ENT

Question 1

What are the causes of sinusitis?

Answer 1

Infection (usually viral)
Allergic
Air pollution
Structural problems

Question 2

Treatment of sinusitis?

Answer 2

1) Watchful waiting
2) © Acute = Intranasal decongestants, nasal douching + warm face packs
3) © Chronic = Intranasal steroids (beclametasone) if symptoms >10 days + prevention
4) No improvement in 7-10 days + systemically unwell – amoxicillin/co-amoxiclav
5) Symptomatic relief – painkillers e.g. naproxen, nasal steroids

Question 3

What is BPPV?

Answer 3

See notes

Question 4

What are the 4 cardinal symptoms of Meniere’s?

Answer 4

• Vertigo (lasts mins-hours, the patient is normal between attacks)
• Hearing loss (uni/bilateral, but level fluctuates)
• Tinnitus (usually precedes an attack of vertigo)
• Aural fullness (described as a pressure, fullness or warm feeling in the ear)
• Can also get nystagmus

Question 5

What are the average number of Menieres attacks/yr?

Answer 5

6-11

Question 6

Mx of Menieres?

Answer 6

• Tx: medical management – beta-histamine, gentamicin injections (saw the lady in GP), low salt diet and diuretics (to prevent fluid build-up)
• Surgical management – decompressing the inner ear (draining the endolymphatic sac), disconnecting the labyrinth (vestibular neurectomy) or labyrinthectomy (destruction of the labyrinth)

Question 7

Difference between labyrinthitis and vestibular neuritis?

Answer 7

Lab - semi-circular canals AND vestibular nerve, hearing IS affected, get NYSTAGMUS

VN - ONLY vestibular nerve, UNaffected hearing, Tx with prochlorperazine (antiemetic) in acute phase

Question 8

What are the S+S of acoustic neuroma?

Answer 8

• Unilateral sensorineural hearing loss (must exclude in all presenting patients)
• Unilateral tinnitus
• Impaired facial sensation (CN5)
• Balance problems
• Otalgia
• Ataxia
• Signs of increased ICP
• Absent corneal reflex

Question 9

How to Tx acoustic neuroma?

Answer 9

1) Watchful waiting – weigh up the risks of surgery vs rapid tumour growth
2) Surgery
3) Stereotactic radiosurgery

Question 10

What are the RFs for oral Ca?

Answer 10

RFs: men, increasing age, smoking, heavy drinking

Question 11

What is the treatment for oral Ca?

Answer 11

Photodynamic therapy

Excision

Question 12

What are the S+S of oral Ca?

Answer 12

• An ulcer that won’t heal
• Red/white plaques on the inside of the mouth
• A painful lump that won’t resolve

Question 13

S+S of cholesteatoma?

Answer 13

Foul-smelling, unresolving watery discharge, unilateral conductive hearing loss
Other – vertigo, facial nerve palsy

Question 14

What do you see on otoscope for cholesteatoma?

Answer 14

Attic crust

Question 15

What are nasopharyngeal tumours and how to Ix?

Answer 15

See notes

Question 16

What is otosclerosis?

Answer 16

See notes

Question 17

Cause of sudden onset sensorineural hearing loss?

Answer 17

Causes – infection, trauma, immunological, toxins, ototoxic drugs, MS

Question 18

Mx of sudden onset sensorineural hearing loss?

Answer 18

many spontaneously recover c/in 3 days, oral corticosteroid therapy immediately
+ refer to ENT, hyperbaric oxygen, antivirals, vasodilators etc

Question 19

What are you concerned about with a unilateral serous effusion?

Answer 19

Nasopharyngeal tumour

Question 20

How to Tx acute OM?

Answer 20

See notes

Question 21

What can you see in OME?

Answer 21

Intact, retracted tympanic membrane

Loss of light reflex

Question 22

What can cause OME?

Answer 22

Obstruction or damage to the eustachian tube

Question 23

How to Tx OME?

