D&M Ear, Nose & Throat

Question 1

Referral symptoms: ear wax – 9

Answer 1

1. Trauma related deafness or perforated ear drum
2. Laceration of ear canal & further impaction
3. Previous history of a perforated ear drum or previous chronic ear disorder
4. Foreign body (Most common in children)
5. OTC medication failure.
6. Pain originating from the middle ear, especially in children. Ear pain in adults would not often result in a Rx for antibiotics
7. Dizziness or tinnitus – but give lifestyle advice (avoid driving, stand up slowly)
8. Sudden hearing loss in one ear only (could be a lesion or disease of the inner ear/auditory nerve)
9. glue ear (where the middle ear fills with fluid) in children – should be referred.

Question 2

Ear Wax Management - 4

Answer 2

1. Selection of products available – cerunol, otex exterol are peroxide based products.
2. Ear drops should not be instilled if there is a perforated ear drum
3. Otex – oxygen is released on contact with the wax so could help dispersal
4. General drops to soften wax

Question 3

Otitis externa – 5

Answer 3

1. Conductive hearing loss occurs when the ear canal becomes oedematous
2. Generalised inflammation of the ear canal
3. Inflammation can be due to bacterial or fungal infections
4. Common in patients with prolonged exposure to water (e.g. swimmers) or hot & humid climates
5. Characterised by irritation, pain, discharge (thin, watery discharge due to trauma to the ear canal) & conductive hearing loss/muffled hearing

Question 4

Referral symptoms for otitis externa - 5

Answer 4

1. Ear pain in children <2yrs – often seen by ‘ear tugging’ & associated fever/loss of appetite, or loss of hearing
2. Generalised inflammation of the pinna – perichondritis
3. Pain on palpation of the mastoid area
4. Slow growing growths on the pinna of elderly patients
5. Duration >7-14 days

Question 5

Otitis externa OTC management – NICE - 3

Answer 5

1. Limited: 1st line - Analgesics – paracetamol or ibuprofen with a warm compress
2. 2nd line - Acetic acid 2% (available OTC as Earcalm spray) is indicated for superficial infections of the ear/otitis externa
3. +See GP if symptoms don’t improve or worse within 48hrs, & should not be used for longer than 7 days

Question 6

Otitis externa Lifestyle advice – 7

Answer 6

1. Avoid damage to the external ear canal
2. Troublesome ear wax should be removed safely to avoid damaging the ear canal. Cotton buds or other objects should not be used to clean the ear canal.
3. Keep the ears clean & dry.
4. Avoid swimming & water sports for at least 7–10 days during treatment.
5. Use ear plugs and/or a tight-fighting cap when swimming.
6. Keep shampoo, soap, & water out of the ear when bathing & showering, e.g. ear plugs
7. Consider using a hair dryer (at the lowest heat setting) to dry the ear canal after hair washing, bathing, or swimming.

Question 7

Nose – symptoms - 11

Answer 7

1. Persistent is more likely to be perennial rhinitis
2. Consider polyps – would need referral if symptoms last for more than one month
3. Blocked nose
4. Runny rose
5. Post nasal drip
6. Reduced sense of smell
7. Fullness/pressure in the nose
8. Snoring
9. Obstructive sleep apnoea
10. Recurrent nasal infections – refer
11. Nose bleeds – depends on occurrence

Question 8

Nose: Treatment for – 6

Answer 8

Saline or saltwater sprays/rinses as needed 2-6 times daily. Very popular for a range of different conditions
1. Rhinitis
2. Congestion
3. General hygiene
4. Contraindications to decongestants
5. Colds
6. Sinusitis

Question 9

Red flags & respiratory referral symptoms – 12

Answer 9

1. Persistent symptoms e.g. cough
2. Cough that gets worse or changes
3. Coughing up blood
4. Breathlessness
5. Unexplained weight loss
6. Persistent chest infections
7. Chest pain
8. Tiredness
9. Hoarse throat
10. Difficulty/pain swallowing
11. Fever above 38oc
12. Fingertip changes (clubbing of fingers – round & large)