ENT

Question 1

What name is given to the condition in which there is formation of an oeseophageal web above the aortic arch in associated with concomitant iron deficiency in women?

Answer 1

Plummer-Vinson syndrome

Main symptom=dysphagia

Question 2

What is concerning with regards to Plummer-Vinson syndrome?

Answer 2

Pre-malignant

associated with development of carcinoma in crico-pharyngeal region

Question 3

When should tonsillectomy be offered to children?

Answer 3

7 or more documented severe sore throats in a year, 5 or more yearly in 2 successive years, 3 or more yearly in 3 successive years (Paradise criteria)

Question 4

Difference between pinna cellulitis and pinna perichondritis on examination?

Answer 4

pinna perichondritis typically spares the lobule (as inflammation of the perichondrium surrounding cartilage)

usually result of penetrating trauma e.g. piercing

Question 5

Most common causative organism in perichondritis and OE?

Answer 5

pseudomonas aeruginosa

whereas staph aureus most common cause of pinna cellulitis-treat with PO Abx +/- topical if underlying OE

Question 6

Usual tx of perichondritis?

Answer 6

ciprofloxacin

admit for IV Abx if fail to respond to tx

Question 7

Which dx should be suspected if repeated episodes of atraumatic pinna perichondritis?

Answer 7

relapsing polychondritis=chronic systemic condition, tx with steroids and immunosuppressants

Question 8

With regards to oral ulcers, when should patients be referred urgently to secondary care? (2ww)

Answer 8

if unexplained oral ulceration persisting for more than 3 weeks

Question 9

Preferred treatment for patients with persistent sx of vestibular neuronitis lasting more than 1 week?

Answer 9

vestibular rehabilitation exercises

NICE recommend urgent referral to balance specialist for further assessment if sx for more than 1 week

Question 10

Most common cause of bullous myringitis (<10% of AOM cases)?

Answer 10

Strep pneumoniae

Question 11

Recommended tx to improve recovery in Bells Palsy if presentation within 72hrs of sx onset?

Answer 11

Prednisolone 50mg OD for 10 days OR

prednisolone 60mg OD for 5 days then dose reduction by 10mg OD for next 5 days

Question 12

Otitis media with effusion (glue ear) occurs in 90% of children with what condition?

Answer 12

cleft palate

Question 13

Which intranasal steroid spray is licensed for children from the age of 4?

Answer 13

fluticasone

from the age of 6 can use beclometasone, and from the age of 12 can use budesonide

Question 14

Who requires a 2ww referral for suspected laryngeal cancer?

Answer 14

if age 45 and over with either:
persistent unexplained hoarseness OR
unexplained lump in neck

also consider 2ww referral for suspected oral cancer at any age with a persistent unexplained neck lump

Question 15

Loss of hearing at what frequency is characteristic of noise induced deafness?

Answer 15

4 kHz

Question 16

When to consider 2ww referral for possilbe H+N cancers?

Answer 16

mass/lump in oropharynx
mass/lump in neck
persistent sore throat (espec. if unilateral)
persistent ulceration in oral cavity
>40yrs with unilateral otalgia/dysphagia/odynophagia
erythroplakia/leukoplakia-urgent dental referral within 2 weeks

Question 17

Management of acute localised OE (furunculosis-S.aureus infection of hair follicle)?

Answer 17

warm compress and analgesia
if severe pain may require incision and drainage
consider PO Abx if systemic involvement suspected

Question 18

Management of mild diffuse OE?

Answer 18

topical acetic acid 2% spray

can combine with antibacterial and steroids if more severe e.g. otomize
topical Abx recommended-aminoglycoside and quinolone

Question 19

When to give PO Abx in acute otitis media?

Answer 19

bilateral infection under 2 yrs of age
systemic features
at high risk of complications
otorrhoea

PO amoxcillin, clari if allergic, erythromycin if pregnant
2nd line=co-amoxiclav

Question 20

Tx of acute otitis externa if cellulitis or disease extends outside ear canal or systemic signs?

