ENT Conditions

Question 1

Describe acute otitis externa

Answer 1

AOE - outer ear infection

• inflammation of one or both parts of the outer ear
• often caused by water activities & hot / humid conditions (swimmers ear)

SSX:

• pain
• rapid unilateral onset
• ear pressure
• hearing blocked
• maybe tinnitus or itching
• pain on palpation of tragus / traction of outer ear
• oedema narrowing EAC
• erythema
• tympanic membrane may be red / inflamed
• otorrhea - intially clear, then purulent & smelly
• maybe Cx lymphadenitis

Treatment:

• OTC analgesics
• topic medications (steroidal, antifungal, antibiotic)

Question 2

Describe acute otitis media

Answer 2

Middle ear infection

• build up of fluid behind tympanic membrane (tympanic membrane may burst which relieves pressure / pain)
• normally caused by strep infection
• common early childhood

SSX:

• pain, pressure, headache
• if discharge indicates tympanic perforation (may reduce pain)
• post auricular Cx lymphadenopathy
• fever or febrile convulsions (young children)
• if signs of systemic infection or lethargy in young children immediate emergency referral

Treatment:

• analgesia
• antibiotics

Question 3

Describe acute mastoidits

Answer 3

• inflammatory process in mastoid air cells of mastoid process (temporal bone)
• usually a complication of AOM (infection spreads from middle ear to mastoid bone)

IMMEDIATE EMERGENCY REFERRAL - if untreated can cause necrosis of bone and spread of infection to meninges

SSX:

• persistent localized pain deep inside ear
• systemic SSX including lethargy & malaise
• high fever
• bulging erythematous tympanic membrane
• protrusion of auricle

Question 4

Acute pharyngitis

Answer 4

• infection of pharynx and/or tonsils
• viral (less serious) or bacterial (urgent referral)
• most common in young school age children

SSX:

• sore throat
• fever
• headache
• malaise
• swollen tonsils maybe with purulent exudates
• tender Cx lymphadenopathy
• maybe halitosis, GI upset, palatal petechiae

Viral - benign & self-limiting
Bacterial -more serious SSX, immediate referral for antibiotics

Question 5

Describe acute cervical lymphadenopathy

Answer 5

• inflammation / enlargement of Cx lymph nodes, can be secondary to localized or systemic infections

SSX:
- soft, fluctuant, tender lymph nodes

SSX OF MALIGNANT LYMPH NODES:
firm, fixed, non-tender

• use management pathways to diagnose & treat

Question 6

Describe acute rhinosinusitis

Answer 6

• inflammation of lining of nose and paranasal sinuses
• viral (more benign) or bacterial (more severe):
• suspect bacterial if persistent, worsening, severe SSX, high fever, discoloured discharge (immediate referral)
• usually caused by URTI

SSX:

• pain over cheek, face and maybe referral to frontal region, teeth, temple, occiput, vertex
• headache
• blocked nose
• postnasal discharge
• cough
• pharyngeal irritation
• lessened sense of smell
• tenderness to pressure over frontal sinuses
• secondary headache

Treatment:

• allergic & viral self-limiting, supportive treatments including analgesia, nasal decongestents
• bacterial - GP referral for antibiotics