ENT

Question 1

What is Otitis Externa?

Answer 1

Inflammation of the skin lining the ear canal

Question 2

Which types of organisms can cause otitis externa?

Answer 2

Bacterial

Fungal

Question 3

How does Otitis Externa present?

Answer 3

Painful ear
Discharge
History of itchy ear
Muffled hearing

Question 4

Which patients are vulnerable to Malignant Otitis Externa?

Answer 4

Diabetics and Immunocompromised patients

Question 5

What is Malignant Otitis Externa?

Answer 5

Infection of the outer ear spreads from soft tissue of the ear to the bone

Question 6

How does Malignant Otitis Externa present?

Answer 6

Chronic ear pain despite topical treatment

Deep=seated severe ear pain

Question 7

What is the recommended management steps of confirmed Otitis Externa

Answer 7

Topical Empirical ear drops
Swab of discharge
Microsuction of Pus/Debris
Wick if severe infection to hold canal open and allow for drainage
Topical antifungals if fungal

Question 8

How should malignant otitis externa be managed?

Answer 8

IV Abx with extended topical treatment

Question 9

What is Otitis Media with Effusion?

Answer 9

Fluid in the middle ear combined with an intact tympanic membrane

Question 10

What causes Otitis Media with Effusion?

Answer 10

Eustachian Tube Dysfunction

Question 11

What is a potentially serious cause of Otitis Media with Effusion in adults?

Answer 11

Nasal Space Tumours

Question 12

How does Otitis Media with Effusion present?

Answer 12

Middle ear effusion

Conductive hearing loss

Question 13

Which investigations can be used to assess hearing?

Answer 13

Tympanogram

Pure Tone Audiogram

Question 14

How should Otitis Media with Effusion be managed?

Answer 14

Conservative
Hearing aid
Surgery - Grommets +/- Adenoidectomy if severe

Question 15

What is Otosclerosis?

Answer 15

Condition where the bones of the middle ear fuse, and mature bone is replaced with woven bone

Question 16

How does Otosclerosis present?

Answer 16

Progressive hearing loss
Tinnitus
Improved hearing in noisy surroundings early on
FHx of Otosclerosis

Question 17

How may Otosclerosis appear on Otoscopy?

Answer 17

Normal

Pink hue to tympanic membrane - Schwartze’s

Question 18

What is Schwartze’s sign?

Answer 18

Pink hue visible on tympanic membrane, suggests Otosclerosis

Question 19

How can Otosclerosis be managed?

Answer 19

Hearing Aid

Stapedectomy

Question 20

What is acute Otitis Media?

Answer 20

Middle ear infection often secondary to Eustachian tube dysfunction. Common in children

Question 21

What are some common causative organisms of acute Otitis Media?

Answer 21

Strep. Pneumoniae
H. Influenza
Moraxella

Question 22

How does acute otitis media present?

Answer 22

Ear pain - Child may pull at ear

Discharge - Increased middle ear pressure leads to tympanic perforation

Question 23

How can acute otitis media be managed?

Answer 23

Conservative - Analgesia

Medical - Abx if severe

Question 24

How can recurrent acute otitis media be managed?

Answer 24

Insertion of Grommets can help to alleviate the problem

Question 25

How can active Chronic Otitis Media Present?

Answer 25

Mucosal - Tympanic Membrane Perforation and Discharge | Squamous - Formation of a Cholesteatoma

Question 26

How can inactive Chronic Otitis Media Present?

Answer 26

Mucosal - Tympanic Membrane Perforation but no discharge | Squamous - Retraction pocket within ear that may become Cholesteatoma

Question 27

How should a Cholesteatoma secondary to Chronic Otitis Media be managed?

Answer 27

Mastoidectomy and Clearance

Question 28

How should Chronic Otitis Media without a Cholesteatoma be managed?

Answer 28

Medical - Topical Abx, Aural Toilet | Surgical - Repair of Perforation

Question 29

What are some potential complications of mastoid surgery?

Answer 29

``` Facial Nerve Palsy Altered taste due to Chordi Tympani nerve damage CSF leak Tinnitus Vertigo Complete hearing loss in affected ear ```

Question 30

What is Vertigo?

Answer 30

Hallucination of movement due to Vestibular System dysfunction

Question 31

What are some central causes of vertigo?

Answer 31

``` Stroke Migraine Neoplasm Demyelination Drugs ```

Question 32

What are some peripheral causes of vertigo?

Answer 32

BPPV Meniere's Disease Vestibular Neuronitis

Question 33

What is BPPV?

Answer 33

Transient vertigo associated with particular head movements

Question 34

What causes BPPV?

Answer 34

Otoliths in the semicircular canal cause abnormal stimulation of hair cells giving the illusion of movement

Question 35

Which test is used to screen for BPPV?

Answer 35

Dix-Hallpike

Question 36

Which maneuvre is used to treat BPPV?

Answer 36

Epley

Question 37

What is Meniere's disease?

Answer 37

Increased fluid within the endolymphatic compartment of the ear gives vertigo like symptoms

Question 38

How can Meniere's disease present?

Answer 38

Tinnitus of affected ear Episodic vertigo associated with N+V Fluctuating sensorineural hearing loss which can become permanent Aural fullness

Question 39

Why does Meniere's naturally improve over time?

Answer 39

Eventually Meniere's "burns out" so the patient is left without vertigo, just with the permanent sensorineural hearing loss

Question 40

Which dietary changes can help to reduce symptoms of Meniere's disease?

Answer 40

``` Reduction in the amount of: Salt Chocolate Alcohol Caffeine Chinese Food ```

Question 41

Which medical management options are available for Meniere's disease?

Answer 41

Thiazide diuretic Beta Histine Vestibular Sedatives - Prochlorperazine for attacks

Question 42

Which surgical management options are available for Meniere's disease?

Answer 42

``` Grommet insertion Dexamethasone middle ear injection Endolymphatic sac decompression Vestibular destruction with Gentamicin injection Surgical labyrinthectomy ```

Question 43

What is Vestibular Neuronitis?

Answer 43

Inflammation of the inner ear giving incapacitating vertigo lasting several days

Question 44

How does Vestibular Neuronitis present?

Answer 44

Horizontal Nystagmus

Question 45

How can Vestibular Neuronitis be managed?

Answer 45

Vestibular Sedatives IV Fluids if needed Vestibular Rehabilitation