ENT

Question 1

Treatment for AOM

Answer 1

Use ABx if:
- <6 months
- <2 years if bilateral
- systemically unwell
- otorrhoea 
- ATSI
- immunocompromised 
FEVER ALONE NOT AN INDICATION

Amoxicillin 15mg/kg TDS for 5/7
If no improvement for Augmentin 22.5mg/kg BD for 5/7
If hypersensitivity Trimethoprim/Sulfamethoxazole 4+20mg/kg BD for 5/7

Typanostomy if 3 or more episodes in 6/12 or 4 or more in 12/12
If effusion with no AOM, observe for 3/12. >20dB bilateral loss consider 2-4/52 ABx + ventilation tubes/adenoidectomy

Question 2

Meniere’s Disease

Answer 2

Sx:
Vertigo - minutes/hours
Progressive hearing loss
Tinnitus
Aural fullness

Peripheral nystagmus

Audiogram:
Low frequency sensorineural hearing loss

Question 3

Otosclerosis

Answer 3

Footplate of stapes becomes ossified

Bone conduction better than air conduction
- typically bilateral conductive hearing loss +/- minor sensorineural

20-30yo
F>M
Bilateral or unilateral
Can rapidly deteriorate during pregnancy
Autosomal dominant

Mx
Surgical referral -> Stapedectomy
Some require cochlear implants

Question 4

Cholesteatoma

Answer 4

Frequent ear infections
Foul smelling discharge
Can involve facial nerve causing facial weakness
Otalgia
Conductive hearing loss
Vertigo

Question 5

Orbital vs Pre-orbital cellulitis

Answer 5

Red flags for orbital

1. Vision affected
   - Diplopia
   - Loss of red/green colour (may be an early sign)
   - Pupil defect
   - Reduced acuity
2. Proptosis
3. Pain on occular movement
4. Severe headache/intracrnial features

Orbital >80% related to recent sinus infection

Orbital = surgical emergency. Can lead to venus sinus thrombosis, intracranial abscess, vision loss, meningitis.
= ENT + Opthal urgent referral

Question 6

Salivary gland stones = Sialolithiasis

Answer 6

RF: Dehydration, Anticholinergic medication, diuretics, trauma

Sx
Pain during or prior to eating
Small rock hard stones palpable or visible

Consider acute bacterial sialadenitis if purulent discharge -> Either Dicloxacillin/Cefalexin = 500mg QID 7-10 days

Mx
Milk the duct with massage
Stay well hydrated
Suck on tart/sour hard candies to promote saliva production
Discontinue anticholinergic medication
NSAIDs for pain

Question 7

Otitis Media with effusion

Answer 7

Effusion persists for a while post-AOM
Typically resolves
Need to review in 9 weeks. if still present -> ENT referral + Audiometry

Question 8

Acute unilateral cervical lymphadenitis

Answer 8

Staph or Strep
If bilateral, usually viral

Providing relatively well , Ix and Mx usually not warranted

If suppurative disease (= fluctuant or pointing abscess) for cefalexin 12.5mg/kg up to 500mg cefalexin/dicloxacillin QID for 7 days
Consider USS if suspected abscess
If incision and drainage -> MCS
Kawasaki can also present with unilateral cervical lymphadenitis

Question 9

Idiopathci Bell’s Palsy

Answer 9

Unilateral facial nerve involvement

If <72 since onset of symptoms -> Prednisolone 1mg/kg up to 75mg daily for 5/7

Consider varicella infection of facial nerve (Ramsay Hunt syndrome) = vesicles in ear. Treat same with pred as above + antiviral

Recovery can be weeks to months. Typically very good prognosis.
If eye closure impaired -> lubricating drops + cover affected eye if windy/dusty