DISORDERS OF THE EARS, NOSE, AND THROAT (based on T)

Question 1

What are the anatomic characteristics of the Eustachian tube?

Answer 1

Shorter length, 10-degree angle from the horizontal axis, variable angle of the tensor veli palatini muscle to cartilage, greater cartilage cell density, less elastin at the hinge portion, smaller lumen, wider Ostmann fat pad, greater mucosal fold, less cartilage volume.

Question 2

What is the anatomy of the medial 2/3 of the Eustachian tube?

Answer 2

Posteromedially: cartilage plate with medial and lateral laminae separated by elastin hinge.
Anterolaterally: fibrous tissue and Ostmann’s pad.

Question 3

How does the Eustachian tube differ between children and adults?

Answer 3

In children, it is more horizontal, narrower, less rigid, and shorter.
In adults, it is more vertical, wider, and rigid, allowing easier drainage of secretions.

Question 4

What are the clinical manifestations of ear infections?

Answer 4

Bulging tympanic membrane (TM),
limited or absent TM mobility,
air-fluid level behind TM,
otorrhea (ear discharge),
otalgia (ear pain).

Question 5

What is acute otitis externa?

Answer 5

Infection of the external auditory canal related to water exposure , common in warm, humid climates.

Question 6

What are the common pathogens in otitis externa?

Answer 6

Aerobes (36%),
fungi (35% - Aspergillus 20%),
anaerobes (29%),
Pseudomonas (32%),
Staphylococcus (21%),
polymicrobial (19%).

Question 7

What are the clinical manifestations of otitis externa?

Answer 7

Localized furunculosis, diffused ‘swimmer’s ear ,’ pain on manipulation, redness and swelling of the external auditory canal, possible purulent discharge, TM non-visualized

Question 8

What is the treatment for otitis externa?

Answer 8

Antibiotics, insertion of ear wicks with topical antibiotics or povidone iodine, analgesics (ibuprofen), acetic acid.

Question 9

What is acute otitis media (AOM)?

Answer 9

An infection of the middle ear, often preceded by a viral respiratory infection , causing congestion and Eustachian tube dysfunction.

Question 10

What are the peak incidence ages for AOM?

Answer 10

6-11 months, with 20% experiencing at least one episode by age 3.

Question 11

What are the clinical manifestations of AOM?

Answer 11

Fever, acute onset of signs/symptoms, middle ear effusion (bulging TM, limited TM mobility, air-fluid level, otorrhea) , middle ear inflammation (erythema, otalgia).

Question 12

What are the stages of otitis media?

Answer 12

HE’S -RC
1. Hyperemia,
2. Exudation,
3. Suppuration,
4. Resolution,
5. Complication (e.g., mastoiditis).

Question 13

What are complications of otitis media?

Answer 13

Intracranial: extradural/subdural abscess, meningitis, brain abscess, lateral sinus thrombophlebitis, otitic hydrocephalus. Intratemporal: mastoiditis, facial paralysis, petrositis, labyrinthitis.

Question 14

What is otitis media with effusion (OME)?

Answer 14

Presence of fluid behind an intact tympanic membrane (TM) without acute signs of inflammation
Also known as glue ear

Question 15

What are the potential causes of OME?

Answer 15

Hearing impairment, HIV, pneumonia, chronic rhinitis.

Question 16

What is the diagnosis and treatment for OME?

Answer 16

Diagnosis: air-fluid levels and impaired TM mobility on pneumatic otoscopy.
Treatment: myringotomy with ventilation tube insertion.

Question 17

What are the common pathogens of AOM?

Answer 17

Streptococcus pneumoniae,
non-typeable Haemophilus influenzae,
Moraxella catarrhalis,
Staphylococcus aureus,
gram-negative organisms,
rhinovirus,
RSV.

Question 18

What are the clinical stages of hyperemia in otitis media?

Answer 18

Hyperemia of the tympanic membrane, vascular engorgement, otalgia, fever, fullness in the ear, and dilated vessels visible on otoscopy.

Question 19

What is the etiology of mastoiditis as a complication of otitis media?

Answer 19

Persistent infection leads to thickening of the mucoperiosteum, drainage blockage, local acidosis, decalcification, and coalescence of mastoid air cells.

Question 20

What is the function of ventilation tubes in OME treatment?

Answer 20

A hole is created in the TM to allow fluid drainage; a ventilation tube maintains drainage until the TM regenerates and closes.

Question 21

What defines chronic otitis media?

Answer 21

Discharge through a perforated tympanic membrane lasting for more than 2 weeks (WHO definition).

Question 22

What is the prevalence of chronic otitis media in the Asia-Pacific region?

Answer 22

2-4% prevalence (Philippines, Korea, Thailand, Malaysia, Vietnam, China).

Question 23

What percentage of hearing loss among Filipinos is due to chronic otitis media?

Answer 23

19% of hearing loss among Filipinos is due to chronic otitis media.

Question 24

What are the common pathogens causing chronic otitis media in the Asia-Pacific region?

Answer 24

(CHRONIC -PS)
Pseudomonas
Staphylococcus.

Question 25

What defines chronic suppurative otitis media?

Answer 25

A perforated tympanic membrane with **persistent drainage** from the middle ear **lasting more than 6-12 weeks**

Question 26

What is cholesteatoma?

Answer 26

A complication of otitis media characterized by an **abnormal skin growth in the middle ear or mastoid area**

Question 27

What is the first-line treatment for initial or delayed antibiotic therapy in otitis media?

