ENT RED FLAGS

EAR
Persistent unilateral hearing loss/tinnitus
discharging ears [espec in immunocompromised =malignant otitis externa]
Pain
Facial nerve palsy
NOSE:
Blood stained mucous
Facial pain [esp unilateral,persistent, getting worse]
Orbital symptoms [epiphoria]
inusitus in immunocompromised !!"ungal
#F lea$
%asal s$in cancer
THROAT
&ysphonia ' one month duration
&ysphagia
Odynophagia
Pain [can radiate to ear]
(ny persistent growing lump
ENT emergencies
Facial palsy #aused by problem in middle ear/parotid
o/e) other cranial nerves, vesicles on pinna[ramsey hunt]
Bell's palsy *+, resolve by - months
.ore common in diabetes
/0) 1ye care [patch to prevent drying out and eye lubricants]
Oral steorids) 2+mg "or 3 days then stop
%o evidence "or antivirals
4ho to re"er)
Other #% palsy
%o improv at - wee$s
5ncomplete recovery
Sudden hearing loss: %ormal /.
(etiology)
6n$nown
7are) acoustic neuroma, perilyph lea$
71F17 5..1&5(/189
/0) oral steroids
Allerigc response to
BIPP:
[B5PP is used to pac$ ear a"ter surgery: #an develop very severe
allergic reaction the second time it is used in subse;uent operation
AOM+ headache !(B#1
Epistaxis 6se < in <+,+++ adrenaline with <, lignocaine on cotton bud
%asal vestibulitis) cautery vs naseptin are e;ually e""ective
Periorbital cellulitis will lose colour vision "irst
nilateral rhinorrhoea FB until proven otherwise
FB in bronchus li$ely right main bronchus
Examination in ENT
#entral structures in nec$=thyroid and thyroglossal cyst and will move with swallowing
8ymphatic drainage) Posterior triangle) lymphoma//B
/ongue)
#rac$ed/deep "issuring = iron de"ic/crohn=s
7ed "lat = pernicious anaemia
geographic ' di""erent area o" proli"eration = benign
nerve palsy = deviate to side o" lesion
%ose) i" touch the turbinate will be sore and patient will move bac$wards>
.ucousal retention cyst = benign
&on=t bother with 7inne and 4eber tests ' not clinically help"ul
7inne ?ve) B#@(# [i:e: abnormal] = conductive loss
4eber) to side o" sensorineural loss or away "rom side o" conductive hearing loss
&iAAiness)
nystagmus, cranial nerves, romberg [will "all to side o" pathology], dix?hallpi$e [BPPB],
"inger nose, dysdiado$ineses, bp [postural, 1#C]
EAR
Otitis externa: bacterial) staph, pseudomonas, proteus
"ungal) aspergillosis, candida
/0) so"radex, gentisone [use "or 3 days]: O"loxacin is not ototoxic
4(B
Beware .(85C%(%/ otitis externa [this actually osteomyelitis o"
temporal bone]
5mmunocompromised [e:g: diabetic]
6sually pseudomonas
PainDDD, #% palsy
71E6571 5B (bs "or F wee$s
Furuncolosis taph) re;uires 5D&
!a"sey #unt
Syndro"e
P(5%>>>>
Bertigo
Besicular rash
Perichondritis: 1ar piercing, laceration, surgery, connective tissue disease
can cause) cauli"low ear
Pre$auricalar sinus: i" become in"ected re;uire 5B antibiotics>>>
%i&&iness: (""ects G+, o" population
H3, don=t re;uired 5x
Iey points in the history)
7oom spinning)
JoriA [more common]
Bertical [indicates central cause]
Better with eyes open
peripheral i:e: ear
closed [central]
&uration)
.enierre=s=hours/all day
BPPB? diAAy only on turning head
Positional trigger! turning head ;uic$ly
&ea"ness D tinnitus
Other symptoms) syncope/headache
!7ecent viral illness
!past history migraine [o"ten co?exist with menierre=s]
any assoc aura!
