ENT

Question 1

What is a Pure Tone Threshold (PTT)?

Answer 1

Softest sound audible at least 50% of time

Question 2

How do you read an Audiogram?

Answer 2

• As Frequency increases, so does the Hearing Level in dB

• Left ear: Represented by a BLUE line or Xs
• Right ear: Represneted by a RED line or Os

Question 3

Q5: Compare Normal hearing, Mild/ Moderate/ Severe/ Profound Hearing Loss

Answer 3

• Normal: Both ears < 20dB for every frequency
• Mild hearing loss: In 20-40 dB range
• Moderate hearing loss: In 40-70 dB range (Talks loudly, asks for things to be repeated)
• Severe hearing loss: In 70-90 dB range
• Profound hearing loss: In 90-120 dB range (Needs visual assistance

Question 4

List 3 Outer Ear pathologies

Answer 4

• Earwax
• Foreign body
• Otitis externa (Fungal/ Bacterial, Hospitals insert a “wick’ if drops don’t work)

Question 5

Compare Acute OM with and without perforation

Answer 5

With perforation ;

• Wet/ Dry
• Central/ Attic/ Peripheral (Central safer than Attic)

Without perforation;
- Bulging red TM due to Middle ear exudate

Question 6

Why is dizziness more worrying than vertigo?

What does vertical Nystagmus indicate?

Answer 6

Dizziness can be caused by problems from a wider range of systems

Vertical N indicates brain problem rather than eye

Question 7

When do you consider Acute Bacterial Sinusitis?

1st and 2nd line treatments?

Answer 7

• If >10 days and sinus pain
  1: Phenoxymethylpenicillin (also in Tonsillitis) 500mg QDS for 5 days
  2: Doxycycline/ Clarithromycin (Erythro- if pregnant)

Question 8

List 4 tests to assess pts with Suspected Vertigo

Answer 8

• Head Impulse/ Thrust test
• Unterberger/ Stepping test
• Rhomberg
• Dix-Hallpike

Question 9

Describe Head Impulse/ Thrust test

Answer 9

• To detect unilateral peripheral vestibular defects, tests VOR
• Sit in front of pt, ask them to keep focus on distant object/ examiner’s nose
• Move their head quickly to 10-15 degrees of rotation
• Abnormal: Eyes dragged ‘off target’ by head rotation, then rapid movement back to target

Question 10

Describe Unterberger/ Stepping test

Answer 10

• Ask pt to march on spot with eyes closed

- If there is Labyrinthine damage, pt rotates to affected side

Question 11

Outline Dix-Hallpike test

Answer 11

• While sitting on bed, turn head 45 degrees to one side
• Lower patient into Supine position ensuring head hangs over bed 30degrees below horizontal plane
• Observe for Nystamus for 30 seconds
• Repeat test turning head to other side

Question 12

Outline Epley Manoeuvre

Answer 12

From same position, Turn patient’s head 90degrees and maintain for 30 seconds

Ask pt to roll onto side, Rotate head so they are looking directly at floor. Hold for 30-60 seconds

Sit patient up sideways, maintaining head rotation

Once sitting upright, head can be re-aligned to midline and neck flexed. Hold for 30seconds

Question 13

List 7 Middle Ear pathologies

Answer 13

• Mastoiditis
• ET Dysfunction
• Otosclerosis
• Tympanosclerosis
• Chronic Supparative OM
• OM with Effusion

Acute OM with/ without perforation

Question 14

List criteria for Tonsillectomy

Answer 14

• 7 episodes in 1yr
• 5 episodes in each of 2 consecutive yrs
• 3 episodes in each of 3 consecutive yrs

Question 15

Describe the mechanism of BPPV

Answer 15

• Small fragments of debris deposited in inner ear (CaHCO3 Crystals)
• When head still, they sit at the bottom of the canal
• On movement, fragments swept along the fluid-filled canal
• This sends confusing signals to the brain, interpreted as Vertigo