ENT in GP

Question 1

Describe what is meant by perichondritis [1]

Answer 1

Perichondritis is infection or inflammation of the tissue that covers the cartilage of the external ear (the pinna or auricle).

Hallmark feature:
- redness that extends from pinna but does not go to lobule

NB: can’t get it in lobule as there is no cartilage

Question 2

CDNH

Question 3

Dx? [1]

Answer 3

Squamous cell carcinoma

Question 4

How can you differentiate which ear is being shown from a picture? [1]

Which ear is this? [1]

Answer 4

Cone of light skews anteriorly
- the right ear typically shows the light reflex in the 5 o’clock position, while the left ear shows it in the 7 o’clock

Left ear shown

Question 5

Dx? [1]

Answer 5

Occlusive wax

Question 6

Function of wax? [3]

Answer 6

Cleaning ear canal

Antibacterial
* H. Influenzae, Staph. Aureus and E. Coli

Antifungal

Question 7

Management for wax removal? [2]

Answer 7

Olive oil
Irrigation of external ear canal (good for soft wax)

Question 8

Dx? [1]

Answer 8

Otitis Externa
- inflammation of external ear canal

Question 9

Which factors predipose people to otitis externa? [+]

Answer 9

Canal:
- Narrow EAM, Eczema

Environ:
- Humidity, Water (swimmers ear: fungal inflammation)

Trauma:
- Cottonbuds, Matchsticks etc

Question 10

Signs [2] and symptoms [4] of Otitis Externa?

Answer 10

Symptoms
* Itching
* Pain
* Discharge
* Hearing impairment (if significant swelling to ear canal)

Signs
* Pain on moving pinna / pain on pressing tragus
* Swelling/ erythema/ Debris in canal eczema

Question 11

Furunculosis: is an infection of the hair follicles most commonly caused by [1]

Answer 11

Furunculosis
* Staph infection of the hair follicles

Question 12

What is the type of otitis externa called otomycosis [1]

What is it caused by? [1]

Which species is it most commonly caused by? [2]

Answer 12

Otomycosis
* Primary fungal infection or secondary to prolonged antibiotics.
* Fungi: C albicans, Aspergillus niger

Question 13

Treatment for Otitis Externa?

Answer 13

• Clear debris (Microsuction)
• Steroid based drops and topical hydrocortisone to pinna
• Water precautions - put cotton wool in vaseline and place in ear before showering
• Avoid local trauma

Question 14

Dx? [1]

Answer 14

Acute Otitis Media- mainly children

Question 15

[3] acount for 90% of pathogens in AOM

Answer 15

S.Pneumoniae, H Influenza, Moraxella Catarrhalis acount for 90% of pathogens in ASOM

Question 16

Why does glue ear prevalence start dropping at ~ 5 years [1]

Answer 16

Adenoids start shrinking at the age of 5