ENT 👃🩺 Flashcards
What is the skin prick test used for?
To test for allergies by placing diluted allergens on the skin and piercing it with a needle
It includes controls with histamine (positive) and sterile water (negative) and is interpreted after 15 minutes.
What does a positive skin prick test indicate?
A wheal develops, indicating an allergy
This test is useful for food allergies and pollen allergies.
What does the radioallergosorbent test (RAST) measure?
The amount of IgE that reacts with specific allergens
Results are graded from 0 (negative) to 6 (strongly positive) and are useful for food allergies and inhaled allergens.
When are blood tests preferred over skin prick tests?
When skin prick tests are unsuitable, such as in extensive eczema or when taking antihistamines
Blood tests can provide necessary allergy information in these cases.
What is skin patch testing used for?
To diagnose contact dermatitis
30-40 allergens are placed on the back and read by a dermatologist after 48 hours.
Define oral allergy syndrome (OAS).
An IgE-mediated hypersensitivity reaction to specific raw, plant-based foods
It is linked to birch pollen and presents with oral symptoms after eating certain raw foods.
What triggers oral allergy syndrome?
Cross-reaction with non-food allergens, primarily birch pollen
Cooking the food denatures the proteins and prevents symptoms.
List common associations with oral allergy syndrome.
- Birch pollen allergy
- Rye grass pollen allergy
- Rubber latex allergy
These associations highlight the link between pollen allergies and OAS.
What symptoms are common in oral allergy syndrome?
- Itching and tingling of the lips, tongue, and mouth
- Mild swelling and redness
- Nausea and vomiting in severe cases
Symptoms typically resolve within one hour of contact.
How is oral allergy syndrome diagnosed?
Clinically, but further tests may rule out food allergies
Standard IgE RAST and skin prick testing can identify common allergens.
What is the primary management for oral allergy syndrome?
Avoidance of culprit foods
Oral antihistamines can be taken if symptoms develop after ingestion.
What are local allergic reactions to venom?
Redness, swelling, and pain at the site of venom exposure
Defined as spreading >10 cm from the site.
What characterizes systemic allergic reactions to venom?
Cutaneous reactions distant from the exposure site, such as widespread redness and urticaria
Anaphylaxis may occur with or without systemic cutaneous reactions.
What is the immediate management for anaphylaxis?
Intramuscular adrenaline, intravenous steroids, and antihistamines
Supportive care may also include oxygen and nebulised bronchodilators.
What is venom immunotherapy (VIT)?
An effective immunotherapy for patients with a history of systemic reactions to venom
Recommended for those with raised levels of venom-specific IgE.
What are the features of acute epiglottitis?
- Rapid onset
- High temperature
- Stridor
- Drooling of saliva
- Tripod position
It is a serious infection that can lead to airway obstruction.
What is the primary diagnostic method for acute epiglottitis?
Direct visualization by senior airway-trained staff
X-rays may show swelling of the epiglottis (thumb sign).
What management steps are critical for acute epiglottitis?
- Immediate senior involvement
- Possible endotracheal intubation
- Oxygen and intravenous antibiotics
Avoid examining the throat to prevent airway obstruction.
Define chronic rhinosinusitis.
An inflammatory disorder of the paranasal sinuses lasting 12 weeks or longer
It affects up to 1 in 10 people.
List predisposing factors for chronic rhinosinusitis.
- Atopy (hay fever, asthma)
- Nasal obstruction (septal deviation, polyps)
- Recent local infection
- Swimming/diving
- Smoking
These factors contribute to the development of chronic rhinosinusitis.
What are the common features of chronic rhinosinusitis?
- Facial pain (frontal pressure)
- Nasal discharge (clear or purulent)
- Nasal obstruction
- Post-nasal drip
Symptoms can vary based on the underlying cause.
What are red flag symptoms in chronic rhinosinusitis? (3)
- Unilateral symptoms
- Persistent symptoms despite treatment
- Epistaxis
These symptoms may indicate a more serious condition.
What is croup?
An upper respiratory tract infection characterized by stridor in infants and toddlers
Caused by laryngeal edema and secretions, mainly due to parainfluenza viruses.
What are the common features of croup?
