ENT

Question 1

How is otitis media managed? Risk/benefit of abx, indications.

Answer 1

Analgesia (incl 2% lignocaine if TM ok), 48hr review. Abx adverse in 7%. Abx: amoxy 15mg/kg TDS 5 days, augmentin if not responding. Cefuroxime or bactrim. Abx if < 6 mo, < 2y w both ears, systemically unwell, discharge, immunocompromised.

Question 2

What is recurrent AOM? How is mastoiditis treated?

Answer 2

3+ episodes in 6mo or 4+ in 1 year. M: IV fluclox and cepahlosporin.

Question 3

How is otitis media with effusion managed? What is if it discharges?

Answer 3

OME for 3mo normal post AOM. Longer = glue ear, check hearing + ENT. Chronic suppurative otitis media if 6 weeks discharge, risk hearing loss - dry aural toilet, cipro drops until discharge stops for 3 days.

Question 4

Cholesteatoma - cause, symptoms, features management.

Answer 4

Epithelial cell growth from canal into mid ear. Hearing loss, discharge, smell. TM perforation superior + posterosuperior risk. Surgery to treat.

Question 5

How is allergic rhinits managed?

Answer 5

Intranasal antihistamine 1st. If >4d + >4weeks OR bothersome, affecting sleep/work/school, add steroid for 4 weeks. Beyond, if obstructive - dymista combo for >12yo. If allergic - montelukast.

Question 6

Sialolithiasis - Symptoms, preciptiants, management.

Answer 6

Pain/swelling w eating or pre-food. Dehydration, diuretics, anticholinergics. Conservative: massage, milk duct, sour candies. Abx if infected. Surgery if recurrent/not improving.

Question 7

Otitis externa management, prevention.

Answer 7

Keep dry 2 weeks, dry aural toilet. Otodex, locorten vioform, cipro HC. No otodex or kenacomb if perforation. Cover ears for shower/swimming. Can do aqua ear after getting wet.

Question 8

Features of audiograms with CHL, SNHL, age, noise and menieres.

Answer 8

C: air reduce, bone normal. SNHL: both reduced. Age: SNHL at high frequency. Noise: SNHL mid frequency. Menieres: SNHL one side at low frequency.

Question 9

What are the causes of sensorineural hearing loss?

Answer 9

Vestibular schwannoma, ototoxic drugs, noise induced, MS, stroke, meniere’s disease. If sudden - steroids and ENT

Question 10

What are the causes of conductive hearing loss? Features of otosclerosis.

Answer 10

Cerumen, otitis externa, otitis media, cholesteatoma. OS: overgrowth of stapes plate, uni or bilateral, autosomal dominant, develops in 20-30s. ENT for surgery.

Question 11

Exostoses and barotrauma - features, management.

Answer 11

Surfers ear, benign bony overgrowth: pain, hearing loss,infection late. Surgery if big or hearing affected. Baro: pain, tinnitus,hearing loss, bleeding into TM. From flying. Analgesia, refer if TM rupture, vertigo or SNHL.

Question 12

Rhinosinusitis management

Answer 12

Analgesia, nasal spray/rinse, IN steroid. If >7-10d, severe symptoms likely bacterial -may improve within 2 weeks. Abx: amoxy 5 days, cefuroxime if allergy, doxy if severe. Augmentin if not responding.

Question 13

What are the red flag symptoms of rhinosinusitis? What are possible complications?How are nasal polyps managed?

Answer 13

Confusion, diplopia/vision change, meningism, proptosis, bad smell. Peri/orbital cellulitis, meningitis, fungal, nasopharyngeal ca ddx (if recurrent or unilateral). If polyps, use 3 weeks of steroids then refer if needed.

Question 14

Causes of sialadenitis. Acute management.

Answer 14

Inflam (bacterial infection, viral mumps EBV, TB, sjogrens), obstructive (stone, trauma), metabolic (obesity, hypothyroid, eating disorder), tumour. Acute bacterial: IV fluclox, urgent surgical review.

Question 15

Features and indications of abx for sore throat.

Answer 15

Acute onset, fever >38, tonsilar exudate, cervical lymphadenopathy, no viral features. High risk: ATSI/maori, fhx of rheum heart disease, immunosuppressed. Abx if severe: phenoxymethylpenicillin 500mg BD 10 days OR amoxicillin. Single dose benzathine benpen. Allergic: keflex, azithromycin.

Question 16

Causes and red flags for hoarse voice.

Answer 16

Laryngopharyngeal reflux, vocal cord mass, parkinsons, myasthenia. Red flags: smoking, dysphagia, stridor, haemoptysis, fevers/sweats, weight loss.

Question 17

How are grommets managed?

Answer 17

No swimming 1 week post, use cap/plugs when swimming. If discharging, treat as CSOM - dry mopping, cipro ear drops for 3-7 days.

Question 18

How is epistaxis managed in kids?

Answer 18

Usually bleed from anterior septal wall (Little’s). Sit up, head tilt forward, pressure above nostrils, breathe through mouth, don’t swallow blood.

Question 19

Ludwig’s angina - symptoms, pathology, risk factors

Answer 19

Fever, stridor, tongue displaced, bull neck. From gangrenous bilateral cellulitis of submandibular space, polymicrobial infection from oral flora. Often post procedure in diabetes, IVDU, alcohol, HIV, smoking.