BPP' /est is &ix?hallpi$e = causes rotational vertigo
/x) 1pley manouver
RHINOLOGY
Septal de(iation: /rauma/unilateral bloc$age especialy during the day: #orrection usually
ma$es no di""erence to snoring
)asal crusting: /hin$ vasculitis e:g: 4egener=s [unwell o"ten with Koint pains]
arcoid
Per*oration bleeding, whistling, bloc$age
Epistaxis 7is$s) Jypertension/clopidogrel
/x)
stop aspirin i" prophylactic
Baseline on earbud
[i" doesn=t settle with above re"er]
)asal trau"a 7e"er < wee$ a"ter trauma
Beware) eptal haematoma, #F lea$, Jead inKury/"acial "racture
!#I)O SI)SI+IS #aused by)
mucousal damage) strept, haemophilus,moraxella
ciliary impairment
allergy
re"lux
intubation/ng tube
G or more symptoms plus < sign
ymptoms)
bloc$age/obstruction/congestion
discharge) anterior/posterior
"acial pain,pressure
reduction o" sense o" smell
igns) endoscopic [polyp], discharge
(cuteL<G wee$s
%on?viral usually worse a"ter 3?<+ days
.ost will get better within <+ days with no treatment, although it may
ta$e G?- wee$s "or complete resolution:
%ote) give amoxil 3++mg tds or Pen v: 5" allergic doxycycline or
oxytetracydcline: %ote that erythromycin in"ective against J 5n"luenAe
which cause G<, o" cases:
%%/ "or antibiotics=<3
5" pain, purulent discharge, "ever li$elihood o" bacterial cause increases:
(void decongestants) will cause rebound congestion [rhinitis
medicamentosa]:
%asal/oral steroids can be help"ul i" pain [nasonex bd, avamys "or eye
symptoms]
%asal douching) with /175.(7 drops = saline drops as moisturiAer
o"ten very J18PF68:
THROAT
ymptoms
Pain Beware especially i" unilateral: #an re"er to ear
Joarseness
&ysphagia initially to solids then li;uids
%ec$ lumps site, duration, "luctuation["luct is normally a good sign]
1xamination) (9..1/75#(8 /O%58 [71F17 67C1%/89]
,uinsy #an have symptoms o" trismus [di""iculty opening mouth]
!ecurrent tonsillitis 3@= episode o" sore throat/year "or at least < year
4atch "or F months
+hroat pain 6nilateral, no "ever, persistent = #(%#17 until proven otherwise
%ysphagia &uration, progressive, regurg
site) high/low
!voice changes
Sali(ary gland 7ecurrent tender with meals = stones
Persistent slow growing = !tumour
+hyroid .ost benign
6 D F%(
Paediatric lu"p /hin$ lymphoma i" progressive night sweats
5" persistent cervical lymphadenopathy @Gcm) give G wee$s o"
antibiotics and do virology) 1BB, #.B, toxoplasmosis
Pharyngitis 6se centor criteria)
/onsillar exudate
/endar anterior cervical lymph nodes
(bsence o" a cough
Jistory o" "ever
5" - out o" 2 critera 2+?F+, sensivity "or trep]
/x) Pen B 3++mg bd to ;ds "or <+ days/ erythro 3++mg ;ds
ome evidence "or use o" steroids i" severe pharyngitis i" used with
antibiotic: O%89 5% (&68/ [%%/=2]
Obstu(ie sleep apnoea #onsider i" complain o" sleepiness Mnot tirednessN, especially i"
overweight:
5mportant as) H times more li$ely to have a road tra""ic accident:
(ssociated with hypertension, type G diabetes and metabolic
syndrome: /rea-tment reduces cardiovascular ris$:
(""ects <, o" men: .ore common in type G diabetics:
7e"er "or sleep study i" good history and witnesses [ta$e video>] and
high 1pworth sleepiness score Mscores o" @=O li$ely signi"icantN
811P /6&51 (71 /J1 O%89 4(9 /O &5(C%O1 5/>>
/x) #P(P
&riving: Once diagnosed patients must in"orm &B8(
Once on treatment, drivers are allowed to continue driving even JCB:
Paediatric ENT
/o get stridor must have H3, reduction in diameter to air"low ' O (84(9 5C%5F5#(%/>>>
8aryngomalacial develops in the "irst G?2 wee$s o" li"e
S+!I%O! Jx) (ge o" onset
/ype)
5nspiratory [obstruction above glottis e:g: haemangioma typically
develops at -?2 months [/x) propranolol]
Biphasic [below glottis]
Progressive
Previous intubations
Feeding di""iculty
#yanosis
#oughing/cho$ing
4eight gain [i" cross G centile lines problem]
#ry/voice
-lue ear #ommon, o"ten resolves spontaneously: Pea$s at ages G and 3:
Jx) &ea"ness, poor education, tinnitus, intolerance to loud
noise,clumsiness,behavioural problems:
Following guidance does not apply to children with &owns/cle"t palette [see
separate %5#1 guidance]
3+, will be better at - months with no intervention:
8oo$ "or impairment o" hearing/speech/language/behaviour
4atch"ul waiting "or - months [consider o""ering auto?in"lation device i" old
enough to understand how to use in the meantime]
("ter -m o" watch"ul waiting) i" hearing loss@G3?-+db or signi"icant impact on
development/education 71F17 [consider grommets/hearing aids]
don=t give) antibiotics/antihistamine/decongestants/inhal steroids
[suggestion i" adenoiditis to give trimethoprim "or F wee$s at Gmg/$g]
Acute otitis
"edia
*+, children recover with - days without antibiotics
%%/=%%J "or antibiotics
7e"er i" @2 in F months
&elay (bs i" no resolution by HGhours ' give 3 days o" amoxil
(dd topical ;uinolone i" per"oration or in"ected grommet:
#omplications) mastoiditis, "acial palsy [red "lag], labryinthitis
Mastoiditis #an have proptosis
Obstructi(e
sleep apnoea
/a$e video>
Obstruction 6nilateral chest signs: /hin$ "oreign body
.hronic otitis
"edia
Beware attic crusting) can have congenital acoustic neuroma: