectomy
Indications
- Obstructive sleep apnoea (OSA)
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Risks
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- Damage to teeth / tongue / TMJ due to Boyle-Davis gag
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Grommets
- Most common ENT surgical procedure
- Mainly paediatric due to horizontal Eustachian tube
- Occasionally done in adults in those with muffled hearing for weeks ater a cold etc
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Indications
- Fluid in the middle ear 4/5 times in 6 months
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Adenoidectomy
Indications
- Obstructive sleep apnoea
Cessation in breathing for >10 sec
- Recurrent / presistent infection or recurrent adenoiditis
- Consider after muliple pairs of grommets
- Enlarged adenoids block eusachian tube
- Does not cause immunological issues - remaining tissue compensates
Tympanoplasty
Procedure
Temporal fascia, tragal cartilage or fat grafted into hole
Complications
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- chorda tympani damage - changes in taste, decreased hearing
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Laryngology
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Pathology
Globus Pharyngeus
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- Generally resolves spontaneously
- Link to LPR or GERD, or anxiety
- Doesn't impair swallowing but can be irritating
- Local to C6
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Epiglottitis
Presentation
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- Moderate / sevre inspiratry stridor
- Drooling and leaning forward
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Rhinology
Pathology
Fractured Nasal Bones
- Leads to deformed looking nose and should be referred to ENT
- Swelling for 7 days post injury
- Do not leave suspected fracture untreated for >14 days - bone sets
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Septal Haematoma
- Potential complication of nasal fracture - Do not miss
- Mucoperichondrium seperates from skin and potential space fills with blood
Treatment
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- Broad spectrum antibiotics
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Septal Perforation
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Causes
KITTENS
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I - Infection (Infective Septal haematoma)
Iatrogenic - septoplasty
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PURRRRforation
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Nasal polyposis
Formation of oedematous sinonasal mucosal growth which encroaches into the nostril
Allergic aetiology
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Symptoms
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- Mucopurulent discharge / rhinorrhoea
Treatment
- Reducing dose of oral steroids
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Periorbital Cellulitis
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Chandler's Grade
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- Orbital cellulitis without abcess
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- Cavernous sinus thrombosis
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Epistaxis
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Treatment
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- BIPP Pack +/- balloon
48-72 hrs
- Surgery - SphenoPalatine Aartery ligation / Embolisation
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Symptoms
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- PND Paroxysmal nocturnal dyspnea
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