ENT

Question 1

What are the symptoms of acoustic neuroma/vestibular schwannoma?

Answer 1

Sensorineural hearing loss, tinnitus, vertigo

+ V1 affected usually (loss of sensation face, loss of corneal reflex)

+ VII affected (face weakness)

Benign tumour of VIII, which affects V and VII as it grows

Question 2

What is the gold standard investigation for acoustic neuroma/vestibular schwannoma?

Answer 2

MRI with contrast

Question 3

Vertigo only, following URTI?

Answer 3

Vestibular neuronitis

Question 4

Vertigo plus hearing loss or tinnitus after URTI?

Answer 4

Labyrinthitis

Question 5

Triad of sensorineural hearing loss, vertigo, tinnitus plus feeling of ear fullness?

Answer 5

Ménière’s disease

Question 6

Conductive hearing loss, discharge and small mass top of tympanic membrane?

Answer 6

Cholesteatoma

Question 7

What is glue ear?

Answer 7

Otitis media with effusion

Common in 2 year olds, insert grommet if persists

Question 8

Mx of perforated ear drum?

Answer 8

Watch and wait for 6 weeks, avoid water

If no improvement, ENT referral

ABx only given if caused by otitis media

Question 9

what is the prognosis of Ménière’s disease?

Answer 9

attacks last mins-hours

Disease has relatively long course - lasts for 5-10 years

Most patients left with degree of hearing loss :(

Question 10

What is the Mx of Meniere’s?

Answer 10

Buccal/IM prochlorperazine

ENT referral for diagnosis

Question 11

when is a HINTS exam indicated?

Answer 11

in cases of vertigo and nystagmus when neuro exam is otherwise all normal, it’s used to differentiate the cause of acute vestibular syndrome being central (STROKE) vs peripheral (e.g. vestibular neuronitis).

Question 12

What would HINTS exam show in vestibular neuronitis?

Answer 12

Head impulse - abnormal
Nystagmus - unidirectional to affected side
Skew test - negative

In stroke, impulse normal, nystagmus bidirectional and skew test positive.

Question 13

What is the difference clinically between OE and OM?

Answer 13

Externa - ear pain, itchy, discharge, red ear canal

Media - ear pain, fever, potential hearing loss, bulging TM (loss of light reflex). Preceding URTI.

Question 14

Common consequences of OM?

Answer 14

TM perforation

CSOM (when following perforation, there’s ongoing discharge for 6 weeks)

Labyrinthitis

Question 15

Complications of OM?

Answer 15

Meningitis, Brain abscess, mastoiditis, hearing loss

Question 16

Otitis externa bacteria

Answer 16

S.Aureus and Pseudomonas

Question 17

OM bacteria

Answer 17

HMS

HiB
Moraxella
Streptococcus pneumoniae

Question 18

What should you do if you find unilateral nasal polyp?

Answer 18

ENT 2ww referral

Question 19

which specific pathogen are diabetics susceptible to?

Answer 19

Pseudomonas Aeruginosa

Question 20

Otitis externa + immunosuppression/diabetes?

Answer 20

Malignant otitis externa (spreading infection)

Treat with IV Ciprofloxacin to cover pseudomonas

Question 21

When is Abx treatment indicated in OM?

Answer 21

after 3 days

if bilateral and under 3yrs

if systemically unwell/any complications

Question 22

Which nerve can be affected in parotid gland and/or ear pathology?

Answer 22

Facial nerve!
Runs through parotid

parotid tumour or its removal can affect facial nerve

Question 23

Parotid glands - 80% of

Answer 23

salivary gland tumours

Question 24

Submandibular glands - 80% of

Answer 24

salivary gland stones