ENT

Question 1

What typically preceeds acute otitis media

Answer 1

Viral URTI

Question 2

causes of acute otitis media

Answer 2

viral or bacterial

Question 3

S/s acute otitis media

Answer 3

• otalgia
• ear tugging
• fever
• URTI sx

Question 4

Otoscopy findings in acute otitis media

Answer 4

• loss of light reflex due to bulging tympanic membrane
• middle ear effusion
• inflammation (erythema)

Question 5

How is acute otitis media diagnosed

Answer 5

Clinical

Otoscopy

Question 6

When are abx indicated in acute otitis media

Answer 6

• sx persist >4 days
• systemically unwell (not requiring admission)
• immunocompromised
• <2yo and bilateral otitis media
• perforation and/or discharge

Question 7

sx of cerumen impaction

Answer 7

• Hearing loss
• Blocked ears
• Ear discomfort
• Feeling of fullness in ear
• Earache
• Tinnitus

Question 8

When should ear drops NOT BE USED

Answer 8

perforated tympanic membrane, active dermatitis, or active infection of the ear canal.

Question 9

Causes of labyrinthitis

Answer 9

viral, bacterial or associated with systemic diseases

Question 10

labyrinthitis

Answer 10

inner ear infection

Question 11

labyrinthitis vs vestibular neuritis

Answer 11

vestibular neuritis : only the vestibular nerve is involved, hence there is no hearing impairment

labyrinthitis : both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment

Question 12

sx of labyrinthitis

Answer 12

• vertigo
• n&v
• hearing loss
• tinnitus
• preceding or conceding URTI sx

Question 13

signs of labyrinthitis

Answer 13

• sensorineural loss
• gait disturbance
• nystagmus

Question 14

how is labyrinthitis diagnosed

Answer 14

clinical

Question 15

otitis externa

Answer 15

inflammation (redness and swelling) of the external ear canal

Question 16

sx of otitis externa

Answer 16

• ear pain
• itch
• discharge

Question 17

common trigger of otitis externa

Answer 17

swimming

Question 18

What should be done if otitis externa is not responding to initial treatment

Answer 18

ENT referral

Question 19

Vertigo

Answer 19

false sensation that the body or environment is moving.

Question 20

Which neurological finding may be found with vertigo

Answer 20

nystagmus

Question 21

Main causes of vertigo

Answer 21

central : brain pathology - uncommon

peripheral : inner ear pathology

Question 22

chronic suppurative otitis media (CSOM)

Answer 22

Ear discharge persisting for more than 2 weeks, without ear pain or fever

Question 23

chronic suppurative otitis media sx

Answer 23

persistent ear discharge
hearing loss
tinnitus

Question 24

chronic suppurative otitis media management

Answer 24

ENT referral

Question 25

What is mastoiditis

Answer 25

when an infection spreads from the middle to the mastoid air spaces of the temporal bone

Question 26

s/s of mastoidits

Answer 26

- otalgia: severe, classically behind the ear - fever - swelling, erythema and tenderness over the mastoid process - external ear may protrude forwards

Question 27

how is mastoiditis diagnosed

Answer 27

clinical CT if complications supected

Question 28

complication of mastoiditis

Answer 28

- meningitis - facial nerve palsy - hearing loss

Question 29

s/s menieres disease

Answer 29

- recurrent episodes of vertigo, tinnitus and hearing loss - fullness / pressure in ear - positive Romberg

Question 30

management of menieres disease

Answer 30

- ENT specialist referral - acute attacks: buccal or intramuscular prochlorperazine - stop driving until sx controlled

Question 31

how long do attacks last in menieres disease

Answer 31

present for at least 20 minutes, but typically last a few hours

Question 32

What does barotrauma lead to

Answer 32

perforated tympanic membrane

Question 33

sx of barotrauma

Answer 33

- hearing loss - ear pain - fullness in ear

Question 34

What does positive and negative Rinnes test indicate

Answer 34

Positive : air conduction > bone conduction (normal) | Negative : bone conduction > air conduction (conductive hearing loss)

Question 35

What is the webers test result in conductive and sensorineural hearing loss

Answer 35

conductive : lateralises to affected ear | sensorineural : lateralises to unaffected ear

Question 36

How to manage hearing loss in primary care if all other causes have been treated/excluded

Answer 36

- ENT referral for audiological assessment | - hearing aids

Question 37

When to urgently refer a patient with hearing loss

Answer 37

- Sudden onset (over 3 days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and all other causes excluded - Unilateral hearing loss associated with focal neurology - Hearing loss associated with head or neck injury - Hearing loss associated with severe infection or Ramsay Hunt syndrome - Rapidly progressive hearing loss

Question 38

Causes of tympanic membrane perforation

Answer 38

- infection (most common) - barotrauma - direct trauma

Question 39

most common infectious agents of acute sinusitis

Answer 39

Haemophilus influenzae rhinovirus Streptococcus pneumoniae

Question 40

sx of acute sinusitis

Answer 40

- facial pain (worse on leaning forward) | - thick nasal discharge

Question 41

How can allergic rhinitis be classified

Answer 41

- seasonal - occupational - perennial: symptoms occur throughout the year

Question 42

sx of allergic rhinitis

Answer 42

- sneezing - bilateral nasal obstruction - clear nasal discharge - post-nasal drip - nasal pruritus

Question 43

sx of nasal polyps

Answer 43

- nasal obstruction - rhinorrhoea - sneezing - poor sense of taste and smell

Question 44

which feature of nasal polyps is unusual and requires further investigation

Answer 44

unilateral nasal polyps or bleeding

Question 45

management of nasal polyps

Answer 45

- ENT referral | - topical corticosteroids

Question 46

how long do sx have to persist to be chronic sinusitis

Answer 46

12 weeks