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1
Q

Presbycusis audiogram?

A
  1. Bilateral impairment
  2. High frequency hearing loss (The loss of hearing is most pronounced at higher frequencies (e.g., 2,000–8,000 Hz), which are important for understanding speech sounds like consonants (e.g., “s,” “f,” “th”).
  3. Downward sloping pure tone thresholds

*Gradual deterioration
*Sensorineural HL

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2
Q

Presbycusis causes?

A
  1. Arteriosclerosis
  2. DM, HTN, Hyperlipidaemia
  3. Noise exposure
  4. Drug exposure = salicylates, aminoglycosides, chemo (Cisplatin)
  5. Stress (Oxidative from free radicals)
  6. Genetic predisposition
  7. Age related (cochlear haircell loss, basilar membrane stiffening)
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3
Q

Presbycusis presentation?

A

Cant hear when old

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4
Q

Presbyacusis signs?

A

Possible Weber’s test bone conduction localisation to one side if sensorineural hearing loss not completely bilateral

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5
Q

Presbyacusis Ix?

A
  1. Otoscopy = normal
  2. Tympanometry = normal middle ear function with hearing loss
  3. Audiometry = bilateral sensorineural hearing loss
  4. Bloods = normal
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6
Q

Labyrinthitis definition?

A

Inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases

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7
Q

Most common form of labyrinthitis?

A

Viral

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8
Q

How to distinguish between viral labyrinthitis and vestibular neuritis?

A

Vestibular neuritis = only vestibular nerve involves, so there is no hearing impairment

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9
Q

Viral labyrinthitis presentation?

A

Acute onset of:
1. Vertigo
2. N&V
3. Hearing loss
4. Tinnitus
5. Preceding or concurrent URTI

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10
Q

Viral labyrinthitis signs?

A
  1. Unidirectional horizontal nystagmus towards unaffected side
  2. Sensorineural hearing loss
  3. Abnormal head impulse test: impaired VOR
  4. Gait disturbance: pt may fall towards the affected side
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11
Q

Viral labyrinthitis Dx?

A

History and examination

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12
Q

Viral labyrinthitis Rx?

A
  1. Usually self limiting
  2. Prochlorperazine or antihistamines may help reduce the sensation of dizziness
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13
Q

Epistaxis classification?

A

Anterior and posterior bleeds

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14
Q

Anterior epistaxis from?

A

Kiesselbach’s plexus

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15
Q

Posterior epistaxis mushkies?

A

Tend to be more profuse and originate from deeper structures. They occur more frequently in older patients and confer a higher risk of aspiration and airway compromise.

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16
Q

Epistaxis causes?

A
  1. Trauma
  2. Foreign bodies
  3. Bleeding disorders
  4. Juvenile angiofibroma
  5. Cocaine use
  6. HHT
  7. GPA
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17
Q

Epistaxis Rx?

A
  1. 1st aid
  2. If 1st aid successful
  3. Bleeding not stopping
  4. Haemodynamically unstable
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18
Q

Epistaxis 1st aid?

A
  1. Sit with torso forward and mouth open
  2. Pinch cartilagenous area firmly for 20 mins
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19
Q

If 1st aid successful?

A
  1. Naseptin to reduce crusting and risk of vestibulitis (caution if peanut/soy/neoymcin allergy, use mupricon instead)
  2. Consider admission if comorbidity or < 2 y/o
  3. Self care advice = blowing or picking the nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks should be avoided
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20
Q

If bleeding does not stop after 10-15 mins?

A
  1. Cautery = if bleed visible and cautery tolerated, blow nose, topical anaesthetic spray e.g. co-phenylcaine and wait 3-4 mins, apply silver nitrate stick for 3-10 seconds, apply naseptin/mupirocin
  2. Packing = anaesthetise with co-phenylcaine, pack nose, admit for observation and review
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21
Q

Bleed from unknown posterior source Rx?

A

Admit to hospital

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22
Q

Epistaxis that has failed all emergency management?

A

Sphenopalatine ligation

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23
Q

Sinusitis definition?

A

Inflammation of the mucous membranes of the paranasal sinuses. The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

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24
Q

Acute sinusitis predisposing factors?

A
  1. Nasal obstruction = septal deviation, nasal polyps
  2. Recent local infection
  3. Swimming/diving
  4. Smoking
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25
Q

Acute sinusitis features?