- Barking cough
- Stridor
- Fever
- Coryzal symptoms
- Increased work of breathing
Symptoms tend to worsen at night.
What is the severity grading for croup?
Mild, Moderate, Severe
Severity is assessed based on symptoms such as stridor at rest and level of distress.
What is the recommended treatment for mild croup?
A single dose of oral dexamethasone (0.15mg/kg)
Prednisolone is an alternative if dexamethasone is unavailable.
What is the importance of the Hib vaccine in relation to epiglottitis?
The incidence of epiglottitis has decreased since the introduction of the Hib vaccine
It was traditionally considered a childhood disease but is now more common in adults.
What is the peak incidence age range for croup?
6 months - 3 years
During which season is croup more common?
Autumn
What are the characteristic features of croup?
- Barking, seal-like cough
- Stridor
- Fever
- Coryzal symptoms
- Increased work of breathing
What is the recommended management for all children with croup?
A single dose of oral dexamethasone (0.15mg/kg)
What are the three severity grades of croup?
- Mild
- Moderate
- Severe
What defines mild croup?
- Occasional barking cough
- No audible stridor at rest
- No or mild retractions
- Child is happy and plays
What defines moderate croup?
- Frequent barking cough
- Audible stridor at rest
- Retractions at rest
- Little distress
- Child can be placated
What defines severe croup?
- Frequent barking cough
- Prominent stridor at rest
- Marked retractions
- Significant distress or lethargy
- Tachycardia
What conditions warrant the admission of a child with croup?
- Moderate or severe croup
- < 3 months of age
- Known upper airway abnormalities
- Uncertainty about diagnosis
What imaging findings are associated with croup on a chest x-ray?
Subglottic narrowing (the ‘steeple sign’)
What are vestibular schwannomas also known as?
Acoustic neuromas
What is the classical history of vestibular schwannoma?
- Vertigo
- Hearing loss
- Tinnitus
- Absent corneal reflex
Which cranial nerve is affected in vestibular schwannoma leading to vertigo?
Cranial nerve VIII
What is a common investigation for suspected vestibular schwannoma?
MRI of the cerebellopontine angle
What is achalasia?
Failure of oesophageal peristalsis and relaxation of the lower oesophageal sphincter
What are the clinical features of achalasia?
- Dysphagia for both liquids and solids
- Heartburn
- Regurgitation
- Cough and aspiration pneumonia
What is the most important diagnostic test for achalasia?
Oesophageal manometry
What does a barium swallow show in achalasia?
‘Bird’s beak’ appearance and grossly expanded oesophagus
What is the first-line treatment for achalasia?
Pneumatic (balloon) dilation
What is acute epiglottitis?
A rare but serious infection caused by Haemophilus influenzae type B
What are the key features of acute epiglottitis?
- Rapid onset
- High temperature
- Stridor
- Drooling of saliva
- ‘Tripod’ position
What is the ‘thumb sign’ associated with?
Swelling of the epiglottis in acute epiglottitis
What is the management for suspected acute epiglottitis?
- Immediate senior involvement
- Endotracheal intubation if necessary
- Oxygen
- Intravenous antibiotics
What red flag symptoms indicate a need for urgent endoscopy in dysphagia?
New-onset dysphagia
What are some causes of dysphagia?
- Oesophageal cancer
- Oesophagitis
- Oesophageal candidiasis
- Achalasia
What are the features of chronic rhinosinusitis?
- Facial pain
- Nasal discharge
- Nasal obstruction
- Post-nasal drip
What are the predisposing factors for chronic rhinosinusitis?
- Atopy
- Nasal obstruction
- Recent local infection
- Smoking
What is the management for recurrent or chronic sinusitis?
- Avoid allergens
- Intranasal corticosteroids
- Nasal irrigation with saline
What is Bell’s palsy?
Acute, unilateral, idiopathic facial nerve paralysis
What is the recommended treatment for Bell’s palsy?
Oral prednisolone within 72 hours of onset
What are the features of Meniere’s disease?
- Recurrent episodes of vertigo
- Tinnitus
- Hearing loss
- Aural fullness or pressure
What is the management for acute attacks of Meniere’s disease?
