ENT !!

Question 1

Otosclerosis

Answer 1

remodelling of the bones of the middle ear

leads to hearing loss and tinnitus

Question 2

otitis media- presentation, diagnosis and tx

Answer 2

• ear pain, discharge, hearing loss
• Dx- otoscopy- visualise tympanic membrane- look for hole/ discharge
• tx- Abx (amoxicllin), delayed prescription if systematically well

Question 3

otitis externa- presentation, diagnosis and tx

Answer 3

• ear pain, hearing loss, discharge, itching
• Dx- otoscopy- erythema of the middle ear, discharge, intact tympanic membrane
• Tx- Otmizole ear spray

Question 4

what is benign paroxysmal positional vertigo

Answer 4

calcium carbonate (otoconia) crystals in the semicircular canals- peripheral cause of vertigo

triggered by movement !!

Episodes last around 1 minute

Question 5

describe the diagnosis of benign paroxysmal positional vertigo

Answer 5

Dix-Hallpike manoeuvre- moving the patients head to trigger vertigo (due to movement of endolyph and otoconia)

Question 6

Tx of benign paroxysmal positional vertigo

Answer 6

Epley manoeuvre- similar to dix-hallpike manoeuvre

aims to move crystals in the semicircular canal to a position that does not disrupt endolymph flow

Question 7

what is Meniere’s disease

Answer 7

excess endolymph in the canals

not associated with movement !!

episodes last from 20 mins to a few hours

Question 8

triad of Meniere’s disease

Answer 8

hearing loss
vertigo
tinnitus

Question 9

other sx of meniere’s disease (apart from triad)

Answer 9

‘fullness’ in ear

drop attacks (falls) without LOC

inbalance after episodes

nystagmus

Question 10

management of Meniere’s disease

Answer 10

maanging Sx- prochloroperazine and antihistamines (cyclizine)

prophylaxis- Betahistine

Question 11

what is vestibular neuronitis

Answer 11

inflammation of the vestibular nerve

Question 12

presentation of vestibular neuronitis

Answer 12

• acute onset vertigo
• Hx of URTI
• N&V, balance issues

NO TINNITUS/ HEARING LOSS

Question 13

tx of vestibular neuronitis

Answer 13

prochloroperazine

Question 14

what is labyrinthitis

Answer 14

inflammation of the bony labyrinth of the middle ear

Question 15

presentation of labyrinthitis

Answer 15

vertigo, hearing loss, tinnitus

+ Hx of URTI

Question 16

Tx of labyrinthitis

Answer 16

prochloroperazine

Question 17

peripheral causes of vertigo

Answer 17

bening paroxysmal positional vertigo

Meniere’s disease

Labyrinthitis

Vestibular neuronitis

Question 18

central causes of vertigo

Answer 18

tumour

posterior stroke

MS

Vestibular migraine

Question 19

what is cholesteatoma

Answer 19

abnormal collection of squamous epithelial cells in the middle ear

Question 20

presentation of cholesteatoma

Answer 20

foul discharge from ear

unilateral conductive hearing loss

can also develop into pain, vertigo and facial nerve palsy

Question 21

Dx and Tx of cholesteatoma

Answer 21

CT

surgical removal

Question 22

what is an acoustic neuroma/ vestibular schwannoma (same thing)

Answer 22

benign tumour of the schwann cells surrounding the auditory (vestibulocochlear) nerve in the inner ear

Question 23

what are bilateral acoustic neuromas/ vestibular schwannoma’s associated with

Answer 23

neurofibromatosis type 2

Question 24

presentation of acoustic neuromas/ vestibular schwannoma

Answer 24

unilateral sensorineural hearing loss

unilateral tinnitus

dizziness/ imbalance

fullness in ear

associated with facial nerve palsy (compress it- LMN)