A
  1. Facial pain = frontal pressure pain worse on bending forwards
  2. Nasal discharge = thick and purulent
  3. Nasal obstruction
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26
Q

Acute sinusitis Rx?

A
  1. Analgesia
  2. Intranasal decongestants
  3. Sx > 10 days = Intranasal corticosteoids
  4. Oral abx for severe presentations = Phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
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27
Q

Why CXR for hoarseness?

A

Exclude apical lung lesion

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28
Q

Laryngeal cancer 2ww referral?

A

45 and over with
1. Persistent unexplained hoarseness
2. Unexplained lump in the neck

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29
Q

Otitis externa causes?

A
  1. Infection = S. aureus, P. aeruginosa, fungal
  2. Seborrhoeic dermatitis
  3. Contact dermatitis
  4. Recent swimming
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30
Q

Otitis externa causes?

A
  1. Infection = S. aureus, P. aeruginosa, fungal
  2. Seborrhoeic dermatitis
  3. Contact dermatitis
  4. Recent swimming
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31
Q

Otitis externa features?

A
  1. Ear pain, itch, discharge
  2. Otoscopy: red, swollen or eczematous canal
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32
Q

Otitis externa Rx?

A
  1. Combined topical Abx + Steroid (Or just topical Abx)
  2. Consider removal of canal debris
  3. If extensively swollen canal consider ear wick
  4. 2nd line = Flucloxacillin if spreading, Empirical use of antifungal, taking swab inside ear canal
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33
Q

Otitis externa fails to respond to topical Abx Rx?

A

Refer to ENT

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34
Q

Malignant otitis externa more common in?

A

DM

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35
Q

Malignant otitis externa definition?

A

Extension of infection into the bony ear canal and the soft tissues deep to the bony canal. Intravenous antibiotics may be required.

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36
Q

BPPV average age of onset?

A

55 y/o

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37
Q

BPPV features?

A
  1. Vertigo triggered by change in head position
  2. Nausea
  3. Each episode 10-20 seconds
  4. Positive Dix-hallpike = experiences vertigo with rotatory nystagmus
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38
Q

BPPV prognosis?

A

Resolves spontaneously after a few weeks to months

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39
Q

BPPV symptomatic relief?

A
  1. Epley manoeuvre (successful in 80%)
  2. Brandt-Daroff exercises
  3. Betahistine sometimes given but of limited value
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40
Q

BPPV recurrence?

A

50% will have recurrence 3-5 years after diagnosis

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41
Q

Rinne’s positive?

A

Normal = AC > BC

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42
Q

Rinne’s negative?

A

Conductive deafness = BC > AC

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43
Q

Weber’s interpretation?

A
  1. Unilateral sensorineural deafness = sound localised to unaffected side
  2. Unilateral conductive deafness = sound localised to affected side
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44
Q

Normal hearing Rinne and Weber?

A
  1. AC > BC bilaterally
  2. Weber midline
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45
Q

Conductive hearing loss Rinne and Weber?

A
  1. BC > AC in affected ear
  2. Weber lateralises to affected ear
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46
Q

How to remember conductive hearing loss?

A

Everything points to the side affected

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47
Q

Sensorineural hearing loss Rinne and Weber?

A
  1. AC > BC bilaterally (normal)
  2. Lateralises to unaffected ear
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48
Q

Nasal polyp epidemiology?

A
  1. 1% in UK
  2. 2-4x more common in men
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49
Q

Nasal polyp associations?

A
  1. Asthma
  2. Aspirin sensitivity
  3. Infective sinusitis
  4. CF
  5. Kartagener’s syndrome
  6. Churg-Strauss syndrome
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50
Q

Samter’s triad?

A
  1. Asthma
  2. Aspirin Sensitivity
  3. Nasal polyposis
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51
Q

Nasal polyp features?

A
  1. Nasal obstruction
  2. Rhinorrhoea, sneezing
  3. Poor sense of taste and smell
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52
Q

Unilateral nasal polyp?

A

Red flag

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53
Q

Nasal polyp Rx?

A
  1. Refer to ENT
  2. Topical corticosteroids will shrink polyp size in 80%
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54
Q

Otosclerosis mushkies?

