ENT

Question 1

Define chronic otitis media

Answer 1

Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent otorrhoea through a tympanic perforation

Question 2

Who is most frequently affected by chronic OM

Answer 2

Children <5

Question 3

When does acute OM become chronic OM

Answer 3

After at least 2 weeks of discharge

Question 4

Who is most affected by chronic OM

List some other risk factors

Answer 4

Children <5

Other risk factors include: recurrent OM, history of allergy/atopy, smoking household, social deprivation

Question 5

Organisms which cause chronic OM

Answer 5

Pseudomonas aeruginosa (most common)
Staph aureus
Proteus
Aspergillus
Candida albicans

Question 6

Most common organism to cause chronic OM

Answer 6

Pseudomonas aeruginosa

Question 7

Management of chronic OM

Answer 7

Insertion of grommets
Long term Abx rarely useful
Audiology assessment if suspected hearing loss

Question 8

When a grommets usually extruded spontaneously?

Answer 8

6-9 months

Question 9

Can children with grommets go swimming?

Answer 9

Yes - studies have shown swimming is not considered harmful however they should avoid diving

Question 10

Why is Pen-V recommended over Amoxicillin for those with suspected bacterial throat infection?

Answer 10

Risk of widespread rash / misdiagnosed penicillin allergy with Amoxicillin if the underlying infection is EBV/glandular fever

Question 11

Which children are more likely to benefit from Abx in OM?

Answer 11

Children <2 with bilateral OM or those with OM and otorrhoea

Question 12

First line Abx for acute OM

Answer 12

Amoxicillin

Question 13

Best hearing test for those aged 2-5?

Answer 13

Play audiometry

Question 14

Best hearing test for those aged 8 months - 1 year

Answer 14

Distraction testing (requires the child to sit unsupported)

Question 15

Best hearing test for those aged >5

Answer 15

Pure tone audiometry

Question 16

Best hearing tests for babies (<6mths)

Answer 16

Automated auditory brainstem response (AABR) / Brain stem evoked potentials

Oto acoustic test (100% sensitivity for moderate - profound sensorineural hearing loss). THIS IS THE INITIAL NEWBORN SCREENING TEST IN THE UK.

Question 17

Most common cause of conductive hearing loss

Answer 17

Chronic OM

Question 18

Most common cause of sensorineural hearing loss

Answer 18

Genetic (e.g. Klinefelter syndrome, Turner syndrome)

Question 19

Which is more common: conductive or sensorineural hearing loss

Answer 19

Conductive

Question 20

Causes of sensorineural hearing loss

Answer 20

Genetic (e.g. Klinefelter syndrome, Turner syndrome)
TORCH infections
Maternal drugs (alcohol, cocaine)
Encephalitis
Meningitis
Prematurity
Hypoxic injury at birth
Severe hyperbilirubinaemia

Question 21

Rinne and Weber findings in conductive hearing loss

Answer 21

Preservation of bone conduction and diminished air conduction

Question 22

Rinne and Weber findings in sensorineural hearing loss

Answer 22

Equal impairment of both air and bone conduction

Question 23

What is the most common embryological aetiology of cleft lip?

Answer 23

Failure of fusion of the medial nasal and maxillary processes.
This occurs in the 5-6th week of gestation.

Question 24

Which type of hearing loss has a greater prevalance of tinnitus?

Answer 24

Conductive hearing loss

Also mild hearing loss