Buccal or intramuscular prochlorperazine
What are the causes of otitis externa?
- Infection (bacterial or fungal)
- Seborrhoeic dermatitis
- Contact dermatitis
- Recent swimming
What is the initial management for otitis externa?
Topical antibiotic or combined topical antibiotic with a steroid
What are the two types of epistaxis?
- Anterior
- Posterior
What is the management for stable patients with epistaxis?
First aid measures: sit forward, avoid lying down
What should be inquired about if a patient is abraded or atrophied?
Drug use
Inhaled cocaine is a powerful vasoconstrictor that may result in the obliteration of the septum.
What is hereditary haemorrhagic telangiectasia?
A genetic disorder that leads to abnormal blood vessel formation
It can cause frequent nosebleeds and other bleeding issues.
What is granulomatosis with polyangiitis?
A rare disease that causes inflammation of blood vessels
It can affect various organs, including the respiratory system.
What is the first step in managing a stable patient with epistaxis?
Ask the patient to sit with their torso forward and mouth open
What should be avoided to reduce the risk of aspirating blood during an epistaxis episode?
Lying down unless feeling faint
How long should the cartilaginous area of the nose be pinched to control bleeding?
At least 20 minutes
What topical antiseptic can be used to reduce crusting and the risk of vestibulitis?
Naseptin (chlorhexidine and neomycin)
What are contraindications for using Naseptin?
Peanut, soy, or neomycin allergies
What is a viable alternative to Naseptin for patients with allergies?
Mupirocin
What self-care advice should be given to patients to reduce the risk of re-bleeding?
Avoid blowing or picking nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks
If bleeding does not stop after 10-15 minutes of pressure, what should be considered?
Cautery or packing
When should cautery be used in the management of epistaxis?
If the source of the bleed is visible and cautery is tolerated
What should be done before applying silver nitrate for cautery?
Use a topical local anaesthetic spray (e.g. Co-phenylcaine) and wait 3-4 minutes
What should be avoided when applying cautery to prevent perforation?
Touching areas which do not require treatment and cauterising both sides of the septum
What should be done if cautery is not viable or the bleeding point cannot be visualised?
Use nasal packing
What is the recommended position for a patient during nasal packing?
Sitting with their head forward
What should be examined for continuing bleeding after nasal packing?
The patient’s mouth and throat
What is the management for patients who are haemodynamically unstable or compromised?
Admit to the emergency department
What should be done for patients with a bleed from an unknown or posterior source?
Admit to hospital
What surgical procedure may be required for epistaxis that has failed all emergency management?
Sphenopalatine ligation in theatre
What is chronic rhinosinusitis?
An inflammatory disorder of the paranasal sinuses and linings of the nasal passages lasting 12 weeks or longer
Affects up to 1 in 10 people.
List at least three predisposing factors for chronic rhinosinusitis.
- Atopy (hay fever, asthma)
- Nasal obstruction (e.g. septal deviation, nasal polyps)
- Recent local infection (e.g. rhinitis, dental extraction)
- Swimming/diving
- Smoking
What are common features of chronic rhinosinusitis?
- Facial pain (frontal pressure worse on bending forward)
- Nasal discharge (clear if allergic, purulent if infected)
- Nasal obstruction
- Post-nasal drip
What is a recommended management strategy for recurrent or chronic sinusitis?
- Avoid allergens
- Intranasal corticosteroids
- Nasal irrigation with saline solution
Identify red flag symptoms for chronic rhinosinusitis.
- Unilateral symptoms
- Persistent symptoms despite 3 months of treatment
- Epistaxis
What is the role of the trigeminal nerve in facial pain?
It innervates the face and transmits pain sensations to the trigeminal nucleus in the brainstem
The trigeminal nerve has three main branches: ophthalmic (V1), maxillary (V2), and mandibular (V3).
What characterizes trigeminal neuralgia?
Severe lancinating facial pain along one or more branches of the trigeminal nerve
It is often idiopathic but can be due to compression of trigeminal roots.
State the definition of trigeminal neuralgia according to the International Headache Society.
A unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve.
What are common triggers for trigeminal neuralgia pain?
