Ear, nose and throat

Question 1

What are the systemic risk factors for oral candidiasis?

Answer 1

Infancy or old age
Immune deficiency (cancer, HIV)
Broad-spectrum antibiotics, systemic steroids
Nutritional deficiency, for example, iron or B-vitamin deficiency

Question 2

What are the local risk factors for oral candidiasis?

Answer 2

Dentures
Dry mouth
ICS
Poor oral hygiene
Smokine
Candida infection elsewhere
In a newborn, maternal vaginal yeast infection
Mouth injury

Question 3

Describe (oral) pseudomembranous candidiasis (thrush).

Answer 3

White patches on the tongue and other mucosal surfaces that can often be wiped off, leaving behind red areas that may bleed slightly.
Mostly in infants

Question 4

Management for oral candidiasis?

Answer 4

Miconazole 2% gel
Nystatic liquid
Amphotericin B lozenge

Question 5

Describe angular cheilitis (stomatitis).

Answer 5

Painful erythema and fissuring of the corners of the mouth.

Question 6

Causes of angular cheilitis

Answer 6

Infections: Candida, S. aureus and Streptococcus species

Iron, B12, folate deficiency, Crohn disease

Question 7

Describe otitis externa

Answer 7

AKA ‘swimmer’s ear’
Inflammation of the external ear canal that often follows water exposure and maceration of the skin.
Form of cellulitis

Question 8

Which structures does otitis externa involve?

Answer 8

External auditory canal, with acute inflammation and variable oedema

Question 9

What are the risk factors for otitis externa?

Answer 9

External auditory canal obstruction
High environmental humidity, warm environment
Swimming
Local trauma (manual ear wax cleaning)
Allergy, skin disease (dermatitis)
Immunosuppression
Prolonged use of topical antibacterials

Question 10

Describe localised otitis externa (furunculosis)

Answer 10

Localised infection in the hair follicles in the cartilaginous portion of the external auditory canal

Question 11

Symptoms of otitis externa

Answer 11

Pain
Pruritus
Hearing loss
Aural fullness

Question 12

Signs of otitis externa

Answer 12

Inflammation, erythema, oedema of the external ear
Tenderness on manipulation of the tragus or auricle
Discharge (otorrhoea)
Fungal debris

Question 13

Non-pharmacological Mx of otitis externa.

Answer 13

Keeping external ear canal dry
By doctor using suction or cotton wool
At home, using dry aural toilet 6-hourly with rolled tissues

Question 14

Pharmacological Mx of otitis externa

Answer 14

Analgesia
Eardrops - Corticosteroid + antibiotic ± antifungal. Eg. kenacomb otic (triamcinolone + neomycin + gramicidin + nystatin)

Question 15

Describe otitis media

Answer 15

Infection involving the middle ear space and is a common complication of viral respiratory illnesses
This infection can be bacterial or viral.

Question 16

Risk factors for otitis media

Answer 16

Younger age
Recent URTI
Attending day care/sick contacts
FHx of otitis media
Low SES
Exposure to smoking (household smoking)

Question 17

What are the symptoms of otitis media?

Answer 17

Otalgia
Irritability 
Sleep disturbance
Fever
Otorrhoea
Nausea/vomiting

Question 18

What are the signs of otitis media?

Answer 18

Bulging of the tympanic membrane
Myringitis (erythema of the tympanic membrane)
Otorrhoea (tympanic membrane perforation)

Question 19

Management of acute otitis media

Answer 19

Supportive therapy 
Analgesia 
Reassuring patient and explaining self-limiting nature 
Discussing risks of Abx 
Review is 24-48 hours
Consider Abx and grommets

Question 20

What are the indications for Abx use in acute otitis media?

Answer 20

<6 months old
<2 years with bilateral infection
Systemically unwell (not just fever)
Otorrhoea or perforated tympanic membrane
ATSI
Immunocompromised
No improvement after 48 hours of supportive therapy

Question 21

Which Abx is used for acute otitis media?

Answer 21

Amoxicillin 15 mg/kg, oral TD, 5 days (up to 500 mg)

Question 22

What are the indications for grommets in otitis media?

Answer 22

Effusion lasts >3 months
Recurrent bacterial infections
Hearing loss with risk of speech/language problems