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ENT - Coggle Diagram

- - - - viral
        
        rhinovirus
        
        RSV
        
        influenza
        
        adenovirus
        
        both
      - bacterial
        
        Strep. pneumoniae
        
        H. influenzae
    - - child (6–24 mths)
    - - otalgia
        
        tugging at ear
      - recent URTI/cough/coryzal symptoms
      - fever/irritability
      - perforation
        
        otorrhoea
    - - simple analgesia
        
        paracetamol
        
        ibuprofen
      - consider antibiotics (amoxicillin) IF
        
        systemic features
        
        high risk
        
        otorrhoea
        
        mastoiditis
        
        admit
        
        IV antibiotics
    - - usually resolves spontaneously in 1–3 days
      - can spread through mastoid air cells into CNS, causing meningitis
      - perforation usually heals completely within a few weeks
    - - look for mastoiditis
        
        tenderness over mastoid process
        
        ear pushed forwards
      - otoscopy
        
        opacified, bulging tympanic membrane
        
        prominent dilated vessels
        
        loss of normal anatomy
        
        can't pinpoint cone of light
  - - - more likely bacterial
        
        Pseudomonas aeruginosa
        
        Staphylococcus aureus
      - fungal
        
        Aspergillus
    - - inflammation of external auditory canal & auricle
      - oedema & swelling in external auditory canal can close it off, leading to
    - - DM
      - water immersion
        
        swimmer's ear
    - - otalgia
      - jaw pain
      - itchy external ear
      - a lot of purulent otorrhoea
      - conductive hearing loss
    - - topical ear drops
        
        acetic acid
        
        antibiotic ± corticosteroid
        
        ciprofloxacin 0.3% ± dexamethasone 0.1%
        
        consider antifungal
    - - complications
        
        malignant/necrotising otitis externa
        
        presentation
        
        facial nerve palsy
        
        osteomyelitis of mastoid process
        
        CNS spread
        
        meningitis
        
        very high mortality
        
        cerebral abscess
        
        management
        
        ENT admission
        
        surgical debridement
        
        systemic antibiotics
        
        typical patient
        
        older patient
        
        immunocompromised
        
        long-term steroid use
        
        DM
        
        pathology
        
        most often
        
        granulation tissue in external auditory canal
  - - - abnormal collection of keratinising squamous epithelium (skin) within the middle ear
      - pharyngotympanic tube dysfunction
      - chronic negative middle ear pressure
      - retraction pocket (skin lining tympanic membrane, esp. pars flaccida, is sucked in)
    - - foul smelling chronic otorrhoea
      - conductive hearing loss
    - - refer to ENT
        
        surgical excision
  - - - vertigo
        
        N&V
    - - central
        
        cerebellar stroke
      - peripheral
        
        BPPV
        
        prognosis
        
        tends to get better on its own
        
        typical patient
        
        woman over 50
        
        pathology
        
        otoliths (calcium crystals) dislodge in semicircular canal
        
        usually posterior semicircular canal
        
        presentation
        
        sudden, brief (30s or less) episodes of vertigo brought on by head movement
        
        investigation
        
        Dix-Hallpike manoeuvre
        
        recreates vertigo
        
        nystagmus
        
        management
        
        clinician
        
        Epley manoeuvre
        
        patient
        
        Brandt-Daroff exercise
        
        Meniere's disease
        
        pathology
        
        raised pressure in endolymphatic system
        
        presentation
        
        vertigo (>20 mins to hours)
        
        aural fullness
        
        sensorineural hearing loss
        
        tinnitus
        
        typical patient
        
        50–60 yrs
        
        Caucasian
        
        FH
        
        migraine
        
        investigation
        
        MRI head to exclude vestibular Schwannoma
        
        management
        
        prochlorperazine (antipsychotic which works as antiemetic)
        
        during acute attack
        
        cyclizine (antihistamine which works as anti-sickness)
        
        betahistine
        
        prophylaxis
        
        stemetil
        
        acoustic neuroma/vestibular Schwannoma
        
        viral labyrinthitis
        
        pathology
        
        usually viral
        
        inflammation of membranous labyrinth
        
        typical patient
        
        30–50 yrs
        
        presentation
        
        vertigo
        
        sensorineural hearing loss
        
        tinnitus
        
        management
        
        refer to ENT
        
        vestibular rehab
        
        vestibular neuronitis
        
        pathology
        
        inflammation of vestibular nerve (Cr. N. VIII)
        
        presentation
        
        vertigo
  - - - swimmer
    - - hearing loss
- - - - 95% anterior (Kiesselbach plexus in Little's area)
    - - trauma
        
        facial
        
        child (more commonly)
        
        digital (nose picking)
      - rhinitis
      - hypertension
      - anticoagulation
        
        liver failure
        
        blood thinners
        
        warfarin
        
        apixoban
    - - A–E
        
        major haemorrhage protocol (particularly in anticoagulated elderly patients, posterior bleed)
        
        blood products
      - first aid for 10–15 mins
        
        leaning forwards
        
        applying pressure to soft part of nose
        
        nose clip
        
        ice pack on bridge of nose
      - visible bleeding point
        
        silver nitrate cautery
      - anterior nasal packing
        
        rapid rhino
      - nothing else works or posterior bleed
        
        refer to ENT
    - - can get airway compromised from blood flowing down the nasopharynx
  - - - inflammation of paranasal sinuses
      - usually viral URTI
        
        rhinovirus
        
        influenza
      - bacterial
        
        Strep. pneumoniae
        
        H. influenzae
      - allergic
    - - can become chronic (>12 wks)
        
        intranasal corticosteroids
    - - nasal congestion
      - rhinorrhoea
      - facial pain/tenderness
        
        worse on leaning forwards
      - headache
      - fever
    - - saline nasal irrigation
      - nasal decongestants
        
        only short-term
      - consider antibiotics (amoxicillin)
        
        10 days
- - - - usually viral
        
        common cold viruses
        
        rhinovirus
      - bacterial
        
        Strep. pyogenes (group A strep)
      - inflammation of palatine tonsils
    - - sore throat
      - fever
      - cough
      - lymphadenopathy
      - quinsy (peritonsillar abscess)
        
        trismus (difficulty opening jaw)
        
        muffled voice
        
        uvula displacement
    - - 5–15 yrs
    - - encourage fluid intake
      - FeverPAIN/CENTAUR scoring system
        
        fever in past 24 hrs
        
        absence of cough/coryzal symptoms
        
        symptom onset 3 days or less
        
        2–3
        
        consider delayed antibiotics
        
        phenoxymethylpenicillin
        
        4–5
        
        consider immediate antibiotics
        
        purulent tonsils
        
        severe tonsil inflammation