- Light touch
- Washing
- Shaving
- Smoking
- Talking
- Brushing teeth
List red flag symptoms indicating a serious underlying cause in facial pain.
- Sensory changes
- Deafness or other ear problems
- History of skin/oral lesions
- Pain only in the ophthalmic division
- Optic neuritis
- Family history of multiple sclerosis
- Age of onset before 40 years
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine
Referral to neurology is indicated if there is failure to respond to treatment or atypical features.
What is anaphylaxis?
A severe, life-threatening, generalised or systemic hypersensitivity reaction.
What are common causes of anaphylaxis?
- Food (e.g. nuts)
- Drugs
- Venom (e.g. wasp sting)
What features are indicative of anaphylaxis?
- Sudden onset and rapid progression of symptoms
- Airway, breathing, or circulation problems
What are the recommended doses for adrenaline in anaphylaxis for adults and children over 12 years?
500 micrograms (0.5ml 1 in 1,000)
Adrenaline can be repeated every 5 minutes if necessary.
What is the management for refractory anaphylaxis?
IV fluids for shock and consideration of an IV adrenaline infusion.
What is glue ear?
Otitis media with effusion; common in children, often leading to conductive hearing loss.
List risk factors for glue ear.
- Male sex
- Siblings with glue ear
- Higher incidence in Winter and Spring
- Bottle feeding
- Day care attendance
- Parental smoking
What is the most common presenting feature of glue ear?
Hearing loss
It is the commonest cause of conductive hearing loss in childhood.
What management options are available for glue ear?
- Active observation for 3 months
- Grommet insertion
- Adenoidectomy
What does Rinne’s test assess?
Differentiates conductive from sensorineural deafness.
What is a positive Rinne’s test result?
Air conduction (AC) is better than bone conduction (BC).
What does a negative Rinne’s test indicate?
Bone conduction (BC) is greater than air conduction (AC), suggesting conductive deafness.
What does Weber’s test assess?
Determines lateralization of sound to differentiate between conductive and sensorineural hearing loss.
In unilateral sensorineural deafness, where is the sound localized in Weber’s test?
To the unaffected side.
What is the management for sudden-onset sensorineural hearing loss (SSNHL)?
Urgent referral to ENT and high-dose oral corticosteroids.
What is acute epiglottitis and its common cause?
A rare but serious infection caused by Haemophilus influenzae type B.
List features of acute epiglottitis.
- Rapid onset
- High temperature
- Stridor
- Drooling of saliva
- Tripod position
What is the recommended management for suspected acute epiglottitis?
- Immediate senior involvement
- Endotracheal intubation if necessary
- Oxygen
- Intravenous antibiotics
What are common causes of hoarseness?
- Voice overuse
- Smoking
- Viral illness
- Hypothyroidism
- Gastro-oesophageal reflux
- Laryngeal cancer
- Lung cancer
What referral guidelines exist for suspected laryngeal cancer?
Consider a suspected cancer pathway referral for people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck.
What is the umbrella term for head and neck cancer?
Head and neck cancer typically includes:
* Oral cavity cancers
* Cancers of the pharynx (oropharynx, hypopharynx, nasopharynx)
* Cancers of the larynx
Head and neck cancers encompass a variety of malignancies affecting the anatomical structures of the head and neck region.
What are common features of head and neck cancer?
Common features include:
* Neck lump
* Hoarseness
* Persistent sore throat
* Persistent mouth ulcer
These features can indicate potential malignancies and warrant further investigation.
What are the NICE suspected cancer pathway referral criteria for laryngeal cancer?
Consider referral for laryngeal cancer in individuals aged 45 and over with:
* Persistent unexplained hoarseness
* Unexplained lump in the neck
This referral should be made for an appointment within 2 weeks.
What criteria indicate a suspected cancer pathway referral for oral cancer?
Referral indications for oral cancer include:
* Unexplained ulceration in the oral cavity lasting more than 3 weeks
* Persistent and unexplained lump in the neck
Urgent referrals to a dentist are indicated for specific oral findings.
What is a characteristic feature of thyroid cancer that warrants referral?
An unexplained thyroid lump warrants a suspected cancer pathway referral for thyroid cancer.
This referral is also for an appointment within 2 weeks.
