ENT

Question 1

what is likely diagnosis for itchy ear canal with discharge?

Answer 1

otitis externa

Question 2

what is otitis externa?

Answer 2

inflammation of the external ear canal, which can be due to infection or allergic reaction of the skin.

Question 3

causes of otitis externa?

Answer 3

infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal

seborrhoeic dermatitis

contact dermatitis (allergic and irritant)

recent swimming is a common trigger of otitis externa

Question 4

management of otitis externa?

Answer 4

Paracetamol or ibuprofen
steroid cream or steroid cream + aminogylycoside ->Dexamethasone 0.1%, ciprofloxacin 0.3% (Cilodex®)

second line: oral flucloxacillin

Question 5

what is the. likely diagnosis in a patient with severe, unrelenting, deep-seated otalgia, temporal headaches and purulent otorrhea?

Answer 5

Malignant otitis externa

Question 6

what is malignant otitis externa?

Answer 6

condition commonly occurring in immunosuppressed/type 1 diabetes
Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal and eventually to temporal bone osteomyelitis

Question 7

what are the symptoms of malignant otitis externa?

Answer 7

Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Question 8

management of malignant otitis externa?

Answer 8

usually IV abs to cover pseudomonas in diabetes

Question 9

most likely diagnosis in patient with facial pain that is worsened by leaning forwards?

Answer 9

acute sinusitis

Question 10

what is acute sinusitis?

Answer 10

Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses. The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

Question 11

Management of acute sinusitis?

Answer 11

analgesia
intranasal decongestants or nasal saline
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required but may be given for severe presentations.
The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection

Question 12

when should a patient with hoarseness be referred for 2ww?

Answer 12

A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.

Question 13

Differential diagnoses for hoarse voice?

Answer 13

voice overuse
smoking
viral illness
hypothyroidism
gastro-oesophageal reflux
laryngeal cancer
lung cancer

Question 14

what are the features of nasal polyps?

Answer 14

rhinorrhea
sneezing
nasal obstruction
poor sense of smell + taste

Question 15

management of nasal polyps?

Answer 15

all patients with suspected nasal polyps should be referred to ENT for a full examination
topical corticosteroids shrink polyp size in around 80% of patients

Question 16

what criteria can be used to assess severity of sore throat?

Answer 16

centor criteria

Question 17

what is the centor criteria?

Answer 17

The Centor criteria are: score 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

Question 18

management of bacterial tonsillitis?

Answer 18

Phenoxymethylpenicillin for 10 days is the first-line antibiotic choice

Question 19

likely diagnosis in patient with persistent episodes of vertigo lasting hours to days + horizontal nystagmus weeks after a viral illness?

Answer 19

vestibular neuronitis

Question 20

symptoms of vestibular neuronitis?

Answer 20

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 21

management of vestibular neuronitis?

Answer 21

a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)

Question 22

what causes mennieres disease?

Answer 22

It is characterised by excessive pressure and progressive dilation of the endolymphatic system

Question 23

features of mennieres disease?

Answer 23

Recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural).
Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Question 24

management of mennieres disease?

Answer 24

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit