ENT

Question 1

Investiagtions for hearing in adults ?

Answer 1

first thing is to exclude impacted ear wax and acute infections

Question 2

Investigations for hearing in children?

Answer 2

AOAE is done as part of new-born hearing screen
- ideally in children hearing should be checked within the first 4-5weeks

9/12 - 1.5yrs = ‘distraction testing’

4-5yrs = ‘conditioned ausitory response’

audiological assessment referall

• sudden loss of hearing = Immediate ENT
• if more than 30days = 2wwr ENT

rapid hearing loss - ENT/Adio-vestibular medicine

Pure tone audiogram

Question 3

What is tympanometry?

Answer 3

Tympanometry refers to a test that helps in the evaluation of the proper functioning of the middle ear.

The test seeks to establish the condition and movement of the tympanic membrane as it responds to changes in pressure

Question 4

Tympanometry classifications?

Answer 4

Type A = normal movement of TM

Type B = little or no TM movement - possible fluid in middle ear

Type C = middle ear has negative pressure

• ?retracted eardrum
• ?blockade of eustachian tubes

Question 5

What is flexible rigid fiberoptic nasopharyngoscopy?

What are its uses?

Answer 5

FNE is a diagnostic prodcedure used to visualise the anterior notstrils, through postnasal space into the upper airwarys to the epiglottis and vocal cords

• often used in the investiagtions of foreign bodies, polpys and malignancy

Question 6

What is microsuction? What is it used for?

Answer 6

microsuction is a cleaning procedure for the ear.

aural microsuction is commonly performed to removed impacted wax, discharge or foreign bodies

Question 7

What is lymph node biopdy?

Answer 7

US-guided FNA can be used to get a sample from a neck lymph node or from a thyroid nodule

Question 8

When is XR used in ENT?

Answer 8

• lateral neck XR can be used in cases of suspected FB in the throat

Question 9

When in CT used in ENT?

Answer 9

• allows visualisation fo soft tissue and bony structures
• visualise possible sinus disease
• iodine contrast - abnormal blood flow to lymph node enlargement and cancer

Question 10

When is MRI used in ENT?

Answer 10

anatomical definition provides better differentiation between normal or inflamed or neoplastic tissue

gadolinium contrast use - iodine should uo in areas of increased vascularity

Question 11

When is contrast studies used in ENT?

Answer 11

when assessing swallowing using barium swallow as well as pharyngeal webs and pouches

Question 12

When is US used in ENT?

Answer 12

particularly used for swelling of the head and neck area

also used to guide fine needle aspiration

Question 13

Indications for Ear swabs?

Answer 13

rarely done in general practice - can be useful if tx failure in Otitis externa or if recurrent

can also be useful if effusion leaks into external auditory canal secondary to a TM perforation

Question 14

Indications for nasopharyngeal swabs?

Answer 14

flu, covid19, RSV, whooping cough, meningitis and MRSA

Question 15

Indications for throat swabs?

Answer 15

not routinely done

• concerned about rare cause of STI or diphtheria
• concerned about scarlett fever

Question 16

When is Dix-hallpike manoeucre used?

Answer 16

to assess whether pt has BPPV

• turn pts head to one side at 45°
• lay them down flat quickly
• observe for any nystagmus for at least 30s
• repeat on the other side

Question 17

When is the Epley manoeuvre used?

Answer 17

used to treat BPPV

• have pt lying flat and just off the edge of bed
• turn head 90° and hold fro 30s
• rotate pt to their side and rotate head so theyr’re facing the floor, hold 30-60s
• sit up pts maintaining sideways position
• once upright, realign head to midline

Question 18

What Investigations are done in suspected acute otitis media?

Answer 18

usually a clinical diagnosis

if perforated with visible discharge - can do ear swb
- usually only in recurrent cases or if tx fails

Question 19

What Investigations are done in suspected cerumen impaction?

Answer 19

usually clinical diagnosis aided with otoscopy

Question 20

What Investigations are done in suspected Labrynthitis?

Answer 20

usually a clinical diagnosis

Question 21

What Investigations are done in suspected otitis externa?

Answer 21

clinical diagnosis with otoscopy

ear swab - usually not required but can be used to find out causative organism

Question 22

What Investigations are done in suspected malignant otitis externa?

Answer 22

CT scan of head

sometimes MRI head

Question 23

What Investigations are done in suspected BPPV?

Answer 23

clinical diagnosis with +ve dix-hallpike - rotatory nystagmus

Question 24

What Investigations are done in suspected meniere’s disease?

Answer 24

clinical diagnosis

• vertigo, hearing loss and tinnitus
• aural fullness/pressure

Question 25

What Investigations are done in suspected Vestibular neuritis/neuronitis?

Answer 25

usually a clinical diagnosis

- no tinnitus or hearing loss

Question 26

What Investigations are done in suspected Mastoiditis?

Answer 26

usually a clinical diagnosis

culture of the ear if discharge present

CT scan - If complications suspected

Question 27

What Investigations are done in suspected hearing impairment?

Answer 27

clinical diagnosis

clinical examination - rhinne’s and webers

Question 28

What Investigations are done in suspected Perforated tm?

Answer 28

usually a clinical diagnosis with otoscopy

• loss of cone of light
• handle of maleus

Question 29

What Investigations are done in suspected Acoustic Neuroma?

Answer 29

Suspected Acoustic neuroma needs urgent ENT referral

MRI cerebellopontine angle

audiometry important - check for any sensorineural hearing loss

Question 30

What Investigations are done in suspected cholesteatoma?

Answer 30

CT head - confirm diagnosis and planning for surgery

MRI - assess invasion and damage to local soft tissue

Question 31

What Investigations are done in suspected vestibular migraine?

Answer 31

usually a clinically diagnosis