Answer 20

PO flucloxacillin

BUT NEED TO REFER TO EXCLUDE MALIGNANT OTITIS EXTERNA

Question 21

2nd line Abx for sinusitis?

Answer 21

co-amoxiclav

1st line=penicillin V

Question 22

What specific feature is required to make a diagnosis of otitis media?

Answer 22

a middle ear effusion

can be diagnosed by loss of light reflex on otoscopy or reduced TM movement or bulging TM or otorrhoea

Question 23

Which adults with hearing loss should be referred for urgent ENT review within 2 weeks?

Answer 23

• sudden onset (over 3 days or less) of unilateral or b/l hearing loss that occurred more than 30 days ago (if less then 30 days require immediate referral) and cannot be explained by external or middle ear causes
• rapidly progressing hearing loss (over 4-90 days), not explained by external or middle ear causes
• features of H+N cancer e.g. hearing loss+middle ear effusion not associated with URTI-NP carcinoma

Question 24

Monitoring of hearing in patients with dementia or mild cognitive impairement?

Answer 24

should have hearing assessment every 2 years if not previously diagnosed with a hearing problem

Question 25

Which patients with glue ear (OME) require immediate referral to ENT?

Answer 25

• children with down’s syndrome or cleft palate
• hearing loss of any level assoc with significant impact on child’s educational/social/developmental status
• persistent foul smelling discharge-semi urgent referral
• severe hearing loss (61dB or greater)
• significant hearing loss persists on 2 documented occasions
• TM structurally abnormal

Question 26

How long should active observation be continued for children with glue ear (OME)?

Answer 26

6-12 weeks

spontaneous resolution is common

Question 27

Most common fungal pathogen as cause for otitis externa?

Answer 27

aspergillus

Question 28

When is newborn hearing screening carried out?

Answer 28

ideally within first 4-5 weeks after birth, can be done up to age of 3 months

Question 29

What test is used in newborn hearing screening?

Answer 29

automated otoacoustic emission test (AOAE)

2nd test may be needed-automated auditory brainstem response test (AABR)

Question 30

Drugs that may cause tinnitus?

Answer 30

aminoglycosides
loop diuretics
aspirin/NSAIDs
quinine

Question 31

Which patients with tinnitus should be referred to be seen within 24 hours?

Answer 31

if tinnitus and hearing loss that has developed suddenly (over 72hrs or less) in the last 30 days-ENT or ED

Question 32

Which patients with tinnitus should be referred to be seen within 2 weeks?

Answer 32

• tinnitus associated with distress which is affecting their mental well being despite having tinnitus support at first POC
• sudden onset hearing loss that developed more than 30 days ago or rapidly progressing hearing loss
• persistent otalgia or otorrhoea that does not resolve with routine tx

Question 33

Which patients with tinnitus should be referred in line with local pathways?

Answer 33

• tinnitus that bothers them despite support at first POC
• persistent objective tinnitus
• tinnitus associated with unilateral or asymmetric hearing loss

consider referring for tinnitus assessment and management if persistent pulsatile tinnitus-imaging should be offered (*note sudden onset pulsatile tinnitus should be seen immediately), or persistent unilateral tinnitus

Question 34

What assessment should be offered to all patients presenting with tinnitus?

Answer 34

audiological assessment

Question 35

In a patient with hx of Bells palsy when should r/f to plastics be made for residual weakness?

Answer 35

after 6 months

R/f to a facial nerve specialist e.g. neurology should be done if:

• any doubt about diagnosis
• no improvement after 3 weeks of treatment
• sx of aberrant reinnvervation e.g. gustatory sweating 5 months or more after onset of bells palsy
• any atypical features

r/f to ophthalmology if any eye sx

Question 36

When is emergency admission needed in presentation of pt with a cholesteatoma?

Answer 36

• facial nerve palsy
• vertigo
• other neurological sx or signs including pain that could be associated with an intra cranial abscess or meningitis