ENT: Common problems

Question 1

Anatomy

Answer 1

Outer ear - pinna - tympanic membrane
Middle ear cleft - TM –> oval window
Inner ear - CNVIII

Question 2

Oval window

Answer 2

Where stapes goes into inner ear

Question 3

Pinna parts

Answer 3

Lobes 
Tragus
Anti-tragus
Helix
Anti-Helix

Question 4

Bones

Answer 4

Stapes
Incus
Malleus - joined to a lateral process

Question 5

Hearing loss

Answer 5

Conductive

Sensory-neural

Question 6

If they can hear bone conduction but not air conduction

Air-bone gap

Answer 6

Conductive hearing loss

Question 7

Inner ear malfunctioning
Air conduction is poorer than expected
Bone conduction also poor

Answer 7

Sensory-neural hearing loss

Question 8

Otitis externa
presentation?
Treatment

Answer 8

inflammation of outer ear
Painful
Swelling

Ear drops, oral antibiotics only if spreading infection

Question 9

Wax blockage

Answer 9

Build up of wax –> impaction against tympanic membrane

Question 10

Pinna haematoma/abscess

Can result in?

Answer 10

Trauma to ear –> haemorrhage between skin and perichondrium
Devascularisation of tissue –> cauliflower ear

Question 11

Foreign body in the ear canal

Answer 11

Suction, flick out with wax hook

Question 12

SCC of ear
Common on
Will need

Answer 12

Helix

Urgent resection e.g wedge resection

Question 13

Pinnaplasty

Answer 13

Correction of protruding ears

Question 14

Glue ear
Can cause –>

Treatment
Grommets

Answer 14

Middle ear condition
Fluid behind eardrum
Otitis media with effusion
Middle ear fluid
Can cause conductive hearing loss leading to speech development issue
Conservative, grommets, hearing aids
Lets air in behind the eardrum to prevent fluid accumulation
Doesn’t let fluid leave therefore discharge = infection

Question 15

Acute otitis media

Bacteriology

Answer 15

Infection building up behind eardrum
Will eventually perforate
Resolves after this
Hearing deficit for a few weeks

Strep. Pneumoniae
H. influenza
M. cat

Question 16

Complications of Acute/Chronic ear infections

Extra cranial/intratemporal

Intracranial

Other

Answer 16

Mastoiditis
Petrositis
Fistula/Labyrinthitis - balance problems
Facial nerve paralysis - runs through middle ear cleft –> Palsy
Hearing loss

Extradural/subdural/brain abscess
Meningitis
Sigmoid sinus thrombophlebitis
Otic hydrocephalus

OTITIS EXTERNA, PINNA CELLULITIS AND PERICHONDRITIS

Question 17

Traumatic perforation

Answer 17

Excess cleaning

Question 18

Basal skull fracture

Answer 18

Haemotympanum

Seen in combination with post auricular bruising - can also be non-accidental injury in children

Question 19

Cholesteatoma

Pathology

Signs

Answer 19

Ball of skin which invades into ear drum into middle ear cleft and destroy nervous tissue, bone –> intracranial abscesses

Recurrent discharge from ear

Question 20

Facial nerve palsy

Caused by?

Answer 20

Tumour of parotid gland

Check tonsil on specific side

Question 21

Inner ear

Illusion of movement

Sudden

Answer 21

Vertigo

• illusion of movement
• benign paraoxysmal positional vertigo - displacement of crystals –> spinning
• labyrinthitis
• Meniere’s disease - fluctuating disease

Sudden sensorineural hearing loss - ideally need steroid tx

Vestibular Schwannoma/Acoustic Neuroma - benign tumour mainly on CN VIII - ringing or hearing loss in that ear - collapse, hydrocephalus

Question 22

Function of nose

Answer 22

Temp regulator 
Moisture regulation 
Air filter
Smell 
Immune defence 
Resonance

Question 23

History of sinonasal symptoms

Answer 23

Blockages - congestion, time, trigger
Sense of smell/taste
Sneezing
Rhinorrhoea
Nasal/ocular or palatal pruritus 
Facial/sinus pain - acute, recurrent, chronic 
Snoring
Bleeding

Question 24

Epistaxis 
First aid
Posterior?
Fracture
Observe for

Answer 24

Most common source is little's area
Pinch nose and put head forwards 
Can occur in older adults 
Patient usually seen 1/52 post injury 
Septal haematoma - blood collected between mucoperichondrium and overlying tissue --> devascularisation of cartilage --> septal perforation 
- can get infected 
- thrombosis and abscesses

Question 25

Saddle nose

Answer 25

Result of septal haematoma causing apoptosis of cartilage

Question 26

Foreign body in nose

Answer 26

Old sponge e.g

Remove

Question 27

Periorbital cellulitis

Answer 27

Caused by infection of sinuses

Pus has tracked backwards behind orbit

Question 28

Nasal polyps

Caused by

Answer 28

Growths on mucosa
Allergy
CF
Asthma

Question 29

Sinonasal tumours e.g

Answer 29

SCC

Question 30

The pharynx

Answer 30

Tonsillitis and peritonsillar abscess
Glandular fever caused by EBV e.g
Foreign bodies 
Ludwig's angina 
Tumours causing upper airway obstruction

Question 31

Tonsils are graded

Answer 31

According to emergence from mucosa and obstruction of airway

Question 32

Tonsillitis

Grade?

Bacterial tonsillitis can result in

IF looks further back

Answer 32

Tonsils covered in exudate and meet in middle - grade IV

Tonsillar abscesses - tonsil pushed outwards and displaces the uvula

Parapharyngeal infection

Question 33

Tonsil cancer signs

Answer 33

Unilateral enlarged irregular tonsil

Question 34

Foreign objects in throat

Answer 34

Swallowed fishbone e.g

Extracted

Question 35

Ludwig’s angina

Risk of? q

Answer 35

Infection tracked into floor of mouth –> swelling

Airway obstruction

Question 36

Tongue base cancer

Answer 36

Pain on swallowing, sore throat
Easily localised at side of neck
Radiation to ear

Question 37

Larynx

Answer 37

Epiglottis and supra glottis
Foreign body swallowing
Tumours causing UA obstruction

Question 38

Epiglottis

Answer 38

Can be caused by H. influenzae type E
Airway obstruction
Inspiratory stridor
Inspiratory and expiratory

Question 39

Presence of laryngeal cancer

Answer 39

Hoarse voice - progressive
Sob
Stridor
Pain 
Dysphagia
Neck lump 
Smokers

Question 40

Neck trauma

Answer 40

Stabbings - breach platysma

Abscesses

Question 41

Ulceration

Characteristic?

Answer 41

Non-healing
Wait and watch for 2-3 weeks
Proper biopsy