ENT

Question 1

22 y/o female. singer - noticed deeper voice. Smoker. Examination = bilateral nodules on vocal cord

What is the diagnosis?
What is the treatment?

Answer 1

Vocal cord nodules - small, hard growth on vocal cords caused by voice abuse.

Tx = conservative - rest cords and speech therapy.

Surgical excision may be needed.

Question 2

At what age does laryngeal carcinoma commonly occur?

• how does it present?
• what is the most common type?
• does it affect men or women more often?
• what are some risk factors?

Answer 2

• middle aged- older patients

hoarse voice, cough or difficulty swallowing

may have systemic signs of distant mets

• usually squamous cell carcinoma
• more common in men
• RF: smoking, alcohol

Question 3

Globus pharyngeus

• what is it?
• How does it present?

Answer 3

sensation of lump at back of throat.

• no difficulty swallowing

RF: GORD, chronic sinusitis

Question 4

Achalasia

• what is it?
• how is it investigated?

Answer 4

disorder of oesophagus

• muscle layer affected - failure of relation of lower esophageal sphincter
• swallowing difficult and associated with regurgitation
• may be painful

Barium swallow = birds beak

Manometry - used to confirm hyper contraction

Question 5

Eosinophilic esophagitis

• presentation

Answer 5

allergic reaction with proliferation of eosinophils in oesophagus.

Pain - felt on swallowing
heart burn
may vomit and lose apetite

Question 6

Oesophageal ring

Answer 6

benign structure at lower end of oesophagus - may cause swallowing difficulties.

• not always symptomatic
• regurgitation - food gets obstructed and stuck in oesophagus

Ix = upper GI endoscopy

Question 7

Otitis externa

• risk factors
• treatment

Answer 7

RF: psoriasis

Tx = 2% acetic acid, neomycin or aminoglycosides

• may add steroid drops
• continue drops for 3 days after symptoms go away