ENT

Question 1

What are the causes of tonsillitis?

Answer 1

Bacterial: Group A Strep
Viral: EBV, Rhinovirus, Coronavirus, Adenovirus

Question 2

What are the 2 types of hearing loss?

Answer 2

Conductive: Common
Sensorineural: Majority of permanent impairment

Question 3

What is a common cause of conductive hearing loss?

Answer 3

Glue ear
50% conductive deafness resolves in 3m
95% resolves in 1year

Question 4

What are the causes of deafness?

Answer 4

Genetic: Turners, Kleinfelters
Infection: TORCH, HIV
Asphyxia
Alcohol & drugs

Question 5

What are the RFs for deafness?

Answer 5

Fhx
Infection
Ototoxic medications
Craniofacial abnormalities
Low birth weight
Prematurity
Head injury
Neurodegenerative disease

Question 6

How does deafness present?

Answer 6

Speech delay
Behavioural problems
Other physical signs

Question 7

How is hearing loss investigated?

Answer 7

Hearing tests
MRI/CT
Chromosomal studies

Question 8

How is deafness managed?

Answer 8

Cochlear implant
Conductive: Grommets
Hearing aids
BSL
Communication help

Question 9

What are the causes of a middle ear infection?

Answer 9

Viruses
Pneumococcus
Group A strep
H.influenzae

Question 10

What is seen on examination in otitis media?

Answer 10

Red bulging tympanic membrane
Loss of normal light reflection
Occassional perforation
Effusion: Air bubble, fluid level, retracted/concave/indrawn drum

Question 11

What are the signs & symptoms otitis media is associated with (systemically)?

Answer 11

Pain
Fever
Irritability
Pulling/tugging on ear
Poor feeding

Question 12

How is acute otitis media treated?

Answer 12

Admit: <3m w/temp >38
Paracetamol/NSAID
If no systemic features or no better after 72hrs:
Broad-spec Abx: Amoxicillin 20-30mg/kg TDS 5days (Clarithromycin if penicillin allergic)

Question 13

What are the complications of otitis media?

Answer 13

Mastoiditis
Meningitis
Recurrent ear infections: Secretory otitis media

Question 14

What is glue ear?

Answer 14

Otitis media with effusion

Question 15

Who is affected by glue ear?

Answer 15

90% with cleft palates

Question 16

What is the treatment for glue ear?

Answer 16

Active observation: 6-12w spont resolution common (followed by 2 hearing tests)
>6-12w: Refer to ENT
After referral: 3m active observation, hearing aids, autoinflation (Valsalva manoeuvre)
Surgery: Myringotomy & grommets

Question 17

What investigations are done to diagnose Otitis media with effusion?

Answer 17

Examination
Assess any hearing loss
Tympanometry: Assess ability of eardrum to react to sound
Audiometry: Determine the level of hearing loss

Question 18

What are the signs & symptoms of tonsillitis?

Answer 18

Fever > 38.5
Pain on swallowing
Painful cervical lymphadenopathy
Tonsillar Exudate

Question 19

How is tonsillitis treated?

Answer 19

Viral: Conservative
Bacterial: After confirmation with throat swab
Abx: Penicillin V/ Erythromycin for 10days

Question 20

What antibiotics should you avoid giving in tonsillitis?

Answer 20

Amoxicillin

If caused by EBV will cause maculopapular rash

Question 21

What is the Centor criteria?

Answer 21

Diagnosis of Group A Strep as cause of sore throat:
Tonsillar Exudate
Tender anterior cervical lymph nodes
Absence of cough
History of fever

Question 22

When should a tonsillectomy be considered?

Answer 22

Tonsillitis:
>7 episodes in 1 year
OR
5 in 2 consecutive years
OR
3 in 3 consecutive years

Question 23

What are the signs & symptoms of a peritonsillar abscess?

Answer 23

Unwell
Severe dysphagia
Earache
Trismus (lockjaw)
Unilateral bulge of the soft palate
Deviated uvula to the opposite side
Tonsilitis w/associated halitosis
Rupture: Aspiration pneumonia

Question 24

How is a peritonsillar abscess treated?

Answer 24

Penicillin

6w post: Tonsillectomy

Question 25

What are the complications of not treating tonsillitis caused by Group A Strep?

Answer 25

Rheumatic fever (mitral stenosis)