What is the most common cause of neck swellings?
Reactive lymphadenopathy is by far the most common cause of neck swellings.
This condition may be associated with local infections or general viral illnesses.
Which neck lump condition is characterized by rubbery, painless lymphadenopathy?
Lymphoma is characterized by rubbery, painless lymphadenopathy.
Additional features may include night sweats and splenomegaly.
What are common symptoms of obstructive sleep apnea-hypopnea syndrome (OSAHS)?
Common symptoms include:
* Daytime somnolence
* Compensated respiratory acidosis
* Hypertension
These symptoms can significantly affect quality of life and overall health.
What is the first line management for moderate or severe OSAHS?
Continuous positive airway pressure (CPAP) is the first line for moderate or severe OSAHS.
This treatment is critical for managing symptoms and improving sleep quality.
What is acute epiglottitis and its causative agent?
Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B.
Recognition and treatment are essential to prevent airway obstruction.
What is the classic triad of symptoms for infectious mononucleosis?
The classic triad includes:
* Sore throat
* Lymphadenopathy
* Pyrexia
This triad is seen in around 98% of patients with the condition.
What is the first line antiviral treatment for influenza?
The first line antiviral treatment for influenza is oseltamivir.
This is used particularly in at-risk groups within 48 hours of symptom onset.
What is the management approach for sore throat?
Management includes:
* Paracetamol or ibuprofen for pain relief
* Antibiotics are not routinely indicated
A single dose of oral corticosteroid may reduce severity and duration of pain.
What scoring system is used to assess likelihood of strep infection in adults with sore throat?
The Centor criteria and FeverPAIN criteria are used for this assessment.
These scoring systems guide the decision-making process regarding antibiotic usage.
What are the common symptoms of upper respiratory tract infections (URTIs)?
Common symptoms include:
* Nasal discharge
* Nasal obstruction
* Sore throat
* Headache
* Cough
* Tiredness
* General malaise
URTIs are often caused by viral infections.
What is whooping cough caused by?
Whooping cough is caused by the Gram-negative bacterium Bordetella pertussis.
It typically presents in children and is notable for prolonged coughing fits.
What phases are involved in the presentation of whooping cough?
The phases include:
* Catarrhal phase
* Paroxysmal phase
* Convalescent phase
Each phase has distinct symptoms and duration.
What is the diagnostic criteria for whooping cough?
Diagnostic criteria include:
* Acute cough lasting 14 days or more
* Paroxysmal cough
* Inspiratory whoop
* Post-tussive vomiting
These features help differentiate it from other respiratory illnesses.
What type of antibiotic is indicated for cough onset within the previous 21 days?
An oral macrolide (e.g. clarithromycin, azithromycin, or erythromycin)
This is to eradicate the organism and reduce the spread.
What should be offered to household contacts of a patient with whooping cough?
Antibiotic prophylaxis
This is to prevent the spread of the infection.
Does antibiotic therapy alter the course of whooping cough?
No
Antibiotic therapy has not been shown to alter the course of the illness.
What is the school exclusion period for children after starting antibiotics for whooping cough?
48 hours after commencing antibiotics or 21 days from onset of symptoms if no antibiotics
This is to reduce the risk of spreading the infection.
List some complications associated with whooping cough. (4)
- Subconjunctival haemorrhage
- Pneumonia
- Bronchiectasis
- Seizures
What vaccination program was introduced in 2012 for pregnant women?
Whooping cough vaccination program
This was introduced due to an outbreak that resulted in the death of 14 newborn children.
What is the effectiveness of the whooping cough vaccine in preventing newborns from developing the disease?
More than 90% effective
The vaccine significantly reduces the incidence of whooping cough in newborns.
At what stage of pregnancy are women offered the whooping cough vaccine?
Between 16-32 weeks pregnant
This timing is crucial for maternal and newborn protection.
What is acute epiglottitis and what causes it?
A rare but serious infection caused by Haemophilus influenzae type B
Prompt recognition and treatment are essential to prevent airway obstruction.
What is a key feature of epiglottitis diagnosis?
Direct visualisation by senior/airway trained staff
X-rays may also be used, particularly for foreign body concerns.