A
  1. AD, replacement of normal bone by vascular spongy bone. Onset 20-40 y/o
  2. Features = conductive deafness, tinnitus, tympanic membrane flamingo tinge, positive FHx
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55
Q

Flamingo tinge?

A

Otosclerosis

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56
Q

Commonest cause of conductive hearing loss in childhood?

A

Glue ear

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57
Q

Glue ear AKA?

A

OME

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58
Q

Meniere’s more common in what age group?

A

Middle aged adults

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59
Q

Noise damage hearing loss mushkies?

A

Bilateral and typically worse at frequencies 3000-6000 Hz

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60
Q

Acoustic neuroma features?

A
  1. Cranial nerve VIII: hearing loss, vertigo, tinnitus
  2. Cranial nerve V: absent corneal reflex
  3. Cranial nerve VII: facial palsy
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61
Q

Black hair tongue definition?

A

Relatively common condition which results from defective desquamation of the filiform papillae. Despite the name the tongue may be brown, green, pink or another colour

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62
Q

Black hairy tongue predisposing factors?

A
  1. Poor oral hygiene
  2. Antibiotics
  3. Head and neck radiation
  4. HIV
  5. IVDU
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63
Q

Black hairy tongue Ix?

A

Swabbed to exclude candida

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64
Q

Black hair tongue Rx?

A
  1. Tongue scraping
  2. Topical antifungals if Candida
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65
Q

Audiogram interpretation rules?

A
  1. Anything above 20dB normal
  2. In sensorineural hearing loss both air and bone conduction impaired
  3. In conductive hearing loss only air conduction impaired
  4. In mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone
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66
Q

Malignant otitis externa most common cause?

A

Pseudomonas aeruginosa

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67
Q

Malignant otitis externa most common cause?

A

Pseudomonas aeruginosa

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68
Q

Malignant otitis externa can progress to?

A

Temporal bone osteomyelitis

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69
Q

Malignant otitis externa history features?

A
  1. DM (90%) or immunosuppression
  2. Severe, unrelenting, deep-seated otalgia
  3. Temporal headaches
  4. Purulent otorrhoea
  5. Possibly dysphagia, hoarseness and/or facial nerve dysfunction
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70
Q

Malignant otitis externa Dx?

A

CT scan

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71
Q

Malignant otitis externa Rx?

A
  1. Non-resolving otitis externa with worsening pain should be referred urgently to ENT
  2. IV Abx that cover Pseudomonas e.g. IV Ciprofloxacin
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72
Q

Diabetic pt presenting with non-malignant otitis externa Rx?

A

Ciprofloxacin

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73
Q

Otosclerosis inheritance?

A

AD

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74
Q

Otosclerosis definition?

A

Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window.

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75
Q

Otosclerosis features?

A
  1. Conductive deafness
  2. Tinnitus
  3. Normal tympanic membrane/10% have flamingo tinge caused by hyperaemia
  4. Positive FHx
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76
Q

Otosclerosis Rx?

A
  1. Hearing aid
  2. Stapedectomy
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77
Q

Sore throat encompasses?

A
  1. Pharyngitis
  2. Tonsillitis
  3. Laryngitis
78
Q

Sore throat indications for Abx?

A
  1. Marked systemic upset
  2. Unilateral peritonsillitis
  3. Hx of rheumatic fever
  4. Increased risk e.g. child with DM/immunodeficiency
  5. 3 or more Centor criteria
79
Q

Sore throat scoring systems?

A
  1. Centor criteria
  2. FeverPAIN criteria
80
Q

Centor criteria?

A

3 of:
1. Pus
2. Tender anterior cervical lymphadenoapthy
3. Fever
4. Absence of cough

81
Q

FeverPAIN?

A

Greater than 3/4 of:
1. Fever > 38
2. Pus
3. Attend rapidly (<3d)
4. Inflamed tonsils
5. No cough/coryza

82
Q

Sore throat Abx choice?

A

Phenoxymethylpenicillin or Clarithromycin (if allergic) –> Either a 7 or 10 day course should be given

83
Q

Glue ear risk factors?

A
  1. Male
  2. Siblings with glue ear
  3. Winter and spring
  4. Bottle feeding
  5. Day care attendance
  6. Parental smoking
84
Q

Glue ear features?

