ENT

Question 1

Nasophargyneal carcinoma:

a) . What cell type is nasophargyneal carcinoma?
b) . What is commonly associated with nasophargyneal carcinoma?
c) . Give 3 risk factors
d) . Presentations?
e) . Ix?
f) . Mx?

Answer 1

a) . Squamous cell carcinoma (SCC)
b) . EBV infection
c) . Asians (esp those from Southern China), EBV exposure, heavy alcohol intake
d) . Presentations:

• Nasal obstruction, discharge, epistaxis
• Otalgia, tinnitus
• Unilateral serous otitis media –> unilateral conductive hearing loss
• In advanced disease, it can invade the skull and spread intracranially. If the cavernous sinus is involved –> CN3, 4, 6, 5i, 5ii palsies
• Cervical lymphadenopathy in the posterior triangle!

e). Ix:

Combined CT and MRI, fine needle aspiration (biopsy) of the nasopharyngeal mass

f). Mx:

External beam radiotherapy +/- chemotherapy as adjunct

Question 2

Deafness can be divided into conductive hearing loss and sensorineural hearing loss.

What are the differential diagnoses of conductive hearing loss?

Answer 2

Conductive hearing loss:

• FB, earwax, tumour of the EAM
• Perforated eardrum
• Severe otitis externa (esp if the inflammation completely narrows the ear canal)
• Acute otitis media (AOM)
• Otitis media with effusion (OME/ glue ear)
• Nasopharygneal carcinoma - causes unilateral serous otitis media –> unilateral conductive hearing loss
• Otosclerosis

Question 3

What are the differential diagnoses of sensorineural hearing loss?

Answer 3

Sensorineural hearing loss:

Viral labyrinthitis

Meniere’s disease

Noise damage/ trauma

Presbycusis

Drug-induced ototoxicity

Acoustic neuroma

Systemic disease - diabetes, MS, hypothyroidism

Question 4

What are the differential diagnoses of tinnitus?

Answer 4

Tinnitus:

Meniere’s disease

Otosclerosis

Presbycusis

Sudden-onset sensorineural hearing loss

Acoustic neuroma

Excessive noise damage

Drug-induced ototoxicity

Impacted earwax

Question 5

How do you investigate for tinnitus?

Answer 5

Ix:

• Audiological assessment - detect underlying hearing loss
• Imaging
  
  • Non-pulsatile tinnitus does NOT require imaging unless it’s unilateral or there are other neurological or otological signs.
    
    • 1st line - MRI of the internal acoustic meatuses
  • Pulsatile tinnitus (the auditory perception is repetitively synchronous to the patient’s heartbeat) requires imaging
    
    • 1st line - Magnetic resonance angiography (MRA)

Question 6

How do you manage tinnitus?

Answer 6

Mx:

Treat underlying cause!

Amplification device

Cognitive behavioural therapy

Tinnitus support groups

Question 7

What are the differential diagnoses of vertigo?

Answer 7

Viral labyrinthitis

Vestibular neuronitis

BPPV

Meniere’s disease

Acoustic neuromma

Vertebrobasilar ischaemia

Posterior circulation stroke (since posterior circulation supplies the inner ear)

Trauma

MS

Drug-induced ototoxicity e.g. gentamicin