Ear, Nose and Throat

Question 1

What is Benign Paroxysmal Positional Vertigo?

Answer 1

BPPV is the most common cause of vertigo, which is a spinning sensation that occurs when changing head position

It occurs when small crystals (otoliths) in the inner ear become dislodged and stimulate the vestibular system, which controls balance and orientation

Question 2

H&E of BPPV

Answer 2

• Recurrent episodes of vertigo lasting <1 minute
• Triggered by head movements such as rolling over in bed, looking up, or bending over
• Negative HINTS examination
• No symptoms of hearing loss, tinnitus or neurological deficits
• Dix-Hallpike test is the first-line diagnostic test which is preformed to elicit nystagmus from BPPV

Question 3

Investigations for BPPV

Answer 3

• First line is Dix-Hallpike test
  
  • Latent and fatiguable nystagmus
• Additional testing to rule out other causes of vertigo

Question 4

Management of BPPV

Answer 4

• Particle repositioning manoeuvres, such as Epley manoeuvre or the Semont manoeuvre
• Home exercises (Brandt-Daroff)
• Referral to balance specialist if unresolving and resistant to manoeuvres
• Education about avoiding head positions that can caused BPPV

Question 5

What is Tonsilitis?

Answer 5

Infection and inflammation of the tonsils

Viral causes:
- Rhinovirus
- Adenovirus
- Respiratory Syncytial Virus

Bacterial causes:
- Group A Streptococcus

Question 6

What are the risk factors for Tonsilitis?

Answer 6

• 5-15 year olds
• Crowded environments
• Winter/early Spring
• Incomplete Abx course

Question 7

H&E for Tonsilitis

Answer 7

Viral:
- low grade fever
- cough
- rhinorrhoea

Bacterial:
- high grade fever
- sore throat
- odynophagia, dysphagia

Question 8

What is the Fever-PAIN and CENTOR grading system for Tonsilitis?

Answer 8

Both 1 point each -
Fever
P - Pus
A - Attend rapidly <3 days
I - Inflamed tonsils (severe)
N - No cough or coryza

C - Can’t cough
E - Exudate (tonsillar)
N - Nodes (ant. cervical lymphadenopathy)
T - Temperature > 38
OR (age < 15 = +1, OR age > 44 = -1)

Question 9

Investigations for Tonsilitis

Answer 9

Confirm diagnoses if high risk of rheumatic fever, very old/young, immunosuppressed or very severe

• Rapid antigen group A strep test - RAST
• Culture if negative

Question 10

Management of Tonsilitis

Answer 10

If Fever-PAIN is 0-1 or CENTOR is 0-2:
- do not offer antibiotic

If Fever-PAIN is 2-3:
- Consider no Abx or backup prescription

If Fever-PAIN is 4-5, or CENTOR is 3-4:
- consider immediate Abx
- Phenoxymethylpenicillin
- If allergic - clarithromycin OR erythromycin (if pregnant)

Question 11

Complications of Tonsillitis

Answer 11

• otitis media
• quinsy - peritonsillar abscess
• rheumatic fever and glomerulonephritis very rarely

Question 12

NICE recommendations for surgical intervention of Tonsillitis

Answer 12

• sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
• the person has five or more episodes of sore throat per year
• symptoms have been occurring for at least a year
• the episodes of sore throat are disabling and prevent normal functioning