ENT

Question 1

Bells palsy Mx

Answer 1

Usually recovers within 2 weeks - fully by 3 months
corneal protection - lubricating eye drops, eye patch
Prednisolone 50mg for 10 days if <72 hrs presentation
no evidence for antivirals

Refer: diagnostic uncertainty, worsening symptoms or no resolve within 3 weeks

DDx - stroke, Cancer, parotid tumour, cholesteatoma

Question 2

Acute otitis media Mx

Answer 2

Often self resolve within 3-7 days

Admit if:
unwell
<3 months + temp >38
3-6 months + temp >39
suspected complications - meningitis, facial nerve paralysis, sinus thrombosis

Antibiotics
- if symptoms >3days
- otorrhea
- unwell but not for admission
- can consider delayed script

ABx choice - Amox 5/7 or Erythro 5/7 (pen allergy)

Question 3

Deafness red flags

Answer 3

Unilateral
Sudden onset <3/7
Fluctuating hearing levels
Persistent tinnitus esp pulsatile or causing distress

Immediate referral:
sudden <3/7
plus facial droop ?stroke
immunocompromised, pain, otorrhea, no response to Tx after 72hrs

2WW:
Unilateral progressive hearing loss with vertigo or tinnitus
Nasal obstruction or epistaxis
Southeast asian with hearing loss and middle ear effusion without infection

Question 4

Tinnitus Mx

Answer 4

Urgent referral:
Unilateral
pulsatile
otalgia/ pain
unilateral hearing loss

General Mx:
reassure + address underlying cause if any
check meds eg ototoxic?
Sound therapy
Counselling or CBT

Question 5

Acute sinusitis Mx

Answer 5

1st - paracetamol/ ibuprofen, nasal irrigation, self resolve

2nd - Nasal corticosteroids eg mometasone, betamethasone

3rd - antibiotics
- <10 days + unwell
- >10 days
eg Phenoxymethylpenicillin/ Co-Amox, or pen allergy Doxy/ Clari

Immediate admission red flags:
Severe systemic infection
Orbital involvement
Intracranial involvement - eg meningitis, bone swelling, neurology

Question 6

Chronic sinusitis (>12 weeks) Mx

Answer 6

3 months nasal corticosteroids

ENT refer:
No resolve after 3/12 nasal steroids
unilateral Sx
nasal polyps
recurrent otitis media + pneumonia in children
effecting quality of life

Question 7

Benign paroxysmal positional vertigo (BPPV) Mx

Answer 7

Epley manoeuvre
Brandt-Danroff
Medications - betahistine, cyclizine

Question 8

2WW ENT

Answer 8

Laryngeal
- age >45 with unexplained hoarse voice or neck lump

Oral
- oral ulcers >3 weeks or neck lump

Thyroid
- unexplained thyroid lump

Dental
- red/ white patches in oral cavity - erythroplakia

Question 9

ENT emergency immediate admission

Answer 9

Unexplained Sudden onset unilateral deafness < 3 days

?Epiglottitis
Adult - sore throat, airway obstruction

Children - careful breathing , reluctant to talk, muffled voice/ cry, noisy breathing, drooling