Answer 27

Amoxicillin (80-90 mg/kg/day in 2 divided doses), Amoxicillin-clavulanate (90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate), or Ceftriaxone (50 mg IM/IV for up to 3 doses).

Question 28

What is an alternative treatment for otitis media if the patient is allergic to penicillin?

Answer 28

Cefdinir (14 mg/kg/day in 1-2 doses), Cefuroxime (30 mg/kg/day in 2 divided doses), Cefpodoxime (10 mg/kg/day in 2 divided doses), or Ceftriaxone (50 mg IM/IV per day for 1-3 days).

Question 29

What is the recommended treatment for otitis media if the initial antibiotic fails after 48-72 hours?

Answer 29

**Amoxicillin-clavulanate or Ceftriaxone for up to 3 doses** Alternative: **Clindamycin with or without a third-generation cephalosporin**

Question 30

What defines bacterial rhinosinusitis?

Answer 30

Sudden onset of 2 or more symptoms: nasal blockage, discolored nasal discharge, or cough lasting less than 12 weeks.

Question 31

What is the usual progression to bacterial rhinosinusitis?

Answer 31

Begins as an upper respiratory tract infection that progresses to a secondary bacterial infection.

Question 32

What are common pathogens causing bacterial rhinosinusitis?

Answer 32

SO MUCH HATE SIYA Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus.

Question 33

What is the treatment for bacterial rhinosinusitis?

Answer 33

Penicillin.

Question 34

What are common symptoms of pharyngo-tonsillitis?

Answer 34

Sore throat, dysphagia, odynophagia, fever, tender and enlarged cervical lymphadenopathies.

Question 35

What are the common viral pathogens causing pharyngo-tonsillitis?

Answer 35

APIR Adenovirus, Parainfluenza Influenza RSV.

Question 36

What are the common bacterial pathogens causing pharyngo-tonsillitis?

Answer 36

BACTERIA - GSM-H Group A Streptococcus (GABHS), Streptococcus pyogenes, Moraxella catarrhalis Haemophilus influenzae type B (HiB),

Question 37

What are the complications of bacterial pharyngo-tonsillitis?

Answer 37

Peritonsillar abscess, retropharyngeal abscess, neck abscesses, rheumatic fever/rheumatic heart disease, acute glomerulonephritis (post-streptococcal GN).

Question 38

What are the clinical features of bacterial pharyngo-tonsillitis?

Answer 38

High fever, intense pharyngeal and tonsillar inflammation with pain, edema, exudates, and painful/enlarged cervical lymph nodes.

Question 39

What are the features that suggest bacterial rather than viral pharyngo-tonsillitis?

Answer 39

Absence of conjunctivitis, hoarseness, diarrhea, coryza, and presence of enlarged cervical lymph nodes.

Question 40

What is the most common cause of infectious mononucleosis?

Answer 40

Epstein-Barr Virus (EBV).

Question 41

What are the clinical manifestations of infectious mononucleosis?

Answer 41

Sore throat, fever, swollen glands, pus on tonsils, hepatosplenomegaly.

Question 42

What is the peak incidence of infectious mononucleosis?

Answer 42

Adolescent period (15-19 years old).

Question 43

What is the diagnostic finding on a peripheral smear for infectious mononucleosis?

Answer 43

Atypical lymphocytosis with atypical mononuclear cells.

Question 44

What is the treatment for infectious mononucleosis?

Answer 44

Non-specific and symptomatic treatment.

Question 45

Why is infectious mononucleosis called the 'kissing disease'?

Answer 45

It is commonly transmitted through saliva, especially during kissing.

Question 46

What is epiglottitis?

Answer 46

An inflammatory, edematous disease of the epiglottis and adjacent structures.

Question 47

What are the clinical manifestations of epiglottitis?

Answer 47

High-grade fever, sore throat, dyspnea, and rapidly progressive respiratory obstruction.

Question 48

What is the most common finding in epiglottitis that may cause respiratory arrest?

Answer 48

Rapidly progressive respiratory obstruction.

Question 49

What is the pathogen commonly associated with epiglottitis?

Answer 49

Haemophilus influenzae type B.

Question 50

What are the methods for diagnosing epiglottitis?

Answer 50

History and clinical findings.

Question 51

What is a key caution during intubation in a patient with epiglottitis?

Answer 51

Inflammation increases the risk of bleeding, which may lead to cardiac arrest.

Question 52

What is acute laryngotracheobronchitis or croup syndrome?

Answer 52

An upper airway obstruction caused by inflammation of the larynx and trachea.

Question 53

What are the clinical manifestations of croup syndrome?

Answer 53

**Barking cough** inspiratory stridor, respiratory distress, and hoarseness.

Question 54

What is the diagnosis method for croup syndrome?

Answer 54

Clinical diagnosis.

Question 55

What is the typical cause of croup syndrome?

Answer 55

A viral infection, such as influenza or parainfluenza.

Question 56

What does inflammation in croup syndrome lead to?

Answer 56

Mucus production and noisy breathing.

Question 57

What are the chest x-ray findings in croup syndrome?

Answer 57

Chest x-rays are typically normal.

Question 58

What is the steeple sign in croup syndrome?

Answer 58

Radiographic narrowing of the subglottic larynx and trachea area.

Question 59

What is the origin of the term 'croup'?

Answer 59

Derived from the Anglo-Saxon word 'kropan' or the old Scottish word 'roup,' meaning to cry out in a hoarse voice.