Ear and ENT

Question 1

anatomy of the ear

Answer 1

a normal tympanic membrane will have a light reflection on examination
you can see the handle of the malleus

Question 2

a membrane in acute otitis media might look

Answer 2

opaque
inflamed
bulging

Question 3

typical history of acute otitis media

Answer 3

acute onset of pain (may be difficult to tell in young children)
fever
concurrent URRTI symptoms common

Question 4

treatment for acute otitis media

Answer 4

antibiotics ??
more likely to help in bilateral OM in age <2
recommended in aboriginal children due to high prevalence of complications
symptomatic management is reasonable in non-severe cases
analgesia

Question 5

otitis media with effusion

Answer 5

persisting middle ear effusion, follows acute otitis media or accompanies rhinitis/sinusitis
best confirmed by pneumotoscopy or tympanometry
painless, sometimes causes hearing loss
often resolves spontaneously within <3 months

Question 6

when is hearing testing needed

Answer 6

if persists >3 months

Question 7

when is ENT consult needed

Answer 7

bilateral hearing loss >30dB or
speech delay, educational impairment or behavioural difficulties

Question 8

grommets are also called

Answer 8

tympanovstomy tubes
ventilation tubes

Question 9

a grommet is

Answer 9

a small plastic tube, narrower in its middle than its ends
inserted surgically to maintain a hole in the tympanum

Question 10

main indicators for grommet are

Answer 10

recurrent otitis media
otitis media with effusion

Question 11

possible adverse effects of grommets

Answer 11

anaesthetic risks, ear discharge, persisting perforation, tympanosclerosis

Question 12

chronic suppurative otitis media

Answer 12

chronic bacterial infection of the middle ear with persistent drainage of mucous from the middle ear via perforation

Question 13

chronic suppurative otitis media may occur following

Answer 13

acute otitis media

Question 14

chronic suppurative otitis media is especially common in

Answer 14

resource poor settings internationally
in remote aboriginal communities

Question 15

chronic suppurative otitis media is an important cause of

Answer 15

conductive hearing loss

Question 16

treatment of chronic suppurative otitis media

Answer 16

ear cleaning (aural toilet) - dry mopping with tissue spears or dilute butadiene washout
topical antibiotic

Question 17

what sort of antibiotic is best for chronic suppurative otitis media

Answer 17

topical antibiotics are better
best evidence is for fluroquinolones which are also not ototoxic (unlike some other topical antibiotics)

Question 18

perforation

Answer 18

may follow otitis media or trauma
often causes some hearing loss depending on extent of perforation

Question 19

perforation prognosis

Answer 19

often heals spontaneously in absence of infection, especially in childhood

Question 20

treatment for persistent perforation

Answer 20

tympanoplasty is a surgical option
involves grafting other tissue over the perforation

Question 21

cholesteatoma

Answer 21

beware the attic perforation (perforation should always be at the bottom)
not actually a malignancy
expanding mass of keratinising squamous epithelium
potentially locally destructive including to ossicular chain
can lead to permanent hearing loss or vertigo
needs surgery

Question 22

treatment for cholesteatoma

Answer 22

needs surgery - only option

Question 23

is cholesteatoma a malignancy

Answer 23

no

Question 24

cholesteatoma can cause

Answer 24

can lead to permanent hearing loss or vertigo

Question 25

tympanosclerosis

Answer 25

local opacity or scarring of tympanum often seen after past perforation/grommets commonly seen often has little or no effect on hearing often no treatment needed

Question 26

what does otitis externally look like

Answer 26

Question 27

acute otitis externa is due to

Answer 27

acute otitis exterrna is due to infection of the external auditory canal

Question 28

chronic otitis externa is due to

Answer 28

is due to dermatological disease common risk factors - eczema - swimming - diabetes

Question 29

acute otitis extra is characterised by

Answer 29

acute onset of ear pain, sometimes with discharge

Question 30

risk factors for acute otitis externa

Answer 30

moisture (commonly swimming) ear trauma or irritation pre-existing skin disease in canal

Question 31

causative agents of acute otitis externa

Answer 31

usually bacterial pseudomonas most common followed by staphylococcus species about 10% fungal (immunocompromised or ear drops use)

Question 32

treatment for acute otitis externa

Answer 32

aminoglycoside + anti fungal + steroid drops often used, only considered safe if there is an intact tympanum quinolone-based drops considered safe in setting of tympanic perforation

Question 33

if acute otitis externa does not respond to initial treatment

Answer 33

consider swab for microscopy and culture

Question 34

if the acute otitis externa is severe

Answer 34

consider oral antibiotics if there is a spreading infection with if very swollen canal (to allow entry for medicines) referral to ENT for canal cleaning (microscopic toilet)

Question 35

with treatment, symptoms of acute otitis externa should last

Answer 35

6 days on average

Question 36

what is an exostoses

Answer 36

benign bony overgrowth of external ear canal associated with repeated water exposure - 'surfer's ear'

Question 37

treatment for exostoses

Answer 37

usually of no consequence unless leading to frequent occlusion or infection (can then be treated surgically)

Question 38

symptoms of wax impaction

Answer 38

hearing loss pain, tinnitus, vertigo diagnosis is usually obvious on examination but beware pathology behind the wax

Question 39

treatment for wax impaction

Answer 39

- drops - syringing - manual removal by a specialist

Question 40

drops for wax impacting

Answer 40

water based or oil based not effective and uncertain evidence base

Question 41

syringing for wax impaction

Answer 41

contraindications include current infection, perforation, grommets, recent trauma, past ear surgery

Question 42

risks of syringing

Answer 42

small (1/1000?) risk of perforation stop irrigation if severe pain or vertigo and have ENT review

Question 43

hearing loss presentations in children

Answer 43

neonatal screening low threshold for audiometry/referral

Question 44

sudden idiopathic sensorineural hearing loss

Answer 44

often spontaneously improves but not always high dose steroids are standard of care refer urgently to an ENT

Question 45

things to look for on throat examination

Answer 45

symmetry tonsil size tonsil inflammation or exudate (tonsil crypts are normal finding) pharyngeal inflammation +/- lymphoid hyperplasia ulcers plaques dentition

Question 46

when is antibiotics recommended for sore throats

Answer 46

scarlet fever or rheumatic fever some guidelines suggest antibiotics for tonsillitis if criteria are met

Question 47

peritonsillar abscess

Answer 47

aka. quinsy presents with severe unilateral throat pain, high fever, perhaps change in voice or truisms

Question 48

treatment for peritonsillar abscess

Answer 48

surgical - emergency due to potential airway obstruction plus penicillin

Question 49

mouth ulcers

Answer 49

often viral/idiopathic beware malignancy in ulcer persisting >2 weeks especially in the setting of risk factors eg. smoking, chewing tobacco, alcohol

Question 50

hoarseness

Answer 50

commonly post viral also benign nodules with overuse e.g in singers beware malignancy - refer to ENT if hoarseness lasts >3 weeks and red flags present

Question 51

red flags in voice hoarseness

Answer 51

significant smoking history otalgia dysphagia/odynophagia stridor haemoptysis fevers/night sweats /weight loss neck mass hot potato voice

Question 52

which hand do you use to hold an otoscope

Answer 52

right hand for right ear left hand for left ear

Question 53

otitis media may progress to

Answer 53

mastoiditis

Question 54

what happens if you miss sudden idiopathic sensorineural hearing loss

Answer 54

can progress to permanent hearing loss without treatment

Question 55

what is trismus

Answer 55

being unable to open their mouth

Question 56

what to do if hot potato voice

Answer 56

emergency contact ENT surgeon