ENT

Question 1

How do you treat perforated tympanic membrane?

Answer 1

• no treatment is needed as usually heal after 6-8 weeks. (avoid getting water in the ear during this time)
• can prescribe antibiotics to perforations which occur following an episode of acute otitis media.

myringoplasty may be performed if the tympanic membrane does not heal by itself

Question 2

If someone receives minor trauma to the nose, has a nosebleed, and OE there is bilateral swelling visible- what is the initial management?

Answer 2

Immediate ENT referral- nasal septal haematoma. Needs drainage to avoid necrosis and ‘saddle nose’ deformity

Question 3

What congenital condition can increase the risk of cholesteatomas?

Answer 3

cleft palate (100 fold)

Question 4

What is the Dx and treatment of BPPV?

Answer 4

• Dx Dix-hallpike manouvre
  Treatment- epley manouvre or Brandt-Daroff exercises- vestibular rehabilitation

Question 5

What are the main symptoms of cholesteatoma?

Answer 5

Hearing loss
Foul smelling non- resolving discharge

Question 6

At what age are cholesteatomas most common in?

Answer 6

10-20 yo

Question 7

Where is the most common origin of nosebleeds?

Answer 7

Little’s area in anterior nasal septum - confluence of 4 arteries (Kiesselbach’s plexus)

anterior 90%, posterior 10%

Question 8

What is the management for a patient with haemorrhage 5-10 days after tonsillectomy (at GP)?

Answer 8

Refer to ENT and consider Abx prescription (ass with wound infection)

Question 9

Management for persistent mouth ulcer (>3 weeks)

Answer 9

Refer 2ww oral surgery -> squamous cell carcinoma ?

Question 10

define otosclerosis

Answer 10

sclerosis of bones and fixation of stapes to oval window, often leading to BL conductive HL. autosomal dominant, and affects 20-40yo. may be precipitated by pregnancy

Question 11

define presbycusis

Answer 11

age related SN hearing loss
high freq BL
slow progression as sensory hair cells and neurons in cochlea atrophy over time

Question 12

Define ramsay hunt syndrome

Answer 12

reactivation of the varicella zoster virus in the geniculate (sensory) ganglion of the seventh cranial nerve.

Question 13

Medication to treat vestibular neuronitis first line

Answer 13

prochlorperazine
- buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
- a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

Question 14

What imaging is needed for voice hoarsness?

Answer 14

Cxr to exclude apical lung lesions

Question 15

Which Abx would you use for otitis media if needed?

Answer 15

Amoxicillin or erythromycin

Question 16

What features can indicate a septal haematoma?

Answer 16

• Sensation of nasal obstruction
• Bilateral red swelling arising from nasal septum
  -Boggy swelling (nasal deviations are firm)

Question 17

what are some signs of a basal skull fracture?

Answer 17

battle sign in ear and raccoon eyes

Question 18

how should you treat otitis externa in diabetics?

Answer 18

prescribe ciprofloxacin drops to cover pseudomonas infections that can cause malignant otitis externa

Question 19

what organism is malignant otitis externa most commonly caused by?

Answer 19

Pseudomonas aeruginosa

Question 20

what is the pathophysiology of malignant otitis externa?

Answer 20

Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
Progresses to temporal bone osteomyelitis

Question 21

Management of malignant otitis externa

Answer 21

non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections

Question 22

Management of recurrent or chronic sinusitis

Answer 22

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

Question 23

Abx for managing tonsillitis

Answer 23

Phenoxymethylpenicillin or clarithromycin 7-10 days

Question 24

pathophysiology of Cholesteatoma

Answer 24

squamous epithelium forming in small pockets on the tympanic membrane which becomes cyst-like as it produces keratin and sloughs over time. There will be middle ear erosion which will create an environment for anaerobic bacterial growth to occur.

Question 25

what can ‘double sickening’ suggest

Answer 25

bacterial sinusitis

Question 26

management of otitis media

Answer 26

generally no ABx!
Abx if
1. Symptoms lasting more than 4 days or not improving
2. Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
3. Younger than 2 years with bilateral otitis media
4. Otitis media with perforation and/or discharge in the canal

Question 27

what is Laryngopharyngeal reflux

Answer 27

inflammatory changes to the larynx/hypopharynx mucosa due to gastro-oesophageal reflux

Question 28

what is the usual type of cancers in the aerodigestive tract (nasal, oral cavity, pharynx, larynx)?

Answer 28

squamous cell carcinomas

Question 29

what is trismus and what could it indicate?

Answer 29

locked jaw- oropharyngeal malignancy, peritonsillar abscess (quinsy)

Question 30

define stertor and stridor and different types of stridor

Answer 30

stertor= noisy breathing ABOVE larynx
stridor= noisy breathing BELOW larynx
inspiratory: supraglottis
expiratory: level of glottis
biphasic: subglottis or trachea

Question 31

define odynophagia

Answer 31

pain when swallowing

Question 32

define dysphagia

Answer 32

difficulty swallowing

Question 33

what are the risk factors for H and N cancer?

Answer 33

1. tobacco/ alcohol incl chewing tobacco
2. HPV 16 and 18
3. occupation: woodwork, textiles, nickel
4. leukoplakia -1/3 become cancerous
5. erythroplakia- 1/2 become cancerous

Question 34

what should be considered in UL epistaxis in adolescent boys?

Answer 34

juvenile angiofibroma (nasopharyngeal tumour)

Question 35

side effect of prolonged use of nasal decongestants

Answer 35

tachyphylaxis (need to use more to achieve same effect)

Question 36

when are grommet’s indicated?

Answer 36

patients with recurrent acute otitis media, otitis media with effusion in both ears 3 months or one ear for 6 months, and in patients with speech delays

Question 37

which bacteria typically precede otitis media

Answer 37

URTI
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

Question 38

Mr Zhang, a 56-year-old Mandarin-speaking patient, attends with his daughter, who translates for him. He has had reduced hearing and mild discomfort in his left ear for about two weeks which he attributes to an ear infection, and he is asking for antibiotics. He describes the hearing as being a bit muffled, and he hears clicking and popping at times, especially when swallowing. He says he hasn’t had a cold recently. He is a current smoker. On examination, the right tympanic membrane appears normal, and the left tympanic membrane looks dull and retracted. The oral cavity looks normal and there are no enlarged cervical lymph nodes.

What is the management?

Answer 38

2ww referral- UL middle ear effusion, Chinese/ SEA origin - nasopharyngeal cancer

Question 39

how does presbycusis present in an audiogram?

Answer 39

BL high frequency hearing loss, air> bone

Question 40

when is treatment needed for perforated eardrum?

Answer 40

if not healed in 6-8 weeks
otherwise myringoplasty

Question 41

how can you distinguish between vestibular neuronitis and posterior circulation stroke?

Answer 41

The HiNTs exam