ENT

Question 1

Acute viral Labrynthitis presentation:

Answer 1

• Sudden onset horizontal nystagmus towards unaffected side, nausea, vomiting, hearing disturbances, a cold in the past few days, hearing loss, tinnitus, vertigo(not triggered by movement, exacerbated-made worse by movement)
  ddx: Vestibular Neuronitis= except hearing would not be affected in this condition.
  Acute viral labrynthitis: sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo

Question 2

Meniere’s disease presentation difference:

Answer 2

• Presents with aural fullness
• Has similar features to Viral Labrynthitis but is a more recurrent condition
  -Duration: Episodes lasts for MINutes to hours
  Symptoms: Unilateral hearing loss and Tinnitus
• ENT assessment is required to confirm the diagnosis.
  Mx: Acute attack- Buccal/IM Prochlorperazine and might need admission. Prevention: Betahistine and vestibular rehab exercises.
  -Patients should inform DVLA.

Question 3

• Presbyacusis presentation:

Answer 3

• Bilateral age related hearing loss
  -Progressive bilateral sensorineural hearing loss
  -Typical audiogram: Bilateral Impairment, high frequency hearing loss, downward sloping pure-tone thresholds.

Ddx: Acoustic Neuroma: would present with unilateral hearing loss and nausea/vomiting are common

Question 4

Cholesteatoma Presentation:

Answer 4

• Unilateral hearing loss
• Otoscopy: would show a pearly white lump in the tympanic membrane
• Audiogram: Conductive hearing loss

Question 5

Osteoma Presentation:

Answer 5

• ear canal bony growth commonly seen in cold water swimmers
• ## conductive hearing loss on audiogram

Question 6

Otosclerosis Presentation:

Answer 6

• Is a hereditary condition where the stapes(smallest inner most bone of ear) of the ear are fixed.
• Hearing loss becomes noticeable before middle age.
• Causes conductive hearing loss

Question 7

Red flags for chronic sinusitis:

Answer 7

• Unilateral symptoms(as cancer of nasopharynx is more likely to produce one sided symptoms depending on its location.
• Pain worse on leaning forwards is a classical sign of sinusitis.
• other features: nasal pain, post nasal drip, mouth breathing

Question 8

Tonsillitis Diagnosing criteria for a BACTERIAL cause:

Answer 8

CENTOR score(4 characteristics)-
1. Temp more than 38 degrees
2. Tender anterior cervical lymphadenopathy
3. ABSENCE of a cough
4. Exudate present on tonsils
- if person has 3/4 of these criteria, diagnosis is likely.
- is similar to the fever pain score

Question 9

Quinsy (Peri-tonsillar Abscess):

Answer 9

Is a complication of bacterial tonsillitis.
- Presentation: severe throat pain on one side, deviation of uvula to unaffected side, difficulty opening mouth, reduced neck mobility.
- Patients need urgent review by specialist
Mx: IV Antibiotics+needle aspiration(or incision or drainage)+ consider tonsillectomy in a few weeks.

Question 10

BPPV Presentation:

Answer 10

• Vertigo is caused by change in position and only lasts for seconds, there is no change in hearing.

Question 11

Rinne’s and Weber’s test:

Answer 11

Rinne Weber
Positive ( normal) Normal
- Air conduction > bone Sound heard equally in both ears
- Healthy individuals
- Individuals with significant sensorineural hearing loss
Negative Sensorineural hearing loss
- Suggests conductive hearing loss Sound heard louder on side of intact ear(on normal ear, sound is louder)
Conductive hearing loss

Sound is heard louder on affected ear(sound is louder on pathology ear)

Question 12

Horizontal nystagmus is a feature of which condition?

Answer 12

Vestibular Neuronitis

• Also presents with viral URTI beforehand

Question 13

Vestibular Neuronitis:

Answer 13

• Caused by inflammation of vestibular nerve.
• Presents with: Vertigo, nausea, vomiting, balance problems
  -Horizontal Nystagmus

Question 14

Acoustic Neuroma (4 classical features) :

Answer 14

• Tinnitus
• Vertigo
• Hearing Loss (caused by tumour pressing on cranial nerve 5)
• Therefore can also cause an absent corneal reflex
  -Symptoms get worse with each episode

Question 15

Otitis Externa (question will say: external auditory canal) management?

Answer 15

1st line Treatment: Topical antibiotics with or without steroid eg: topical ciprofloxacin and dexamethasone

• Recent swimming is risk factor: mx with: Neomycin + dexamethasone ear spray

Question 16

Acute otitis media mx?

Answer 16

oral amoxicillin