ENT Treatments

Question 1

Temporal bone fracture
(2 points)

Answer 1

Usually just let recover
May need facial nerve decompression (only decompress if it is unlikely the facial nerve will begin to work)
…

Question 2

Sudden sensorineural hearing loss

Answer 2

Steroids 1mg/kg

(urgent referral to ent)

Question 3

Otitis externa management

Answer 3

Avoid water

1st line: aural toilet then topical aminglycosides (not if perforated!!)/ciproflaxin drop + steroid drop

2nd line: oral flucox

if not responding to antibiotics then refer to ENT

Question 4

Acute otitis media management

Answer 4

supportive unless…

persistent for 4days or more
and/or systemicslly unwell - antibiotics

systemically unwell

Question 5

BPPV treatment

Answer 5

1st line; Epley maneuvre,

other: Brandt daroff,selmont
…

Question 6

Vestibular neuronitis treatment

(3)

Answer 6

Supportive, generally self-limiting,

1st: 3 day course of prochlorperazine/ antihistamine

peristent (>1week): refer to specialist for rehabillitation excerises

Question 7

Mernieres disease treatment 1st line prophylaxis,

Answer 7

1st line: bitahistine

Question 8

when are aminoglycasides contraindicted for ear treatment

Answer 8

tympanic membrane perforation/grommets

Question 9

Diagnose glandular fever

Answer 9

Atypical lymphocytes
+ve monospot/ paul bennet
Low CRP

Question 10

Moderate to severe OSA (obstructive Sleep Apnoea) in kids treatment

Answer 10

Surgery (remove adenoids)

Question 11

a 36 yr old patient walks in with stridor and fever, what is the initial management

Answer 11

oxygen

Question 12

patient has a nose bleed needing a nasal pack and is on warfarin & bp is 170/110
what medication should be given

Answer 12

anti hypertensive

different story if the patient had already been given the nasal pack and was still bleeding heavily

Question 13

nocturnal cough + throat clearning with no nasal symptoms and normal nasal examination. what treatment should be trialled?

Answer 13

PPI and gaviscon

Question 14

patient presents with anosmia (loss of sense of smell) for 3 months and nasal blockage with clear discharge. what is the appropriate management

Answer 14

intranasal steroids

Question 15

otitis media with effusion treatment

when to refer

Answer 15

supportive, ‘watch and wait’ then recheck ears 12 weeks later

refer if downs syndrome or cleft palate patient

persistent for >3months refer for surgery (grommets)

if in an adult and no history of URT refer (2 wk wait & CT scan)

Question 16

treatment for perforated ear

Answer 16

it should heal itself within 6-8 weeks. if not do a myringoplasty

Question 17

acute sinusitis treatment
(3 points)

Answer 17

analgesia

if lasts >10days intransal corticosteroids

if severe/systemically unwell then antibiotics (penicillins). of penicillin allergic give doxcy

Question 18

initial management of mastoiditis

Answer 18

iv antibiotics

diagnosis is clinically made

Question 19

acute otitis media with perforation/discharge management

and what to avoid

Answer 19

1st line: ORAL amoxicillin
2nd: erythomcyin

avoid aminoglycasides (eg. gentamicin)

give ciprofloxacin if it is caused by pseudomonas

Question 20

acute otitis media management for a patient that is less than 2 years old
give drug names

Answer 20

!st line: amox
2nd: erythomycin

Question 21

acute necrotising ulcerative gingitus treatment

Answer 21

paracetemol + oral metronidazole + chlorexidihine

Question 22

light bleeding after tonsillectomy management ( 6-8 hrs after tonsillectomy)

Answer 22

urgent ENT assessment and return to theatre

(v big risk of haemorraghe)

Question 23

treatment for a child with persistent otitis media with effusion

Answer 23

1st line: grommets
2nd: repeat frommet insertion and consider adenoidectomy

Question 24

ramsay hunt syndrome treatment
(2 points)

Answer 24

systemically well- oral aciclovir and corticosteroids
systemically unwell- IV the above^

Question 25

tonsillitis 1st line antibiptocs
give alternative for if allergic
tx course

Answer 25

phenoxymethylpenicillin

clarithromycin if penicillin allergic

give a 7/10 day course

Question 26

secondary haemorraghe after tonsillectomy (secondary:3-10 days after) management

Answer 26

Admit to hospital for ENT review and antibiotic therapy

Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics

Question 27

chronic sinusitis treatment

Answer 27

chronic sinusitis is defined as 3 months + of sinusitis symptoms
treatment:

intranasal steroid- 14 day course
2nd: nasal irrigation with saline

if symptoms perisist for 3 months with treatment then refer

Question 28

treatment for otosclerosis

Answer 28

hearing aid

Question 29

vestibular shwannoma treatment

Answer 29

<40mm, 6 monthky check ups
>40mm surgical removal

Question 30

benign pleomorphic adenoma tx

Answer 30

routine surgical resection

Question 31

tinnitus tx

Answer 31

hearing loss: hearing aid

no hearing loss: counselling and sound wave therapy