A
  1. Peaks at 2 y/o
  2. Hearing loss
  3. Secondary = language delay, behavioural or balance problems
85
Q

Glue ear Rx?

A
  1. Grommet (allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months)
  2. Adenoidectomy
86
Q

Most common cause of a perforated tympanic membrane?

87
Q

Perforated tympanic membrane Rx?

A
  1. No treatment, usually heals in 6-8 weeks, avoid getting water in ear
  2. Abx if perforation occurs following an episode of acute otitis media
  3. Myringoplasty if tympanic membrane doesnt heal by itself
88
Q

Ramsay Hunt syndrome cause?

A

Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve

89
Q

Ramsay Hunt syndrome features?

A
  1. Auricular pain
  2. Facial nerve palsy
  3. Vesicular rash around the ear
  4. Vertigo and tinnitus
90
Q

Ramsay Hunt syndrome Rx?

A

Oral aciclovir and corticosteroids

91
Q

Moves upward on swallowing?

A

Thyroid swelling

92
Q

Thyroglossal cyst mushkies?

A
  1. < 20 y/o
  2. Midline
  3. Upwards on protrusion of tongue
  4. Painful if infected
93
Q

Pharyngeal pouch mushkies?

A
  1. Older men
  2. Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
  3. Midline lump in neck that gurgles on palpation
  4. Dysphagia, regurgitation, aspiration and chronic cough
94
Q

Cystic hygroma mushkies?

A
  1. Lymphangioma on neck, usually left
  2. More evident at birth, around 90% before 2 y/o
95
Q

Branchial cyst mushkies?

A
  1. Oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
  2. Develop due to failure of obliteration of the second branchial cleft in embryonic development
  3. Early adulthood
96
Q

Cervical rib?

A
  1. Adult females
  2. 10% develop thoracic outlet syndrome
97
Q

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

98
Q

Cholesteatoma definition?

A

Non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction

99
Q

Cholesteatoma RFs?

A
  1. 10-20 y/o
  2. Cleft palate x100
100
Q

Cholesteatoma features?

A
  1. Foul-smelling, non-resolving discharge
  2. Hearing loss
101
Q

Cholesteatoma local invasion features?

A
  1. Vertigo
  2. Facial nerve palsy
  3. Cerebellopontine angle syndrome
102
Q

Cholesteatoma otoscopy?

A

Attic crust

103
Q

Cholesteatoma Rx?

A

ENT referral for consideration of surgical removal

104
Q

Supraglottitis Rx?

A
  1. IV Abx
  2. IV Dexamethaosone
  3. Adrenaline nebulisers
  4. ENT ward/ITU
105
Q

Supraglottitis Rx?

A
  1. IV Abx
  2. IV Dexamethaosone
  3. Adrenaline nebulisers
  4. ENT ward/ITU
106
Q

Mastoiditis features?

A
  1. Otalgia = severe, classically behind the ear
  2. Recurrent otitis media
  3. Fever, unwell
  4. Ear discharge if drum has perforated
  5. Swelling, erythema and tenderness over the mastoid process
107
Q

Mastoiditis Ix?

A

Clinical although CT may be ordered

108
Q

Mastoiditis Rx?

109
Q

Mastoiditis Complications?

A
  1. Facial nerve palsy
  2. Hearing loss
  3. Meningitis
110
Q

Unexplained oral ulcer persisting for >3 weeks?

111
Q

Signs and symptoms in the oral cavity > 6 weeks?

112
Q

Branchial cysts usually present during intercurrent what?

113
Q

Conductive hearing loss causes?

A
  1. Impacted wax
  2. Inner ear effusion
  3. Debris/foreign body in ear canal
  4. Perforated ear drum
  5. Otosclerosis
114
Q

Vertigo definition?

A

False sensation that the body or environment is moving

115
Q

Vertigo causes?

A
  1. Viral labyrinthitis
  2. Vestibular neuronitis
  3. BPPV
  4. Meniere’s
  5. Vertebrobasilar ischaemia
  6. Acoustic neuroma
  7. Other = POCS, trauma, MS, ototoxicity
116
Q

Hearing loss, tinnitus, sensation of fullness?

117
Q

Dizziness on extension of neck?

A

Vertebrobasilar ischaemia

118
Q

Tonsillitis complications?