What does the ‘thumb sign’ indicate in a lateral view x-ray?
Swelling of the epiglottis in acute epiglottitis
This is a characteristic finding in epiglottitis.
What is the primary management step for patients with suspected epiglottitis?
Immediate senior involvement for emergency airway support
Endotracheal intubation may be necessary.
What is croup and which viruses are most commonly responsible?
A form of upper respiratory tract infection in infants and toddlers, primarily caused by parainfluenza viruses
It is characterized by stridor due to laryngeal edema.
What are the peak ages for croup incidence?
6 months to 3 years
Croup is more common during the autumn season.
What is a common feature of croup?
Barking, seal-like cough
Symptoms worsen at night and may include stridor and fever.
List the severity grading for croup.
- Mild: Occasional barking cough, no stridor at rest
- Moderate: Frequent barking cough, audible stridor at rest
- Severe: Frequent barking cough, prominent stridor at rest, significant distress
What should be done for children with moderate or severe croup according to NICE guidelines?
Admit any child with moderate or severe croup
This includes children under 3 months of age or those with known upper airway abnormalities.
What is Meniere’s disease characterized by?
Excessive pressure and progressive dilation of the endolymphatic system
It is often seen in middle-aged adults but can occur at any age.
What are the main features of Meniere’s disease?
- Recurrent episodes of vertigo
- Tinnitus
- Hearing loss (sensorineural)
- Sensation of aural fullness or pressure
What is the typical natural history of Meniere’s disease?
Symptoms resolve in the majority of patients after 5-10 years
Most patients will still experience some degree of hearing loss.
What is tinnitus?
The perception of sounds in the ears or head that do not come from an outside source
It can be distressing and may indicate a serious underlying condition.
List some causes of tinnitus. (7)
- Idiopathic
- Meniere’s disease
- Otosclerosis
- Sudden onset sensorineural hearing loss (SSNHL)
- Acoustic neuroma
- Drugs (e.g. aspirin, aminoglycosides)
- Impacted ear wax
What is the first-line investigation for pulsatile tinnitus?
Magnetic resonance angiography (MRA)
This is used to investigate potential underlying vascular causes.
What is the classical history of vestibular schwannoma?
Combination of vertigo, hearing loss, tinnitus, and absent corneal reflex
Features are predicted by the affected cranial nerves.
What is benign paroxysmal positional vertigo (BPPV) characterized by?
Sudden onset of dizziness and vertigo triggered by changes in head position
Each episode typically lasts 10-20 seconds.
What is the Epley manoeuvre used for?
Treatment for BPPV
It is successful in around 80% of cases.
What should patients with Meniere’s disease inform the DVLA about?
They should inform the DVLA and cease driving until satisfactory control of symptoms is achieved
This is crucial for safety reasons.
What is a peritonsillar abscess typically a complication of?
Bacterial tonsillitis
List the features of a peritonsillar abscess.
- Severe throat pain lateralised to one side
- Deviation of the uvula to the unaffected side
- Trismus (difficulty opening the mouth)
- Reduced neck mobility
What urgent medical specialist should review patients with a peritonsillar abscess?
ENT specialist
What are the management options for a peritonsillar abscess?
- Needle aspiration
- Incision & drainage
- Intravenous antibiotics
- Tonsillectomy to prevent recurrence
What are some complications of tonsillitis?
- Otitis media
- Quinsy (peritonsillar abscess)
- Rheumatic fever
- Glomerulonephritis (very rarely)
What criteria does NICE recommend for considering tonsillectomy?
- Sore throats due to tonsillitis
- 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years
- Episodes are disabling and prevent normal functioning
List other established indications for tonsillectomy.
- Recurrent febrile convulsions secondary to tonsillitis
- Obstructive sleep apnoea secondary to enlarged tonsils
- Peritonsillar abscess unresponsive to standard treatment
What are the primary complications of tonsillectomy?
- Haemorrhage (2-3%)
- Pain
When does primary haemorrhage typically occur after tonsillectomy?
In the first 6-8 hours
What is benign paroxysmal positional vertigo (BPPV) characterized by?
Sudden onset of dizziness and vertigo triggered by changes in head position
What is the average age of onset for BPPV?
