ENT

Question 1

List 5 risk factors for otitis media.

Answer 1

• Male gender
• Day care attendance
• Pacifier use
• Parental smoking
• FHx of middle ear disease
• Anatomic abnormalities (Down syndrome)
• Immunocompromise (HIV)
• Winter

Question 2

Define otitis media vs acute otitis media vs otitis media with effusion

Answer 2

otitis media: inflammation of middle ear
AOM: S/S of acute middle ear infection with evidence of effusion

Otitis media with effusion: effusion without s/s of acute infection

Question 3

List the 3 most common bacteria associated with AOM.

Answer 3

• Streptococcus pneumoniae
• Haemophilus influenzae (primarily nontypeable)
• Moraxella catarrhalis

Question 4

List 5 intratemporal and 6 intracranial complications or AOM.

Answer 4

Intratemporal:
- Hearing impairment
	o Temporary conductive
	o Sensorineural
- TM perforation
	o Spontaneous resolution
	o Chronic perforation
- Cholesteatoma
- Labrynthitis
Infectious eczematous dermatitis

Intracranial:

• Meningitis
• Encephalitis
• Brain abscess
• Epidural abscess
• Subdural empyema
• Lateral venous thrombosis
• Mastoiditis

Question 5

List the most common bacterial causes of otitis externa.

Answer 5

• P. aeruginosa
• S. aureus
• S. epidermidis
  Polymicrobial

Question 6

List bugs associated with necrotizing external otitis?

Answer 6

• Pseudomonas
• S. aureus
• S. epidermidis
• Proteus mirabilis
• Klebsiella
• Aspergillus
  Salmonella

Question 7

List conditions that can be complicated by mastoiditis?

Answer 7

• AOM
• Leukemia
• Mononucleosis
• Sarcoma or the temporal bone
  Kawasaki’s disease

Question 8

List 8 causes of SSHL:

Answer 8

Idiopathic (71%)

Infectious (12.8%) 
- URTI NOS
- Meningitis
- GAS
- Syphillis
- EBV (Ebstein barr virus)
- Toxoplamososis
- Mumps
- HSV
- HCV
- Adenovirus
- VZV
- Viral encephalitis
- Rubeola

Otologic Disease (2.8%)
- Meniere’s disease
- Fluctuating hearing loss
- Post operative NSx or ENT
- Autoimmune hearing disease
- Otoscelrosis
- Aminoglycoside toxicity
Progressive hearing loss
Trauma (4.2%)
- Head injury or skull base #
- Acoustic trauma
- Barotrauma
- Iatrogenic
- SDH

Vascular or hematologic emergency (2.8%)
- CVA / TIA
- Pontine hemorrhage
- Sickle cell
- Hypercoaguable states
- Leukemia
- Macroglobulinemia
- Polycythemia

Neoplastic (2.3%)
- Vestibular shwannoma
- Cerebellar angioma
- Meningioma
- Multiple myeloma

Other (2.2%)
- Pregnancy related
- Other CNS disease
- Non-otologic surgery post operative
- Post-rabies vaccination
- CO toxicity
Hyperlipoproteinuria

Question 9

What are complications of posterior packing?

Answer 9

• Hypoxia
• Hypercarbia
• Dysrhythmia, bradycadia
• MI
• CVA
• Aspiration, apnea
• (Should be admitted with ENT referral)
• Apnea

Question 10

List the 8 deep spaces of the head and neck:

Answer 10

1. Submandibular
2. Parotid
3. Peritonsillar
4. Parapharyngeal
5. Retropharyngeal
6. Pretracheal
7. Prevertebral
   Danger space

Question 11

What is Ludwig’s angina, and how is it treated?

Answer 11

• Bilateral infection of submandibular space (sublingual and submyohyoid spaces)
• Woody cellulitis rapidly spreading without lymphatic involvement and without abscess formation
• May spread into parapharyngeal space à retropharyngeal space à mediastinum
• Rx:
  o Airway management
  o Antibiotics: piptazo
  o ENT consult
  o Most don’t need surgical drainage because there’s no collection

Question 12

What is the presentation of retropharyngeal absesses?

Answer 12

• Dyshpagia
• Odynophagia
• Neck pain, torticollis, unwilling to extend neck
• Fever
• Change in quality of voice
• Respiratory distress (esp peds)
• Neck swelling, mass, lymphadenopathy
• Trismus (20%)
• Chest pain if mediastinal involvement