ENT

Question 1

List some causes of sensorineural hearing loss

Answer 1

Perinatal abnormalities 
Infective/Inflammatory (meningitis) 
Trauma 
Drugs - aminoglycosides 
Neoplasia - vestibular schwannoma 
Idiopathic - Meniere's 
Ageing

Question 2

List some causes of conductive hearing loss

Answer 2

Wax
Otitis externa
Foreign Bodies 
MIddle ear effusion (glue ear) 
Chronic suppurative otitis media 
Otosclerosis 
Ossucular disruption

Question 3

What foreign body must you be aware of

Answer 3

Hearing aid betteries - acid can corrode the skin.

Patient must go to hospital

Question 4

Organisms causing otitis externa

Answer 4

S. aureus

Pseudomonas aeruginosa

Question 5

Presentation of otitis externa

Answer 5

Red, swollen, eczematous canal

Question 6

Treatment of otitis externa

Answer 6

Topical Abx (aminoglycosides not used if perforated tympanic membrane)
Topical Steroid
Severe - microsuction in ENT clinic

If extensively swollen use an ear wick
Oral abx if infecton is spreading
IV abx if malignant

Question 7

Otitis media presentation

Answer 7

Otalgia - ear pain
Fever
Deafness
Otorrhoea - ear discharge

Question 8

Complication of otitis media

Answer 8

mastoididtis

Question 9

Otitis media Mx

Answer 9

Oral amox (erythromycin 2nd line) if:

• lasting longer than 4 days
• Immunocompromised
• Younger than 2 yrs
• Perforation
• Systemically unwell

Question 10

Timescale of otitis media with effusion (glue ear)

Answer 10

Fluid in middle ear for less than 3 months

Question 11

Symptoms of glue ear

Answer 11

Conductive hearing loss
Prolonged cases = speech development
Mild dizziness or clumsiness

Question 12

Mx of glue ear

Answer 12

Conservative
If deafness persists = hearing aid and grommet (drains the fluid)
Adenoidectomy - last resort

Question 13

Pathophysiology of cholesteatoma

Answer 13

Squamous epithelium of external ear migrates to middle ear and forms a mass - erodes bone and soft tissue

Question 14

What does cholesteotoma present with?

Answer 14

Smelly discharge
Severe hearing loss
Dizziness

Question 15

Cholesteatoma Mx

Answer 15

Surgery. Drops do not help

Question 16

What conditions present with tinnitis

Answer 16

Meniere's 
Osteosclerosis 
Acoustic neuroma 
Hearing loss 
Drugs

Question 17

What kind of drugs can cause tinnitus?

Answer 17

Aspirin, Aminoglycosides, Loop diuretics, Quinine

Question 18

What is an acoustic neuroma

Answer 18

Hearing loss, vertigo, tinnitus, headaches - deep earache
Absent corneal reflex
Assoc. with NF2

Question 19

Signs of osteosclerosis

Answer 19

Onset 20-40
Conductive deafness
Tinnitus
Normal tympanic membrane

Question 20

Mx of tinnitus

Answer 20

Hearing aids,

White noise generator

Question 21

BPPV investigation and management

Answer 21

Ix and diagnosis- Dix Hallpike

Mx - Epley manoevre and vestibular exercises

Question 22

Acute attack of meniere’s Mx?

Answer 22

Prochlorperazine

Question 23

Prevention of Meniere’s

Answer 23

Betahistidine and Vestibular exercises

Question 24

Signs of acute labrynthitis

Answer 24

Dizziness
Deafness
Nausea

Recent viral infection
Nystagmus
Lasts for days

Question 25

Epitaxis Mx

Answer 25

Compress nose & Lean forward
Cautery
Nasal packing

Question 26

Septal haematoma Mx

Answer 26

Drained and give Abx

Question 27

What are nasal polyps normally associated with?

Answer 27

Eosinophilia
Aspirin allergy
Asthma

Question 28

Nasal polyps Mx

Answer 28

Topical corticosteroids

Surgical treatment if failed

Question 29

Nasal fracture - how to deal with it?

Answer 29

If non-displaced and uncomplicated - leave it

If massive swelling and displaced, wait for it to die downand manipulate under general aneasthetic

If complicated - may need general and srugery

Don’t leave it for more than 2 weeks

Question 30

Pharyngeal infection organisms

Answer 30

H. influenzae
Pneumococcus
Haemolytic strep

Question 31

Pharyngeal MX

Answer 31

Penicillin V

Do a monospot test if you suspect EBV

Question 32

Complications of pharyngeal infection

Answer 32

Rheumatic fever
Glomerulonephritis
Septicaemia
Quinsy

Question 33

Tonsilectomy guidelines

Answer 33

SIGN: >7 per year
>5 in 2 consecutive years
>3 in 3 consecutive years

NICE - more than 5 episodes per year

If disabling normal function, it should be considered

Question 34

When assessing a neck lump, what are you looking at/asking?

Answer 34

Size
Location - anteroir triangle/posterior triangle/mid-line
Shape - well defined?
Consistency - smooth, nodular, hard
Fluctuance - suggests fluid filled
Trans-illumination - suggest fluid filled - cystic hygroma
Pulsatility - suggests vascular - carotid body tumour/aneurysms
Temp - suggests infective cause
Overlying skin changes - erythema / ulceration?
Relation to overlying tissue - mobility/ask to turn head
Asculatation - assess bruits - carotid aneurysm

Question 35

Brachial cyst

Answer 35

Anterior triangle
Embryonic development - failure of obliteration of secind brachial cleft
Presents in early adulthood

Question 36

Congenital neck lump, typically on the L side and presents before 2yrs

Answer 36

Cystic hygroma

Question 37

What lump moves upward with protrusion of tongue

Answer 37

Thyroglossal cyst

Question 38

Does a carotid aneurysm move with protrusion of tongue?

Answer 38

No