ENT

Question 1

trauma to the nose:
- sites of injury
- Ix/ examination
- Mx

Answer 1

sites:
- internal –> septal haematoma
- external –> nasal fracture

Ix:
- when examining a fracture , must check for orbital fracture and eye muscles range of motion intact.
- look for signs of skull base fracture: racoon eyes and battle sign.

Mx:
- must reset fracture within 14 days.

Question 2

epistaxis:
- RFs
- location of bleed
- 1st step of Mx always

Answer 2

1. elderly/ young, HTN, cardiac disease, trauma, anticoagulants
2. 90% of cases = little’s area [Kiesselbach’s plexus]. 10% posterior
   usually in the elderly
3. applying pressure to stop the bleeding - packing may be necessary

Question 3

how to identify a thyroglossal cyst on examination

Answer 3

thyroglossal is linked to the hyoid bone so sticking out the tongue will cause the lump to move as the muscles of the tongue also attach to hyoid.
the thyroid is not linked to the hyoid

Question 4

bilateral septal swelling after trauma to nose

Answer 4

• indicates septal haematoma
• requires surgical drainage under local or GA and abx after.
• complication = saddle nose deformity if left untreated

Question 5

how is vertigo classified - give examples

Answer 5

Vertigo can be divided into central and peripheral [otological] causes

central:

• posterior stroke
• acoustic neuroma
• MS
• vestibular migraine

peripheral:

• BPPV
• Menieres
• vestibular neuronitis
• viral labyrinthitis

Question 6

Meniere’s

1. pathophysiology
2. trigger
3. duration [continuity + time]
4. hearing loss
5. other sx
6. Dx
7. Mx

Answer 6

1. unknown pathophysiology. - possibly increased fluid pressure in the ear
2. spontaneous - not positional
3. mins/ hours - episodic. resolves within 24hrs
4. hearing loss + tinnitus, it is sensorineural + unilateral
5. vertigo [duh] fullness in the ears, imbalance, drop attacks [noLoC]
6. referral to ENT
7. prochlorperazine for acute Tx + Betahistine for prophylaxis.

Question 7

BPPV

1. pathophysiology
2. trigger
3. duration [continuity + time]
4. hearing loss
5. other sx
6. Dx
7. Mx

Answer 7

1. canaliths [crystals] in the semicircular canals not the urtricle.
2. head movements and posture - may be preceeded by neuronitis
3. seconds / mins - episodic
4. no hearing loss
5. none just vertigo
6. Dix hallpike manouvre
7. epley maneouvre ± brandt exercises

Question 8

Vestibular neuronitis

1. pathophysiology
2. trigger
3. duration [continuity + time]
4. hearing loss
5. other sx
6. Dx
7. Mx

Answer 8

1. viral infection –> inflammation of the vestibular nerve
2. initially continuous due to inflammation, then can be triggered or worsened by head movement.
3. days - continuous. resolves within a week
4. no hearing loss or tinnitus
5. N+V, balance problems
6. +ve head impulse test + clinical Dx
   
   7. +ve = eyes saccade -ve = normal or central cause of vertigo
7. supportive care + short term symptomatic Tx.
   
   9. prochlorperazine + antihistamines [cyclizine]

Question 9

Labyrinthitis

1. pathophysiology
2. trigger
3. duration [continuity + time]
4. hearing loss
5. other sx
6. Dx
7. Mx

Answer 9

1. viral URTI –> inflammationof the labyrinth [bony inner ear structures]
2. none
3. continuous - days
4. hearing Loss and tinnitus
5. sx of viral or bacterial illness
6. +ve head impulse test + clinical Dx
   
   7. +ve = eyes saccade -ve = normal or central cause of vertigo
7. supportive care + short term symptomatic Tx.
   
   9. prochlorperazine + antihistamines [cyclizine]

Question 10

MC cause of perforated ear drum + other causes

Answer 10

• The MC cause of a perforated tympanic membrane = infection.
• Other causes include barotrauma or direct trauma.

Question 11

perforated ear drum Mx

Answer 11

• no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear/swimming during this time
• it is common practice to prescribe antibiotics to perforations which occur following an episode of acute otitis media.
  
  • Oral Abx NOT topical
• myringoplasty may be performed if the tympanic membrane does not heal by itself.

Question 12

Globus, hoarseness and no red flags → ?

Answer 12

laryngopharyngeal reflux

Question 13

otitis media with effusion Mx

paeds

Answer 13

• For the majority of children, otitis media with effusion (OME), or glue ear, can be managed by active observation over 6-12 weeks.
• Patients with Down’s syndrome or cleft palate are less likely to recover spontaneously from OME, and therefore require immediate referral to ENT.