ENT

Question 1

BPPV

Answer 1

Often self-limiting in 6 months
Vestibular rehab with Epley manoeuvre
Antiemetics like prochlorperazine but low effectiveness
Surgical - denervate posterior semicircular canal
Stop driving if sudden, unexpected or disabling dizziness and inform DVLA

Question 2

Acute otitis media

Answer 2

Otoscopy, resp exam, cranial nerves
Urgent ENT referral if mastoiditis
Clinical diagnosis, consider ear swab or audiological assessment
Supportive management + amox if bacterial and systemically ill
Tympanocentesis

Question 3

Otitis media with effusion

Answer 3

Conservative - watchful waiting for 3 months + Eustachian tube autoinflation
Medical - none
Surgical = grommets +/- adenoidectomy are recommended if hearing loss > 3 months, language delayed, craniofacial abnormalities or recurrent AOM with OME. Consider hearing aids.

Question 4

Meniere’s disease

Answer 4

Recurrent vertigo, SN hearing loss, aural fullness
ENT+neuro exams, audiology, ?MRI
Conservative - salt + caffeine restriction, alco, smoking, stress, vestibular rehab
Medical - vestibular sedatives (prochlor), betahistine
Surgical - intratympanic injection

Question 5

Epistaxis

Answer 5

FBC, G&S, coagulation
A to E approach with wide cannulas
Pinch soft nose for 10min + ice pack
Silver nitrate cautery + LA
Pack with nasal tampon/rapid rhino
Posterior - pack with Foley
Surgical ligation of artery