ENT

Question 1

labryinthitis vs vestibular neuritis?

Answer 1

vestibular neuritis: only vestibular n involved -> no hearing impairment.

Labyrinthitis: affects vestibular n and labyrinth -> vertigo and hearing impairment

Question 2

Features of labyrinthitis?

Answer 2

acute onset:

vertigo, N+V, hearing loss (uni or bilateral), tinnitus, preceding/ concurrent URTI

Question 3

Signs of labyrinthitis?

Answer 3

• spontaneous unidirectional horizontal nystagmus towards the unaffected side
• sensorineural hearing loss: shown by Rinne’s test and Weber test
• abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
• gait disturbance: the patient may fall towards the affected side
• normal skew test
• abnormality on inspection of the external ear canal and the tympanic membrane e.g. vesicles in herpes simplex infection

Question 4

Mx of sudden onset sensorineural hearing loss?

Answer 4

urgent referral to ENT to rule out rare serious causes. High dose oral corticosteroids are used for all cases of sudden onset sensorineural hearing loss

Question 5

Features of otosclerosis?

Answer 5

autosomal dominant, affects young adults (20-40 usually):

• progressive conductive deafness
• tinnitus
• normal tympanic membrane
• positive family history

*caused by fixation of stapes at oval window due to replacement of normal bone by vascular spongy bone

Question 6

Mx of otosclerosis?

Answer 6

• hearing aid

- stapedectomy

Question 7

What is a strong risk factor for ocular involvement in herpes zoster ophthalmicus?

Answer 7

Hutchinson’s sign: rash on tip or side of nose. indicates nasociliary involvement

Question 8

Management of herpes zoster ophthalmicus?

Answer 8

Oral aciclovir for 7-10 days (IV if severe, or pt immunocompromised), urgent ophthalmology review if ?ocular involvement, topical corticosteroids may be used to tx secondary inflammation of the eye