ENT

----. TEMPORO-MANDIBULAR JOINT DYSFUNCTION:

--------------------------------------. H/O of teeth grinding at night.
. Referred pain to ear.
. Worse with eating.
. Peri-tonsillar abscess:
------------------------. Muffled voice make one consider other diagnosis than simple tonsillitis or
pharyngitis. . Deviation of the Uvula + Unilateral lymphadenopathy = Peri-tonsillar
abscess.
. Tx: URGENT NEEDLE ASPIRATION + IV Antibiotics.
. PRESBYCUSIS:
-------------. Old pt in 60s.
. Sensori-neural hearing loss.
. HIGH frequency BILATERAL hearing loss.
. Difficult hearing in noisy crowded places.
. OTOTOXIC drugs:
----------------. Aminoglycosides antibiotics.
. Loop diuretics e.g. Furosemide. NOT THIAZIDEs !!
. Aspirin.
. REMEMBER:
----------. SE of BBs -------> Bronchoconstriction - Bradycardia - fatigue - depression.
. SE of ACEIs -----> Cough - Hyperkalemia - Angioedema.
. SE of Aspirin ---> Tinnitus.
. SE of Thiazides -> Orthostatic Hypotension - photosensitivity - hypercalcemia.
. Serous O.M.
------------. is associated with HIV pts manifesting as middle ear effusion without infection.
. causing dull hypomobile tympanic membrane.
. NASAL POLYP:
-------------. is associated with chronic rhino-sinusitis, asthma.
. H/O of aspirin or NSAIDs induced broncho-spasm
. (ASPIRIN EXACERBATED RESPIRATORY DISEASE).
. Symptoms of bilateral nasal obstruction, nasal discharge & anosmia.
. LEKOPLAKIA:

------------. Hard to remove white patches in the floor of the mouth.

. due to chronic irritation by smoking or alcohol.
. May lead to squamous cell carcinoma.
. CANDIDIASIS:
-------------. Diabetic pt. with poor control.
. Whitish plaques with underlying erythema.
. Easily scrapped off with a tongue depressor.
. Epiglottitis:
--------------. High fever.
. Severe sore throat.
. Odynophagia.
. DROOOOOOOOOOOOOOOOLING.
. Progressive airway obstruction.
. HARSH SHRILL.
. Causative organisms: Haemophilus influenzae & Streptococcus pyogenes.
. Retro-pharyngeal space is the most common neck space susceptible to infection.
. Otosclerosis:
--------------. is the most common cause of conductive hearing loss in middle aged adults 2030s.
. AMINOGLYCOSIDES - GENTAMYCIN is the most common cause of sensorineural
hearing loss.
. Retro-pharyngeal abscess:
--------------------------. Fever & sore throat.
. Dysphagia & Odynophagia.
. Trismus (pain on mouth opening).
. Pain on neck EXTENSION (pain on neck flexion = Meningitis).
. H/O of local trauma to the pharynx e.g. FISH BONE.
. MENIERE's disease:
-------------------. Vertigo = Severe spinning sensation + nausea.
. The type of vertigo is peripheral not central as it last just for 1-2 hours with the
presence of ear fullness & H/O of excessive cell phone use.
. EAR FULLNESS suggests Meniere's disease
. from an abnormal accumulation of endo-lymph within the inner ear.
. Meniere's dis. is an INNER ear disease.
. Simply exclude CEREBELLAR dis. by absence of inco-ordination or gait
disturbances!
. MALIGNANT OTITIS EXTERNA:

--------------------------. caused by PSEUDOMONAS AERUGINOSA.

. Elderly with poorly controlled DM.
. Ear pain, discharge.
. GRANULATION TISSUE within the ear canal on otoscopy.
. Progression to the base of the skull may damaga the facial nerve causing facial
palsy. . Dx: CT skull base.
. Tx: IV CIPROFLOXACIN. not surgery !!
. Meniere's disease:
-------------------. Vertigo + Ear fullness + Hearing loss.
. 1st line ttt ----> LOW SALT DIET.
. ASSESSMENT a case of hearing loss:
-----------------------------------. A louder tone is heard when a TF is placed on the pt's Rt mastoid process
& a softer tone when the TF is placed near her Rt. external auditory meatus
-> Abnormal Rinne
-> CONDUCTIVE hearing loss
-> bec. the diseased ear hears better due to obscuring of the external noise.
. When the TF is placed on the middle of the forehead, she feals the vibration better
in her Rt ear than the Lt
-> Abnormal Weber test
-> The sound lateralizes to the diseased ear due to better bone conduction.
-> CONDUCTIVE hearing loss.
. APHTHOUS ULCERS:
----------------. CROHN's disease can involve any part of the GIT from the MOUTH to the ANUS.
. APTHOUS ulcers in the mouth can be seen as extra-intestinal manifestation.
. Pathology: GRANULOMATOUS inflammation.