Ear nose and throat

Question 1

What criteria must someone meet according to NICE for consideration of tonsillectomy?

Answer 1

1. Sore throats are due to tonsillitis (not upper respiratory infection)
2. 7 episodes for 1 year, 5 episodes per year for episodes 2 years or 3 episodes per year for 3 years
3. Episodes of sore throats must be disabling and prevent normal functioning

Question 2

What are some other reasons for tonsillectomy?

Answer 2

1. Recurrent febrile convulsions secondary to episodes of tonsillitis

2.Obstructive sleep apnea, stridor or dysphagia secondary to enlarged tonsils

3. Peritonsillar abscess (quinsy) if unresponsive to standard treatment

Question 3

Complications of tonsillectomy?

Answer 3

-Primary (<24 hours) haemorrhage 2-3%, pain
-Secondary (24 hours to 10 days) haemorrhage (most commonly due to infection, pain

Question 4

Pain pattern post tonsillectomy

Answer 4

Pain increases up to 6 days following tonsillectomy

Question 5

Haemorrhage post-tonsillectomy?

Answer 5

Assesed by ENT

Question 6

Primary haemorrhage tonsilectomy?

Answer 6

Immediate return to theatre

Question 7

Secondary haemorrhage tonsillectomy?

Answer 7

-Associated with wound infection
-Admission and antibiotics
-if severe immediate surgery

Question 8

Nasal polyp associations?

Answer 8

Asthma, aspirin sensitivity, infective sinusitis, CF, Kartagener’s syndrome, churg-strauss syndrome

Question 9

What is Samter’s triad?

Answer 9

Asthma, aspirin sensitivity and nasal polyposis

Question 10

Features of nasal polyps

Answer 10

-Nasal obstruction
-Rhinorrhoea, sneezing
-Poor sense of taste and smell

Question 11

What is an unusual feature nasal polyps that would require further investigation?

Answer 11

-Unilateral symptoms or bleeding

Question 12

When to refer to ENT nasal polyps?

Answer 12

All patients with suspected nasal polyps should be referred to ENT for full examination

Question 13

Management of nasal polyps?

Answer 13

-Intranasal corticosteroids are first line (if no malignancy is suspected)
-Surgical managed may be considered (FESS and polyectomy)

NOTE: intranasal corticosteroids shrink polyps in approx 80% of patients

Question 14

What is the endolymphatic system responsible for?

Answer 14

-Regulating fluid balance
-Regulating function of structures that are involved in hearing and balance

Question 15

What is endolymphatic system made up of?

Answer 15

-Part of inner ear made ducts and chambers filled with endolymph fluid

Question 16

What is menieres disease?

Answer 16

-Chronic disorder of the inner ear that affects hearing and balance

Question 17

WHat is thought to be the cause of meniere’s disease?

Answer 17

Abnormal buildup of endolymph fluid in the inner ear - this can interfere with normal functioning of auditory and vestibular systems

Question 18

What happens in the endolymph system due to excess endolymph fluid?

Answer 18

Increase pressure because of excess fluid causes progressive dilatation of endolymphatic system

Question 19

What are the features of menieres disease?

Answer 19

-Vertigo (most prominent)
-Tinnitus
-Sensorineural hearing lsos
-Aural fullness
-Nystagmus and positve romberg test

Question 20

Unilateral or bilateral symptoms in menieres disease?

Answer 20

Typically unilateral but bilateral symptoms may occur after a number of years

Question 21

Progression of meniere’s disease?

Answer 21

-Symptoms resolve in majority of patients after 5-10 years
-Can be left with a degree of hearing loss

Question 22

What medication can be used in acute attacks of meniere’s disease?

Answer 22

Buccal or IM prochlorperazine
-In acute severe cases admission may be required

Question 23

What medication can be used to used to help prevent meniere disease symptoms?

Answer 23

Betahistine

Question 24

Chornic rhinosinustis?

Answer 24

Chronic inflammation of paranasal sinuses and nasal passage >12 weeks

Question 25

Predisposing factors of chronic rhinosinustis?

Answer 25

-Atopy
-Nasal obstruction (polys, spetal deviation)
-Recent infection
-Swimming
-Smoking

Question 26

Features of chronic rhinosinusitis

Answer 26

-Facial pain - frotnal pressure worse when bending forward
-Nasal discharge
-Nasal obstruction causing mouth breathing
-Post nasal drip causing cough

Question 27

Management of recurrent sinusitis

Answer 27

-Avoid allegren
-Intranasal corticosteriod
-Nasal irrigation with saline solution

Question 28

Red lfag symoptoims