A
  1. Otitis media
  2. Quinsy = peritonsillar abscess
  3. Rheumatic fever
  4. Glomerulonephritis
119
Q

Tonsillectomy criteria?

A

All of:
1. Sore throats due to tonsillitis (not URTI)
2. 5 or more episodes per year
3. For at least 1 year
4. Episodes disabling and prevent normal functioning

120
Q

Other established indications for tonsillectomy?

A
  1. Recurrent febrile convulsions secondary to episodes of tonsillitis
  2. OSA, stridor or dysphagia secondary to enlarged tonsils
  3. Quinsy if unresponsive to standard treatment
121
Q

Complications of tonsillectomy classification?

A
  1. Primary = <24 hours
  2. Secondary = 24h - 10 days
122
Q

Tonsillectomy primary complications?

A
  1. Haemorrhage in 2-3% (most commonly due to inadequate haemostasis)
  2. Pain
123
Q

Tonsillectomy secondary complications?

A
  1. Haemorrhage (most commonly due to infection)
  2. Pain
124
Q

Meniere’s disease definition?

A

A disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age.

125
Q

Meniere’s disease features?

A
  1. Recurrent vertigo, tinnitus and sensorineural hearing loss
  2. Sensation of aural fullness/pressure
  3. Nystagmus, positive Romberg
  4. Episodes last mins to hours
  5. Typically unilateral but bilateral disease can develop after a number of years
126
Q

Meniere’s disease features?

A
  1. Recurrent vertigo, tinnitus and sensorineural hearing loss
  2. Sensation of aural fullness/pressure
  3. Nystagmus, positive Romberg
  4. Episodes last mins to hours
  5. Typically unilateral but bilateral disease can develop after a number of years
127
Q

Meniere’s disease natural history?

A
  1. Symptoms resolve in majority after 5-10 years
  2. Majority of patients will be left with a degree of hearing loss
  3. Psychological distress is common
128
Q

Meniere’s disease Rx?

A
  1. ENT assessment to confirm Dx
  2. Pts should inform DVLA - current advice is to cease driving until satisfactory control of symptoms is achieved
  3. Acute attacks = Buccal/IM prochlorperazine
  4. Prevention = Betahistine and vestibular rehab
129
Q

Meniere’s disease acute Rx?

A

Buccal/IM Prochlorperazine

130
Q

Meniere’s disease chronic Rx?

A

Betahistine and vestibular rehab

131
Q

Post-tonsillectomy haemorrhage mushkies?

A
  1. All post-tonsillectomy haemorrhages should be assessed by ENT
  2. Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
  3. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
132
Q

Chronic rhinosinusitis epidemiology?

133
Q

Chronic rhinosinusitis definition?

A

An inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer

134
Q

Chronic rhinosinusitis predisposing factors?

A
  1. Atopy
  2. Nasal obstruction
  3. Recurrent local infection
  4. Swimming/diving
  5. Smoking
135
Q

Chronic rhinosinusitis features?

A
  1. Facial pain
  2. Nasal discharge
  3. Nasal obstruction = mouth breathing
  4. Post-nasal drip = chronic cough
136
Q

Chronic rhinosinusitis Rx?

A
  1. Avoid allergens
  2. Intranasal corticosteroids
  3. Nasal irrigation with saline solution
137
Q

Chronic rhinosinusitis red flags?

A
  1. Unilateral symptoms
  2. Persistent symptoms despite compliance with 3m of treatment
  3. Epistaxis
138
Q

Postnasal drip mushkies?

A

Occurs as a result of excessive mucus production by the nasal mucosa. This excess mucus accumulates in the throat or in the back of the nose resulting in a chronic cough and bad breath.

139
Q

Head and neck cancer includes?

A
  1. Oral cavity cancers
  2. Cancers of the pharynx
  3. Cancers of the larynx
140
Q

Head and neck cancer features?

A
  1. Neck lump
  2. Hoarseness
  3. Persistent sore throat
  4. Persistent mouth ulcer
141
Q

A history of unilateral earache with no obvious cause, persisting for more than 4 weeks?

142
Q

OME children Rx?

A

Observe child for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period

143
Q

Paediatric OME immediate referral criteria?

