ENT

Question 1

Benign paroxysmal positional vertigo

Answer 1

o crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
o symptoms triggered by movement and last around a minute
o Dix-hallpike manoeuvre to diagnose, Epley manoeuvre to treat

Question 2

Meniere’s disease

Answer 2

o excessive buildup of endolymph in the semicircular canals, causing a higher pressure than normal, disrupting the sensory signals.
o It causes attacks of hearing loss, tinnitus, vertigo and a sensation of fullness in the ear – last several hours, middle ages adults, not associated with movement, nystagmus, hearing deteriorates over time
o Treat with beta histamines

Question 3

vestibular neuronitis

Answer 3

o Inflammation of vestibular nerve, usually linked with viral infection, acute vertigo that improves over a few weeks

Question 4

labyrinthitis

Answer 4

o Inflammation of the inner ear, linked with viral infection, improves within few weeks, can cause hearing loss

Question 5

central causes of vertigo

Answer 5

• Posterior circulation infarction (stroke)- sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms.
• Tumour – gradual onset with associated symptoms
• Multiple sclerosis – relapsing and remitting symptoms
• Vestibular migraine - symptoms lasting minutes/hours with trigger, manage similar to migraine

Question 6

what is an acoustic neuroma

Answer 6

• benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear
• also called vestibular schwannomas

Question 7

presentation of acoustic neuroma

Answer 7

• 40-60 y/o with gradual onset of:
  o Unilateral sensorineural hearing loss (often the first symptom)
  o Unilateral tinnitus
  o Dizziness or imbalance
  o A sensation of fullness in the ear
  o Can be associated with facial nerve palsy (forehead not spared = LMN)

Question 8

what condition is bilateral acoustic neuroma linked to

Answer 8

neurofibromatosis type 2

Question 9

where is the most common site for epistaxis

Answer 9

Kiesselbach’s plexus, which is located in Little’s area- area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels

Question 10

what can be prescribed after epistaxis to improve healing

Answer 10

• Naseptin cream (chlorhexidine and neomycin) - contraindicated in peanut and soy allergy

Question 11

otitis externa

Answer 11

• Inflammation of the skin of external ear canal
• Acute <3w, chronic >3w
• Swimmers ear
• Can be caused by bacterial infection, fungal, eczema, dermatitis

Question 12

bacterial causes of otitis externa

Answer 12

pseudomonas aeruginosa (gram negative aerobic rod-shaped bacteria), staph.aureus

Question 13

mild/moderate/severe management of otitis externa

Answer 13

• mild - acetic acid 2% (can be used prophylactically)
• moderate - otomize spray (neomycin, dex, acetic acid)
• severe - oral flucloxacillin
• if fungal then clotrimazole drops

Question 14

malignant otitis externa

Answer 14

• potentially life threatening
• spreads to bone - osteomyelitis of temporal bone
• at risk if immunocompromised

Question 15

otitis media

Answer 15

• Infection of middle ear – between tympanic membrane and inner ear
• Bacteria enter through the eustachian tube
• A viral upper resp infection often preceded bacterial infection of the middle ear

Question 16

most common bacterial causes of otitis media

Answer 16

most common is strep.pneumoniae which causes sinusitis and tonsilitis
* H.influenza, M.catarrhalis, s.aureus

Question 17

management of otitis media

Answer 17

• most resolve in 3 days with nothing
• analgesia
• amox if systemically unwell or immunocompromised
• delayed prescription

Question 18

severe/rare complication of otitis media

Answer 18

mastoiditis

Question 19

rhinosinusitis

Answer 19

• Inflammation of paranasal sinuses and nasal cavity
• Acute <12w, chronic >12w

Question 20

paranasal sinuses

Answer 20

• Frontal sinuses (above the eyebrows)
• Maxillary sinuses (either side of the nose below the eyes)
• Ethmoid sinuses (in the ethmoid bone in the middle of the nasal cavity)
• Sphenoid sinuses (in the sphenoid bone at the back of the nasal cavity)
• Drain into nasal cavity via ostia (holes)

Question 21

causes of rhinosinusitis

Answer 21

infection
allergies
obstruction to drainage by trauma/foreign body/polyp
smoking

Question 22

symptoms of sinusitis

Answer 22

• Congestion, discharge, facial pain, pressure, swelling, anosmia

Question 23

management of sinusitis

Answer 23

• No treatment if <10days (could use saline nasal washing) as most are viral and resolve within 2-3w
• > 10 days could give high dose steroid nasal spray for 14 days with delayed abx (phenoxymethylpenicillin

Question 24

treatment of chronic sinusitis

Answer 24

saline nasal irrigation, steroid sprays, functional endoscopic sinus surgery

Question 25

most common bacterial cause of tonsilitis

Answer 25

group A strep (strep pyogenes) – treated effectively with pen V

Question 26

Waldeyer's tonsillar ring

Answer 26

* In pharynx there is a ring of lymphoid tissue * There are six areas of lymphoid tissue in Waldeyer’s ring, comprising of the adenoids, tubal tonsils, palatine tonsils and the lingual tonsil. * Palatine tonsils most affected

Question 27

FeverPAIN score

Answer 27

* Fever during previous 24 hours * P – Purulence (pus on tonsils) * A – Attended within 3 days of the onset of symptoms * I – Inflamed tonsils (severely inflamed) * N – No cough or coryza

Question 28

management of tonsilitis

Answer 28

- admission if immunocompromised, had airway difficulties or if peritonsillar abscess - FeverPAIN >3 consider abx or delayed prescription - pen V for 10 days or clarithromycin in penicillin allergy

Question 29

quinsy/peritonsillar abscess

Answer 29

* Complication of tonsilitis * Trismus (unable to open mouth), hot potato voice, severe swelling and erythema * Treat with needle aspiration or surgical drainage, abx (often broad spec such as co-amox)