ENT

Question 1

What are the three parts of the ear?

Answer 1

External
Middle
Inner

Question 2

What are some parts of the outer ear?

Answer 2

Pinna
Lobe
Tragus
Anti-tragus
Helix
Anti-helix

Question 3

What are the parts of the middle ear?

Answer 3

Tympanic membrane
Ossicles

Question 4

What are the names of the ossicles?

Answer 4

Malleus
Incus
Stapes

Question 5

What are the parts of the inner ear?

Answer 5

Semi-circular canals
Cochlea
Vestibulocochlear nerve
Round Window
Oval window

Question 6

What are the two main features of the ear?

Answer 6

Hearing
Balance

Question 7

What symptoms can you get from problems in ear?

Answer 7

Ear pain
Otorrhea
Vertigo
Tinnitus
Itching
Fullness

Question 8

What are some examinations for ear problems?

Answer 8

Otoscopy
Weber’s and Rinne’s

Question 9

How do you use otoscope?

Answer 9

Pull patients ear up and back
Place in ear - not too far

Question 10

How do you do Rinne’s Test?

Answer 10

Vibrate tuning fork and place behind ear on mastoid process. Ask them when they stop hearing it.
Then place it in front of ear and ask if they still can, they should be able to as AC>BC ( normal or sensorineural)

Question 11

How do you perform Weber’s test?

Answer 11

Bang tuning fork and place on centre of forhead
Ask them if its the same on both sides ( normal )

Question 12

What is the difference between conductive and sensorineural?

Answer 12

Conductive = problem with transfer of waves e.g blockage

Sensorineural - problem with the VC nerve

Question 13

How do you tell on otoscope with ear you are looking at?

Answer 13

Cone of light will be on the same side as which ear it is

Question 14

What is audiometry?

Answer 14

First line investigation for hearing loss
Place headphones on patient with muffling sounds on non test ear and see the minimum pure tone sound the patient can hear

Question 15

What is normal in audiometry?

Answer 15

Above 20dB

Question 16

What is a Cholesteatoma?

Answer 16

An abnormal collection of skin cells that gets trapped behind the eardrum/ossicles .

Question 17

How does a Cholesteatoma form?

Answer 17

Either congenital, or due to poor ventilation of the Eustachian Tube ( poor negative pressure leads to ear drum retraction where skin cells and ear wax collect )

Question 18

What are the symptoms of a Cholesteatoma?

Answer 18

Watery/smelly discharge
Gradual loss of hearing in one ear
Discomfort

Question 19

What will appear on otoscopy for a Cholesteatoma?

Answer 19

Retracted pocket of pearly white/ keratin material on the upper part of the tympanic membrane

Question 20

What would a Cholesteatoma result on a Weber’s and Rinne’s test show?

Answer 20

Conductive hearing loss of the affected side

BC > AC , lateralised to unaffected side

Question 21

What is the treatment for a Cholesteatoma?

Answer 21

Surgical removal

Question 22

What serious consequences can result from a Cholesteatoma?

Answer 22

It can erode bone to can spread

Brain abcesses
Facial paralysis
Vertigo

Question 23

What is the causes of referred pain to the ear ( Secondary Otalgia )

Answer 23

Dental issues
TMJ dysfunction

Question 24

What are the symptoms of dental issues?

Answer 24

Pain
Difficulty chewing
Difficulty swallowing
Bleeding hums

Question 25

What are symptoms of TMJ dysfunction?

Answer 25

Pain Jaw stiffness Popping/ locking or jaw Pain can spread to face or neck

Question 26

What is the treatment for Secondary Otalgia?

Answer 26

Treatment of underlying cause OTC ear medication may be used for symptom relief

Question 27

What is Otitis Media with Effusion?

Answer 27

Also known as glue ear. It is a collection of fluid within the middle ear space

Question 28

What are the symptoms of Otitis Media with Effusion?

Answer 28

Earache Hearing Ringing Problems with balance Retracted, straw coloured tympanic membrane

Question 29

What are the signs of otitis media with effusion on otoscopy?

Answer 29

Retracted, straw coloured membrane

Question 30

What would be shown on an Audiogram in Otitis media with effusion?

Answer 30

Mild conductive hearing loss, reduced specifically in middle ear

Question 31

What is Tympanometry?

Answer 31

A test for fluid in the middle ear. It measures the movement in the eardrum to a change in the air pressure . When there is fluid it does not move so well and sound waves bounce back rather than through to the middle ear

Question 32

What is the treatment Otitis Media with effusion?

Answer 32

Most resolve spontaneously in 2-3 months. If it doesn’t, use a nasal balloon treatment , blow it up three times a day to open up ET and drain fluid Can use grommets

Question 33

Why are children more prone to OM with Effusion?

Answer 33

They have a shorter, more horizontal ET

Question 34

What are some complications of OM with Effusuion?

Answer 34

Chronic damage to TM Hearing loss Speech and language development

Question 35

What is the treatment for Acute Otitis Externa?

Answer 35

Acetic Acid Spray If this is ineffective or there are signs of more severe infection such as discharge or oedema, antibiotic and steroid ear drops can be given.

Question 36

What is the treatment for Acute Otitis Media?

Answer 36

No systemic upset/fever - Analgesia Systemic upset/very unwell/ bilateral/ high risk of complications/ More than 4 days - Amoxicillin

Question 37

What is the treatment for Pinna Haemtoma?

Answer 37

Antibiotics Aspiration to prevent complications

Question 38

What is the management for TMJ dysfunction?

Answer 38

Explanation its usually caused by stress Reassurance it is self-resolving Simple analgesia

Question 39

What is the treatment for noise induced hearing loss?

Answer 39

Hearing aids

Question 40

Whar is the first line treatment for Nasal Polyps?

Answer 40

Nasal Steroid Drops

Question 41

What are the presenting symptoms of Acute LAbrynthitis?

Answer 41

Sudden onset of unilateral vertigo, with associated hearing loss on the background of a recent viral infction. Appears normal on otoscopy

Question 42

What is given for bacterial tonsillitis/laryngitis if the patient is Penicillin allergic?

Answer 42

Clarithromycin or Erythromcyin

Question 43

What are indications for tonsillectomy?

Answer 43

Recurrent OM, Chronic Rhino-sinusitis, Chronic Tonsillitis

Question 44

What is Otosclerosis?

Answer 44

Abnormal bone growth in the middle ear, progressive hearing loss in both ears , usually 40s/50s Treated with Stapedectomy or Hearing aids

Question 45

What are the three conditions associated with vertigo?

Answer 45

Viral labyrinthitis BPPV Meniere's Disease

Question 46

How can you distinguish between the causes of vertigo?

Answer 46

Acute/Viral Labyrinthitis - any movement triggers vertigo / constant , recent history of URTI, tinnitus , hearing loss, nsytagmus BPPV - episodic vertigo when turning head, NO hearing loss, NO tinnitus, nystagmus Meniere's Disease - no clear trigger, tinnitus, hearing loss

Question 47

What makes a central cause of vertigo more likely?

Answer 47

Neurological symptoms Constant No tinnitus/hearing loss Symptoms not altered by position

Question 48

How do you confirm BPPV? and how is this done?

Answer 48

Dix-Hallpike Maneuver Sit patient up on bed Turn patient's head to 45 degrees on the left or right, then support neck and make patient lean back with head turned and stay there for 1-2 minutes Check for Nystagmus Repeat on other side

Question 49

What are two classes of drugs that can treat chronic vertigo?

Answer 49

Antihistamines ( Promethazine) Phenothiazines ( Prochlorperazine )