A
  1. Symptoms significantly affecting hearing, development or education
  2. Immediate referral in children with Downs syndrome or cleft palate
144
Q

Nasal septal haematoma definition?

A

Development of a haematoma between the septal cartilage and the overlying perichondrium.

145
Q

Nasal septal haematoma features?

A
  1. Precipitated by relatively minor trauma
  2. Sensation of nasal obstruction is the most common symptoms
  3. Pain and rhinorrhoea
  4. Bilateral, red swelling arising from nasal septum
  5. BOGGY
146
Q

Nasal septal haematoma Rx?

A
  1. Surgical drainage
  2. IV Abx
147
Q

Nasal septal haematoma complication?

A

If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a ‘saddle-nose’ deformity

148
Q

Bilateral parotid gland swelling causes?

A
  1. Infection = Mumps
  2. Inflammation = Sarcoid, Sjogrens
  3. Malignancy = Lymphoma
  4. Alcoholic liver disease
149
Q

Unilateral parotid gland swelling cause?

A
  1. Tumour = pleomorphic adenomas
  2. Stones
  3. Infection
150
Q

Acute otitis media in children pathophysiology?

A
  1. Whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
  2. Viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube
151
Q

Acute otitis media features?

A
  1. Otalgia
  2. Fever
  3. Hearing loss
  4. Recent Viral URTI Sx
  5. Ear discharge if membrane perforates
  6. Children may tug/rub ears
152
Q

Otitis media otoscopy findings?

A
  1. Bulging tympanic membrane –> loss of light reflex
  2. Opacification or erythema of the tympanic membrane
  3. Perforation with purulent otorrhoea
  4. Decreased mobility if using a pneumatic otosopic
153
Q

Otitis media Dx criteria?

A
  1. Acute onset of symptoms
  2. Presence of a middle ear effusion
  3. Inflammation of the tympanic membrane
154
Q

Acute otitis media Initial Rx?

A

Acute otitis media is generally a self-limiting condition that does not require an antibiotic prescription. There are however some exceptions listed below. Analgesia should be given to relieve otalgia. Parents should be advised to seek medical help if the symptoms worsen or do not improve after 3 days.

155
Q

When should Abx be given for acute otitis media?

A
  1. Symptoms lasting more than 4 days or not improving
  2. Systemically unwell but not requiring admission
  3. Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  4. Younger than 2 years with bilateral otitis media
  5. Otitis media with perforation and/or discharge in the canal
156
Q

Otitis media Abx choice?

A

5-7d Amoxicillin (erythromycin/carithromycin if pen allergic)

157
Q

Otitis media common sequelae?

A
  1. Hearing loss
  2. Labyrinthitis
  3. Perforation of tympanic membrane –> otorrhoea
158
Q

CSOM?

A
  1. Chronic suppurative otitis media
  2. Unresolved acute otitis media with perforation may develop into CSOM
  3. Defined as perforation of the tympanic membrane with otorrhoea for > 6 weeks
159
Q

Otitis media complications?

A
  1. Mastoiditis
  2. Meningitis
  3. Brain abscess
  4. Facial nerve paralysis
160
Q

Ramsay Hunt syndrome Rx?

A

Oral aciclovir and steroids

161
Q

Vestibular neuronitis features?

A
  1. Recurrent vertigo attacks lasting hours or days
  2. N&V
  3. Horizontal nystagmus
  4. No hearing loss or tinnitus
  5. Following viral infection
162
Q

Vestibular neuronitis Ddx?

A
  1. Viral labyrinthitis
  2. POCS (use HiNTs exam)
163
Q

Vestibular neuronitis Rx?

A
  1. Acute = Buccal/IM Prochlorperazine
  2. Short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
  3. Chronic = vestibular rehabilitation exercises
164
Q

Allergic rhinitis definition?

A

An inflammatory disorder of the nose where the nose become sensitized to allergens such as house dust mites and grass, tree and weed pollens.

165
Q

Allergic rhinitis classification?

A
  1. Seasonal = symptoms occur around the same time every year. Seasonal rhinitis which occurs secondary to pollens is known as hay fever
  2. Perennial = symptoms occur throughout the year
  3. Occupational = symptoms follow exposure to particular allergens within the work place
166
Q

Allergic rhinitis features?