55 years
List the features of BPPV.
- Vertigo triggered by head position change
- May be associated with nausea
- Episodes last 10-20 seconds
- Positive Dix-Hallpike manoeuvre
- Rotatory nystagmus
What is the prognosis for BPPV?
Usually resolves spontaneously after a few weeks to months
What is the Epley manoeuvre used for?
Symptomatic relief in BPPV (successful in around 80% of cases)
What chronic condition affects up to 1 in 10 people?
Chronic rhinosinusitis
What are the predisposing factors for chronic rhinosinusitis?
- Atopy (hay fever, asthma)
- Nasal obstruction (e.g. septal deviation)
- Recent local infection (e.g. rhinitis)
- Swimming/diving
- Smoking
List the features of chronic rhinosinusitis.
- Facial pain (typically frontal)
- Nasal discharge
- Nasal obstruction
- Post-nasal drip
What are ‘red flag’ symptoms for chronic rhinosinusitis?
- Unilateral symptoms
- Persistent symptoms despite treatment
- Epistaxis
What virus is predominantly responsible for infectious mononucleosis?
Epstein-Barr virus (EBV)
What is the classic triad of symptoms for infectious mononucleosis?
- Sore throat
- Lymphadenopathy
- Pyrexia
What is the management for infectious mononucleosis?
- Supportive care
- Rest
- Hydration
- Simple analgesia
- Avoid contact sports for 4 weeks
What is Meniere’s disease characterized by?
- Recurrent episodes of vertigo
- Tinnitus
- Hearing loss
- Aural fullness or pressure
What is the management for acute attacks of Meniere’s disease?
Buccal or intramuscular prochlorperazine
What is a common consequence of obstructive sleep apnoea-hypopnoea syndrome (OSAHS)?
Daytime somnolence
What is the first-line treatment for moderate or severe OSAHS?
Continuous positive airway pressure (CPAP)
What is malignant otitis externa most commonly caused by?
Pseudomonas aeruginosa
What are the key features of malignant otitis externa?
- Severe deep-seated otalgia
- Temporal headaches
- Purulent otorrhea
- Possible dysphagia or facial nerve dysfunction
What is a common initial management strategy for otitis externa?
Topical antibiotic or combined topical antibiotic with a steroid
What is the most common cause of acute otitis media in children?
Bacterial infections secondary to viral upper respiratory tract infections
List the common sequelae of acute otitis media.
- Perforation of the tympanic membrane
- Chronic suppurative otitis media
- Hearing loss
- Labyrinthitis
What is glue ear also known as?
Otitis media with effusion
What are the treatment options for glue ear?
- Active observation
- Grommet insertion
- Adenoidectomy
What are vestibular schwannomas also referred to as?
Acoustic neuromas
What cranial nerve symptoms are associated with vestibular schwannoma?
- Cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
- Cranial nerve V: absent corneal reflex
What percentage of intracranial tumours do vestibular schwannomas account for?
Approximately 5%
Vestibular schwannomas are also known as acoustic neuromas.
What are the classical symptoms of vestibular schwannoma?
Vertigo, hearing loss, tinnitus, absent corneal reflex
Symptoms vary based on affected cranial nerves.
Which cranial nerve is associated with vertigo and unilateral sensorineural hearing loss in vestibular schwannoma?
Cranial nerve VIII
This nerve is also associated with unilateral tinnitus.
What symptom is associated with cranial nerve V in vestibular schwannoma?
Absent corneal reflex
Which cranial nerve is involved in facial palsy in vestibular schwannoma?
Cranial nerve VII
In which condition are bilateral vestibular schwannomas commonly seen?
Neurofibromatosis type 2
What should patients with a suspected vestibular schwannoma be referred for?
Urgent ENT evaluation
How are vestibular schwannomas typically characterized in terms of growth and behavior?
Slow growing, benign, often observed initially
What is the investigation of choice for vestibular schwannoma?
MRI of the cerebellopontine angle
What is an important diagnostic tool alongside MRI for vestibular schwannoma?
Audiometry
What percentage of patients with vestibular schwannoma will have a normal audiogram?
Only 5%
What are the management options for vestibular schwannoma?
Surgery, radiotherapy, observation
