ENT

Question 1

Cholesteatoma features

Answer 1

Proliferation of skin cells in middle ear and mastoid air cell spaces
Risk factors:
-trisomy 21
-cleft palate
-recurrent childhood OM
Sx:
-conductive hearing loss
-balance issues
-foul-smelling ear discharge
-otalgia
-vertigo
-facial palsy
-positive fistula test
-retraction pocket + squamous debris esp posterosuperior aspect
-granular polyp
-Weber’s to affected side
-Rinne = bone>air
Needs audiogram, CT and referral + antibiotic/steroid drops while review awaited

Question 2

Sudden sensorineural hearing loss

Answer 2

Weber will localise to unaffected ear
Rinne will appear similar to normal but will be diminished
For DW ENT and urgent audiometry
Likely for steroids after DW ENT

Question 3

Tinnitus causes

Answer 3

Most likely impacted cerumen, AOM, associated with noise or age
More concerning diagnoses include:
-acoustic neoplasm (unilateral with associated hearing loss)
-Meniere’s (fluctuating)
cholesteatoma (conductive hearing loss)
-vascular abnormalities (pulsatile tinnitus)

Question 4

Risk factors for OM

Answer 4

6mo-2yo
Daycare
Tobacco smoke exposure
Pacifier use >6mo
Formula-fed
URTI
FHx
Ethnicity
Prematurity
Low birth weight
Asthma or other chronic illness