ENT

Question 1

What is a cystic hygroma and what would you see on examination

Answer 1

Collection of dilated lymphatic sacs which are fluctuant and brilliantly transilluminable. Recurrence is common.

On examination there is a swelling in the subcutaneous tissue of the posterior triangle which transilluminates.

Question 2

Usual history of a pharyngeal pouch includes?

Answer 2

coughing up or regurgitation of food, often at night.

Halitosis is often associated

Question 3

Where is a thyroglossal cyst usually located and what simple movement can you do to confirm diagnosis?

Answer 3

midline due to its embryological descent.

“painless swelling in the midline of the neck”

Sticking out the tounge will move it, due to it’s connection to the foramen ovale

Question 4

Common pathogenic causes of otitis externa

Answer 4

staph aureus, pseudomonas aeruginosa or fungal

seborrhoeic dermatitis or contact dermatitis also a cause.

Question 5

Tx of otitis externa

Answer 5

1. topical antibiotic or a combined topical antibiotic with steroid (drops usually)
2. if infection continues to spread then oral AB indicated (usually oral flucloxicillan)

Question 6

Treatment for otitis media?

Answer 6

• although predominatley viral, if symptoms dont ease after 2-3 days then oral antibiotics are indicated.
• First Line: amoxicillan 500mg TDS
• If penicillin allergy: erythromycin or clarithromycin

**also kids under 2 years with bilateral infection, or infection with perforation.

Question 7

Episodic facial pain and discomfort whilst eating, halitosis and a dry mouth. He has a smooth swelling underneath his right mandible.

What are you thinking?

Answer 7

Sialolithiasis: stone in the salivary gland

As this is in the submandibular gland it is more likely to be obstruvting Whartons Duct

• Patients typically develop colicky pain and post prandial swelling of the gland
• Investigation involves sialography

Question 8

Management of a perforated eardrum?

Answer 8

Review in 6-8 weeks and avoid bathing/swimming

Question 9

Features of Menieres

Answer 9

• Recurrent episodes of vertigo, tinnitus and sensironeural hearing loss
• Feeling of aural fullness and pressure
• *nsytagmus and a positive Rombergs

This can last minutes to hours

Question 10

Treatment of Menieres

Answer 10

• Symptoms of menieres often resolve after 5-10 years
• Acute attacks: buccal or intramuscular prochlorperazine.
• Prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Question 11

Common bacterial causes of otitis media?

Answer 11

Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.

Question 12

Vestibular neuronitis is what?

Answer 12

Vertigo that develops following a viral infection

• vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
• betahistine is often used although the evidence base suggests it is less effective than vestibular rehabilitation

Question 13

what is malignant otitis externa and in what patients is it most commonly seen?

Answer 13

• an uncommon type of otitis externa most commonly seen in immunocompromised patients
• Infective organism is usually Pseudomonas aeruginosa
• infection spread from auditory meatus → soft tissues → bony structures
• Temporal bone osteomyelitis can occur

Key features in history

• Diabetes (90%) or immunosuppression (illness or treatment related)
• Severe, unrelenting, deep-seated otalgia
• Temporal headaches
• Purulent otorrhea
• Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Question 14

What is this?

What is it due to?

Answer 14

‘Black Hairy Tounge’

• relatively common condition which results from defective desquamation of the filiform papillae, oral scraping or antifungals may be effective. **Despite the name the tongue may be brown, green, pink or another colour.

Predisposing factors

• poor oral hygiene
• antibiotics
• head and neck radiation
• HIV
• intravenous drug use

Question 15

What is the most common tumour of the salivary glands and where is it most commonly located?

Answer 15

80% of salivary gland tumours are in the parotid gland and 80% of parotid gland tumours are benign pleomorphic adenomas

These are slow growing and lobular

Question 16

Someone presents with a unilateral polyp, what do you do?

Answer 16

Urgent referal to ENT

Unilateral polyps are a red-flag symptoms for nasopharyngeal cancer

Question 17

What is Ramsay Hunt Syndrome?

Answer 17

‘Herpes zoster oticus is caused by the reactivation of the varicella zoster virus within the facial nerve

Question 18

Features of Ramsay Hunt Syndrome

Managment

Answer 18

• Auricular Pain
• Facial nerve palsy
• Vesicular rash around the ear
• Features of vertigo and dizziness

Oral acicylovir and corticosteroids are usually given