A
  1. Sneezing
  2. Bilateral nasal obstruction
  3. Clear nasal discharge
  4. Post-nasal drip
  5. Nasal pruritis
167
Q

Allergic rhinitis Rx?

A
  1. Allergen avoidance
  2. Mild-moderate = oral/IN antihistamines
  3. Moderate-severe = IN corticosteroids
  4. Short course of oral corticosteroids occasionally needed to cover important life events
  5. May be a role for short courses of topical nasal decongestants (e.g. oxymetazoline). They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal
168
Q

Menieres triad?

A
  1. Vertigo
  2. Tinnitus
  3. Hearing loss
169
Q

Drug causes of gingival hyperplasia?

A
  1. Phenytoin
  2. Ciclosporin
  3. CCBs esp. nifedipine
170
Q

Other causes of gingival hyperplasia?

171
Q

Sudden-onset sensorineural hearing loss (SSNHL) Rx?

A

Urgent referral to ENT

172
Q

Main cause of SSNHL?

A

Idiopathic

173
Q

SSNHL Ix?

A

MRI to exclude vestibular schwannoma

174
Q

SSNHL Rx?

A

High dose oral corticosteroids are used by ENT for all causes of SSNHL

175
Q

Geohraphic tongue definition?

A

A benign, chronic condition of unknown cause. It is present in around 1-3% of the population and is more common in females

176
Q

Geographic tongue features?

A
  1. Erythematous areas with a white-grey border (the irregular, smooth red areas are said to look like the outline of a map)
  2. Some pts report burning after eating certain food
177
Q

Geographic tongue Rx?

A

Reassurance about benign nature

178
Q

Thyroid surgery complications?

A
  1. Anatomical = recurrent laryngeal nerve damage
  2. Bleeding = Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema
  3. Parathyroid damage –> hypocalcaemia
179
Q

Tinnitus definition?

A

Perception of sounds in the ears or head that do not come from an outside source

180
Q

Tinnitus prevalence?

A

1 in 10 people will experience an episode of tinnitus at some point in their life

181
Q

Causes of tinnitus?

A
  1. Idiopathic
  2. Menieres
  3. Otosclerosis
  4. Acoustic neuroma
  5. Hearing loss
  6. Drugs
  7. Impacted ear wax
182
Q

Drugs that cause tinnitus?

A
  1. Aspirin/NSAIDs
  2. Aminoglycosides
  3. Loop diuretics
  4. Quinine
183
Q

Tinnitus Ix?

A
  1. Audiological assessment = detect underlying hearing loss
  2. Imaging
184
Q

Tinnitus imaging mushkies?

A
  1. Not all patients will require imaging. Generally, non-pulsatile tinnitus does not require imaging unless it is unilateral or there are other neurological or ontological signs. MRI of the internal auditory meatuses (IAM) is first-line
  2. Pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus
185
Q

Tinnitus Rx?

A
  1. Underlying cause
  2. Amplification devices = more beneficial if associated hearing loss
  3. Psychological therapy may help a limited group of pts e.g. CBT
  4. Tinnitus support groups
186
Q

Salivary glands?

A
  1. Parotid (serous) = most tumours
  2. Submandibular (mixed) = most stones
  3. Sublingual (mucous)
187
Q

Salviary gland pathology?

A
  1. Tumours = 80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe
  2. Malignant = short hx, painful, hot skin, hard, fixation, CN VII involvement
188
Q

Pleomorphic adenoma mushkies?

A
  1. Benign, AKA mixed parotid tumour, 80%
  2. Middle age
  3. Slow-growing, painless lump
  4. Rx = superficial parotidectomy: risk = CN VII damage
189
Q

Warthin’s tumour mushkies?

A
  1. Benign, AKA adenolymphomas, 10%
  2. Males, middle age
  3. Softer, more mobile and fluctuant (although difficul tto differentiate)
190
Q

Salivary gland stones mushkies?

A
  1. Recurrent unilateral pain and swelling on eating
  2. May become infected –> Ludwig’s angina
  3. 80% submandibular
  4. Plain XR = sialography
  5. Rx = surgical removal
191
Q

Other causes of salivary gland enlargement?

A
  1. Acute viral infection = mumps
  2. Acute bacterial infection = 2nd to dehydration/diabetes
  3. Sicca syndrome and Sjogrens e.g. RA

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