Answer 23

o 95% resolve spontaneously within 1 year
o Only consider treatment for persistent bilateral OME and hearing loss after 3 months – Tx with decongestants and antibiotics
o Grommets in some cases

Question 24

What pathogens © cause OM?

Answer 24

H. influenza, S. pneumonia, Moraxella catarrhalis

Question 25

What are the causes and RF for OE?

Answer 25

``` Narrow, tortuous ear canal Moisture Foreign body Trauma Chronic skin condition ```

Question 26

Ix for OE?

Answer 26

Test urine for sugar if >50 | Swabs

Question 27

Tx for OE?

Answer 27

abx + steroids = Gentisone-HC Flucloxacillin Clotrimazole Aural toileting

Question 28

What is malignant OE?

Answer 28

OE that has spread to cause osteomyelitis of the skull base, due to pseudomonas aeruginosa + anaerobes causing a mound of tissue in the external canal

Question 29

Tx of malignant OE?

Answer 29

emergency | IV ciprofloxacin

Question 30

What are the S+S of mastoiditis?

Answer 30

Earache + discharge Pyrexia, ill-looking Tenderness over mastoid antrum Pinna may be pushed down and forward due to a swelling in the post-auricular region Tympanic membrane = red, bulging or perforated Signs of conductive deafness

Question 31

How to Mx mastoiditis?

Answer 31

IV 3rd gen cephalosporin | May req drainage

Question 32

What is masked mastoiditis?

Answer 32

abx fail to resolve acute presentation so low-grade granular osteitis develops in the mastoid bone

Question 33

What is a pre-auricular sinus and how to Tx?

Answer 33

Form by incomplete fusion of the pinna Can be foul-smelling pus if infected Need surgical removal

Question 34

What are the worrying signs for nasal polyps?

Answer 34

Unilateral Bleeding Triggers thoughts of nasal Ca

Question 35

What is Samter's triad?

Answer 35

Aspirin sensitivity, asthma and nasal polyposis

Question 36

Management of nasal polyps?

Answer 36

- Test for allergy - Check for CF in children - Biopsy for neoplasia if unilateral Medical Mx – topical steroids Surgical Mx – nasal polypectomy

Question 37

What is the presentation of nasal septal haematoma?

Answer 37

* © the sensation of nasal obstruction * Pain + rhinorrhoea * Classically pt has a bilateral, ‘boggy’, red swelling arising from the septum

Question 38

Why do you need to treat nasal septal haematomas as an emergency and how to Tx?

Answer 38

Because the septum could become necrotic within 3-4 days and cause a saddle-nose deformity Tx with drainage and IV abx

Question 39

What is the management for allergic rhinitis?

Answer 39

Mild-mod: oral/intranasal antihistamines Mod-sev: intranasal corticosteroids For topical decongestants role, see notes

Question 40

S+S of ramsay hunt syndrome?

Answer 40

PAIN, hearing loss + earache, FN palsy, vesicular rash around the ear or on tongue, vertigo, tinnitus

Question 41

What is the pathophysiology of ramsay hunt syndrome?

Answer 41

Shingles that is affecting the facial nerve

Question 42

What is the management of Ramsay-hunt syndrome?

Answer 42

PO acyclovir and corticosteroids

Question 43

Mx of Bell's palsy?

Answer 43

prednisolone PO 10 days within 72 hours + artificial tears

Question 44

Causes of Bell's?

Answer 44

Herpes predominently

Question 45

Which drugs are ototoxic?

Answer 45

Gentamicin, quinine, furosemide, aspirin + some chemo

Question 46

What is the presentation of quinsy?

Answer 46

* Severe throat pain, lateralises to one side * Deviation of the uvula to the unaffected side * Reduced neck mobility * ‘lockjaw’ may occur d/t trismus (motor disturbance of the trigeminal nerve)

Question 47

Tx of quinsy?

Answer 47

Need urgent ENT review Tx with needle aspiration under local anaesthasesia Systemic penicillin Consider tonsillectomy in 6wks time