Otology

Question 1

What makes up the outer ear?

Answer 1

Pinna + ear canal

Question 2

What makes up the middle ear?

Answer 2

Timpanic membrane + middle ear ossicles + ad ventilated by Eustachian tube

Question 3

What makes up the inner ear?

Answer 3

Semi-circular canals
Cochlea

Question 4

What are important clinical findings in a history?

Answer 4

Hearing loss
Tinnitus
Discharge
Otalgia
Dizziness
Facial weakness, headaches, other ENT symptoms, skin conditions, allergies

Question 5

What is used for an ear examination to look inside the ear?

Answer 5

Otoscope

Question 6

Is removal always necessary with wax buildup?

Answer 6

No

Question 7

When would you remove ear wax?

Answer 7

If symptoms, TM examination essential, H aid

Question 8

What can be used to treat wax buildup?

Answer 8

Ear drops- olive/almond oil, NAHCO3, 0.9% saline

Question 9

What should be used if no import net in earwax after treatment?

Answer 9

Irrigation

Question 10

When is nurse led clinic used?

Answer 10

If known perforation, trauma, infection, surgery

Question 11

What should you advise to prevent people from getting ear irritation?

Answer 11

Advise against inserting anything into the ear
Cotton buds
Matchsticks
Hair pins
Ear candling
Vacuuming

Question 12

What are examples of inorganic foreign bodies?

Answer 12

Beads/ plastic material

Question 13

Can inorganic foreign body cause damage to skin?

Answer 13

No, inert

Question 14

What are examples of organic foreign bodies?

Answer 14

Cotton bud, nuts

Question 15

What can organic foreign bodies cause?

Answer 15

Excoriation of skin
Risk of otitis externa

Question 16

What can cause a penetrating injury in the ear?

Answer 16

Cotton buds, ear syringing, pellets injury

Question 17

What can penetrating injury cause?

Answer 17

Rupture of tympanic membrane
May cause damage to the ossicles

Question 18

What are the symptoms of a foreign body?

Answer 18

H/o of foreign body
Persistent unilateral discharge
Ear discharge
Bleeding- occasionally
Hearing loss- penetrating

Question 19

What is the treatment of foreign bodies?

Answer 19

Foreign body removal

Question 20

What are ways of removing a foreign body?

Answer 20

Hawthorne wax hook
Right angled hook
Syringing
Suction

Question 21

What is the treatment of penetrating trauma?

Answer 21

Do nothing
ENT review six weeks later

Question 22

What is the treatment for acute otitis externa?

Answer 22

Sofradex, gent is one HC ear drops or otomize spray

Question 23

If tympanic membrane perforation present in acute otitis externa, what should be used?

Answer 23

Cilodex- pseudomonas

Question 24

When does acute otitis externa get better?

Answer 24

Within a week

Question 25

What should happen if AOE persisten after 2 weeks

Answer 25

Arrange microbiology swabs and treat according to sensitivities If unresponsive refer to ENT nurse- Led clinic

Question 26

When are oral antibiotic indicated in acute otitis externa?

Answer 26

If infection is spread to cause facial pinna cellulitis

Question 27

What can cause fungal otitis externa?

Answer 27

Chronically wet ear Uses a lot of antibiotics

Question 28

How is fungal otitis externa treated?

Answer 28

Micro suction Check for underlying perforation Keep ears a dry Topical clotrimazole or nystatin ear drops for 2 weeks

Question 29

What patient is predisposed to malignant otitis externa?

Answer 29

Diabetic or immune suppressed patient

Question 30

What kind of process is malignant otitis externa?

Answer 30

Long-standing

Question 31

What can malignant otitis externa cause?

Answer 31

Granulation tissue Systemic upset Cranial nerve deficits

Question 32

Who are at risk of necrotising otitis externa?

Answer 32

Elderly diabetic or immune suppressed patient

Question 33

How does necrotising otitis externa present compared to other otitis externa infections?

Answer 33

Topical treatment not working Increasing pain

Question 34

How do you test for necrotising otitis externa?

Answer 34

Swab Fasting blood sugar CRP

Question 35

What is a hallmark of necrotising otitis externa?

Answer 35

Granulation tissue in EAC

Question 36

What can also present with necrotising otitis externa?

Answer 36

Facial palsy Cranial nerve deficits

Question 37

What is the management of necrotising otitis externa?

Answer 37

Immediate referral Systemic anti-pseudonomonas antibiotics Surgical debridement Control of diabetes

Question 38

What does a swimmer presenting with hearing loss likely have?

Answer 38

Exotoses

Question 39

What does a 4yr old with fever and ear ache likely have?

Answer 39

Acute supportive otitis media

Question 40

What is the typical treatment of acute supportive otitis media?

Answer 40

Give painkillers, wait for 2 to 3 days, if still symptomatic, give systemic antibiotics

Question 41

What would you use to confirm the diagnosis of otitis media with effusion?

Answer 41

Audio gram

Question 42

What kind of hearing loss would present in otitis media with effusion?

Answer 42

Low frequency conductive hearing loss

Question 43

What kind of tympnetry would you get in otitis media with effusion?

Answer 43

Flat

Question 44

What would a possible presentation of chronic mucoid +/- tympanic membrane perforation be?

Answer 44

Grommet insertion as a child Ear discharge Hearing loss Conductive hearing loss

Question 45

What is the first line treatment of chronic mucoid +/- tympanic membrane perforation?

Answer 45

Prescribe 2 week course of cilodex (ciproflaxacin with dexamethasone) ear drops 4 drops twice daily

Question 46

What is the second line treatment of chronic mucoid?

Answer 46

If after 2 weeks ear discharge persists - send a swab and consider refer to ENT If not fungal cilodex can be given for further 2 weeks while the patient is awaiting to be seen in ENT

Question 47

What can be the complication of otitis media with cholestaetoma?

Answer 47

Can go into mastoid bone, eats away at ossicles, cause damage to balance organs Can go into brain and hit visual nerve

Question 48

what is the treatment of cholesteatoma?

Answer 48

Temporal mastoid surgery

Question 49

What cannot be used to treat cholesteatoma?

Answer 49

Antibiotic drugs

Question 50

What are the two types of progression of chronic otitis media?

Answer 50

Mucosal Squamosal

Question 51

What are the types of mucosal chronic otitis media?

Answer 51

Active (CSOM) Inactive (permanent perforation) Healed (adhesive OM)

Question 52

What are the types of sqamosal chronic otitis media?

Answer 52

Retraction pockets (PT/PF/atelectatic ear) Active (C+ discharge)

Question 53

What is a complication of squamous otitis media?

Answer 53

Acute mastoiditis

Question 54

what can happen if acute mastoiditis is left untreated?

Answer 54

Brain abscess

Question 55

What is the step for managing accurate mastoiditis?

Answer 55

Acute emergency Admit -> IV antib -> urgent CT -> Drain mastoid -> put in grommet If brain abscess -> also needs drained

Question 56

Wha are questions to ask with dizziness?

Answer 56

Is it positional Does nausea come with dizzy episodes Any recent hearing loss since episodes started Manoeuvres to do - hallpikes and epleys in clinic

Question 57

What is the treatment for Ménière’s disease?

Answer 57

Betahistine Stemetil PRN — only

Question 58

What is Bell’s palsy likely caused by?

Answer 58

Herpes simplex virus

Question 59

How should you treat Bell’s palsy?

Answer 59

Steroids Can have spontaneous self resolution

Question 60

What is Ramsey hunt syndrome caused by?

Answer 60

Varicella zoster virus

Question 61

How do you treat Ramsey hunt syndrome?

Answer 61

Give acyclovir