ENT

Question 1

Nasal Polyps

Causes
Features
Managagement

Answer 1

RED FLAG- Unilateral Polyps

Causes - Asthma, Aspirin sensitivity, infective sinusitis, CF, Churg-strauss syndrome, Kartagnener’s syndrome

Features - Nasal obstruction, Rhinorrhoea, sneezing, poor sense of taste and smell

Management
ENT Referral - Unilateral (Urgent) + Bilateral (Non-urgent)

Topical corticosteroids - Shrink polyp size

Question 2

Samter’s Triad?

Answer 2

Asthma, Aspirin sensitivity, Nasal polyps

Question 3

Sinusitis

1, Define?

2. Types of Paranasal sinuses?
3. Most common causative agents?
4. Clinical Features
5. Management

Answer 3

Inflammation of the mucous membranes of the paranasal sinuses.

Frontal, Ethmoid, Sphenoid, Maxillary

Streptococcus pneumoniae, Hib, Rhinovirus

4. Facial pain, Nasal discharge (Thick + purulent), Nasal obstruction.

5. Anaglesia, Decongestants, 
Intranasal corticosteroids (>10 Days) 
Severe cases - Oral Abx (Co-amoxiclav/Pehnoxymethlypenicillin)

Question 4

Explain ‘Double-sickening’ with sinusitis?

Answer 4

An initial period of recovery from being unwell followed by a sudden worsening of symptoms.

Secondary bacterial infection following a viral rhinosinusitis.

Question 5

Perforate Eardrum (Tympanic Membrane)

Management?

Answer 5

Watch and Wait -Perforated eardrum will usually heal by itself within 6-8 weeks. ENT referral persists beyond 6W

Eardrum is a skin-like structure and therefore it heals in the same way - Avoid getting water into the ear as this can impair healing and increase the chance of infection.

Oral Abx for perforations following Acute Otitis Media

Surgical Myringoplasty for eardrum that doesn’t self-heal.

Question 6

Differences in Rinne and Weber tests for

Positive (Normal),
Negative (Abnormality)

Answer 6

Conductive hearing loss
Rinne result: Bone conduction > air conduction in affected ear (Negative Test)
Air conduction > bone conduction in unaffected ear
Weber Result: Lateralises to affect ear

Normal
Weber: Midline
Rinne: Air conduction > bone conduction bilaterally

Sensorineural hearing loss
Rinne result: Air conduction > bone conduction bilaterally
Weber result: Lateralises to unaffected ear

Question 7

Name the condition

Chronic, smelly ear discharge and recurrent glue ear. Associated with conductive hearing loss?

Answer 7

Cholesteatoma

Occurs due to squamous epithelium forming in small pockets on the tympanic membrane which becomes cyst-like as it produces keratin and sloughs over time. There will be middle ear erosion which will create an environment for anaerobic bacterial growth to occur.

Question 8

Conductive hearing loss conditions?

Answer 8

OME(Glue Ear) 
AOM 
Perforated Eardrum 
Wax 
Otitis Externa
Disease of ossicles
Cholesteatoma

Question 9

Sensorineural hearing loss conditions?

Answer 9

Meniere's disease 
Trauma 
Ototoxicity 
Acoustic Neuroma
Prebyacusis (Age-related hearing loss)

Question 10

What are the indications for a Tonsillectomy referral?

[7 Marks]

Answer 10

Indications for consideration of a tonsillectomy
7 repeated Episodes of tonsillitis in 1 Year
5 repeated Episodes in 2 Years
3 repeated Episodes in 3 Years
Unilateral tonsil enlargement
OSA/Storidor/Dysphagia - 2* to enlarged tonsils
Quinsy (Peritonsillar abscess) unresponsive to standard treatment.
Recurrent febrile convulsions 2* to episodes of tonsillitis

Question 11

Complications of Tonsilitis & Tonsillectomy?

Answer 11

Acute Tonsilitis
Otitis media, Quinsy, Rheumatic fever, Glomerulonephritis(very rarely)

Tonsillectomy
Primary haemorrhage (<24H)- Inadequate haemostasis, Urgent ENT Theatre Assessment.  
Secondary haemorrhage (24H - 10D) - Infection, Treated with Abx

Question 12

Criteria for 2WW Referral for Suspected Laryngeal Ca?

Answer 12

> 45 Y.O
Persistent unexplained hoarseness
OR
Unexplained lump in the neck.

Question 13

Causes for Hoarseness?

Answer 13

Voice overuse
Smoking
Viral illness
Hypothyroidism
GORD
Laryngeal Ca
Lung Ca

Question 14

Causes for Tinnitus?

Answer 14

Tinnitus -Ringing in-ear (Perception of sounds in the ears or head that do not come from an outside source)

Menier’s disease
Otosclerosis
Sudden onset sensorineural hearing loss (SSNHL)
Hearing Loss - Excessive loud noise /Presbycusis (Age-related h.loss)
Drugs - Asprin/Nsaids, Aminoglycosides, loop diuretics, quinine
Impacted ear wax

Question 15

Sudden onset sensorineural hearing loss

SSNHL?

Answer 15

Around 80% of Acoustic neuroma

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2

Question 16

Otosclerosis?

Answer 16

Onset is usually at 20-40 years
Conductive deafness
Tinnitus
Normal tympanic membrane although 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia

Positive family history

Question 17

Meniere’s disease?

Answer 17

Associated with hearing loss, vertigo, tinnitus and sensation of fullness or pressure in one or both ears

Question 18

Causes of Vertigo?

Answer 18

Vertigo - False sensation that the body or environment is moving.

Viral labyrinthitis
Vestibular neuronitis
Benign paroxysmal positional vertigo (BPPV)
Meniere's disease
Acoustic neuroma
Vertebrobasilar ischaemia
Posterior circulation stroke
Trauma
MS
Ototoxicity - Gentamicin

Question 19

Which organism is the most common cause of bacterial otitis media?

Answer 19

Haemophilus influenzae