Tutorial 9 - ENT - conditions (B)

Question 1

1. What is acute sinusitis?
2. How does not present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 1

1. Sinusitis is inflammation of the sinuses. This disrupts mucus drainage, causing them to become congested and nose congestion. Normally resolves in 2-3 weeks.
2. Difficulty breathing through nose, yellow/green mucus from nose, pain around forehead/eyes/cheeks, bad breath, tooth pain, cough, fever.
3. Allergic rhinitis, smoker/passive smoker, nasal passage abnormality i.e. deviated septum, polyps, having the common cold.
4. Nasal endoscopy, allergic skin testing, imaging i.e., CT. (often tests are not needed for a diagnosis - only if complications i.e., meningitis, chronic sinusitis, vision problems).
5. Supportive management (fluids, rest, analgesia), saline nasal spray, allergy medications.

Question 2

1. What is chronic sinusitis?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 2

1. Chronic sinusitis is sinusitis which has persisted for over 3 months despite efforts to treat.
2. Mucous yellow/green, difficulty nose breathing, pain around eyes/ forehead/cheeks, bad breath, tooth pain, cough, fever.
3. Allergic rhinitis, nasal passage abnormality, RTI i.e. common cold.
4. Nasal endoscopy, allergic skin testing, imaging i.e. CT.
5. ENT referral - sinus enlargement, sinus tissue removal, polyps removal.

Question 3

1. What are thyroid nodules?
2. How does it present?
3. What tests can be ordered?
4. How is it managed?

Answer 3

1.Thyroid nodules are lumps found on the thyroid gland. They are normally asymptomatic, harmless and you won’t know about them - they’re only found on routine. checks by a doctor. Some are cancerous, can grow large, and cause breathing/swallowing difficulties.
2. They can often be seen as a mass at neck baseline, cause difficulty in swallowing/breathing, symptoms of hyperthyroidism I.e., sweaty, diarrhoea, weight loss.
3. Thyroid function test, ultrasound scan, biopsy.
4. Depends if benign or cancerous. Watchful waiting, surgery, thyroid hormone replacement, radioactive iodine (hypo/hyper thyroid).

Question 4

1. What is acute labyrinthitis?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 4

1. Acute labyrinthitis is inflammation of the inner most part of your ear (viral commonly but can be bacterial).
2. Vertigo, dizziness, hearing loss, tinnitus.
3. Recent viral infection / URTI, smoking.
4. Clinical diagnosis
5. Antibiotics/antivirals, corticosteroids to reduce inflammation.

Question 5

1. What is allergic rhinitis?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 5

1. Allergic rhinitis is a type 1 hypersensitivity age mediated response, due to exposure and subsequent sensitisation to allergens.
2. Runny nose, blocked nose, sneezing, coughing, swollen/itchy eyes.
3. Having other allergies i.e., eczema, having a blood relative with allergic conditions such as asthma, working/living in environments with allergens such as animal dander.
4. Skin prick test to find allergen causing symptoms.
5. Nasal corticosteroids, combined nasal steroids and antihistamines, avoid triggers.

Question 6

1. What is nasal polyps?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 6

1. Nasal polyps are soft, painless non cancerous masses growing on the nasal passage and sinuses.
2. Runny nose, blocked nose, sinus pains, loss of sense of smell, frequent nose bleeds.
3. Having asthma, ongoing nasal inflammation i.e., due to chronic sinusitis.
4. CT scan, skin prick immune test, nasal endoscopy, vitamin D blood test(can cause nasal polyps).
5. Surgery(remove nasal polyps), nasal corticosteroids

Question 7

1. What is cervical lymphadenopathy?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 7

1. Cervical lymphadenopathy is the swelling of the lymph nodes in the head and neck. Can be due to numerous reasons, often sign of infection, less commonly of something more sinister such as cancer.
2. Blocked nose, congested nose, runny nose, ear pain, tooth ache, fever, lumps under jaw, armpits - may be red, tender, painful, weight loss, fatigue.
3. URTI, common cold, ear infections, dental infection ,eye infection.
4. Depends on what the clinical history indicates is the cause for the swollen nodes, accompanied with other lymph nodes swelling/weight loss/ night sweats/ fatigue - further investigations needed.
5. Often resolves on own. Antibiotics/antivirals if underlying infection, supportive treatment (fluids, rest, analgesia).

Question 8

1. What is benign paroxysmal positional vertigo?
2. How does it present?
3. What tests can be ordered?
4. How is it managed?

Answer 8

1. BPPV is caused by loose crystals in semi - circular canals, when you move your head the crystals move, causing movement of the fluid, the sterocilia - which then gives the impression of vertigo.
2. Dizziness, vertigo (< 1 minute)), loss of balance, nausea and vomitting.
3. Do a cardiovascular, neurological, ear test to rule out other causes of vertigo symptom. Conduct dix - hall pike exam - if it elicits vertigo and nystagmus than positive.
4. Main treatment are head exercises and movements which reposition the crystals to an area of inner area that does not cause trouble I.e, epley manoeuvre.

Question 9

1. What is a deviated nasal septum?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 9

1. A deviated nasal septum is when the nasal septum is off centre. This makes one half of the nasal cavity smaller, causing various symptoms.
2. Difficulty breathing, nose bleeds(due to drying effect from lack of airflow), noisy breathing when sleeping.
3. Congenital, contact sports.
4. Clinical diagnosis following inspection of septum and nasal cavity.
5. Decongestant, steroid, antihistamine sprays, if this all fails - referral to ENT for potential surgery.

Question 10

1. What is a nasal fracture?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Answer 10

1. Break / crack in bones that form nose.
2. Pain around nose/eyes, swelling, mucous discharge, bleeding, crooked nose, difficulty breathing.
3. Contact sports, physical fight.
4. Xray / CT scan sometimes used but often unnecessary.
5. ENT referral. Minor - may not need interventions apart from supportive measures such as ice, rest, pain relief, more serious fractures ,may be able to be aligned using hands and order fractures may need surgery.

Question 11

1. What is a vestibular migraine?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?

Question 12

1. What is vestibulopathy?
2. How does it present?
3. What are its risk factors?
4. What tests can be ordered?
5. How is it managed?