ENT

Question 1

Acoustic neuroma definition

Answer 1

benign schwannoma develops in CNVIII (most commonly vestibular division)
Can be auditory canal or extracanalicular
Occurs in inner ear

Question 2

Acoustic neuroma aetiology/RF

Answer 2

NFM type 2 biggest RF

radiation exposure

Question 3

Acoustic neuroma epi

Answer 3

40-60
unless NFM2 (peak incidence 30)
rarely can occur in children

Question 4

Acoustic neuroma symptoms

Answer 4

most present with: unilateral hearing loss due to cochlear n. interruption
May have: tinitus, vertigo, headache, facial numbness/paralysis.
If large mass at cerebellopontine angle: compress brainstem (gait abnormality)

Question 5

Acoustic neuroma investigations

Answer 5

CT/MRI for dx

audiometry

Question 6

Acoustic neuroma management

Answer 6

1. Observation if small or elderly w/comorb
   
   2. Stereotactic radio or
   3. Open craniotomy to remove tumour
      After surgery perform MRI at 6-12 months

Question 7

acoustic neuroma complications

Answer 7

mostly post surgical: hearing loss (most common) injury to anterior inferior cerebrla artery, heamorrhage, cerebellar trauma, facial paralysis

Question 8

acoustic neuroma prognosis

Answer 8

Depends on patient status and speed of growth/structures It grows around
Progressive if not removed
Symptoms can persist despire Rx

Question 9

BPPV mangement (advice)

Answer 9

Most recover over several weeks even w/o Mx.
Sx may last longer and recurr
Simple repositioning manoeuvre can help majority
Get out of bed slowly and avoid looking up
Discuss safety to drive (most fine) and workplace/home safety

Question 10

BPPV management active

Answer 10

Offer Epley manoeuvre (repeat at 1w if not resolved)
Offer brandt-daroff exercises at home
Return in 4w if not resolved
NOT routinely drugs (consider antiemetic if symptomatic)

Question 11

BPPV referral

Answer 11

hospital: severe N+V and unable to tolerate PO fluid
specialist: If Epley cant be performed in primary care. or hasnt worked repeatedly OR no resolution after 4w

Question 12

BPPV complications

Answer 12

persistent N+V - antiemetic (ondansetron) ?hospital for fluids

Question 13

BPPV prognosis

Answer 13

Often recurrent (15-37% after initially effective manoeuvres
Most recurrences in first year

Question 14

Cholesteatoma definition

Answer 14

Accumulation of keratinising squamous epithelium and keratin debris usually involving the middle ear and the mastoid. Although benign it can inlarge and invade adjacent bone.

Question 15

Cholesteatoma aetiology/RF

Answer 15

Middle ear disease (otitis media)
Eustacian tube dysfunction
Prior otological surgery
Traumatic ear blast injury
Congential abnormality (cleft palate, craniofacial abnormality)

Question 16

Cholesteatoma epi

Answer 16

10:100,000/yr in adults, 3-10:100,000 in children
M:F 1.4:1
Peak incidence in second decade but occurs from babies to elderly

Question 17

Cholesteatoma symptoms

Answer 17

Malodorous discharge(resistant to Abx) with associated conductive hearing loss

Question 18

Examination of cholesteatoma

Answer 18

Crust/keratin in attic (upper part of middle ear), pars flaccida, or pars tensa +/- tympanic membrane perforation

Question 19

Cholesteatoma investigations

Answer 19

Pure tone audiogram - may have conductive (+sensorineural if cochlear damage of pre-existing hearing loss) but may be normal
CT of petrous temporal bones
Order MRI if suspecting intracranial Cx (abscess, meningitis or other inner ear Cx)

Question 20

Management of cholesteatoma

Answer 20

1. Surgery indicated in all patients:
   Canal wall up or down mastoidectomy
   i. Up leaves canal wall intact but requires a second look procedure at 9-12m to ensure disease has not recurred. Preferred in children as avoids long term Cx of mastoid cavity
   ii. Canal down involves drilling through attic wall posteroirly. If otic attic is not repaired in canal down then this permits visualisation of disease recurrence.
   - The use of endoscopy during the procedure has a postive impact
   - 8mg of dexamethasone reduces post-op N+V and reduces requirement for analgesia
   - If discharge is present on intial presentation ciprofloxacin/dexamethasone otic can be prescrbed to clear it up before surgery

Question 21

Complications of cholesteatoma

Answer 21

Otitis media - ciprofloxacin/dexamethasone otic if prepping for surgery. Consider amoxicililin
Vertigo - managed with surgery to remove cholesteatoma
Hearing loss (conductive or sensineural if affecting inner ear)
Mastoiditis
Facial palsy

Question 22

Prognosis of cholesteatoma

Answer 22

Will continue to grow if not removed
May recurr after surgery
Surgery is typically effective
Some Cx may be permanent if structures are damaged