Basics of ENT first

Question 1

What does the vastibular system do?

Answer 1

It maintains equilibrium or balance in the ear by detecting angular and linear accelerations of the head

Angular rotation is detected by semicircular canals
Linear accelerations is detected by the ottolothic organs

Question 2

Where does Otitis externa take place? What is it caused by?

Answer 2

The outer ear.

It’s caused by bacterial (staphylococcus aureus) or fungal (candida)

Question 3

What’s the treatment for acute otitis externa? (5)

Answer 3

By through cleaning with:

1. Anti-inflammatory corticosteroid ear drops, or
2. Anti-effective chloramphenicol ear drops, or
3. An astrigent such as aluminium acetate, or
4. 2% Acetate acid solution (EarCalm spray)
5. Topical antibiotics plus glucocorticoid: Neomycin./ polymyxin plus dexamethasone/ hydrocortisone (e.g. Otomize spray)

Question 4

What’s the treatment for chronic otitis externa? (2)

Answer 4

1. Oral flucloxacillin (or clarithromycin if penicillin-allergic)
2. Antifungal agent e.g. nystatin

Question 5

Name some mixtures that can be used to remove ear wax (3) and what do they do?

Answer 5

1. Olive oil
2. Almond oil
3. Sodium bicarbonate

Cerumenolytic products act by softening the ear wax (cerumen)

Question 6

Where is otitis media located (1) and what are the symptoms of acute otitis media? (4)

Answer 6

Otitis media is located in the middle ear

• Sudden onset of ear ache
• fever
• hearing loss
• preceded by an upper respiratory tract infection lasting for several days

Question 7

What are the available treatments for acute otitis media? (2)

Answer 7

1. local cleansing
2. anti-effective (antibiotics); a systemic antibacterial is used such as oral amoxicillin (or clarithromycin if penicillin-allergic)

Question 8

What are the available treatments for chronic otitis media? (2)

Answer 8

1. Oral amoxicillin

2. IV cephalosporin

Question 9

Where does labyrinthitis occur?

Answer 9

In the inner ear

Question 10

What are some of the symptoms of labyrinthitis? (4)

Answer 10

1. Vertigo
2. Balance disorder
3. Tinnitus
4. Hearing loss

Question 11

What are the available treatments for labyrinthitis? (3)

Answer 11

1. anti-effective (antibiotics); a systemic antibacterial is used such as oral amoxicillin (or clarithromycin if penicillin-allergic)
2. Anti-viral agents e.g. valacyclovir
3. Vestibular rehabilitation therapy (VRT)

N.B. Treatment of vertigo and nausea: prochlorperizine and treatment of anxiety symptoms: benzodiazepines and/or depression: SSRIs

Question 12

Define rhinitis

Answer 12

An allergic acute or chronic inflammation of the nasal mucosa e.g. hay fever

Question 13

Define rhinorrhea

Answer 13

The production of excessive watery nasal secretions by the nasal mucosa

Question 14

Name the available treatments of rhinitis and rhinorrhea (4) include their target and also MoA

Answer 14

1. Sympathomimetic agents (e.g. ephedrine). These target nasal blood flow. MoA: Vasoconstriction (to limit histamine effects)
2. Glucocorticoids (e.g. Beclomethasone mometasone). These target anti-inflammatory. MoA: Anti-inflammatory steroid
3. Cromolyn sodium and Omalizumab. These target the suppression of mediator release. MoA: Inhibits histamine release and prevents IgE interaction
4. H1-receptor antagonists (e.g. Azelastine), Leuokitriene (E.g. Montelukast). These target mediator receptor blockade. MoA: They block vasodilation and inflammation

Question 15

What’s the treatment for non-allergic watery rhinorrhoea?

Answer 15

Treated with the antimuscarinic; ipratroprium nasal spray

Question 16

What are the available treatments for nasal congestion? (2)

Answer 16

1. Ephedrine or systemic pseudoephedrine (Sudafed)

2. Sodium chloride (0.9%)

Question 17

What’s the available treatment of nasal staphylococci?`

Answer 17

Mupirocin

N.B. To avoid the development of resistance, if the MRSA strain is mupirocin-resistant, alternatives such as chlorhexidine or neomycin cream should be used

Question 18

Within the oropharynx, the main fungal infection is thrush. What treatments are predominantly used? (3)

Answer 18

Thrush: Nystatin or miconazole antibiotic oral suspension/gel/tablet or,

fluconazole capsules or IV

Severe invasive candidiasis: amphoteracin

Question 19

Within the oropharynx, the main viral infection is herpes s. What treatments are predominantly used? (3)

Answer 19

Primary herpetic gingivostomatitis:

• Benzydamine
• Chlorhexidine mouthwash

Herpetic stomastis: a systemic antiviral such as aciclovir
Herpes simplex: Aciclovir, valaciclovir and doxycycline

Question 20

Treatments available for oral ulceration and inflammation in the oropharynx? (4)

Answer 20

1. Benzydamine (NSAID oromucosal spray)
2. Choline salicyclate gel e.g. Bonjela (not for under 16)
3. Carmellose gelatin paste

N.B. Inflammation treated by hydrocortisone and betamethasone

Ulceration occurs predominately in the oropharynx

Question 21

What mouthwashes contain for someone with oral candidiasis?

Answer 21

1. Compound sodium chloride

2. Chlorhexidine mouthwash e.g. Corsodyl

Question 22

What type of drugs can cause dry mouth? (2)

Answer 22

• anti-muscarinic drugs

- diuretic drugs