ENT

Question 1

Describe diagnostic testing used for sinusitis.

Answer 1

• best initial test is CT if asked but rarely necessary

- most accurate test is biopsy but only needed if there are frequent recurrences or no response to empiric therapy

Question 2

Describe the etiology, presentation, diagnosis, and treatment of cavernous sinus thrombosis.

Answer 2

• most often due to Staph, Strep, or anaerobic organisms that spread from the adjacent sinus
• presents with fever, headache, ptosis, proptosis, and abnormal ocular movements in someone with a history of recent sinusitis
• best initial test is a CT or MRI with contrast
• treat with vancomycin and ceftriaxone

Question 3

What is Tolosa-Hunt syndrome and how is it diagnosed and treated?

Answer 3

• it is granulomatous inflammation of the cavernous sinus
• diagnosed with MRI
• treated with steroids

Question 4

What is the difference between an anterior and a posterior epistaxis?

Answer 4

• anterior are far more common and bleeding is from Kiesselbach’s venous plexus
• posterior are less common but more dangerous because they are arterial bleeds

Question 5

How is a posterior epistaxis treated?

Answer 5

• requires packing

- after bleeding is controlled, give cephalexin to prevent Staph toxic shock syndrome

Question 6

Describe the presentation, diagnosis, and treatment of otitis media.

Answer 6

• presents with redness, immobility, bulging, and a decreased light reflex of the tympanic membrane
• in most cases it is a clinical diagnosis but tympanocentesis and culture is the most accurate for recurrent otitis media
• treat with amoxicillin or azithromycin

Question 7

Describe the pathogenesis, presentation, and treatment of otitis externa.

Answer 7

• it is a cellulitis of the skin of the EAC caused by water exposure which raises the pH and facilitates bacterial growth
• presents with pain on moving the tragus and erythema or discharge within the EAC
• treat with topical neomycin-polymyxin, topical quinolones, or gentamicin; hydrocortisone drops will reduce pain

Question 8

What is the treatment treatment for each fo the following ear infections:

• otitis media
• otitis externa
• malignant external otitis
• mastoiditis

Answer 8

• otitis media: amoxicillin or azithromycin
• otitis externa: topical neomycin-polymyxin, quinolones, or gentamicin
• malignant external otitis: ciprofloxacin, cefepime, or anti-pseudomonal penicillins like piperacillin
• mastoiditis: ceftriaxone or levofloxacin

Question 9

What is the treatment for malignant external otitis?

Answer 9

it is typically due to pseudomonas so use ciprofloxacin, piperacillin, or cefepime

Question 10

Describe the etiology, presentation, complications, diagnosis, and treatment of mastoiditis.

Answer 10

• due to the same organisms as otitis media: Strep pneumo, Hib, and Moraxella
• presents with mastoid tenderness
• may be complicated by hearing loss and meningitis
• initially diagnosis is with CT or MRI and it is treated with ceftriaxone or levofloxacin
• for recurrent or chronic infection, get a biopsy and treat with vancomycin and piperacillin

Question 11

Describe the presentation, diagnosis, and treatment of labyrinthitis.

Answer 11

• presents with acute hearing loss, tinnitus, vertigo, and nystagmus in patients with a recent viral illness
• there are no specific diagnostic tests but a head impulse test will be positive
• treat with steroids and meclizine

Question 12

Describe the presentation and treatment of Meniere disease.

Answer 12

• presents with chronic hearing loss, tinnitus, vertigo, nystagmus, and a feeling of fullness in the ear
• treat with sodium restriction and carbonic anhydrase inhibitors

Question 13

Describe the pathophysiology, presentation, and treatment of perilymph fistula.

Answer 13

• it is a leaking hole in the oval window of the inner ear
• presents with nystagmus and vertigo in a patient with a history of barotrauma or exposure to explosions
• treat surgically

Question 14

Describe the etiology, presentation, diagnosis, and treatment of Lemierre syndrome.

Answer 14

• it is an expansion of Fusobacterium necrophorum beyond the mouth to the neuromuscular bundle around the jugular vein
• this contributes to sepsis in a patient with recent ENT infection
• diagnosis is with CT of the neck
• treat with ampicillin/sulbactam or piperacillin/tazobactam

Question 15

Describe the presentation, diagnosis, and treatment of Ludwig angina.

Answer 15

• it is a cellulitis of the floor of the mouth
• best initial test is CT of the neck
• treat with ampicillin/sulbactam or piperacillin/tazobactam

Question 16

How is sialolithiasis treated?

Answer 16

removal of the stone manually or with I&D, sialoendoscopy, or lithotripsy

Question 17

Describe the etiology, presentation, diagnosis, and treatment of sialadenitis.

Answer 17

• most commonly caused by S. aureus
• presents with swelling, pain, and expulsion of pus which increase after meals
• it is a clinical diagnosis supported by CT or US
• treat with antibiotics, warm compresses, massage, and sour candy