Ear, Nose and Throat

Question 1

When is referral to ENT needed for ear drum perforation?

Answer 1

After 6 weeks

Question 2

What is the management of mastoiditis?

Answer 2

IV abx

NOTE: CT only if complications suspected

Question 3

What is the management of otitis externa?

Answer 3

Topical abx +/- topical steroid

Question 4

What are the criteria for tonsillectomy?

Answer 4

1) sore throats are due to tonsillitis (i.e. not recurrent URTI)
2) the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms)
3) the episodes of sore throat are disabling and prevent normal functioning

Other:
1) recurrent febrile convulsions secondary to episodes of tonsillitis
2) obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
3) peritonsillar abscess (quinsy) if unresponsive to standard treatment

Question 5

What are the CENTOR score criteria?

Answer 5

1) presence of tonsillar exudate
2) tender anterior cervical 3)) lymphadenopathy or lymphadenitis
3) history of fever
4) absence of cough

Question 6

What are the FeverPAIN criteria?

Answer 6

1) Fever over 38°C.
2) Purulence (pharyngeal/tonsillar exudate).
3) Attend rapidly (3 days or less)
4) Severely Inflamed tonsils
5) No cough or coryza

Question 7

What is the antibiotic management of tonsillitis?

Answer 7

phenoxymethylpenicillin

pen allergic: clarithromycin

Question 8

What are the features of an acoustic neuroma (AKA vestibular schwannoma)?

Answer 8

1) cranial nerve VIII: hearing loss, vertigo, tinnitus
2) cranial nerve V: absent corneal reflex
3) cranial nerve VII: facial palsy

NOTE: seen in NF2

Question 9

What is the management of malignant otitis externa?

Answer 9

IV abx (ciprofloxacin)- abx to. cover pseudomonas

Question 10

What is the management of nasal polyps?

Answer 10

All should be referred to ENT

Urgent- if unilateral or bleeding

Question 11

What are the most common causative organisms of bacterial otitis media?

Answer 11

Streptococcus pneumonaie, Haemophilus influenzae
Moraxella catarrhalis

Question 12

What is the management of Meniere’s disease?

Answer 12

1) acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required

2) prevention: betahistine and vestibular rehabilitation exercises may be of benefit

3) Inform DVLA

Question 13

What are causes of gingival hyperplasia?

Answer 13

phenytoin, ciclosporin, calcium channel blockers and AML

Question 14

What is the manoeuvre used in the diagnosis of BPPV?

Answer 14

positive Dix-Hallpike manoeuvre

Question 15

What is the manoeuvre used in the symptomatic relief of BPPV?

Answer 15

Epley manoeuvre

Question 16

What are clinical signs of BPPV?

Answer 16

1) Vertigo triggered by head movement
2) May be associated nausea
3) Episodes last 10-20 seconds

Question 17

What is the management of BPPV?

Answer 17

1) Epley manoeuvre
2) Vestibular rehabilitation, for example Brandt-Daroff exercises
3) Meds e.g. betahistine

Question 18

What are the clinical features of Vestibular neuronitis?

Answer 18

1) recurrent vertigo attacks lasting hours or days
2) nausea and vomiting may be present
3) horizontal nystagmus is usually present
4) NO hearing loss or tinnitus

NOTE: often develops following a viral infection

Question 19

What is the management of vestibular neuronitis?

Answer 19

If severe:
buccal or IM prochlorperazine

Less severe:
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)

Chronic symptoms:
vestibular rehabilitation exercises

Question 20

What are the clinical features of Viral labyrinthitis?

Answer 20

1) vertigo: not triggered by movement but exacerbated by movement
2) nausea and vomiting
3) hearing loss: may be unilateral or bilateral, with varying severity
4) tinnitus
5) preceding or concurrent symptoms of upper respiratory tract infection

Question 21

What are the signs of Viral labyrinthitis?

Answer 21

1) spontaneous unidirectional horizontal nystagmus towards the unaffected side
2) sensorineural hearing loss: shown by Rinne’s test and Weber test
3) abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
4) gait disturbance: the patient may fall towards the affected side

Question 22

What is the management of Viral labyrinthitis?

Answer 22

prochlorperazine or antihistamines may help reduce the sensation of dizziness

Question 23

What are the clinical features of Ramsay Hunt syndrome?

Answer 23

1) auricular pain is often the first feature
2) facial nerve palsy
3) vesicular rash around the ear
4) other features include vertigo and tinnitus

Question 24

What is the management of Ramsay Hunt syndrome?

Answer 24

Oral aciclovir and corticosteroids

Question 25

What are the clinical features of Otosclerosis?

Answer 25

1) Onset is usually at 20-40 years
2) conductive deafness
tinnitus
3) tympanic membrane- only 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
4) positive family history
5) autosomal dominant

Question 26

What is the management of Otosclerosis?

Answer 26

1) hearing aid
2) stapedectomy

Question 27

What are the clinical features of Meniere’s disease?

Answer 27

1)recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
2) a sensation of aural fullness or pressure is now recognised as being common
3) nystagmus
4) a positive Romberg test
5) episodes last minutes to hours
6) typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Question 28

What is the management of Meniere’s?

Answer 28

1) ENT assessment is required to confirm the diagnosis
2) patients should inform the DVLA.
3) acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
4) prevention: betahistine and vestibular rehabilitation exercises may be of benefi

Question 29

What are the clinical features of cholesteatoma?

Answer 29

Main features
1) foul-smelling, non-resolving discharge
2)hearing loss

Other features are determined by local invasion:
3) vertigo
4) facial nerve palsy
5) cerebellopontine angle syndrome

Otoscopy:
6) ‘attic crust’ - seen in the uppermost part of the ear drum

Question 30

What is the management of Cholesteatoma?

Answer 30

patients are referred to ENT for consideration of surgical removal