ENT

Question 1

What often precedes Otitis Media

Answer 1

Viral upper Resp tract infection

Question 2

Commonest Bacterial cause of Otitis Media?

Answer 2

Streptococcus Pneumoniae

Question 3

Otitis Media Presentation:

Answer 3

Ear Pain,
Reduced hearing
Upper airway infection symptoms

Question 4

Otitis Media Examination

Answer 4

Bulging, red, inflamed tympanic membrane

Question 6

Otitis Media management

Answer 6

Most cases resolve w/o abx within 3 days
Immediate abx in patients w/ sig comorbidities
Amoxicillin for 5-7 days first line
Clarithromycin in penicillin allergy
Erythromycin (in pregnant women allergic to penicillin)

Question 7

What is glue ear

Answer 7

Otitis media w/ an effusion

Question 8

Glue ear features

Answer 8

Peaks at 2 years old
Hearing loss
Secondary problems eg speech and language delay, behavioural or balance problems

Question 9

Glue Ear treatment

Answer 9

Grommet insertion

Question 10

What is Presbycusis and what type of sound does it affect first?

Answer 10

Age related hearing loss
Tends to affect high pitched sounds first

Question 11

Presbycusis risk factors

Answer 11

Loud noise exposure
Diabetes
HTN
Drug exposure (salicylates)

Question 13

Presbycusis presentation

Answer 13

Hearing loss- gradual and insidious: loss of high pitched sounds

Question 14

Presbycusis examination findings?

Answer 14

Normal

Question 15

Presbycusis management

Answer 15

Optimise environment
Hearing aids
Cochlear implants (in patients where hearing aids aren’t sufficient)

Question 16

Tinnitus types?

Answer 16

Primary- no identifiable cause
Secondary- identifiable cause

Question 17

Tinnitus causes:

Answer 17

Ear wax
Meniere’s disease
Otosclerosis
Acoustic neuroma
Drugs: Aspirin/NSAIDs, Aminoglycosides, Loop diuretics, Quinine

Question 18

Imaging criteria for tinnitus?

Answer 18

Generally non pulsatile tinnitus doesn’t require imaging unless unilateral or other neuro/otological signs.
MRI of the internal auditory meatuses is first line

Question 19

Tinnitus management

Answer 19

Investigate underlying cause
Amplification devices
Psychological therapy may help a limited group of patients- eg CBT
Tinnitus support groups

Question 20

Eustachian tube dysfunction presentation

Answer 20

Reduced or altered hearing
Popping noises/sensations in the ear
Fullness sensation in the ear
Pain
Tinnitus
Symptoms get worse when external air pressure changes and middle ear pressure can’t equalise the outside pressure eg flying, mountain climbing or scuba diving
Generally associated w/ recent viral URTI or hayfever

Question 21

Eustachian tube dysfunction investigation

Answer 21

Tympanometry- tympanogram will show a peak admittance (most sound absorbed) w/ negative ear canal pressures

Question 22

Eustachian tube dysfunction management

Answer 22

Can resolve spontaneously
Valsalva manouevre
Decongestant nasal sprays (short term only)
antihistamines and a steroid nasal spray for allergies or rhinitis

Question 23

Otitis externa- AKA

Answer 23

Swimmer’s ear- exposure to water whilst swimming can lead to inflammation in ear canal

Question 24

Causes of otitis externa? Which fungal causes are more susceptible in ppl who’ve had multiple topical abx courses

Answer 24

Bacterial infection- pseudomonas aeruginosa
Fungal infection- eg aspergillus or candida

Question 25

Otitis externa presentation?

Answer 25

Ear Pain Discharge Itchiness Conductive hearing loss (if ear becomes blocked)

Question 26

Otoscopy findings?

Answer 26

Erythema and swelling in ear canal. Tenderness. Pus or discharge. Lymphadenopathy in neck/around ear.

Question 27

Management of otitis externa?

Answer 27

Mild OE can be treated w/ acetic acid 2% - has antifungal and antibacterial effect Moderate OE- treated w/ a topical abx and steroid eg Neomycin, dexamethasone and acetic acid Severe/systemic OE- oral abx (eg flucloxacillin or clarithromycin) or discussion w/ ENT for admission and IV abx

Question 28

Malignant otits externa- progresses to what?

Answer 28

Osteomyelitis of temporal bone

Question 29

Malignant OE risk factors

Answer 29

Diabetes, immunosppuressed

Question 30

Malignant OE symptoms

Answer 30

More severe than OE, w/ persistent headache, severe pain and fever

Question 31

Malignant OE management

Answer 31

Emergency- admission to hospital under ENT team, IV abx, Imaging to assess extent of infection

Question 32

Vestibular neuronitis presentation

Answer 32

Acute onset of vertigo May be recent viral URTI Symptoms are more severe first few days, initially vertigo may be constant after which it's triggered or worsened by head movement NO LOSS OF HEARING

Question 33

Vestibular neuronitis diagnosis:

Answer 33

Head impulse test

Question 34

Vestibular neuronitis management