Ear, Nose and Throat

Question 1

The name of the structure that connects the middle ear to the nasopharynx

Answer 1

Eustachian Tube/Auditory Tube

Question 2

Name the sections of the ear (Outer, Middle and Inner)

Answer 2

Out ear = External Pina/Auricle, Auditory Canal

Tympanic membrane separates outer ear and middle ear.

Middle Ear = Ossicles - Incus, Malleus and Stapes

Inner Ear = Semicircular Canals, Cochlea, Eustachian Tube, Vestibulocochlear Nerve

Question 3

Briefly describe Bone, Air and Fluid conduction through the ear

Answer 3

Sound passes through the out ear, through the external auditory meatus and vibrates on the tympanic membrane.

Tympanic membrane vibrates, the vibrations are amplified in the ossicles (Bone conduction)

The vibrations travels to oval window of the cochlea where they trigger waves of fluid in the vestibuli. Hair cells in the basilar membrane create action potentials that are conveyed and processed by the auditory nerve.

Question 4

Define: Acute Otitis Media. What may be seen when examining the ear?

Answer 4

Inflammation of the middle ear, commonly caused by a viral or bacterial infection. May be an ascending infection from an URTI.

Tympanic membrane may be bulging, will appear erythematous and cloudy. -/+ pus/discharge

Question 5

Define: Otitis Externa. What may be seen when examining the ear?

Answer 5

Inflammation of the outer ear and auditory meatus. Auricle and auditory meatus itchy and swollen, erythematous, , +/- discharge.

Question 6

Risk factors for Otitis Externa

Answer 6

Immunocompromised, Swimming, Hot Climates, Too little cerumen, Over cleaning, Trauma with cotton bud.

Question 7

Anosmia may be caused by…?

Answer 7

Damage or compression to the olfactory nerve which may be caused by head trauma or extrinsic pressure from a brain tumour. May be caused by inflammation of the nasal mucosa/blockage of the nasal passages.

Question 8

Define: Meniere’s Disease, including symptoms

Answer 8

Over production of endolymph in inner ear, causing pressure and swelling which affects balance and hearing.

Patient may experience acute attacks of vertigo, fluctuating unilateral hearing loss and tinnitus as well as aural fullness.

Question 9

Define: Vestibular Neuronitis, including symptoms

Answer 9

Inflammation of the vestibular nerve, most commonly caused by a viral infection.

Patient may experience sudden attacks of episodic vertigo, nausea and vomiting, NO HEARING LOSS.

Question 10

Define: Benign Paroxysmal Positional Vertigo (BPPV), including symptoms

Answer 10

Most common causes of vertigo.

Caused by calcium carbonate crystals which have become displaced in the semicircular canals, disrupting the normal flow.

Patient will experience vertigo for ~1 minute which is trigged by changing position, e.g. sitting up in bed.

Question 11

Define: Acoustic Neuroma, including symptoms

Answer 11

Benign tumour caused by over production of Schwann cells which presses on vestibulocochlear nerve.

Defining symptom: Sensorineural hearing loss

Question 12

Name three conditions that can affect the outer ear

Answer 12

1. Dermatitis
2. Perichondritis (cauliflower ear)
3. Infected ear piercing

Question 13

Define: Conductive hearing loss

Answer 13

Secondary to damage in external auditory canal, tympanic membrane or middle ear

Question 14

Define: Sensorineural hearing loss

Answer 14

Caused by lesions/damage to either to the tiny hair cells in the inner ear or to the nerve pathways that lead from the inner ear to the brain.

Question 15

(4) COMMON causes of hearing loss

Answer 15

1. Cerumen Accumulation
2. Noise Induced Trauma to Cochlea
3. Aging
4. Infection (common in children/adolescents)

Question 16

(3) Red flags with regards to hearing loss

Answer 16

1. Unilateral sensorineural hearing loss
2. Abnormal cranial nerve exam (other than hearing loss)
3. Rapidly worsening hearing loss

Question 17

Risk factors of obstructive sleep apnoea (OSA)

Answer 17

Hypertension, Obesity (excess fat in neck tissue), Male sex, Alcohol/other sedative use before sleep.

Question 18

Two different types of ear wax drops for ear wax removal

Answer 18

1. Olive oil

2. Sodium bicarbonate (chemically dissolve wax)

Question 19

How long should Acute Otitis Media last?

Answer 19

3 days - 1 week

Question 20

in Acute Otitis Media, when should an immediate antibiotic prescription be given?

Answer 20

Systemically unwell, symptoms ongoing for more than 4 days, perforated tympanic membrane/discharge, children under 2 years old with bilateral OM.

Question 21

Antibiotics used for Acute Otitis Media

Answer 21

Amoxicillin or Clarithromycin

Question 22

Treatment/Management for Otitis Externa

Answer 22

Analgesia and localised heat, e.g. warm flannel

7 day treatment with topical acetic acid OR gentamycin +/- steroid

Question 23

In the treatment of vertigio, what is the MOA of Betahistine?

Answer 23

Acts on H1 receptors on blood vessels in inner ear to dilate them and relieve pressure.

Question 24

How long should sinusitis symptoms be ongoing before a back up antibiotics prescription be considered?

Answer 24

10 days

Question 25

If sinusitis symptoms have been ongoing for 10 days, other than an antibiotic, what other treatment can be used?

Answer 25

Consider high-dose nasal corticosteroid for 14 days in adults and children over 12.

Question 26

What elements make up the Fever PAIN Score and when is it used

Answer 26

Used to assess antibiotic requirement for sore throat.

Fever - in last 24 hours
Purulence - (pus) on tonsils 
Attended - within 3 days of symptom onset
Inflamed - tonsils (severe)
No cough or coryza 

Each element represents 1 point. 4-5 points = back up/immediate antibiotic prescription.

Question 27

First line treatment for oral thrush and its MOA

Answer 27

Nystatin. Liquid antifungal preparation which binds to fungal cell membranes and slows growth/kills cell.