ENT

Question 1

Management of allergic rhinitis

Answer 1

Advice: diet, exercise, rest, don’t rub eyes, avoid decongestant nose drops, avoid allergens, bedding, carpets, keep pets outside, avoid chemical irritants
Oral/intranasal antihistamines
Oral/topical decongestants
Sodium chromoglycate intranasal or eye drops
Corticosteroids - in above forms too but good one is intranasal
LTRA
Immunotherapy

Question 2

Triad of ménière’s disease and what are attacks preceded by

Answer 2

hearing loss, vertigo, tinnitus

fullness in the ear

Question 3

Treating meniere’s attacks and prophylaxis

Answer 3

Prochlorperazine 25mg PR prophylaxis

Diazepam 5mg IV +/- prochloperazine

If persistent consider HCTZ 25mg PO OD

Question 4

What is BPPV and features

Answer 4

Acute vertigo induced by changing head position - esp with tilting head backwards, changing from recumbent to sitting or turning to affected side

• recurs periodically for several days
• attacks brief, 10-60 s and subsides fast
• not accompanied by vomiting, tinnitus or deafness

Question 5

How to diagnose BPPV

Answer 5

Hallpike manoeuvre - hold for 30s and observe for vertigo and nystagmus, there is latent period before symptoms
Hearing and vestibular function normal

Question 6

Otitis media treatment adults

Answer 6

Analgesia 
Rest in warm room 
Nasal decongestants if nose congested
antibiotics: amoxicillin 500mg TDS for 5 days 
treat associated conditions 
review and test hearing 

if continuous discharging after 6 weeks, treat with topical steroid and antibiotics combination drops after ear toilet

Question 7

Features, Red flags and Mx for cholesteatoma

Answer 7

Visible through perforation as white flakes/discharge/scab, it’s foul smelling and purulent

Meningitis type features
Cranial nerve deficits
Sensorineural hearing loss
Persistent deep ear pain

Need to refer because need surgical removal

Question 8

Management of otitis externa

Answer 8

Aural toilet via suction and dry mopping
Dressing
Topical mixture of antibacterial anti fungal and anti steroid
Strong analgesia
Prevent scratching and water entry

Question 9

How to treat impacted wax

Answer 9

If soft, use sodium bicarbonate drops to melt it and cotton mops to remove

If hard, need to remove manually using syringe or instrumentation

Question 10

How to treat glue ear

Answer 10

Bromhexine elixir

If >3 months, hearing assessment and refer to ENT for Grommet (ventilation tube) inserted after myringotomy

Question 11

Treatment of nasal polyps

Answer 11

Oral pred 50mg OD for 7 days, supplement with betamethasone spray simultaneously for 3 months
Antibiotics for purulent nasal discharge

Can refer to surgeon to remove polyp with mucosa of sinuses

Question 12

Sinusitis diagnosis (viral) and treatment

Answer 12

Must have one of first two

1. discolored nasal discharge
2. nasal obstruction
3. frontal headache
4. reduced smell

Typically resolves in 7-10 days without treatment.

• oral analgesia
• saline nasal wash
• steam inhalation
• intranasal CS
• intranasal decongestants (<7 days)

Question 13

Bacterial sinusitis diagnosis and treatment

Answer 13

If symptoms unchanged after 10 days or increasing after 5, bacterial infection if have at least 3 of

• discolored discharge
• severe local pain
• fever >38 C
• elevated ESR/CRP
• double sickening

Give amoxicillin 500MG TDS for 5 days or doxycycline

Question 14

Chronic sinusitis diagnosis and treatment

Answer 14

Symptoms >12 weeks

Amoxicillin 500mg TDS for 10-14 days or hp to 6 weeks
The rest same as acute sinusitis
If ineffective, use nasal irrigation to remove stagnant mucus
If no response refer to surgeon, might need FESS
Or if orbital/facial cellulitis also need to refer

Question 15

Complications of sinusitis

Answer 15

Orbital: ophthalmoplegia, diplopia, proptosis, impaired vision, orbital cellulitis
Subdural abscess
Osteomyelitis

Question 16

Management of BPPV

Answer 16

Management

• explanation and reassurance
• avoid movement that ppt attack
• drugs not recommended
• special exercises - Epley manouvre
• surgical treatment

Question 17

OSA management

Answer 17

CPAP (numbness, rhinitis, bloating) 
Mandibular Advancement device 
LOW 
Sleeping in non-supine position 
Nasal surgery 
Tonsillectomy 
Uvulopalatopharyngoplasty
Tongue Surgery 
Hard tissue surgery

Question 18

OSA investigations

Answer 18

Apnoea hypopnea index (5 or more per hour, mod-to severe is 15 or more)
Assess for signs of adenotonsillar hypertrophy, driving and workplace safety, obesity, HTN, depression
Questionnaires: Berlin, OSA50, STOP-BANG, Epworth Sleepiness Scale
Polysomnography

Question 19

Acoustic neuroma symptoms and diagnosis

Answer 19

Unilateral tinnitus + hearing loss + vertigo/unsteady gait

High-resolution MRI, audiometry

Question 20

What is acoustic neuroma and what are their complications

Answer 20

Schwannoma arising from the vestibular nerve

With progression can affect the ipsi lateral cranial nerves 5,6,9 and 10, cerebellar also, ICP signs

Question 21

Treatment for adult strep tonsillopharyngitis

Answer 21

indications for antibiotics in paeds

Phenoxymethylpenicillin 500mg PO BD 10 days
if hypersensitive, azithro 500mg OD 10 days
Poor compliance: Benzathine penicillin 900mg IM single dose
Severe; procaine penicillin 1.5mg IM OD for 3-5 days plus phenoxymethyl
Frequent fluids + PCM

Question 22

What is Quinsy and what are the typical features?

Answer 22

Peritonsillar abscess

Severe unilateral throat pain + high fever followed by difficulty swallowing and trismus

Question 23

Managing Quinsy

Answer 23

Antibiotics (procaine penicillin IM/clindamycin, can broaden with metronidazole)
Aspiration/drainage in hospital

Question 24

Diphtheria management

Answer 24

Throat swab
Antitoxin
Penicillin/erythromycin for 10 days
Isolate patient