ENT

Question 1

What is acute otitis externa?

Answer 1

Acute inflammation of the outer ear

Question 2

What are the most common causative organisms for acute otitis externa?

Answer 2

Pseudomonas aureginosa
Staphylococcus aureus

Question 3

How does acute otitis externa present?

Answer 3

Itch of ear canal
Ear pain and tenderness
Ear discharge
Rarely hearing loss due to o ear canal occlusion

Question 4

How does acute otitis externa appear on otoscopy?

Answer 4

Red and oedematous ear canal and ear discharge
Tympanic membrane erythema

Question 5

How is acute otitis externa managed?

Answer 5

Self care measures - dont use cotton buds, avoid swimming/water sports for 7-10 days, use ear plugs

OTC acetic acid 2% (if >12 years) for 7days

Analgesia

Topical antibiotic if necessary

Question 6

When do you follow up a patient with acute otitis externa following treatment?

Answer 6

If symptoms not improving within 48-72hrs
Symptoms not resolved after 2 weeks

Question 7

What is acute otitis media?

Answer 7

Inflammation within the middle ear

Question 8

How does an acute otitis media present?

Answer 8

Ear pain
Holding and tugging of the ear

Red/yellow tympanic membrane
Bulging
Perforation?

Question 9

How is acute otitis media initially managed?

Answer 9

Usually lasts 3-7days
Paracetamol + ibuprofen

Question 10

When do you prescribe antibiotics for a patient with acute otitis media?

Answer 10

Systemically unwell
High risk of complications
Those with otorrhoea

Question 11

What antibiotic is prescribed for acute otitis media if necessary?

Answer 11

5-7day amoxicillin

Question 12

What antibiotic is given to patients with acute otitis media if they are allergic to penicillin?

Answer 12

Clarithromycin or erythromycin

Question 13

What is the second choice of antibiotic for acute otitis media if symptoms worsen after amoxicillin or clarithromycin/erythromycin?

Answer 13

Co-amoxiclav

Question 14

What is acute otitis media with effusion? (Glue effusion)

Answer 14

Collection of fluid within the middle ear space without the signs of acute infection

Question 15

How does otitis media with effusion present?

Answer 15

Conductive hearing loss
Tinnitus
Ear fullness or popping
Changes in behaviour
Speech or language issues
Balance problems

Question 16

How does an ear with otitis media with effusion look on otoscopy?

Answer 16

Abnormal colour of drum
Loss of light reflex
Retracted drum

Question 17

What is the management for otitis media with effusion?

Answer 17

If no hearing loss should resolve within a few months

If hearing loss is suspected. Then need tympanometry and hearing testing

If not resolved in 3 months consider ENT referral for myringotomy (grommet insertion)

Question 18

What is Ménière’s disease?

Answer 18

Triad of vertigo, fluctuating sensineural hearing loss and tinnitus

Mainly unilateral

Question 19

What is the pathophysiology of Ménière’s disease?

Answer 19

Over production of endolymph

Question 20

How is Ménière’s disease managed?

Answer 20

Short course of prochlorperazine or antihistamine like cyclizine

Deep IM injection of prochlorperazine for rapid nausea or vomiting relief

Audiology assessment if hearing loss

Question 21

What medication can prevent recurrent attacks of Menieres?

Answer 21

Betahistine

Question 22

What manoeuvre is used to diagnose BPPV?

Answer 22

Dix-Hallpike manoeuvre

Question 23

How is the Dix-hallpike manoeuvre performed?

Answer 23

Keep eyes open and look straight ahead
Get patient to look 45 degrees to one side
Rapidly flatten teh patient with their head hanging over the edge of the bed

Look for nystagmus for 30 seconds

Question 24

What is the manoeuvre used to help fix BPPV?

Answer 24

Epley manourve

Question 25

What is the difference between central and peripheral causes of vertigo?

Answer 25

Central - related to the brainstem or the cerebellum Peripheral - related to the vestibular apparatus of the inner ear

Question 26

What are some central causes of vertigo?

Answer 26

Posterior stroke Brain tumour Multiple sclerosis Cerebella’s degeneration

Question 27

What are some peripheral causes of vertigo?

Answer 27

BPPV Ménière’s disease Vestibular neuritis Labyrinthitis

Question 28

How can you often differentiate between peripheral and central causes of vertigo?

Answer 28

Peripheral - often has hearing symtpoms, neurological signs often absent Central - hearing symptoms rare, usually has neurological signs